A Rare Nephrotic Syndrome Related to Chronic Lymphocytic Leukemia: Focal Segmental Glomerulosclerosis.

Chronic lymphocytic leukemia (CLL) is a hematological disease characterized by the proliferation of monoclonal B-lymphocytes. Although autoimmune complications such as autoimmune hemolytic anemia and immune thrombocytopenia are common in CLL patients, nonhematological autoimmune complications are rather rare. The most common renal involvements are membranoproliferative glomerulonephritis and minimal change disease. Focal segmental glomerulosclerosis (FSGS) is predominantly associated with Hodgkin's lymphoma among hematological malignancies. FSGS associated with CLL is rarely reported in the literature, with a poor understanding of the common pathophysiology and a very limited experience with this co-occurrence. Although Rai Stage 1/Binet Stage B CLL, our 61-year-old case, who was diagnosed with secondary FSGS, which is a very rare complication, was treated with fludarabine, cyclophosphamide, and rituximab (FCR) combination. Following the treatment, a complete response was achieved about CLL, and the patient, whose renal findings recovered, is in remission and under follow-up for six years. Although the mechanisms between CLL and autoimmune complications are not fully elucidated, it is usually related to immune disorders like an abnormal T-cell response and polyclonal antibody production. While FSGS is very rare in lymphoma, its co-existence with CLL is reported only in a limited number of case reports. Steroids may be used in these patients; however, in cases not responding to steroids, treatment of the underlying CLL is required.

Survival outcomes of hypomethylating agents maintenance therapy in new diagnosed AML patients: Real experience data.

OBJECTIVE: Acute myeloid leukemia (AML) is a hematological malignancy that frequently affects elderly population. With introducing the hypomethylating agents (HMAs) in elderly AML treatment, survival rates and quality of life have improved. However, long-term management in elderly and frail patients is still a challenge. In the present study, we aimed to determine whether HMA maintenance therapy is required until disease progression in frail and elderly AML patients by examining with a real-life data. METHODS: In a multicenter study, we analyzed non-promyelocytic elderly AML patients who were treated with first-line azacitidine or decitabine monotherapy in two different groups, retrospectively. While patients were treated with HMA until progression in the maintenance group, 6+3 cycles of azacitidine or decitabine were administered as a standard care of elderly AML patients in the non-maintenance group. Survival outcomes were compared between the groups. RESULTS: HMA therapy was maintained until progression in 20 patients, and HMA therapy was terminated after 6+3 cycles in 21 patients. Patients received a median of 6 (1-14) HMA cycles during follow-up time. The median 7.5 months of overall survival were observed (2-17 months) in maintenance and 3 months (1-13 months) in non-maintenance groups (p=0.001). CONCLUSION: Despite long-term exposure to HMA may appear as a risk factor for complications and toxicities in elderly and frail AML patients, the maintenance of therapy until disease progression provides a significant survival advantage. Therefore, we suggest that HMA therapy should continue until disease progression regardless the sort of HMA.

Dental follicle mesenchymal stem cells ameliorated glandular dysfunction in Sjögren's syndrome murine model.

OBJECTIVE: Dental mesenchymal stem cells (MSCs) are potential for use in tissue regeneration in inflammatory diseases due to their rapid proliferating, multilineage differentiation, and strong anti-inflammatory features. In the present study, immunoregulatory and glandular tissue regeneration effects of the dental follicle (DF)MSCs in Sjögren's Syndrome (SS) were investigated. METHODS: Dental follicle (DF) tissues were obtained from healthy individuals during tooth extraction, tissues were digested enzymatically and DFMSCs were cultured until the third passage. DFMSCs were labeled with Quantum dot 655 for cell tracking analysis. The induction of the SS mouse model was performed by the injection of Ro60-273-289 peptide intraperitoneally. DFMSCs were injected intraperitoneally, or into submandibular, or lacrimal glands. Splenocytes were analyzed for intracellular cytokine (IFN-γ, IL-17, IL-10) secretion in T helper cells, lymphocyte proliferation, and B lymphocyte subsets. Histologic analysis was done for submandibular and lacrimal glands with hematoxylin-eosin staining for morphologic examination. RESULTS: The systemic injection of DFMSCs significantly reduced intracellular IFN-γ and IL-17 secreting CD4+ T cells in splenocytes (p<0.05), and decreased inflammatory cell deposits and fibrosis in the glandular tissues. DFMSCs differentiated to glandular epithelial cells in submandibular and lacrimal injections with a significant reduction in lymphocytic foci. The results showed that few amounts of DFMSCs were deposited in glandular tissues when applied intraperitoneally, while high amounts of DFMSCs were located in glandular tissues and differentiated to glandular epithelial cells when applied locally in SS murine model. CONCLUSION: DFMSCs have the potential for the regulation of Th1, Th17, and Treg balance in SS, and ameliorate glandular dysfunction. DFMSCs can be a beneficial therapeutic application for SS.

Mysterious visitor in the bladder: Ureteral fibroepithelial polyp. / Visitante misterioso en la vejiga: pólipo fibroepitelial ureteral.

OBJECTIVES: We present a unique case with a ureteral fibroepithelial tumor originating from the ureter, which could be confused with a bladder tumor on ultrasound examination due to its movement in and out of the bladder. METHODS: In cystoscopy, a papillary tumor lesion emerging from the right ureteral orifice was seen. After scanning the other quadrants, however, the tumor was not observed at the right ureteral orifice. It was then protruded back into the bladder. The tumor was seen several times to protrude into the bladder and return to the ureter, possibly due to ureteral peristalsis. Then, a semi-rigid ureteroscope was introduced through the right ureteric orifice, and the tumor was excised in one piece using Holmium laser fiber with 365µm of diameter. The size of the removed tumor was approximately 8 cm long. A double-j stent of 4.8 Fr was placed in the ureter. RESULTS: The patient was discharged on the first day without complications. The fibroepithelial polyps of the ureter, which consist of the stroma of mesoderm origin, covered with histologically normal or hyperplastic urothelial epithelial cells, are extremely rare tumors. It is important to distinguish these polyps from urothelial cancers, since these two entities are different in treatment and prognosis, although similar in symptoms and imaging procedures. CONCLUSIONS: Minimally invasive treatment techniques can be safely applied in the treatment of such exceedingly rare tumors.

OBJETIVO:  Presentamos un caso único de tumor fibroepitelial ureteral originado en el uréter que se puede confundir con un tumor vesical por ecografía debido al movimiento dentro y fuera de la vejiga. MÉTODOS: En la cistoscopia, se vió una lesión tumoral papilar saliendo del meato ureteral. Después de mirar el resto de zona de la vejiga, dejamos de ver el tumor en el meato ureteral derecho. Una vez más, protuía después, en la vejiga. Se realizó una ureteroscopia semirrígida y se quitó el tumor en una pieza con laser holmium de 365. El tumor tenía una longitud de 8 cm. Se colocó un catéter doble J 4.8 Fr en el uréter. RESULTADOS: El paciente fue dado de alta en el primer día postoperatorio sin complicaciones. El pólipo fibroepitelial del uréter consiste en estroma del mesodermo cubierto de histológica normal o hiperplásica. Estos tumores son extremadamente raros. Es importante diferenciarlos de los tumores uroteliales ya que el tratamiento y pronóstico es diferente, aunque los síntomas y las técnicas de imagen son parecidas. CONCLUSIONES:  Las técnicas mínimamente invasivas se pueden aplicar a estos tumores tan poco comunes.

Mysterious visitor in the bladder: ureteral fibroepithelial polyp / Visitante misterioso en la vejiga: pólipo fibroepitelial ureteral

Objetives: We present a unique casewith a ureteral fibroepithelial tumor originating from theureter, which could be confused with a bladder tumor onultrasound examination due to its movement in and out ofthe bladder.Methods: In cystoscopy, a papillary tumor lesion emerging from the right ureteral orifice was seen. After scanningthe other quadrants, however, the tumor was not observedat the right ureteral orifice. It was then protruded back intothe bladder. The tumor was seen several times to protrudeinto the bladder and return to the ureter, possibly due toureteral peristalsis. Then, a semirigid ureteroscope was introduced through the right ureteric orifice, and the tumorwas excised in one piece using Holmium laser fiber with 365μm of diameter. The size of the removed tumor wasapproximately 8 cm long. A doublej stent of 4.8 Fr wasplaced in the ureter.Results: The patient was discharged on the first day without complications. The fibroepithelial polyps of the ureter,which consist of the stroma of mesoderm origin, coveredwith histologically normal or hyperplastic urothelial epithelial cells, are extremely rare tumors. It is important to distinguish these polyps from urothelial cancers, since these twoentities are different in treatment and prognosis, althoughsimilar in symptoms and imaging procedures.Cconclusions: Minimally invasive treatment techniquescan be safely applied in the treatment of such exceedinglyrare tumors.(AU)

Objetivo: Presentamos un caso único detumor fibroepitelial ureteral originado en el uréter que sepuede confundir con un tumor vesical por ecografía debido al movimiento dentro y fuera de la vejiga.Métodos: En la cistoscopia, se vió una lesión tumoralpapilar saliendo del meato ureteral. Después de mirar elresto de zona de la vejiga, dejamos de ver el tumor en elmeato ureteral derecho. Una vez más, protuía después,en la vejiga. Se realizó una ureteroscopia semirrígida yse quitó el tumor en una pieza con laser holmium de 365.El tumor tenía una longitud de 8 cm. Se colocó un catéterdoble J 4.8 Fr en el uréter.Resultados: El paciente fue dado de alta en el primerdía postoperatorio sin complicaciones. El pólipo fibroepitelial del uréter consiste en estroma del mesodermo cubiertode histológica normal o hiperplásica. Estos tumores sonextremadamente raros. Es importante diferenciarlos de lostumores uroteliales ya que el tratamiento y pronóstico esdiferente, aunque los síntomas y las técnicas de imagenson parecidas.Conclusiones: Las técnicas mínimamente invasivas sepueden aplicar a estos tumores tan poco comunes.(AU)

Searching for radiologic and histologic evidence on live vaginal tissue: Does the G-spot exist?

OBJECTIVE: There is a growing debate on the existence of the G-spot. G-spot amplification by various surgical interventions has become mainstream for esthetic vaginal surgery despite a lack of conclusive proof of the G-spot. The aim of this study was to search for histologic evidence in regions of so-called hyperintense focus (HF) (considered as the G-spot) using magnetic resonance imaging (MRI) mapping and biopsied tissues. MATERIALS AND METHODS: Fifteen patients who had grade 2 or higher anterior compartment defects were enrolled in the study. All patients were subjected to MRI. When a HF was seen, its localization, dimensions, and distances to adjacent structures were measured in images. Dissections in the anterior vaginal wall were performed in accordance with the measurements derived from MRI and tissue measuring 0.5x0.5 cm was biopsied from the determined HF. RESULTS: An HF was determined in MRI of three (20%) patients. However, no significant neurovascular tissue density was observed histologically in any of the biopsy specimens obtained from the surgical dissections under the guidance of MRI mapping. CONCLUSION: Our findings denote that there is no G-spot in the anterior vaginal wall.

Could trop-2 overexpression indicate tumor aggressiveness among prostatic adenocarcinomas?

BACKGROUND: TROP-2, a novel marker of trophoblastic cells, is being widely analyzed for its possible role in carcinogenesis and clinical behavior of various carcinomas. In this study, we aimed to evaluate the relationship between clinicopathologic parameters and TROP2 expression in prostatic adenocarcinomas. METHODS: 101 prostatic adenocarcinomas treated by radical prostatectomy in our hospital between 2013 and 2018 were reviewed retrospectively for histopathological features, and one representative block of each case was stained with TROP2 antibody. Histopathologic prognostic features were assessed for their relationship with TROP2 expression. RESULTS: The mean age was found as 64.11 year. TROP2 was stained in over 10% of the tumoral cells in 64 (63.4.%) cases. Gleason grade group, perineural invasion, lymphovascular invasion, ganglionic and seminal vesicle involvement, lateral and basal surgical margin positivity showed a significant relationship with TROP2 staining. CONCLUSION: TROP2 is overexpressed in various human cancers and TROP2 overexpression appears to correlate with poor prognosis leading to the suggestion that TROP2 could be a therapeutic target for various carcinomas. Our results suggest that TROP2 expression is higher in advanced tumors and these results need to be supported by larger studies.

Investigation of the protective effect of nesfatin-1 on testicular ischaemia-reperfusion damage: An experimental study.

This study aimed to determine oxidative stress in the tissue after testicular torsion biochemically and histopathologically and to examine the effects of Nesfatin-1 treatment on this injury. Thirty-two rats were randomly divided into four groups: sham, torsion + detorsion (4 hr torsion followed by 1 hr detorsion), ischaemia/reperfusion + saline (I/R + S) and I/R + nesfatin-1. I/R + S group a single-dose saline treatment was administered intraperitoneally at the two-hundred-tenth minute of torsion (ischaemia; 10 cc/kg). Similarly, I/R + nesfatin-1 group a single dose of nesfatin-1 treatment was administered intraperitoneally at the two-hundred-tenth minute of ischaemia (10 µg/kg). Myeloperoxidase, total oxidant status and oxidative stress index values were significantly increased in the I/R and I/R + S group compared to the sham group. Superoxide dismutase was significantly decreased in the I/R + S group compared to the sham group. No significant difference was found between the I/R + nesfatin-1 group and the other I/R groups (I/R and I/R + S) in terms of biochemical parameters. The mean diameter of the seminiferous tubule decreased in the I/R groups. However, the mean diameter of the seminiferous tubules was not significantly different between the I/R + S group and the I/R + nesfatin-1 group. Thus, the administration of nesfatin-1 after ischaemia did not reduce testicular-oxidative stress.

Both a biopsy method and a therapeutic procedure in BI-RADS 4A and 4B lesions: Ultrasound-guided vacuum-assisted breast biopsy.

OBJECTIVES: This study aimed to evaluate outcomes, complications, and follow-up results of ultrasound-guided vacuum-assisted breast biopsy (UG-VABB) in BI-RADS 4 A and B lesions. MATERIAL AND METHODS: Between Agust 2014 to January 2018, fifty BI-RADS 4A and BI-RADS 4B lesions of 41 patients biopsied with 10G vacuum needle by a single radiologist were retrospectively evaluated. RESULTS: All patients were females and mean age of the 41 patients was 50.12 ± 8.63. Of all lesions, 84% was benign, 6% was ADH, 4% was in-situ cancer, and 6% was diagnosed as malign. Follow-up duration after VABB was 0-51 months and mean was 20.92 months. Complications were as vasovagal-induced seizure in 3 patients (7.3%) and intramammary hematoma in 16 patients (39%). Hematoma was diagnosed in 3 patients (7.3%) at the 6th month follow-up and it was resolved in all patients at the 12th month follow-up. Higher breast density resulted in higher hematoma rates. There was no relationship between lesion BI-RADS subgroups, lesion size or sample number and hematoma development. During the follow-up, residue lesion in 1 (2.4%) patient and scar tissue in 2 (4.9%) patients was detected. CONCLUSION: US-guided VABB, with low complication rates and low scar development, is also a therapeutic excision method without remaining residue, which should be primarily preferred in smaller than 2 cm BI-RADS 4A and 4B lesions whose malignancy rates are relatively low. Hematoma, which is the most frequent complication, resorbed entirely in the 12th month in all patients.

Long-Lasting Follow-Up with Low-Dose Steroid in an 18-Year-Old Male with Rosai-Dorfman Disease.

Rosai-Dorfman disease (RDD) is a rare and benign pathology of sinus histiocytosis of unknown etiology. Lymphadenopathy is the predominant clinical manifestation, but diverse organs can also be affected. Histological features involve S-100+ histiocytes with characteristic nuclear features within the enlarged sinusoids of the lymph nodes. The clinical course is unpredictable, but is often benign with spontaneous resolution of disease in most patients. We report a patient with bilateral massive enlargement of cervical, axillary, and inguinal lymph nodes, moderately enlarged spleen, and a weight loss of 15 kg. Excisional biopsy from the cervical lymph node showed that the dilated sinusoids were infiltrated by lymphocytes, plasma cells, and large histiocytes with CD 68 and S-100 protein positive. Due to the slow progression of the disease, oral prednisolone with a body weight of 1 mg/kg was started in March 2016. The steroid dosage has been adjusted many times during the clinical follow-up. After 33 months, steroid treatment resulted in partial shrinkage of lymph nodes, the spleen returned to its normal size, and the patient gained weight. After 38 months of follow-up, no systemic symptoms, sign, or extranodal involvement were detected, and the patient continued with low-dose steroid treatment.

A grading dilemma; Gleason scoring system: Are we sufficiently compatible? A multi center study.

OBJECTIVE: Gleason scoring is the grading system which strongly predicts the prognosis of prostate cancer. However, even being one of the most commonly used systems, the presence of different interobserver agreement rates push the uropathologists update the definitons of the Gleason patterns. In this study, we aimed to determine the interobserver agreement variability among 7 general pathologists, and one expert uropathologist from 6 different centers. METHODS: A set of 50 Hematoxylin & Eosin stained slides from 41 patients diagnosed as prostate cancer were revised by 8 different pathologists. The pathologists were also grouped according to having their residency at the same institute or working at the same center. All pathologists' and the subgroups' Gleason scores were then compared for interobserver variability by Fleiss' and Cohen's kappa tests using R v3.2.4. RESULTS: There were about 8 pathologists from 6 different centers revised all the slides. One of them was an expert uropathologist with experience of 18 years. Among 7 general pathologists 4 had surgical pathology experience for over 5 years whilst 3 had under 5 years. The Fleiss' kappa was found as 0.54 for primary Gleason pattern, and 0.44 for total Gleason score (moderate agreement). The Fleiss' kappa was 0.45 for grade grouping system. CONCLUSION: Assigning a Gleason score for a patient can be problematic because of different interobserver agreement rates among pathologists even though the patterns were accepted as well-defined.

Management of a patient with primary mucinous testicular adenocarcinoma as a rare case with adjuvant and metastatic sequential treatments.

INTRODUCTION: Mucinous adenocarcinomas of the testicular surface epithelial tumors are very rare and are similar to malignant ovarian-type surface epithelial tumors. Although only 32 cases have been reported to date, there are only five cases of primary testicular mucinous carcinoma with access to literature in English. So there is still limited information about clinical, etiopathogenesis and treatment options. CASE REPORT: In this article, we discuss a 56-year-old male patient diagnosed with testicular mucinous adenocarcinoma due to its rarity in the light of literature review.Management and outcome: We preferred cisplatin-paclitaxel regimen for adjuvant treatment. We then used sequential treatments including oxaliplatin, 5-fluorourasil, etoposide, gemcitabine, and docetaxel to treat metastatic disease. The patient underwent lung metastasectomy for the first relapse. The patient was diagnosed in November 2013 and the response to treatment was evaluated in December 2019 and stable disease was detected. The patient, who has a total survival of 73 months, is still under treatment. DISCUSSION: Excluding malign transformation and borderline mucinous testicular tumors from mucinous cystadenomas of the testis, the knowledge on carcinogenesis, clinical course, and treatment of primary testicular mucinous adenocarcinomas is very limited.

Thrombotic thrombocytopenic purpura associated with pesticides: A report of 4 cases and literature review.

Thrombotic thrombocytopenic purpura (TTP) is a disease characterized by the presence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia, caused by the congenital or acquired decrease of the enzyme activity which degrades unusual large vWF multimers. There is no identifiable cause in half of the acquired TTP cases. Herein, we report four possible pesticide-related cases with decreased ADAMTS13 enzyme activity, increased titer of ADAMTS13 inhibitor and typical clinical and laboratory presentation.

Evaluation of Stromal Myofibroblasts in Laryngeal Dysplasia and Invasive Squamous Cell Carcinoma.

Malignant tumors consist of both carcinoma cells and tumor associated host cells. Host cells has started to receive more attention regarding their role in tumor progression such as invasion and metastasis. Fibroblasts that are incorporated in the tumoral stroma are called as peritumoral fibroblasts, reactive stroma, cancer-related fibroblasts or myofibroblasts. In general fibroblasts next to nich of cancer cells express alpha-smooth muscle actin (α-SMA) which is an important marker for differentiated myofibroblasts. Our aim is to investigate the role of α-SMA positive myofibroblasts in the development and progression of laryngeal carcinoma. The proportion of α-SMA positive myofibroblasts are scored from (1 +) to 3( +) in laryngeal dysplasia (n = 17) and microinvasive and invasive squamous cell carcinoma (n = 66). α-SMA expression in invasive carcinoma and dysplasia was analyzed statistically. No stromal myofibroblast was detected in mild dysplasia (score 0). Among 12 cases of moderate-severe dysplasia, in only 3 cases low α-SMA expression (score 1) was observed and in 9 cases there were no stromal myofibroblasts (score 0) were. In most cases of invasive carcinoma, high α-SMA expression (score 2, 3) was seen. α-SMA positive stromal myofibroblasts were significantly higher in invasive laryngeal squamous cell carcinoma compared to dysplasia (p < 0.05). Results of our study suggested that α-SMA positive stromal myofibroblasts play an important role in creating the permissive environment for tumor invasion in laryngeal squamous cell carcinoma. According to this data, we think that the presence of stromal myofibroblasts might be used as a helpful criterion in the differential diagnosis of true invasion and pseudoinvasion.

Acquired hemophilia A in chronic lymphocytic leukemia: A case report.

Acquired hemophilia A, due to spontaneous autoantibody against FVIII, is a rare hemorrhagic disorder with an incidence of about 1 per million population per year. If unrecognized and untreated, it is associated with a high morbidly and mortality rate of 8-12%. Autoantibody against coagulation factor VIII neutralizes procoagulant activity. We report herein is such a rare case of acquired hemophilia in a patient with CLL.

Evaluation of an Image-based Automated Detection System in Detecting Ki67 Proliferation Index and Correlation with the Traditional Eye-Ball Method in Gastroenteropancreatic Neuroendocrine Tumors.

OBJECTIVE: To design an application which can calculate Ki67 and compare its results with the traditional method in gastroenteropancreatic (GEP)-neuroendocrine tumors (NETs). STUDY DESIGN: Descriptive analytical study. PLACE AND DURATION OF STUDY: Faculties of Medicine and Technology of Mugla Sitki Kocman University between January 2015 to January 2016. METHODOLOGY: A new analyser for detecting the exact percentage of positive cells in images captured from different slides retrospectively selected from hospital records was designed and the concordance with results given by an expert pathologist was compared. Demonstrative slides from randomly selected 50 patients diagnosed as GEP-NETs were stained with Ki67 antibody; and images were captured from the hotspots. The images were then uploaded to the application of the analyser designed for detecting the percentage of Ki67-stained cells. RESULTS: Twenty-seven male (54%) and 23 (46%) female patients with a mean age of 52.3 ±8.80 years were included. According to the pathologist with eye-ball method, 17 cases were grade 1 (34%), 21 cases were grade 2 (42%) and 12 (24%) cases were grade 3. By software, 8 cases were grade 1 (16%), 36 cases were grade 2 (72%) and 6 cases were grade 3 (12%). Statistical evaluation revealed a kappa value of 0.447 indicating moderate aggreement between the pathologist and the software. CONCLUSION: The total count of the cells both by the analyser and the pathologist were similar. However, improvements are needed to raise the precision for the detection of positive and negative tumoral cells.

8-armed octopus: Evaluation of clinicopathologic prognostic factors of urothelial carcinoma of the upper urinary system

Background/aim: This study was designed to determine the characteristic features of upper urinary system urothelial carcinomas (UUSUCs) and to evaluate the clinicopathological parameters associated with prognosis. Materials and methods: A total of 74 cases of UUSUC were included, from three different centers. Demographic data and histopathological features such as tumor localization, concomitant tumor in the urinary system, distant metastasis with overall survival and disease-free survival obtained from the hospital records were evaluated retrospectively. Histopathologic prognostic features such as grade, perineural invasion, lymphovascular invasion, tumor necrosis, and surgical margin status were also evaluated. Results: Seventy cases (94.6%) underwent open nephroureterectomy whereas 4 cases (5.4%) had laparoscopic nefroureterectomy. Thirty-eight (51.4%) cases were located in the pelvis, 7 (9.5%) in the ureter, 29 (39.2%) both in the pelvis and ureter. Fifty-six (75.7%) cases were alive; however, 18 (24.3%) patients were found to be dead. pTa, pT1, pT2, pT3, and pT4 tumors were reported in 16 (21.6%), 13 (17.6%), 4 (5.4%), 28 (37.8%), and 13 (17.6%) patients, respectively. Histopathologically, 17 cases (23%) were low-grade, 57 cases (77%) were high-grade. Statistically significant correlation was observed between overall survival and lymph node metastasis, distant metastasis, tumor necrosis, and differentiation by univariate analysis. Only distant metastasis was statistically associated with overall survival by multivariate analysis. We found no significant relationship between disease-free survival and all parameters. Conclusion: Differentiation and necrosis of tumor, lymph node involvement, and presence of distant metastasis is associated with the overall survival of urothelial carcinoma of the upper urinary system.

Correlation of Prognostic Gleason Grade Grouping and Histopathological Parameters: Can the "New System" Reflect the Pathological Perspective for Prognosis?

BACKGROUND: Gleason score is one of the strongest prognostic predictors of prostate cancer;however, a change was published which is a 5 step grouping system of prostatic adenocarcinomas according to their Gleason scores. The aim of this study is to determine the relationship between histopathological findings and prognosis of tumors subgrouped according to the new Gleason grade grouping system. METHODS: A total of 163 radical prostatectomies subgrouped into 5 prognostic groups were investigated for prognostic features such as pathological stage, extraprostatic extension, surgical margin status, involvement of seminal vesicles, perineural invasion, necrosis, vascular invasion, ganglionic involvement, concomitant high grade prostatic intraepithelial neoplasia (HPIN) in addition to other microscopic features of tumors such as the presence of mucin and foamy cytoplasmic change between groups. RESULTS: The mean age of patients was 65.72 ± 6.67 (min = 46, max = 82). Among 131 patients who completed the study, the mean prostate specific antigen (PSA) value was 11.29 ± 10.88. The statistically significant factors were significantly related to both the original Gleason and the prognostic grade groups.The recurrence rate of grade group 4 patients (57%) was significantly higher than grade group 3 patients (8%) (P = 0.038). But no significant difference was found between grade group 4 and 5 (P = 0.25). CONCLUSION: Grade grouping systems reflect prognostic differences but adapting this new system into routine evaluation of patients may confuse the clinicians; however, pathology reports stating both the traditional Gleason score and the new prognostic group may soften the transition.

Where do these guests come from? A diagnostic approach for metastatic lymph nodes.

OBJECTIVE: In cases presenting with lymphadenopathies (LAP) without a primary focus detected by simple radiological methods, the primary tumor can be diagnosed by a histopathological evaluation of the metastatic lymph nodes. We aimed to discuss the nonhematological malignancies presenting with lymphadenopathies and the histopathological results for primary tumors. MATERIAL AND METHODS: In this retrospective study, cases diagnosed with metastasis in excisional lymph nodes between January 2013 and June 2016 were assessed for a histopathological diagnostic approach. RESULTS: Among 632 lymph node biopsies, a total of 21 cases, involving 12 male and 9 female patients with a mean age of 57.23 y (range, 33-92 y), of nonhematological solid tumors were included. The most common localizations of the involved lymph nodes were inguinal (n=8), axillary (n=6), cervical (n=4), and supraclavicular (n=3) region. The most common primary tumors were malignant melanoma (n=6), breast carcinoma (n=4), ovarian carcinoma (n=2), squamous cell carcinoma (n=2), and germ cell tumor (n=2). Others were papillary thyroid carcinoma, renal cell carcinoma, urothelial carcinoma, prostate adenocarcinoma, and endometrial adenocarcinoma. CONCLUSION: Nonhematological malignancies presenting with lymphadenopathies are one of the most complicated cases for clinicians. The histopathological evaluation of the excisional metastatic lymph node biopsies is an important method because of cost effectiveness and easy applicability.

Matrix metalloproteinase-9, 10, and stress hyperglycaemia in acute kidney injury.

BACKGROUND: This study investigated the effect of matrix metalloproteinase (MMP)-9 and 10, and stress hyperglycaemia on the necessity of emergency renal replacement therapy (RRT) and mortality in nondiabetic geriatric patients with acute kidney injury (AKI). MATERIALS AND METHODS: The present observational and longitudinal study included 101 nondiabetic geriatric patients (age >65 years) with AKI. The serum levels of MMP-9 and MMP-10 were evaluated in these patients. Serum glucose level >140 mg/dL at the time of admission was accepted as stress hyperglycaemia. RESULTS: The average age of patients was 81 ± 7.1 years. Stress hyperglycaemia was diagnosed in 34.6% of the cases; the majority of these cases were patients with high-serum urea, CRP, and chronic kidney disease. The average levels of MMP-9 and MMP-10 were found to be 199 ± 38 and 16.5 ± 7.5 ng/mL, respectively. Thirty-one cases (30.6%) mortality during hospitalization and 20 cases (20%) underwent emergency RRT. Multiregression analysis showed the serum urea (P < .001) and stress hyperglycaemia (P = .03) to be independently associated with mortality. Also, serum urea (P = .01), potassium level (P = .03), and MMP-10 levels (P = .03) were independently associated with the necessity of the emergency RRT. The MMP-9 levels exhibited no relation with the necessity of emergency RRT and mortality. CONCLUSION: Stress hyperglycaemia is a common condition among nondiabetic geriatric patients with AKI and is related to mortality. Serum MMP-10 levels serve as an important predictor of the necessity of emergency RRT in these patients.