Cecal duplication cyst causing ileus: A rare pediatric case report.

Duplication cysts are one of the rare congenital anomalies of the gastrointestinal tract. Although it can be seen at all levels throughout the gastrointestinal tract, it is most common in the ileum. One of the rarest of duplication cysts is cecal duplication cyst. Clinically, they become present in the form of vomiting, distention, abdominal pain and palpable mass. Rarely, it can cause acute abdomen such as perforation and obstruction. We present a case of cecal duplication cyst requiring urgent surgical treatment that causes obstruction in a 3-month-old baby.

An assessment of the protective effect of gonadotropin-releasing hormone agonist and antagonist on bleomycin-induced ovarian toxicity in rats.

The aim of this study is to evaluate the effect of GnRH agonist or GnRH antagonist therapy on bleomycin-administered rats by examining ovarian follicle counts and AMH levels. A total of 30 female Wistar albino rats aged 4-6 months were randomly divided into 4 groups. First, an intramuscular injection of bleomycin (30 mg/m2) was administered to all except the control group on the 1st, 8th and 15th days. The control group (Group I) was administered 0.1 mL intramuscular saline on those days. The bleomycin group (Group II) was followed up without any further treatment. The bleomycin + GnRH agonist group (Group III) was administered subcutaneous GnRH agonist triptorelin (1 mg/kg) at the same time as the bleomycin injections. The bleomycin + GnRH antagonist group (Group IV) was administered 1 mg/kg cetrorelix acetate subcutaneously, concurrently with the bleomycin. Although AMH levels were lower in the bleomycin group than in all the other groups, there was no statistically significant difference between the groups in terms of AMH levels (p > .05). In the bleomycin + cetrorelix acetate and bleomycin + triptorelin groups, significantly higher primordial, secondary and tertiary follicle counts were determined compared to the bleomycin group (p < .001). In conclusion the harmful effects of bleomycin on ovarian reserve can be reduced by the simultaneous administration of GnRH agonist or GnRH antagonist.

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 glottic squamous cell carcinoma with cutaneous metastasis.

INTRODUCTION: Oral cavity malignancies constitute 30% of head and neck cancers. The most common distant metastatic sites of glottic carcinoma are usually lung, liver and bone. Although the cutaneous metastasis of head and cancers have been reported with an incidence of 0.7-2.4%, skin metastasis of glottic carcinoma is extremely rare. CASE REPORT: A 69-year-old male patient was admitted to the emergency department with hemoptysis, dyspnea, weakness in lower extremities and difficulty in swallowing. There were subcutaneous lesions with a diameter of 2-5 cm in the scalp, posterior chest wall, nose and abdomen. In addition, there was an ulcerating, painful mass on the right lateral part of the tongue. The biopsy of lesions on tongue and skin revealed a glottic squamous cell carcinoma with cutaneous metastasis.Management and outcome: The patient was treated with cisplatin 50 mg/m2 on day 1, cetuximab 500 mg/m2 on day 1 and 5-fluorouracil 1000 mg/m2 daily on days 1 and 2, repeated every two weeks. After the first cycle of chemotherapy, the lesions on the skin regressed and dysphagia improved. DISCUSSION: There are limited data about the incidence, diagnostic measures and treatment modalities of glottic cancer with cutaneous metastasis. Our case could provide an important experience to literature by its atypical presentation and treatment-sensitive nature.

A rare soft tissue tumor located in the trunk: Ossifying fibromyxoid tumor.

Ossifying fibromyxoid tumor (OFMT), a rare soft tissue tumor, is generally located in the extremities with a distinct morphology characterized by bland, small cells lying in a fibromyxoid stroma and a peripheral rim of the lamellar bone. These tumors mostly express Leu-7, neuron specific enolase in addition to S-100 and vimentin. Some tumors may have malignant cytological features with aggressive behavior but even in classical morphology, recurrence or metastasis can be detected. Thus, the outcome of the tumor remains a mystery and depends on the different results detected during the follow up. Herein, we report a case of OFMT regarding this entity in the differential diagnosis of subcutaneous masses.

Nodular Fasciitis of the Neck Causing Emergency: A Case Report.

Nodular fasciitis is a benign, reactive, tumor-like lesion composed of fibroblasts and myofibroblasts. It typically occurs in the extremities and the trunk. Head and neck localization is 13-20%. As it grows rapidly, clinicians frequently misdiagnose it as an aggressive or a malignant lesion. Some lesions show moderate cellularity, mild cellular atypia, and mitosis histologically causing pathologists to over-diagnose the lesion as a malignant tumor. It is important to diagnose nodular fasciitis correctly to avoid unnecessary additional surgery and treatment. We report the case of an 82-year-old woman who was admitted to the emergency department with a one-month history of progressive shortness of breath. We found a mass in the patient's neck, invasive to the trachea, which was the cause of her symptom. Complete radical surgery of the mass with the larynx was impossible due to her general status. The mass was treated by local radiotherapy; however, no regression was seen in the size of the mass. The patient is still on follow-up with only symptomatic medical support for airway obstruction.

Silibinin attenuates methotrexate-induced pulmonary injury by targeting oxidative stress.

The aim of the present study was to assess the protective effect of silibinin against methotrexate (MTX)-induced pulmonary toxicity. Rats were divided into four groups (MTX, MTX + silibinin, silibinin and control. MTX was injected intraperitoneally (i.p) into female Wistar rats (10 mg/kg/day for 3 days), which resulted in significant increases in the serum levels of alanine aminotransferase, aspartate aminotransferase and oxidant enzymes, including nitric oxide and myeloperoxidase. Furthermore, significant reductions were detected in the serum activity levels of the antioxidative enzymes, glutathione peroxidase and superoxide dismutase, when compared with the control group. However, administration of silibinin (100 mg/kg/day for 10 days, i.p.) was shown to ameliorate the MTX-induced pulmonary toxicity, as indicated by the normalization of the oxidative stress parameters. Furthermore, silibinin treatment was demonstrated to reduce the histopathological changes associated with MTX. In conclusion, silibinin exhibited protective effects against MTX-induced pulmonary toxicity, which may be attributed to its antioxidant activity.

Prognostic significance of MUC1, MUC2 and MUC5AC expressions in gastric carcinoma.

BACKGROUND/AIMS: The aim of this study was to investigate the expressions of some of the Mucus Core Proteins (MUC) MUC1, MUC2 and MUC5AC in gastric carcinomas, to assess their prognostic values and their relations with the clinicopathological characteristics. METHODS: MUC1, MUC2 and MUC5AC expressions were investigated immunohistochemically in 257 patients with gastric carcinomas. RESULTS: MUC1 was strongly expressed in normal gastric epithelium; however, the expression rate decreased with the loss of tumor differentiation (92.6% in well differentiated tumors, 83.7% in poorly differentiated tumors), with an increase in the number of metastatic lymph nodes (98.4% in tumors with no metastatic lymph nodes, 67.9% in tumors with lymph node metastasis-pN3), and with the progression in the tumor stage (100% in stage 1 tumors, 75.6% in stage 4 tumors). MUC1 expression was lower in distant metastatic tumors (83.3% in distant metastatic tumors and 90.8% in nonmetastatic tumors). There was no staining with MUC2 in normal gastric epithelium; however, de novo expressions appeared in tumoral tissues. In diffuse gastric carcinomas (mucinous and signet ring cell carcinomas), MUC2 expression was higher (97.5% in diffuse type and 89.4% in intestinal type). All of the mucinous carcinomas were MUC2-positive. The expression rate decreased with an increase in the number of metastatic lymph nodes and with the progression in the TNM stages of the cases. All of the tumors with intestinal metaplasia were MUC2-positive. MUC5AC was strongly expressed in normal gastric epithelium; however, the expression rate decreased with the loss of tumor differentiation, with an increase in the tumor invasion depth, and with an increase in the number of metastatic lymph nodes. MUC5AC expression was higher in intestinal type carcinoma (48.4%) than in the diffuse type (10%). The lowest expression rate was in the diffuse type according to the Borrmann's macroscopic classification. All of these results were statistically significant (p<0.05). CONCLUSIONS: When each of these three markers is evaluated, in the light of clinical and pathological parameters, MUC1 and MUC5AC may be accepted as significant prognostic parameters and may be useful in showing the progression of the tumors; MUC2 may be used in determining the mucinous carcinomas.

Use of KAI-1 as a prognostic factor in gastric carcinoma.

AIMS: The purpose of this study was to investigate the expression level of KAI-1 in gastric carcinomas and compare with the clinicopathological characteristics. METHODS: KAI-1 expressions were detected with immunohistochemical methods in 257 patients with gastric carcinomas. RESULTS: KAI-1 was highly expressed in normal gastric epithelium, whereas only 86 of 257 (33.5%) patients with gastric carcinomas were KAI-1 positive. The expression levels, however, decreased with the loss of tumor differentiation, increase in tumor invasion depth, increase in the number of metastatic lymph nodes and perinodal invasions, and progression in the tumor stage. Distant metastatic and stage 4 tumors were all KAI-1 negative. All of these results were statistically significant (P<0.05). There were no correlations between KAI-1 expression and the other parameters such as age, sex, tumor location, tumor size, WHO, Lauren's and Bormann's classifications, neural and angiovascular invasion of the tumor and intestinal metaplasia in adjacent gastric mucosa (P>0.05). CONCLUSION: Loss of KAI-1 may be considered a significant prognostic parameter in predicting the progression of the gastric carcinomas when evaluated along with the clinical and pathological parameters.

Bilateral epithelial-myoepithelial carcinoma: an extraordinary tumor of the paranasal sinuses.

A 54-year-old woman presented with a 6-month history of swelling on the right side of her face. On physical examination she was found to have a huge mass in the right nasal cavity. Magnetic resonance images of the paranasal sinuses revealed a soft tissue mass in the right maxillary sinus and a mass was also seen in the left maxillary sinus. On histopathologic examination, the tumor had a lobular structure with infiltrating margins. Two cell types, an outer layer of myoepithelial and an inner layer of duct-like cells, were found. On immunohistochemical examination, myoepithelial cells stained positively for calponin, p63, GFAP, S-100 protein, alpha-smooth muscle actin cytokeratin-14. The tumors were resected completely and no recurrence or metastasis was found 30 months after surgery. We describe here an unusual case of epithelial-myoepithelial carcinoma (EMC) arising from the paranasal sinuses. This is the first case report in the literature describing bilateral EMC in the maxillary sinuses.