Solitary epithelioid hemangioendothelioma of the metacarpal.

Hemangioendotheliomas are vascular tumors which have an intermediate clinical behavior between hemangiomas and angiosarcomas. The epithelioid subtype of hemangioendothelioma, which is rarely seen in bone, has the potential to metastasize and may be confused radiologically with benign or malignant lesions. A metacarpal origin of this tumor is extremely rare. In this article, we present a 42-year-old female case with an hemangioendothelioma in the second metacarpal which was initially managed as a benign lesion before the patient was referred to our center. The potential malignant nature of epithelioid hemangioendothelioma has been ill-defined. We recommend excision with a wide surgical margin. Amputation may be necessary to perform excision in bones such as the metacarpals or phalanges.

The presence of Epstein-Barr virus (EBV) in diffuse large B-cell lymphomas (DLBCLs) in Turkey: special emphasis on 'EBV-positive DLBCL of the elderly'.

Accumulated evidence has shown the importance of Epstein-Barr virus in the pathogenesis of various lymphomas. This study aimed to determine the prevalence of Epstein-Barr virus expression and its effect on survival amongst diffuse large B-cell lymphoma (DLBCL) cases from two large tertiary care centres in Turkey with a particular interest in identifying cases of 'Epstein-Barr virus-positive DLBCL of the elderly'. Diffuse large B-cell lymphoma cases diagnosed between 1999 and 2009 were retrieved and 340 cases were used to construct tissue microarrays. The presence of Epstein-Barr virus small ribonucleic acids was examined by in situ hybridization using Epstein-Barr virus (EBV)-encoded small RNA (EBER) oligonucleotides. A total of 18 cases (5.3%) showed Epstein-Barr virus expression. Twelve cases were classified as Epstein-Barr virus-positive DLBCL of the elderly. Epstein-Barr virus-positive DLBCL cases showed a significantly inferior overall survival as compared with Epstein-Barr virus-negative cases (p < 0.001). In our study group Epstein-Barr virus expression is not prevalent in DLBCLs. Epstein-Barr virus-positive DLBCL of the elderly is also rare in the Turkish population. The presence of Epstein-Barr virus, however, is associated with poor prognosis.

Primary apocrine adenocarcinoma of the scrotum with distant metastasis: a case report.

A 53-year-old man presented with weakness, loss of weight, pain in upper and lower extremities, and back pain. He had an intermittent abscess like discharge from a left hemi scrotal lesion. Thoraco abdomino pelvic computerized tomography revealed diffuse, multiple and hypodense lesions in the liver parenchyma. Bone scan showed multi metastatic disease of the bone. Complete resection of the scrotal lesion was performed. In histopathological examination, apocrine adenocarcinoma was diagnosed.

Benign multicystic peritoneal mesothelioma.

Benign multicystic peritoneal mesothelioma is a rare tumor that occurs mainly in women in their reproductive age. It is characterized by the formation of multiple, thin-walled, multilocular cysts that frequently produce large, intra-abdominal masses. The short follow-ups and possible etiologies based on the published reports make it difficult to draw any firm conclusions.

Cellular schwannoma of the greater superficial petrosal nerve presenting with abducens nerve palsy and xerophthalmia: case report.

OBJECTIVE: Cellular schwannomas (CS) are rare in the cranial space. This report is the first of a patient with a greater superficial petrosal nerve CS presenting with abducens nerve palsy and xerophthalmia. CLINICAL PRESENTATION: A 16-year-old female patient presented with a 1-month history of diplopia. Neurological examination was normal except for the presence of right abducens nerve palsy. Schirmer's test revealed decreased tear secretion in the right eye. Computed tomography and magnetic resonance imaging showed a mass in the right petrous apex. It was thought that the schwannoma in our patient originated from the greater superficial petrosal nerve, based on the location of the tumor in addition to the absence of partial Horner's syndrome and a persistent decrease in tear secretion. INTERVENTION: The tumor was exposed with the use of a right subtemporal extradural approach and removed entirely. Pathological evaluation of the tumor revealed a CS. CONCLUSION: The abducens nerve palsy improved completely in the follow-up period, but the decreased tear secretion did not resolve. CS is one of the subtypes of ordinary schwannomas and exhibits malignant features on microscopic examination, although it has a good clinical prognosis. No adjuvant treatment was applied because of the tumor's benign character. The greater superficial petrosal nerve schwannoma should be considered in the differential diagnosis of the abducens nerve palsy and petrous apex mass.

Ultrastructure protection and attenuation of lipid peroxidation after blockade of presynaptic release of glutamate by lamotrigine in experimental spinal cord injury.

OBJECT: Lamotrigine is an antiepileptic drug that inhibits presynaptic voltage-gated sodium channels and reduces the presynaptic release of glutamate in pathological states. Neuroprotective effects of this drug have already been demonstrated in cerebral ischemia models. The aim of the present study was to determine the effects of presynaptic glutamate release inhibition on experimental spinal cord injury (SCI). METHODS: A total of 66 adult Wistar rats were randomly allocated into 6 groups. Group I was the control group used to obtain normal blood samples and spinal cord specimens. Spinal cord injury was introduced by using the extradural clip compression technique, but no medication was given to Group II (trauma group) rats. Group III was treated with vehicle, and the same amount of dimethyl sulfoxide used in treatment groups was administered to these rats. A dose of 50 mg/kg lamotrigine was administered intraperitoneally to Group IV (pretreatment), Group V (peritreatment), and Group VI (posttreatment) rats 30 minutes before, during, and 30 minutes after SCI, respectively. Oxidative stress parameters and transmission electron microscopic findings were examined. RESULTS: Blockade of presynaptic release of glutamate by lamotrigine treatment yielded protective effects on the spinal cord ultrastructure even when administered after the SCI, but it prevented oxidative stress only when it was administered before or during the SCI. CONCLUSIONS: Currently, no available agent has been identified, that can block all the glutamate receptors at the same time. To prevent excitotoxicity in SCI, inhibiting glutamate release from the presynaptic buttons instead of blocking the postsynaptic glutamate receptors seems to be a more rational approach. Further research, such as neurobehavioral assessment, is warranted to demonstrate the probable neuroprotective effects of presynaptic glutamate release inhibition in SCI.

Metastatic malignant melanoma of the uterine cervix: first diagnosed on liquid-based cytology.

Malignant melanomas of the female genital tract are uncommon lesions. The first case of vulvar melanomas with a subsequent malignant melanoma of the cervix diagnosed based on liquid-based cytology without evidence of gross pathology is described.

Histopathological parameters with Ki-67 and bcl-2 in the prognosis of meningiomas according to WHO 2000 classification.

AIMS AND BACKGROUND: Meningiomas are classified following the WHO system of 2000 into three grades, benign (grade I), atypical (grade II), and anaplastic (grade III). We investigated the relation between tumor grade and Ki-67 and bcl-2. METHODS: In the present study, 246 cases of meningioma were reclassified according to the WHO 2000 system. The relationship between tumor grade and morphological parameters like pattern, mitotic index, cellularity, pleomorphism, nucleoli, small cell population with high nucleus/cytoplasmic ratio, necrosis and brain invasion was examined. Follow-up data were available for only 80 patients. RESULTS: A correlation was found between all morphologic parameters except for brain invasion. These parameters were related to a poor prognosis. There was no statistically significant difference in the prognosis between WHO grade I and grade II, whereas these two grades collectively exhibited significantly better survival than WHO grade III. Immunohistochemical staining for Ki-67 and bcl-2 was performed, and correlations between their expressions and other clinicopathological findings were investigated. Ki-67 and bcl-2 expression was correlated with tumor grade, and the higher the tumor grade, the higher the Ki-67 and bcl-2 expression. In conclusion, tumor grade appeared to be the most important parameter for a prognosis of meningiomas. CONCLUSIONS: Ki-67 and bcl-2 expression might participate in carcinogenesis and when used with the grading system could provide additional benefit in assessing the biological behavior of the tumor.

Primary ovarian leiomyosarcoma: a review of the clinical and immunohistochemical features of the rare tumor.

UNLABELLED: Primary pure ovarian leiomyosarcomas constitute a malignant subgroup of ovarian smooth muscle tumors which comprise only 1% of ovarian tumors. Their origin, etiology, histologic features, clinical behavior, and optimal treatment are still obscure. Malignant behavior is almost always associated with any 2 of coagulative necrosis, cellular atypia, and mitotic index greater than 10. Immunohistochemical and electron microscopic evaluations may improve diagnostic accuracy. Traditionally, International Federation of Gynecology and Obstetrics (FIGO) staging and treatment of ovarian sarcomas have been the same as for epithelial ovarian carcinomas. Although surgery was performed for all cases, the extent of surgery is debatable. Benefit and modality of adjuvant therapy is controversial. The prognosis of primary pure ovarian leiomyosarcomas is extremely poor depending on tumor stage, tumor size, grade, and mitotic index and mostly recurs in abdomen and pelvis. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to state how rare primary ovarian leiomyosarcoma (POLMS) is, explain that because of its rarity the best diagnostic and treatment modalities are not conclusive, and recall that the authors reviewed the literature to bring the readership current on POLMS.

Surgical conservation of both ovaries in an adolescent with uterine müllerian adenosarcoma: a case report.

Fertility-sparing and minimally invasive surgeries are advancing everyday in gynecologic oncology. However, data on conservation of ovaries in uterine müllerian adenosarcoma are limited due to its very rare incidence in reproductive-aged females. Conservation of both ovaries along with adjuvant chemotherapy was performed in a 14-year-old girl with uterine adenosarcoma. After 30 months, she had no evidence of disease. Therefore, surgical conservation of ovaries might be a solution for fertility sparing in uterine müllerian adenosarcoma.

Rapid communication: renal apoptosis after shockwave application in rabbit model.

PURPOSE: To identify any apoptotic effect of shockwave lithotripsy (SWL) on renal tubular and glomerular cells. MATERIALS AND METHODS: Thirty-five male New Zealand White rabbits were divided into five groups of seven rabbits each: I (control), II (sham), and III, IV, and GV (treated and sacrificed 1, 7, and 28 days after SWL, respectively). Intramuscular anesthetic agent (ketamine HCl; 20 mg/kg) and intravenous contrast medium (iohexol 300 mg of I/mL) were administered to animals in group II. The left kidneys of animals in groups III, IV, and V were exposed to 2000 shockwaves at 18 kV after administration of anesthesia and contrast medium. The animals were sacrificed on day 1, 7, or 28 after SWL, and the kidneys were removed. Apoptotic and proliferative indices of renal tubular and glomerular cells were determined by terminal deoxynucleotidyl transferase dUTP nick and label (TUNEL) and Ki-67 labeling methods, respectively, counting 1000 cells in each preparation. RESULTS: No apoptosis was detected in glomerular cells in any group. The mean apoptotic indices of the tubular cells in animals in groups I and II were 483.0 +/- 85 and 484.4 +/- 105, respectively with no significant difference between the groups. In groups III and IV, the mean apoptotic indices were 343.4 +/- 89 and 358.4 +/- 61, respectively. There were no statistically significant differences between groups III and IV and the control group. Similarly, there were no significant differences in the apoptotic indices in groups III and IV. However, the apoptotic index in group V was 821.4 +/- 57, significantly higher than in the control group. The proliferative indices of all SWL groups were lower than that of the control group. CONCLUSION: Shockwave lithotripsy has an apoptotic effect on renal tubular cells that can be detected 4 weeks after the procedures, but no apoptotic effect on glomerular cells. Treatment with SWL also attenuates the proliferation of both tubular and glomerular cells.

Split-cord malformation and tethered cord associated with immature teratoma.

CASE REPORT: We report a case of a 12-month-old boy with split-cord malformation, tethered cord, and intradural immature teratoma containing immature nephroblastic tissue. He also had a horseshoe kidney. OUTCOME: Surgical removal of the teratoma and tethered cord resulted in functional improvement of the existing bladder dysfunction. DISCUSSION: To our knowledge, such a case has not been reported before.

Epithelioid sarcoma-like hemangioendothelioma: a case report.

Seven cases of an unusual low-grade vascular tumor were reported in a recent study. Despite its similarity to epithelioid sarcoma, this tumor was termed epithelioid sarcoma-like hemangioendothelioma because of the subtle histopathological and immunohistochemical differences. Another case of this rare entity in a 70-year-old woman who suffered from a painful mass on the anterior aspect of the right cubital fossa is presented here, together with a review of the relevant literature.

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up. Case report.

The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft-assisted fusion to achieve long-term stabilization.