Comparison of salpingectomy and tubal detorsion procedures after experimental ischemia-reperfusion injury in a rat fallopian tube model; biochemical and histopathologic evaluation.

OBJECTIVE: To compare salpingectomy and detorsion procedures and investigate the biochemical and histopathological changes in fallopian tubes in the experimentally isolated fallopian tube torsion model in rats. DESIGN: Experimental study. SETTING: Experimental surgery laboratory in a training and research hospital ANIMAL(S): Twenty-seven Sprague-Dawley rats in the reproductive period INTERVENTION(S): Group 1: Control group (n=6); Group 2: bilateral total salpingectomy group after 4 hours of tubal ischemia (n=7); Group 3: 4 hours of bilateral tubal ischemia plus one week of reperfusion (n=7); Group 4: 4-hour period of bilateral tubal ischemia plus 30-days of reperfusion (n=7). A 22-gauge catheter was administered before and after surgery using methylene blue through the uterine horn of the rat to evaluate tubal patency. MAIN OUTCOME MEASURE(S): Preoperative and postoperative serum AMH levels; histopathologic examination of rat tuba uterine and histopathologic damage scores; antioxidant compounds (superoxide dismutase, catalase, glutathione peroxidase); and oxidative stress end product levels (malondialdehyde and 8-hydroxy-2-deoxyguanosine). RESULT(S): While a significant difference was observed in tissue SOD (p<0.001), GPx (p=0.002), MDA (p=0.001), and 8 OHdG (p<0.001) values, no significant difference was observed between the groups in serum samples (p>0.05). Tissue SOD and tissue GPx levels in group 2 significantly decreased, and a significant increase was observed in tissue MDA and 8-OHdG values in group 2. Among the histopathological parameters, epithelial changes (p<0.001), vascular congestion (p = 0.001), and the total fallopian tube mean damage score of 4 (p = 0.003) showed a significant decrease in group 4. When the methylene blue transitions before and after ischemia-reperfusion (I/R) injury were compared, the value of the methylene blue transition after I/R injury in groups 2 (p = 0.008), 3 (p = 0.025), and 4 (p = 0.014) decreased significantly. When serum AMH levels are analyzed, the postoperative AMH value significantly increases in group 2 (p = 0.028). CONCLUSION(S): This study reveals that biochemical and histopathological improvement is observed in the fallopian tube tissues gradually when the detorsion procedure is performed for the necrotized tubal tissue instead of salpingectomy. Although there is a restoration in epithelial integrity after reperfusion, tubal passage remains absent.

Evaluation of whether there is residual polyp tissue after hysteroscopic morcellation at Cam and Sakura City Hospital: a retrospective cohort study.

BACKGROUND: In polypectomy with mechanical hysteroscopic morcellators, the tissue removal procedure continues until no polyp tissue remains. The decision that the polypoid tissues were removed completely is made based on visual evaluation. In a situation where the polyp tissue was visually completely removed and no doubt that the polyp has been completely removed, short spindle-like tissue fragments on the polyp floor continue in most patients. There are no studies in the literature on whether visual evaluation provides adequate information at the cellular level in many patients in whom polypoid tissues have been determined to be completely removed. The aim of the present study was to analyze the pathological results of the curettage procedure, which was applied following the completion of polyp removal with operative hysteroscopy, and to evaluate whether there was residual polyp tissue in the short spindle-like tissue fragments that the mechanical hysteroscopic morcellator could not remove. The secondary aims of this study were to compare conventional loop resection hysteroscopy with hysteroscopic morcellation for the removal of endometrial polyps in terms of hemoglobin/hematocrit changes, polypectomy time and the amount of medium deficit. METHODS: A total of 70 patients with a single pedunculate polypoid image of 1.5-2 cm, which was primarily visualized by office hysteroscopy, were included in the study. Patients who had undergone hysteroscopic polypectomy were divided into two groups according to the surgical device used: the morcellator group (n = 35, Group M) and the resectoscope group (n = 35, Group R). The histopathological results of hysteroscopic specimens and curettage materials of patients who had undergone curettage at the end of operative hysteroscopy were evaluated. In addition, the postoperative 24th hour Hb/HCT decrease amounts in percentage, the polypectomy time which was measured from the start of morcellation, and deficit differences were compared between groups. RESULTS: In total, 7 patients in the morcellator group had residual polyp tissue detected in the full curettage material. The blood loss was lower in the morcellator group than in the resectoscope group (M, R; (-0.07 ± 0.08), (-0,11 ± 0.06), (p < 0.05), respectively). The deficit value of the morcellator group were higher (M, R; (500 ml), (300 ml), (p < 0.05), respectively). The polypectomy time was shorter in the morcellator group (M, R; mean (2.30 min), (4.6 min), (p < 0.05)). CONCLUSIONS: Even if the lesion is completely visibly removed during hysteroscopic morcellation, extra caution should be taken regarding the possibility of residual tissue. There is a need for new studies investigating the presence of residual polyp tissue.

False-Positive 68Ga-DOTATATE PET/CT in Active Chronic Prostatitis.

A 66-year-old man with neuroendocrine tumor originating from midgut was referred to Ga-DOTATATE PET/CT imaging for restaging postoperatively. No suspicious uptake regarding residual primary tumoral involvement was seen. But there was diffuse high uptake in prostate gland suggestive of prostatitis or secondary primary tumoral lesion. Concurrent prostate-specific antigen level was 5.02 ng/mL (range, 0-4 ng/mL), C-reactive protein level was 8.25 mg/L (range, <5 mg/L), and white blood cell count was 6.83 × 10/µL (range, 3.9-10.9 × 10/µL). Diagnosis of active chronic prostatitis was achieved by core biopsy, which is identified as potential cause for false-positive diffuse uptake on Ga-DOTATATE PET/CT.

Diffuse Large B-Cell Lymphoma Involvement in Two Different Localizations: A Case Report.

The genital system and skin involvement of diffuse B-cell lymphomas are quite rare. The appearance of these rare types in the same patient and the same period makes the treatment of the disease difficult. But both types respond well to anthracyclines and immunotherapies. A 74-year-old woman was treated with R-CHOP (Rituximab, cyclophosphamide, doxorubicine, vincristine, prednisolone) without surgery and/or radiotherapy, and no recurrence at 2 years follow-up. Despite the poor prognosis of these types of lymphomas, treatment responses are quite good as they are in other subtypes.

A case of placenta increta mimicking submucous leiomyoma.

In recent years with the increase in cesarean section rates, the frequency of placenta accreta cases rises. It causes 33-50% of all emergency peripartum hysterectomies. We present a 42-year-old case who was caught with early postpartum hemorrhage due to retained placental products. The ultrasonography showed a 65 × 84 mm mass in the uterine cavity after the delivery. Due to presence of early postpartum hemorrhage which needs transfusion, an intervention decision was made. The patient underwent curettage but the mass could not be removed so that placental retention was ruled out. Submucous leiomyoma was made as first-prediagnosis. Hysterectomy operation was performed as a curative treatment. Placenta increta diagnosis was made as a final diagnosis with pathological examination. As a result, placental attachment disorders may be overlooked if it is not a placenta previa case.

Low-grade osteosarcoma, review of 15 cases in a series of 156 osteosarcoma cases.

OBJECTIVE: Osteosarcoma of the bone accounts for approximately 20% of all primary malignant bone tumors. Most cases (75-85%) are high-grade osteosarcomas. We aimed to introduce low-grade osteosarcomas that we found by retrospectively scanning our archives because of the diagnostic difficulties, rarity and different therapeutic approach required. MATERIAL AND METHOD: We found 156 osteosarcoma cases in the archives of the Department of Pathology of Istanbul University, Cerrahpasa Faculty of Medicine covering the period 2000 to 2010. These cases included 141 high-grade and 15 low-grade osteosarcomas. RESULTS: Low-grade osteosarcomas made up 10.4% of all osteosarcomas. Age and sex distribution were 19 to 54 (median 33.6) with 9 females and 6 males. Most cases were located in the distal femur while others were in the proximal tibia, the left wrist, the distal tibia and the right knee. The tumors were generally made up of relatively well-formed trabeculae of woven bone surrounded by a moderately cellular spindle cell proliferation entangled in collagen fibers. Thirteen cases were reported as parosteal osteosarcoma, one as intramedullary well-differentiated osteosarcoma, and one as low-grade osteosarcoma metastasis in the lung. CONCLUSION: Low-grade osteosarcomas account for approximately 3-5% of all osteosarcomas. They are more commonly seen in women and 9 cases out of 6 were female in our series. The average age was 33.6 (19-54). The distal femur was the most common localization as is typical in osteosarcomas. In contrast to high-grade lesions, surgery will be sufficient in low-grade osteosarcomas. The survival rate ranges from 90% to 100%. Differentiating low-grade osteosarcomas from high-grade osteosarcomas and benign lesions and using a multidisiplinary approach for the diagnosis, treatment and follow-up periods are of vital importance.