Parenchymal changes of salivary glands adjacent to a variety of salivary gland disorders.

A fully developed tumor is the first manifestation of a typical salivary gland neoplasm. Identification of precursor lesions and the accompanying clinical findings may improve our understanding of these tumors. The frequency of possible precursor lesions of salivary gland tumors have not been systematically investigated to date. In this study, slides of 661 cases from three pathology laboratories in Ankara, Turkey were reviewed to search for possible precursor lesions. Salivary gland parenchymal changes adjacent to a variety of salivary gland disorders such as metaplastic changes, ductal epithelial hyperplasia, adenomatoid ductal hyperplasia, adenomatoid oxyphilic hyperplasia, adenomatoid hyperplasia of the minor salivary glands, myoepithelial sialadenitis and dysplasia were screened histologically as potentially precursor lesions. Nuclear protein Ki-67 and cellular tumor antigen p53 were also analyzed immunohistochemically in selected cases. Approximately 16% of the cases in this series contained various types of pathologic hyperplasia. Only a minority of these lesions were originally reported, so most of the findings in this study were not part of the original histology reports. The majority of these parenchymal changes were seen in parotids. Adenomatoid ductal hyperplasia was the most frequent possible precursor lesion, and it was found most frequently around pleomorphic adenomas. Although the biological significance of most of the lesions described in this report still remains to be understood completely, efforts to define and detect possible preneoplastic lesions should be intensified. We believe that detection and eradication of the precursors is the best way of decreasing the overall morbidity caused by salivary gland tumors.

A series of 240 odontogenic keratocysts: Should we continue to use the terminology of 'keratocystic odontogenic tumour' for the solid variant of odontogenic keratocyst?

Most of the odontogenic keratocysts show an indolent behaviour like non-neoplastic lesions. For this reason, the odontogenic keratocyst was reclassified within the odontogenic cysts category in the WHO 2017 classification. Some odontogenic keratocysts may contain satellite cysts or solid squamoid islands within their wall. Recently, a solid form of odontogenic keratocyst has also been described which is composed entirely of multiple epithelial islands and small cysts in a collagenous stroma. The true nature of this variant is unclear yet. In this article, we present a series of 204 odontogenic keratocyst cases. Clinical and histologic findings of the cases in this series were described. These were also categorised according to the presence of satellite lesions. Additionally, the features of two cases of the solid form of odontogenic keratocysts were compared with those of the previous reports and other histologically similar odontogenic lesions. Current evidence suggests that this variant may be neoplastic and it differs from other odontogenic keratocysts, at least histologically. We believe diagnosing a solid lesion as a cyst is counterintuitive and the term "keratocystic odontogenic tumour" better describes this particular variant.

Histological evaluation of the possible transformation of peripheral giant cell granuloma and peripheral ossifying fibroma: A preliminary study.

AIMS: The objective of this study is to describe shared morphological features of peripheral giant cell granuloma (PGCG) and peripheral ossifying fibroma (POF) in detail and discuss the possible relationship between them. MATERIALS AND METHODS: Ten intermediate cases with features resembling to both POF and PGCG were selected and type 3 and 1 collagen immunostainings were performed for evaluation of the connective tissue maturation. Immunohistochemical staining percentage (SP) for stromal cells in the slides of POF and PGCG counterparts of intermediate lesions was scored as 1 when the SP was above 10%, 2 when the SP was above 25%, 3 when the SP was above 50% and 4 when the SP was above 75%. Staining intensity (SI) of immunuhistochemical staining was graded and scored as 1 - mild, 2 - moderate, and 3 - severe. An immunoreactivity score was calculated by multiplying SP and SI. RESULTS: All intermediate lesions comprised osteoclast type multinucleated giant cells and partly mineralized hard tissue component. Parts of intermediate lesions resembling POF showed higher type 1 collagen immunoreactivity compared to the PGCG counterparts of intermediate lesions (P < 0.05). PGCG counterparts showed higher type 3 collagen immunoreactivity compared to the POF counterparts of the intermediate lesions (P < 0.05). CONCLUSION: POF may be a later stage lesion with morphologically more mature components. A possible transformation may be considered for these two lesions.

Gnathic osteosarcomas, experience of four institutions from Turkey.

Osteosarcoma is the most frequent primary gnathic sarcoma. Neither the etiology nor the variables effecting the prognosis are fully known due mostly to the rarity of gnathic osteosarcomas. To date a considerable number of clinicopathologic features have been suggested in the evaluation of gnathic osteosarcomas. Still there is a need to experience on several aspects of management. The aim of this study is to report a series of 33 cases of osteosarcoma involving either mandible or maxilla. The clinical, radiological and histopathological features of our cases have usually been non-specific and the most frequent provisional diagnosis were "benign fibroosseous lesion, abnormal mass, giant cell granuloma and benign bone tumor". This non-specific presentation of osteosarcomas of the jaws is compatible with those reported previously. A combined clinical, radiological and pathological study is essential in arriving at the correct diagnosis.

Gastrointestinal stromal tumor in a newborn diagnosed in prenatal period: a case report and review of literature.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Only 1.5% to 2% of all GISTs are observed in children and adolescents. Most of the pediatric cases are between 10 and 18 years of age, with a median age of 13 years. GIST is extremely rare in the newborn period. We could find only 5 reports on the neonatal cases. Herein, we have reported a case with abdominal tumor that was identified by prenatal ultrasonography and magnetic resonance imaging, and diagnosed as GIST on the seventh day of life. We have also reviewed the neonatal GIST cases reported in the English literature.

Giant rhinophyma: Excision with coblation assisted surgery.

An 83-year-old man presented with an unusually severe case of rhinophyma. Giant rhinopyhma is very rare in literature. The giant lesion was widely excised using sharp surgical incision and coblation assisted surgery. Using direct coblation to the nasal dorsum may cause edema in the surrounding tissue. There was minimal edema in surrounding tissue using this technique. A full thickness-skin graft was applied after excision. Cosmetic and functional postoperative results were satisfactory.

Oral epithelial barrier function and the role of nuclear factor kappa-ß pathway in the pathogenesis of aphthous ulceration.

BACKGROUND/AIMS: The normal oral mucosa is usually tolerant to its special microenvironment. Epithelial integrity and a wellmanaged immune system are important in sustaining harmony. A close look at the role played by adaptive immunity during recurrent aphthous ulcerations may throw some light into the pathogenesis. MATERIALS AND METHODS: In this report, we provide a concise review of oral epithelial barrier function and present data on the possible pathogenetic mechanism of aphthous ulceration using immunohistocemical signs of nuclear factor kappa beta pathway activation on fourteen cases of mucosal aphthous ulcerations. RESULTS: We strongly support the hypothesis that oral aphthous ulcerations develop as a result of loss of epithelial barrier function and that nuclear factor kappa beta signaling pathway seems to be involved in this type of injury. CONCLUSION: Interventions that strengthen the mucosal barrier function or modulate inappropriate activation of nuclear factor kappa beta signaling pathway can be considered in the treatment of oral aphthous ulcerations.

Extensive fibrin accumulation and accompanying epithelial changes in the pathogenesis of ligneous mucosal disease (ligneous periodontitis).

Certain abnormal products of human tissues are resistant to degradation. The fibrillary ultrastructure of some of these are seen integrated with normal tissue components. The accumulations seen in colloid milium, lichen, and macular amyloidosis are of this type. Apoptosis of keratinocytes and filamentous degeneration of some proteins can be important in the pathogenesis. A similar pathogenetic mechanism is possible in ligneous mucosal disease, which is a rare disorder of plasminogen deficiency characterized by amyloid-like amorphous accumulations. Gingival and conjunctival mucosal pseudomembraneous masses are typical and concomitant involvement of other sites are not unusual. The accumulated substance is thought to be an abnormal fibrin degradation product. In this study, we have examined 6 representative samples from 5 gingival and 1 conjunctival lesions displaying characteristic features. Immunohistochemically, fibrinogen was detected as an early change. TUNEL staining revealed numerous apoptotic keratinocytes in this phase as well. These cells also expressed nuclear factor kappa beta. Apoptotic cells showed loss of epithelial cadherin immunostaining. In the later phase, the subepithelial accumulations failed to stain with antifibrinogen, wide spectrum, and high molecular keratins, type 4 collagen and nuclear factor kappa beta. Our findings suggest that the accumulations in ligneous mucosal disorder result from an abnormal healing process and they probably form as a combination of organised fibrinogen, epithelial fragments, and connective tissue matrix.

The cell with a thousand faces: detection of myoepithelial cells and their contributions in the cytological diagnosis of salivary gland tumors.

Myoepithelial cells are an important component of salivary gland tumors and are partly responsible from the diverse histology of them. In this study, we focus on the myoepithelial cell differentiation by using cytological morphology in a various types of salivary gland tumors especially with regard to their contribution to the diagnosis. The relation of myoepithelial cells with stromal matrix and the associated epithelial cells were evaluated. Cytologic slides of one hundred and forty one benign and twenty malignant salivary gland tumors were examined for identification of morphologically different myoepithelial cells such as; spindle-stellate, polygonal-epitheloid, plasmacytoid, basal and clear types. The best examples of myoepithelial cells were detected in pleomorphic adenomas, in some monomorphic adenomas and in the adenoid cystic carcinoma cases. Most of the pleomorphic adenomas were composed more than one type of myoepithelial cells and epitheloid-spindle cell combination was frequent. Basal and clear cell types of myoepithelial cells closely resembled the epithelial cells and their identification was relatively difficult. Identification of myoepithelial cell types was easier when they were associated with stromal matrix material and stood as a secondary layer around tubule-forming epithelial cells. Myoepithelial cell components of various salivary gland tumors may be quite different and identification of myoepithelial cell types may pose difficulties. A confident cytologic identification of myoepithelial cells may be critical part of diagnosing salivary gland tumors.

F-18 FDG avid primary CNS lymphoma located in the ventricles.

Primary malignant lymphoma is a non-Hodgkin lymphoma which occurs in the brain in the absence of systemic involvement. A 63-year-old woman presented to emergency service, complaining of sudden onset vomiting and dizziness. She was unconscious when she was admitted to the hospital. She had no complain, until a week ago when she experienced a headache nonresponding to analgesic. Preliminary diagnosis was cerebrovascular hemorrhage or intracranial mass. Magnetic resonance imaging and PET/CT yielded a mass filling all ventricles. Histopathology of the mass matched with malignant lymphoma located in the ventricles.

Nasopharyngeal nonkeratinizing (undifferentiated) monstrous cell carcinoma. A case report.

BACKGROUND: The histologic type of nasopharyngeal carcinoma can be an important factor in the prognosis. The effects, if any, of the degree of cellular pleomorphism is uncertain. CASE: In this report, we present a case of nonkeratinizing, undifferentiated nasopharyngeal carcinoma with monstrous tumor giant cells. An extremely high level of aneuploidy and dense cytoplasmic accumulation of Epstein-Barr virus capsid antigen were found in tumor cells. The patient was treated with concomitant chemoradiotherapy. CONCLUSION: Nine years of follow-up with no recurrences suggests that this extreme morphologic variation may impart no adverse prognostic effect.

Pituitary apoplexy after cardiac surgery in a patient with subclinical pituitary adenoma: case report with review of literature.

We report a case of pituitary apoplexy occurring in a 74-year-old patient 6 hours after cardiac surgery. The patient presented with confusion, unilateral ptosis and ophthalmoplegia. Neurological examination revealed right oculomotor nerve palsy and decreased level of consciousness. Magnetic resonance imaging showed a hemorrhagic and necrotic pituitary macroadenoma. After prompt endocrinological replacement therapy with hydrocortisone and levothyroxine, the confusion of the patient resolved. Removal of a non-functional macroadenoma with large necrotic areas resulted in full recovery. The physician should be aware of pituitary adenoma infarction after open cardiac surgery and should remember that it can be fatal or cause permanent neurological or endocrine damage without proper treatment. Surgical and endocrine treatment can be life-saving procedures.

L-carnitine pre-treatment reduces apoptotic cell death in seven-day-old rats hypoxia ischemia.

PURPOSE: The pre and post-treatment effects of L-carnitine on apoptotic cell death due to hypoxia-ischemia in various regions of the brains of seven-day-old rats were investigated. METHODS: L-carnitine (group 1; n=8) or saline (group 2; n=8) was administered intraperitoneally to seven-day-old rats before hypoxia-ischemia. In addition, 16 seven-day-old rats were given L-carnitine (group 3; n=8) or saline (group 4; n=8) after hypoxic ischemic insult. Apoptotic cell death was investigated by terminal dUDP-biotin nick end-labeling (TUNEL) in all subjects following three days of recovery. In the evaluation of TUNEL-positive cells, firstly the areas (in square millimeters) of the hippocampus, striatum and cortex in the right and left hemispheres were measured by IMAGE analysis. Then the numerical density was calculated as the number of cells per square millimeter by counting all TUNEL-positive cells. Afterwards, the ratios of right side numerical density to the sum of right and left sides' numerical densities (right apoptosis index) were calculated for every brain region in rats receiving L-carnitine and they were compared with the vehicle groups. RESULTS: The right apoptosis indexes of the hippocampus (37.4 ± 18.8; mean ± SD) and striatum (39.2 ± 15.2) in rat pups pre-treated with L-carnitine were significantly lower than those in the vehicles (59.8 ± 17.9 vs. 60.4 ± 19.6 respectively) (p< 0.05), whereas they were not changed by L-carnitine pre-treatment in the cortex. Additionally, L-carnitine post-treatment had no effect on right apoptosis indexes in any of the three brain regions. CONCLUSIONS: It is concluded that pre-treatment with L-carnitine might play a role in reducing apoptotic cell death due to neonatal hypoxic ischemic brain injury. Our results suggested that L-carnitine was useful in perinatal asphyxia for preventing hypoxic ischemic brain injury.

Multiple chromosome abnormalities in the pleural fluid of a patient with recurrent Ewing sarcoma.

The authors report a 5.5-year-old male patient with a right paraspinal tumor, diagnosed as metastatic Ewing sarcoma. The pleural fluid along with the bone marrow was sent to the authors' laboratory for karyotyping. Bone marrow cultures revealed a normal karyotype, whereas 48, XY, i(1)(q11), +10, t(11;22)(q24;q12) karyotype was found in the cells obtained from the pleural fluid cultures. Trisomy 1q is quite frequently observed in Ewing sarcoma patients, mostly as part of unbalanced translocations, along with the common t(11;22) translocation. This patient's findings were significant, as the complex karyotype in the pleural effusion cells was observed.

Induction of apoptosis of rabbit corneal endothelial cells by preservative-free lidocaine hydrochloride 2%, ropivacaine 1%, or levobupivacaine 0.75%.

PURPOSE: To determine and compare the amount of apoptosis and changes in rabbit corneal endothelial cell morphology after intracameral administration of different anesthetic agents. SETTING: Department of Ophthalmology, Baskent University Medical Faculty, Ankara, Turkey. METHODS: Right eyes of 64 Vienna white rabbits were injected intracamerally with preservative-free lidocaine hydrochloride 2%, ropivacaine 1%, levobupivacaine 0.75%, or fortified balanced salt solution (BSS Plus) (control). Animals were humanely killed 1 day or 7 days later. Terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling was used to detect apoptosis. Corneal endothelial cells and apoptotic cells were counted by light microscopy. The morphologic appearance was determined by transmission electron microscopy (TEM). RESULTS: Apoptotic cell density was high in the anesthetic groups on day 1 (P<.01); there was no significant difference between groups at 7 days. Apoptotic cell density declined significantly between 1 day and 7 days in the anesthetic groups (P<.05) but not in the control group. There was no difference in endothelial cell density between the 4 groups at 1 or 7 days. All anesthetic groups showed degenerative changes on TEM, with the least change in the preservative-free lidocaine hydrochloride 2% group. CONCLUSIONS: Intracameral injections of preservative-free lidocaine, ropivacaine, and levobupivacaine induced significantly more apoptotic endothelial cell loss than BSS Plus and led to morphologic changes in the corneal endothelial cells in the early period. This effect was temporary, with recovery by 7 days. Considering the limited proliferative capacity in human eyes, the induced apoptosis might result in the permanent cell loss and enlargement in human corneal endothelium.

Acute massive myelofibrosis with acute lymphoblastic leukemia.

Acute myelofibrosis is characterized by pancytopenia of sudden onset, megakaryocytic hyperplasia, extensive bone marrow fibrosis, and the absence of organomegaly. Acute myelofibrosis in patients with acute lymphoblastic leukemia is extremely rare. We report a 4-year-old boy who was diagnosed as having acute massive myelofibrosis and acute lymphoblastic leukemia. Performing bone marrow aspiration in this patient was difficult (a "dry tap"), and the diagnosis was established by means of a bone marrow biopsy and immunohistopathologic analysis. The prognostic significance of acute myelofibrosis in patients with acute lymphoblastic leukemia is not clear.

Primary intracranial low-grade fibromyxoid sarcoma (Evans tumor).

Low-grade fibromyxoid sarcoma was first described in 1987 as a rare soft tissue neoplasm characterized by a bland and deceptively benign histological appearance but with aggressive behavior. A 20-year-old male patient presented with a recent history of headache and seizure. A right frontal mass was detected on MRI and he was operated upon to remove the intracranial mass. Histological examination revealed mildly atypical fibroblastic cells embedded within a myxoid matrix. Nuclear atypia and pleomorphism were minimal, and necrosis was not present. The lesion was diagnosed as a low-grade fibromyxoid sarcoma. Although primary intracranial low-grade fibromyxoid sarcoma has characteristic histological features, clinical and radiological correlation is necessary to make the correct diagnosis.

Prostate small cell carcinoma and skin metastases: a rare entity.

OBJECTIVES: To report a rare case of small cell carcinoma of the prostate with unusual skin metastasis. CLINICAL PRESENTATION AND INTERVENTIONS: A 60-year-old was evaluated for difficulty in urinating. Abdominal computed tomography scans revealed a prostatic mass invading the surrounding tissues and multiple perirectal, periprostatic, para-aortic and pericaval lymph nodes. Needle biopsy specimens showed both small cell carcinoma and adenocarcinoma. He was treated with combination chemotherapy: cisplatin and etoposide and bilateral orchiectomy. After six cycles of the chemotherapy, disease progressed and the patient did not respond to salvage therapy; hence, palliative care was instituted. During the follow-up, papillary lesions were observed in the scrotal skin; biopsy showed metastatic small cell carcinoma. CONCLUSION: Small cell carcinoma of the prostate is an aggressive disease with a highly metastatic potential; but skin metastases are very uncommon. It has poor prognosis despite therapy. Management resembles that of small cell carcinoma of the lung.

Evaluation of 2407 fetuses in a Turkish population.

OBJECTIVES: Congenital anomalies and intrauterine fetal death (IUFD) are frequent problems in pregnancies. Detection of the etiology is important for genetic counseling, and presenting the geographic distribution of the causes of disorders is necessary for a national policy on precautions. Here, we report the findings of terminated fetuses due to IUFD and congenital anomalies in Turkish population. METHODS: Physical examinations of fetuses and genetic evaluations of families were done. X-ray studies and autopsy were done in the event of necessity. Findings of these studies were combined with prenatal ultrasound results. All cases were classified according to ICD-10. RESULTS: The number of fetuses examined was 2407. Out of these, 1268 fetuses had congenital anomalies. Neurologic anomalies and musculoskeletal system malformations were the most frequent disorders. Specific diagnoses were possible in 64% of all multiple malformation syndromes. Abnormal findings were detected in 18.8% of IUFD fetuses. Nine percent had congenital anomalies and 5.2% had cord complications. The percentage of twins and triplets was 7.5% and 13% of them had anomalies. CONCLUSION: Postmortem evaluation is useful to detect findings necessary for genetic counseling. Our protocol is effective especially in fetuses with congenital anomalies but it can detect only some of the fetal reasons in IUFD cases. A more detailed protocol is needed to investigate IUFD cases.