Have Skin Biopsy Results in Adults Been Affected in the COVID-19 Pandemic?

The purpose of this study was to assess how skin biopsy results from adults, which occupy an important place in dermatological practice, have been affected by the COVID-19 pandemic. Adult patients aged over 18 presenting to the dermatology clinical of a tertiary hospital between March 12, 2019 and March 11, 2020, and between March 12, 2020 and March 11, 2021, from whom skin biopsies had been taken and who had undergone pathological examination were included in the study. Pre-COVID-19 pandemic data were compared with post-pandemic data. No significant difference was determined between the two periods in terms of age, sex, type of biopsy, preliminary diagnosis numbers, or clinicopathological correlation (P>0.05). The diseases most frequently diagnosed through biopsy before the pandemic were psoriasis (13.7%), pseudopelade of Brocq (6.8%), and fibroepithelial polyp (5.5%), compared with psoriasis (9.4%), basal cell carcinoma (BCC) (6.3%), lichen planus (6.3%), and urticarial vasculitis (6.3%) during the pandemic. Diagnoses of BCC and urticarial vasculitis were significantly elevated after the COVID-19 pandemic (P<0.05), while no periodic difference was observed in other diagnoses. A rise in the incidence of various diseases, such as urticarial vasculitis, may be indicative of a risk of asymptomatic COVID-19. Further polymerase chain reaction and/or antibody-based investigations should be carried out in order to establish whether dermatological diseases are associated with asymptomatic COVID-19 cases. Determining the clinical and histopathological aspects of COVID-19, which can progress with various cutaneous findings, will be useful in the early diagnosis and treatment of this novel and life-threatening disease.

Concordance of HPV, conventional smear, colposcopy, and conization results in cervical dysplasia.

BACKGROUND: Cervical cancer screening algorithms are increasingly focused on Human Papillomavirus (HPV)-based screening while the accuracy of using abnormal cytological findings to detect dysplastic lesions still remains important. This retrospective study correlated the results of conventional cervical cytology, colposcopy guided biopsy, and cold knife conization (CKC) procedures performed in a tertiary center. MATERIALS AND METHODS: Data from 9399 patients who underwent screening with conventional cervical cytology between 2010 and 2019 was obtained from the hospital registry. Abnormal cervical cytology and high-risk HPV DNA genotypes were recorded and their colposcopic and CKC pathology was determined. RESULTS: Two hundred and ninety two patients underwent colposcopy for abnormal cervical cytology and/or high-risk HPV positivity. One hundred and twenty three patients were positive for High-risk HPV. Abnormal cervical cytology was detected in 216 patients. The most common cytological anomaly was atypical squamous cells of undetermined significance (ASCUS) found in 9399 patients (1.39%). It was determined that conventional cytology had a sensitivity of 70.8% and a specificity of 62.2% for the detection of low-grade lesions, while it had a sensitivity of 72.4% and a specificity of 86.0% for the detection of high-grade lesions. CKC was applied to 68 patients who were diagnosed with high-grade squamous intraepithelial lesions (HSIL) as a result of the colposcopy. As a result of CKC, a high-grade lesion was detected in 73.5% of these patients. CONCLUSION: Conventional cervical cytology and colposcopy exhibited higher accuracy as the severity of lesions increased. Detection of HPV may prevent unnecessary surgical procedures, especially with ASCUS.

Clinicopathological significance of insulin-like growth factor-1 receptor expression in breast cancer.

OBJECTIVE: Insulin-like growth factor 1 receptor (IGF1R) is a receptor protein tyrosine kinase that is claimed to be related with tumor development and progression of breast cancer with some conflicting results in the literature. The aims of the study are to investigate expression of IGF1R, and correlate with clinicopathological parameters to clarify the significance of IGF1R on breast cancer. MATERIAL AND METHODS: IGF1R and Ki67 were applied immunohistochemically to the tissue microarray sections of 370 female breast cancer patients. The results were correlated with clinical, prognostic, histopathological features, and other immunohistochemical findings [ER, PR, HER2, CK5/6, and CK14] statistically. RESULTS: IGF1R overexpression showed direct correlation with Ki67 index (P=0.028), HER2 positivity (P=0.001), mitotic count (P=0.004), tumor grade (P=0.015), and geographic necrosis (P=0.023); and negative correlation with ER positivity (P=0.003). There was statistically significant difference between IGF1R expression and the molecular subtypes (P<0.001), mostly HER2+ phenotype. IGF1R expression was found to be higher in invasive ductal carcinoma (IDC) than invasive lobular carcinoma (ILC) (P=0.036). Both IGF1R and Ki67 expression were negatively correlated with disease-free survival (DFS) (P=0.020, P=0.023, respectively) and overall survival (OS) [P<0.001, each] rates. The inverse association between IGF1R overexpression and OS rate was also supported by multivariate analyses (P=0.025). CONCLUSIONS: Overexpression of IGF1R was found to be directly correlated with shorter DFS and OS as well as some clinicopathological features associated with adverse prognosis such as higher Ki67 index, mitotic count, tumor grade, presence of geographic necrosis, HER2 positivity, ER negativity, HER2+ molecular subtype, histological tumor type of IDC rather than ILC. Thus, IGF1R might be considered as an useful target for comprehensive future anti-tumor therapy investigations. Additionally, using IGF1R as well as Ki67 as a part of routine pathology practice might be fruitful in breast cancer therapy and prediction of prognosis. KEY WORDS: Breast carcinoma, IGF1R, Insulin-like growth factor-1 receptor, Immunohistochemistry, Prognosis.

Patient with Mal de Meleda in whom a Novel Gene Mutation was Identified.

Mal de Meleda, also known as keratoderma palmoplantaris transgrediens, is a rare type of autosomal recessive palmoplantar keratoderma. A 19-year-old male presented with a congenital yellowish discoloration and thickening of both palms and soles of the feet. His family history revealed that there was no consanguinity between the mother and the father and that the patient had three healthy brothers. The second- and third-degree relatives, five females and one male, also exhibited similar skin findings. From the isolated DNA samples, the extrinsic regions of the SLURP1 gene were screened using the sequence analysis and the Sanger sequencing was performed with the 3130 Sequence Analyzer. Results of this analysis show that a p.Arg 96 Pro (R96P) (c.287 CGA>CCA) homozygous missense point mutation was detected on the SLURP 1 (a secreted toxin-like mammalian lymphocyte antigen 6/urokinase-type plasminogen activator receptor-related protein 1) gene of the patients, while heterozygous p.Arg 96 Pro (R96P) (c.287 CGA>CCA) mutation was detected in the mother, father, and brothers. Our search of the Human Genome Mutation Database and previous literature revealed no reports of this mutation in mal de Meleda. We report this case due to the identification of a novel gene mutation in a patient with mal de Meleda, a palmoplantar keratoderma.

Evaluation of the Ocular Surface in Different Contact Lens Replacement Schedules.

PURPOSE: To evaluate the effects of different contact lens (CL) replacement schedules and different CL materials on the ocular surface and tear function. METHODS: Daily disposable hydrogel CLs were given to group 1 (n = 22), daily disposable silicone hydrogel CLs were given to group 2 (n = 25), and reusable silicone hydrogel CLs were given to group 3 (n = 24). Tear function tests and inflammatory cytokine [interleukin (IL)-6, IL-8, IL-17A, and matrix metalloproteinase (MMP)-9] levels were evaluated before and at 1 and 3 months after CL usage. Impression cytology was evaluated before and at 3 months after CL usage. RESULTS: At the first and third months of CL usage, a statistically significant difference was determined between the groups in the levels of IL-6, IL-8, and IL-17A in tears, with the lowest levels in group 1 and the highest levels in group 3 (all P < 0.05). At the third month of CL usage, the levels of these cytokines (in picograms/milliliter) were 6.06 ± 0.83, 78.18 ± 12.42, 61.69 ± 13.95, and 37.71 ± 5.95 in group 1 and 8.04 ± 0.89, 107.34 ± 14.40, 68.63 ± 13.72, and 46.26 ± 6.50 in group 3, respectively. A statistically significant decrease was determined over time in the Schirmer test in group 1, in only the tear breakup time in group 2, and in the tear breakup time and Schirmer test in group 3 (all P < 0.05). A statistically significant increase was determined over time in the levels of IL-6, IL-8, IL-17A, and MMP-9 in all groups. In the third month, a significant progression was observed in the Nelson grade (P < 0.05) in all groups. CONCLUSIONS: The wear of daily disposable CLs can be considered to cause less damage to the ocular surface and less increase in proinflammatory cytokine levels.

Detection of insulin-like growth factor receptor-1 in the human cremaster muscle and its role in the etiology of the undescended testis.

PURPOSE: Previous studies of undescended testis (UT) has focused on insulin-like hormone 3 (INSL3), the genitofemoral nerve, and androgens in the testicular descent. Leydig cells, which are under the control of insulin-like growth factor-1 (IGF1), produce both androgens and INSL3. We aimed to investigate whether insulin-like growth factor receptor-1(IGFR1) exists in the cremaster muscle (CM) complex and is associated with normally descended testis as well as UT cases in humans. METHODS: We studied 30 CM from 15 patients who comprised the UT group (UTG), and 15 patients with unilateral testicular torsion (Control group; CG). Muscles, nerves, and vessels within the CM specimen were examined to determine the presence of IGFR1. RESULTS: The mean staining score (MSS) of IGFR1 in CM and its nerves were higher in the CG than in the UTG. These results were statistically significant (p = 0.01 and p = 0.02). Although the MSS of IGF1R was higher in the vessels of CM in the CG than the UTG, this was not statistically significant (p = 0.48). CONCLUSIONS: IGFR1 with heterotetrameric receptor via IGF1, IGF2, insulin, and probably androgen, contribute to the remodeling and development of CM as well as the testis descent. In the current study, the presence of the IGFR1 in the CM was shown. Additionally, the IGFR1 density of the CM was lower in the UT cases than in the CG cases. Further evaluation of IGFR1 and other etiological factors can elucidate how they interact.

A case of aquagenic syringeal acrokeratoderma with involvement of periungual area of the hand.

Gürel G, Sahin S, Çölgeçen E. A case of aquagenic syringeal acrokeratoderma with involvement of periungual area of the hand. Turk J Pediatr 2018; 60: 762-764. Aquagenic syringeal acrokeratoderma (ASA) is a rare form of palmoplantar keratoderma occurring after short-term contact with water. Although ASA usually involves the palmar region, there are also several cases with the involvement of dorsum of hand and sole of the feet. We described 15-year old girl who had white keratodermic plaques observed on the flexor side of distal phalanxes especially the periungual area after a 10 min contact with water. Our patient represents a rare case of ASA with the involvement of periungual region of the fingers.

Pityriasis rosea-like eruption induced by isotretinoin.

Pityriasis rosea is a common, self-limited and inflammatory skin disease. The etiology is not clearly known. Viral agents, autoimmunity, psychogenic factors and drugs have all been suggested as risk factors. Isotretinoin is usually used in the treatment of resistant, nodulocytic acne. We present a case of pityriasis rosea-like eruption induced by isotretinoin. To our knowledge, this is the second clinical case of pityriasis rosea-like eruption induced by isotretinoin.

Intussusception of the bowel in adults: two different cases.

Intussusception in adults is considered an unusual condition accounting for 5% of all cases of intussusceptions and almost 1%-5% of all cases of bowel obstruction. We present two cases of patients with a complaint of abdominal discomfort and concomitant vomiting who are 43 and 44 years old. Ileocecal intussusception was diagnosed by computed tomography. One patient underwent open whereas the other underwent laparoscopic right hemicolectomy and ileotransversostomy. A histopathological study revealed lipoma in the first case and adenocarcinoma in the second. We described the diagnosis and treatment of intestinal intussusception in adults.

Thymosin beta-4 overexpression correlates with high-risk groups in gastric gastrointestinal stromal tumors: A retrospective analysis by immunohistochemistry.

BACKGROUND: Thymosin beta-4 (Tß4) is a protein that is linked to a number of important biological actions and recently tumor progression and poor prognosis of some tumors. The aim of this study was to evaluate Tß4 expression in gastric GISTs and correlate with some clinicopathological characteristics related with prognosis and clinical outcome in order to add further data to the current literature. METHODS: Tß4 antibody was applied to the 4µm-thick paraffin sections of 57 gastric GISTs by immunohistochemistry. RESULTS: Tß4 expression was found to be directly corrrelated with higher risk groups, tumor size, mitotic count, cellularity, and necrosis while it was inversely correlated with overall survival (OS) by univariate analysis (p=0.000, p=0.001, p=0.000, p=0.025, p=0.023, and p=0.042, respectively). The direct association between Tß4 expression and risk groups were also supported by multivariate analysis (p=0.000, ß=0.497, t=4.374). CONCLUSION: Overexpression of Tß4 was found to be related with predictive characteristics for tumor progression and adverse prognosis. Thus, we suggest that overexpression of Tß4 might play a role in the progression of gastric GISTs and might be used as a potential prognostic tool as well as a target for novel therapies.

The prognostic significance of ING4 expression on gastric gastrointestinal stromal tumors by immunohistochemistry.

OBJECTIVE: Inhibitor of growth 4 (ING4) is a novel tumor suppressor gene that is reported to be down-regulated in various tumors including gastrointestinal stromal tumors (GISTs) originated from different locations, recently. Herein, we aimed to evaluate ING4 expression and its prognostic significance on gastric GISTs in order to add further data to the current literature. MATERIAL AND METHODS: ING4 was evaluated in samples of gastric GISTs from 62 patients, by immunohistochemistry. The association between ING4 expression and clinicopathological features related with prognosis and overall survival (OS) were analyzed statistically. RESULTS: There was statistically significant inverse correlation between ING4 expression and risk groups according to both NIH and AFIP, Ki67 index, tumor diameter, and mitotic count by univarite analysis (p=0.000, p=0.000, p=0.08, p=0.01, and p=0.028, respectively). The negative association between ING4 expression and risk groups according to both NIH (p=0.002, ß=-0.263, t=-3.166) and AFIP (p=0.016, ß=-0.244, t=-2.492) was supported by multivariate analysis. There was statistically significant direct correlation between low levels of ING4 expression and shorter OS by univariate (p=0.000) and multivariate analysis (p=0.000, ß=0.769, t=9.798), as well as Kaplan-Meier method (p=0.035). CONCLUSIONS: The low ING4 expression level was found to be related with unfavorable prognosis. Thus, we suggest that loss of ING4 expression might play a role in the progression of GISTs and might be used as a potential prognostic tool. Additionally, this is the first study that has evaluated the association of ING4 expression on gastric GISTs, to the best of our knowledge. Therefore, we claim that more comprehensive future studies including higher number of patients and longer follow-up might clarify the potential role of ING4 on pathogenesis and prognosis of GISTs. KEY WORDS: Clinicopathological features, Gastrointestinal stromal tumor, ING4, Immunohistochemistry.

Assessment of therapeutic effect of human choriogonadotropin in a chemical cystitis model.

In this study, female rats induced with chemical cystitis were administered the hormone human choriogonadotropin (HCG), and it was aimed to reveal the usefulness of HCG in the treatment of interstitial cystitis/bladder pain syndrome. The materials for this study were 32 Wistar albino female rats. The study groups were formed as follows: the cystitis group (Group 1), the cystitis + HCG protection group (Group 2), the cystitis + HCG treatment group (Group 3), and the control group (Group 4), with eight rats in each group. In this study, blood and urine samples were taken from the rats, they were euthanized, and their bladders were removed for glutathione, malondialdehyde, tumor necrosis factor alpha, and interferon gamma measurements. It was observed that tissue damage in Group 2 was lower than that in the other two groups. Glutathione levels in Groups 2 and 4 were significantly higher than in Groups 1 and 3 (p = 0.01). Malondialdehyde levels of Groups 2 and 4 were significantly lower than the values in Groups 1 and 3 (p < 0.001). When the cystitis groups were compared in terms of their interferon gamma and tumor necrosis factor alpha levels, the lowest interferon gamma and tumor necrosis factor alpha levels were detected in Group 3. It was found that HCG has positive effects on experimental cystitis in rats. This study revealed that HCG should be researched as a therapeutic agent and formed a step for studies to be carried out on this subject.

Endogenous Thymosin ß4 Expression in Sacrococcygeal Pilonidal Sinus Disease: A Retrospective, Immunohistochemical Analysis of Excisional Skin Biopsy Samples.

Thymosin beta 4 (Tß4) is a peptide that has been shown in dermal, corneal, and cardiac preclinical injury models to potentially affect tissue protection, regeneration, and repair. Sacrococcygeal pilonidal sinus disease (SPSD) is a chronic inflammatory disorder associated with a high incidence of recurrence, chronic fistulation, and a challenging postoperative surgical wound healing process. Retrospectively, an immunohistochemical analysis was conducted to evaluate endogenous Tß4 expression in excisional skin biopsies from patients with SPSD. Patient demographics (age, gender) and surgical procedure data were obtained from their electronic medical records. Two (2) samples were cut from each specimen and prepared for histopathological assessment: 1 from the inflamed sinus tracts containing hair and granulation tissue (chronic wound group) and 1 from the normal tissue at least 1 cm away from the sinus tract (control group). Tß4 expression was evaluated in the epidermal, dermal/subcutaneous collagen, and vascular structures of the samples from the sinus tract and healthy tissue. Inflamed sinus tract tissue and noninflamed normal tissue adjacent to the sinus tract were sampled from each specimen to confirm the diagnosis of SPSD and to determine distribution and intensity of Tß4 expression. Presence of cytoplasmic staining for Tß4 was considered in favor of positive Tß4 expression; intensity of Tß4 expression was scored as 0 = no staining, 1 = mild, 2 = moderate, and 3 = strong level of expression. A total of 31 excisional skin biopsy specimens were available from 31 patients with SPSD (mean age 26.0 ± 7.6 years, 25 [80.6%] men, 6 [19.4%] women) who underwent primary surgical closure. Demographic variables were analyzed using descriptive statistics. Data compliance with normal distribution was evaluated using the Kolmogorov-Smirnov and Shapiro-Wilk tests, and the Mann-Whitney U test was used for comparison of numerical data. P <.05 was considered statistically significant. Inflamed sinus tract tissue had significantly higher Tß4 expression scores than noninflamed tissue samples in the epidermis (2.4 ± 0.8 [1.0-3.0] versus 0.8 ± 0.5 [0.0-2.0], P = .000), dermal/subcutaneous collagen (2.6 ± 0.5 [2.0-3.0] versus 1.6 ± 0.5 [1.0-2.0], P = .000), and vascular structure (2.6 ± 0.5 [2.0-3.0] versus 1.1 ± 0.3 [1.0-2.0], P = .000). Study findings indicate Tß4 is endogenously expressed in normal skin tissue and is overexpressed in inflamed sinus tract tissue in patients with SPSD. Preclinical studies with a larger sample size are needed to enhance understanding of the potential role of Tß4 in the inflammatory and tissue remodeling processes of SPSD by elucidating its mechanism of action at the molecular level, physiological role, and the therapeutic potential in dermal healing.

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts.

OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

The Diagnostic and Prognostic Utility of DOG1 Expression on Gastrointestinal Stromal Tumors.

OBJECTIVE: We aimed to review our archives in order to evaluate both the diagnostic and prognostic significance of DOG1 on gastrointestinal stromal tumors (GISTs), and add further insight about those issues to the current literature including some conflicting results. MATERIAL AND METHOD: DOG1 was evaluated in 100 cases of GISTs, immunohistochemically. Immunostaining index was counted for each antibody by using both the intensity and extent of staining. The association between immunostaining index of DOG1 and CD117, CD34, SMA desmin, S-100, and Ki-67 index and clinicopathological features were analyzed. RESULTS: Ninety cases were positive for DOG1, and 89 were positive for CD117. All CD117-negative tumors were positive for DOG1. High-risk group was directly correlated with tumor diameter, cellularity, necrosis, nuclear pleomorphism, mitotic count and Ki-67 index, by univariate analysis. The association between high-risk group and tumor diameter, mitotic count, and Ki-67 index was proved by multivariate analysis. Immunostaining index of DOG1, Ki-67 index, mitotic count, ulceration and hemorrhage were inversely correlated with overall survival by univariate analysis. The adverse impact of DOG1 ISI and mitotic count on overall survival were supported by multivariate analysis. CONCLUSION: DOG1 positivity was detected in most of GISTs and all in CD117-negative cases as a result underlining its diagnostic utility. Additionally, DOG1 overexpression was related with adverse prognosis. Thus, we suggest that immunostaining index of DOG1 should routinely be used while diagnosing GIST, and DOG1 might be considered as a potential prognostic tool and a target for novel therapies.

Proliferation markers RacGAP1 and Ki-67 in gastrointestinal stromal tumors by immunohistochemistry with respect to clinicopathological features and different risk stratification systems.

RacGAP1 is a protein associated with cell proliferation, cell growth regulation, cell transformation and metastasis. The present study was designed to evaluate RacGAP1 expression in gastrointestinal stromal tumors (GISTs) for the first time in the literature and to determine its association with some predictive clinicopathological features, Ki-67 proliferation index, and risk stratification systems of Armed Forces Institute of Pathology (AFIP) and modified National Institutes of Health (NIH). Paraffin-embedded tissues of 100 GISTs were investigated, retrospectively. High (≥10%) Ki-67 proliferation index, higher mitotic count, high cellularity, small intestinal location, and high-risk groups according to both AFIP and modified NIH criteria were found to be correlated with RacGAP1 positivity in the univariate analysis (all P values <0.05). The association between RacGAP1 expression and higher cellularity was supported by the multivariate analysis (P=0.023). High (≥10%) Ki-67 proliferation index was correlated with higher nuclear pleomorphism, necrosis, ulceration, small intestinal location, greater tumor size, higher mitotic count, and high risk group according to AFIP and NIH criteria in the univariate analysis (all P values <0.05). The correlation of Ki-67 proliferation index and mitotic count and high risk group according to AFIP criteria was confirmed by the multivariate analysis (all P values <0.05). In conclusion, higher RacGAP1 expression and Ki-67 index might be considered as effective complementation of risk stratification systems and unfavorable clinicopathological features in predicting poor outcome of GISTs. However, the utility of RacGAP1 expression in GISTs should be further validated in larger cohorts of patients with long-term follow-up data.

Clinicopathological Significance of the Proliferation Markers Ki67, RacGAP1, and Topoisomerase 2 Alpha in Breast Cancer.

Objectives The aims of this study are to evaluate expressions of Ki67, RacGAP1 (MgcRacGAP) and topoisomerase 2 alpha (TOP2a), the markers related with cell proliferation that have been proposed to affect the prognosis in the literature and correlate the results with clinicopathological parameters of breast cancer patients. Methods Ki67, RacGAP1, and TOP2a antibodies were applied immunohistochemically to the tissue micrarray blocks of 457 female breast cancer patients. The results were correlated with clinical, prognostic, histopathological features, and other immunohistochemical findings (estrogen receptor [ER], progesterone receptor [PR], HER2, cytokeratin [CK]5/6, CK14, epidermal growth factor receptor [EGFR] and vimentin), statistically. Results Ki67 expression demonstrated direct correlation with TOP2a expression, mitotic count, tumor grade, geographic necrosis, basal-like phenotype. RacGAP1 expression was directly correlated with TOP2a expression, nipple invasion, and number of metastatic lymph nodes, and it was inversely correlated with PR expression. TOP2a expression was directly correlated with vimentin and Ki67 expressions, mitotic count, tumor grade, and geographic necrosis, and nipple invasion, and negatively correlated with ER and PR expressions. Higher TOP2a and Ki67 expressions were correlated with shorter overall survival. Higher TOP2a expression and RacGAP1 positivity were directly correlated with shorter disease-free survival. Conclusion This study showed that the overexpressions of Ki67, RacGAP1, and TOP2a affect the prognosis adversely, thus to develop target therapies against RacGAP1 and TOP2a as well as using Ki67 as a part of routine pathology practice might be beneficial in breast cancer therapy and prediction of prognosis.

Our transthoracic biopsy practices accompanied by the imaging process: The contribution of positron emission tomography usage to accurate diagnosis.

OBJECTIVES: The objective of this study was to compare the results of transthoracic biopsies performed through the use of FDG PET/CT imaging with the results of transthoracic needle biopsy performed without using the FDG PET/CT imaging. METHODS: The medical files of a total of 58 patients with pulmonary and mediastinal masses. A total of 20 patients, who were suspected of malignancy with the SUVmax value of over 2.5 in FDG PET/CT, underwent a biopsy process. Twelve patients with no suspicion of malignancy in accordance with CT images and with the SUVmax value below 2.5 underwent no biopsy procedure, and hence, they were excluded from the study. On the other hand, 26 patients directly went through a biopsy process with the suspicion of malignancy according to CT imaging, regardless of performing any FDG PET/CT imaging. RESULTS: According to the biopsy results, the number of the patients diagnosed with cancer was 20 (43.5%), while the number of non-cancerous patients was 26 (56.5%). When these findings were considered, it was determined that the sensitivity of the whole TTNB (transthoracic needle biopsy) was 80.8%, and the specificity was found as 100%. The positive predictive value of the whole TTNB was 100%, while its negative predictive value was found to be 80%. The sensitivity in TTNB performed together with FDG PET/CT was 90.9%, whereas the specificity was 100%. The positive predictive value of TTNB with FDG PET/CT was 100%, while its negative predictive value was found to be 81.8%. The sensitivity in TTNB performed without the use of FDG PET/CT was 73.3%, whereas the specificity was determined as 100%. CONCLUSIONS: Performing FDG PET/CT imaging process prior to a transthoracic biopsy as well as preferring FDG PET/CT for the spot on which the biopsy will be performed during the transthoracic biopsy procedure increases the rate of receiving accurate diagnosis.

Effect of the Human Amniotic Membrane on Liver Regeneration in Rats.

Introduction. Operations are performed for broader liver surgery indications for a better understanding of hepatic anatomy/physiology and developments in operation technology. Surgery can cure some patients with liver metastasis of some tumors. Nevertheless, postoperative liver failure is the most feared complication causing mortality in patients who have undergone excision of a large liver mass. The human amniotic membrane has regenerative effects. Thus, we investigated the effects of the human amniotic membrane on regeneration of the resected liver. Methods. Twenty female Wistar albino rats were divided into control and experimental groups and underwent a 70% hepatectomy. The human amniotic membrane was placed over the residual liver in the experimental group. Relative liver weight, histopathological features, and biochemical parameters were assessed on postoperative day 3. Results. Total protein and albumin levels were significantly lower in the experimental group than in the control group. No difference in relative liver weight was observed between the groups. Hepatocyte mitotic count was significantly higher in the experimental group than in the control group. Hepatic steatosis was detected in the experimental group. Conclusion. Applying the amniotic membrane to residual liver adversely affected liver regeneration. However, mesenchymal stem cell research has the potential to accelerate liver regeneration investigations.

Primary non-necrotizing granulomatous hypophysitis mimicking pituitary adenomas.

AIM: The authors review their experience in the endoscopic endonasal transsphenoidal treatment of 5 patients, finally diagnosed as primary hypophysitis but initially assumed to be pituitary adenomas. MATERIAL AND METHODS: A retrospective study was undertaken to review 5 cases of primary non-necrotizing granulomatous hypophysitis (1.61%) through 310 endoscopic transsphenoidally operated cases with the diagnosis of pituitary adenoma between 2009 and 2013. All 5 cases were female without any background of autoimmunity or recent pregnancy. The initial presumptive diagnosis was pituitary adenoma for all patients. The endocrinological diagnoses of the patients were suspected Cushing's Disease, anterior pituitary deficiency with hyponatremia, hyperprolactinemia, and acromegaly. One of the patients had normal hormonal levels. All patients had macroadenomas including one invasive adenoma with skull base involvement. One of the patients (20%) had visual field defects. All patients underwent endoscopic endonasal transsphenoidal surgery (EETS). RESULTS: All patients had improvement of hormonal levels postoperatively except the one with anterior pituitary deficiency who required long term hormone replacement after the surgery. Mean follow-up duration was 14.8 months. CONCLUSION: Primary granulomatous hypophysitis without any known etiological factors is very rare in the literature. It can mimic pituitary adenomas in radiological and endocrinological aspects. EETS is an effective and safe treatment especially for visual and compression symptoms.