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BACKGROUND: Cervical cancer is a global public health problem with high mortality. Advances in screening programs for cervical cancer are considered key to eliminate cervical cancer. We aimed to examine the contribution of cell block analysis to the detection of epithelial cell abnormalities in cervical smear samples. METHODS: A total of 559 patients with suspected cervical pathology were examined, and their samples were analyzed by both liquid-based cytology (LBC) and cell blocks. The biopsy results of 149 out of the 559 patients were obtained. RESULTS: Of the 50 patients who were identified as HSIL by biopsy, only 12 were diagnosed as HSIL by the LBC method, 22 as LSIL, 12 as ASCUS, and 4 as ASC-H (p < 0.001). With the cell block analysis, results for these patients were: 20 HSIL, 17 LSIL, 7 NILM, 4 'unsatisfactory', and 2 ASC cases (p < 0.001). LBC detected only 1 of the 10 patients with biopsy-diagnosed tumors, while 7 of these were defined as HSIL, 1 as ASCUS and 1 as AGC. The results of cell block analysis in patients with biopsy-diagnosed tumors were as follows: 7 HSIL, 1 tumor, 1 ASC and 1 LSIL. CONCLUSIONS: Cell block analysis might be superior to LBC in terms of diagnostic accuracy in cervical pathologies, particularly in the detection of HSIL. However, both methods were similarly poor in diagnosing tumors. Cell blocks may improve diagnostic accuracy and can be a complementary method to LBC, while having the advantage of revealing histological architecture.
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Células Escamosas Atípicas do Colo do Útero , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Feminino , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Células Escamosas Atípicas do Colo do Útero/patologia , Citologia , Citodiagnóstico/métodos , Biópsia , Displasia do Colo do Útero/patologiaRESUMO
Background Ultrasound-guided fine needle aspiration biopsy (FNAB) of thyroid nodules, though the most accurate method to rule out malignancy, still has an inherent risk of yielding non-diagnostic specimens despite immediate assessment of specimen adequacy by an on-site cytopathologist. Purpose To evaluate the effects of nodule volume and extent of cystic degeneration on total biopsy time and number of aspirations required for obtaining an adequate specimen. Material and Methods A total of 510 patients underwent FNAB by a single radiologist accompanied by a cytopathologist who immediately assessed each sample for specimen adequacy. All sampled nodules were single and had one maximum diameter > 10 mm. Nodule volumes and cystic degeneration ratios were calculated prior to the intervention. Aspirations were repeated until the cytological material was deemed adequate by the cytopathologist; the number of aspirations and total biopsy time were then recorded. Results Nodule volumes did not have significant effect on neither number of aspirations necessary for achieving specimen adequacy ( P > 0.05) nor total biopsy time (r = -0.148 with P = 0.001). Predominantly cystic nodules, compared to predominantly solid nodules, required more sampling per nodule (4.58 ± 1.11 vs. 3.44 ± 1.19 aspirations, P = 0.001) and longer total biopsy time (16.40 ± 6.19 vs. 11.15 ± 6.18 min, P = 0.001). Conclusion Predominantly cystic nodules require allocation of more time for biopsy. To ensure specimen adequacy when immediate specimen evaluation by an on-site cytopathologist is not possible, four samples from predominantly solid nodules and five passes through predominantly cystic nodules are required.
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Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto JovemRESUMO
BACKGROUND: A fine needle aspiration biopsy (FNAB) of thyroid nodules - the least invasive and most accurate method used to investigate malignant lesions - may yield non-diagnostic specimens even under ultrasonographic guidance. PURPOSE: To evaluate the effects of thyroid nodule volume and extent of cystic degeneration on both the non-diagnostic specimen ratio as well as cytopathologist's definitive cytological diagnosis time. MATERIAL AND METHODS: In this single center study, FNAB was performed on 505 patients with single thyroid nodules greater than 10 mm. Nodule volume was calculated prior to FNAB and cystic degeneration ratio was recorded. All biopsies were performed by a single radiologist who also prepared specimen slides. Specimen adequacy and final diagnosis were made in the pathology laboratory by a single-blinded cytopathologist based on the Bethesda system. Definitive cytological diagnosis time was recorded upon reaching a definitive diagnosis. RESULTS: The specimen adequacy ratio was 85.3%. The mean nodule volume of adequate specimens was larger than those of non-diagnostic samples (6.00 mL vs. 3.05 mL; P = 0.001). There was no correlation between nodule volume and cytopathologist's definitive cytological diagnosis time (r = 0.042). Biopsy of predominantly solid nodules yielded better specimen adequacy ratios compared to predominantly cystic nodules (87.8% vs. 75.3%; P = 0.028). Definitive cytological diagnosis times were longer in predominantly cystic nodules compared to predominantly solid nodules (376 s vs. 294 s; P = 0.019). CONCLUSION: Predominantly cystic nodules are likely to benefit from repeated nodular sampling until the specimen is declared adequate by an on-site cytopathologist. If a cytopathologist is not available, obtaining more specimens per nodule may achieve desired adequacy ratios.
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Biópsia por Agulha Fina , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia de Intervenção , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Mycetoma is a chronic discharging infection involving the skin, subcutaneous tissue, fascia, and bone, which is endemic in tropical and subtropical countries. We report a rare case of mycetoma localized on the foot of a patient living in a country with a temperate climate. A 32-year-old male patient presented with painless swelling in the right foot. He had undergone surgery 3 years ago with the same complaints. Magnetic resonance imaging revealed a 90 × 65 × 37â mm cystic soft tissue lesion in the posterior of the right ankle. Histological analysis identified the fungus. Extensive resection was performed. Mycetoma is characterized by chronic granulomatous inflammatory response, often associated with sinus tract formations due to fungal (eumycetoma) or bacterial (actinomycetoma) organisms. Here we provide a literature review and highlight the importance of increasing awareness toward mycetoma, particularly in non-endemic regions.
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OBJECTIVE: Colorectal cancer is common worldwide, and adjuvant treatment's benefit is still controversial. We designed this study to determine the role of MSI and CDX-2 status determined by immunohistochemistry (IHC) combined with the inflammatory markers and pathological parameters in predicting disease recurrence in stage II and III colon cancer. METHODS: A total of 226 stage II/III colon cancer patients with a median age of 59 years who underwent initial surgery were included in this retrospective study. The pathologic assessment of MSI and CDX-2 was performed twice by immunohistochemistry (IHC) and two different pathologists. No staining/weak staining below 10% of the tumor was accepted as CDX-2 negative, and any MSI clones with weak staining below 10% were accepted as MSI-H. The laboratory parameters were noted at the initial diagnosis. RESULTS: One hundred twenty-one and 105 patients were diagnosed with stage III and II colon cancer. 58.0% of patients were male, 46 (20.4%) of tumor tissue were MSS, and 17 (7.5%) were CDX-2 negative. One hundred twenty-nine tumors were localized in the right colon. Disease recurrence was significantly correlated with tumor localization, CDX-2 status, stage at diagnosis, and preoperatively median CRP and CEA levels. DFS rates for MSS patients with CDX-2 negative and positive were 36.7% and 98.1%, respectively [p < 0.001]. There was no significant correlation between MSI status and CDX-2 status. MSI status, the presence of adjuvant treatment, and systemic inflammatory markers were not significant prognostic factors for DFS. CDX-2 status [HR:0.08, CI 95% 0.03-0.17, p < 0.001 HR: 1.7, CI 95% 1.1-3.0, p = 0.03], disease stage [HR:2.6, CI 95% 1.43-4.74], and preoperatively CEA levels [HR:4.1 CI 95% 2.18-785, p < 0.001 were independent significant prognostic factors for DFS. CONCLUSION: CDX-2 loss was an independent prognostic factor for DFS and disease recurrence in early-stage colon cancer. MSS patients with CDX-2 loss had significantly worse survival outcomes, and this might be the reason for deciding on adjuvant chemotherapy.
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OBJECTIVE: To determine the frequency of granulomatous inflammation within hepatocellular carcinoma (HCC) and its clinicopathologic associations. MATERIAL AND METHOD: Fifty-eight HCCs (51 explants, 3 lobectomies, and 4 segmentectomies) were reviewed. RESULTS: Five (8.6%) cases (F/M=1/4, mean age: 63.6) were identified with granulomas.1/5 had history of neoadjuvant therapy. 4/5 patients presented with early stage (pT1/2). All were well-differentiated (Grade1-2/4). The mean number of tumor foci was 3.6, with a median size of 2.2 cm. All of them had advanced fibrosis. No difference was identified from cases without granulomas (n=53) in terms of prognosis and aforementioned parameters (p > 0.05). Granulomas were mainly concentrated in peripheral parts of the tumors. One case with nodule-in-nodule formation had granulomas lined along the border of the inner nodule. In 2 cases, granulomas were identified in steatohepatitic areas, while another had clear cell change. Only 1 had necrotizing granulomas, none with acid resistant bacilli. Two cases revealed concomitant granulomas in the adjacent liver parenchyma in addition to the tumor stroma. Except for one with a history of tuberculosis, none of the cases had a granulomatous disease. CONCLUSION: This is the largest case series of HCCs with granulomas by far. Our data revealed neither clinicopathologic and prognostic difference nor definite etiology related to granulomas. Yet, association with steatotic and clear tumor cells suggests the role of cytoplasmic content, while distribution of granulomas points to host immune response.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/patologia , Granuloma/patologia , Humanos , Inflamação , Neoplasias Hepáticas/patologia , Pessoa de Meia-IdadeRESUMO
Purpose. To examine the relationship between esophageal and gastric cancers commonly seen in Van Lake region and the traditional eating habits of the geography. Materials and Methods. Esophageal and gastric cancer cases, who underwent surgery between January 1, 2012, and December 31, 2013, were examined. Pathology reports of the patients and presence of Helicobacter pylori (HP) were recorded. Surveys were filled by face to face meeting or telephone call. Control group was created with randomly selected individuals without any cancer diagnosis having age, gender, and socioeconomic characteristics similar to patient group. All data were analyzed using SAS.9.3 statistical programme. Results. Compared with the control group, herby cheese consumption (a component of eating habits) and smoking were significantly higher in the patient group (P < 0.001). Tandoor exposure is compared in terms of female gender, and significant difference was found between the groups (P = 0.0013). As a result of the analysis with logistic regression more than 150 gr of herby cheese consumption per day was found to increase the cancer risk (odds ratio 1.017; 95% CI: 1.012-1.022). Conclusion. A high consumption of herby cheese, cooking bread on tandoor, and heavy smoking were seen to be important risk factors for esophageal and gastric cancers.
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Current methods for diagnosis and staging of prostate adenocarcinoma are not sensitive enough to distinguish between patients with indolent disease and those that should receive radical treatment. Epithelial-mesenchymal transition (EMT) is a well-characterized process involved in tumor invasion and metastasis. The aim of this study is to analyze the expression of ß-catenin, Snail, and E-cadherin in prostate cancer patients with prospective evaluation of their value in predicting disease-free survival (DFS). One-hundred-and-three consecutive prostate carcinoma patients who underwent radical prostatectomy and 35 patients with benign prostate hyperplasia (BPH) were enrolled. Age, initial PSA level, tumor size and clinical stage were documented for adenocarcinoma patients and they were enrolled in active surveillance with serum PSA levels. Recurrence was defined as PSA level of ≥ 0.2 ng/ml on at least 2 occasions over a 2-month period. Immunohistochemical staining intensity was scored as negative, weakly positive, moderately positive, and strongly positive. For Snail and ß-catenin immunoreaction, the tumors were considered nuclear positive when more than 5 % of the nuclei of tumor cells were positively stained. Patients with prostate cancer had weaker ß-catenin (p < 0.0001), Snail (p = 0.006), and E-cadherin (p = 0.02) staining when compared to BPH patients and the frequency of nuclear positivity for ß-catenin and Snail were higher in adenocarcinoma group (p < 0.0001). Increased expression and nuclear positivity of ß-catenin were associated with advanced stage (p = 0.012 and p = 0.003) and higher tumor volume (p = 0.013 and p = 0.002). Additionally, patients with increased Snail expression had higher Gleason scores and tumor volume at presentation (p = 0.008 and p = 0.004). However, there were no significant DFS differences in adenocarcinoma patients who did and did not have ß-catenin, Snail, and E-cadherin expression as assessed with log-rank test. Expressions of ß-catenin, Snail, and E-cadherin were significantly lower in prostate cancer patients compared to BPH patients and both ß-catenin and Snail had nuclear staining pattern in patients with adenocarcinoma. However, none of these markers predicted DFS in 36-month follow up of our cohort.
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Adenocarcinoma/patologia , Biomarcadores Tumorais/metabolismo , Caderinas/metabolismo , Transição Epitelial-Mesenquimal/fisiologia , Neoplasias da Próstata/patologia , Fatores de Transcrição/metabolismo , beta Catenina/metabolismo , Adenocarcinoma/metabolismo , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Prospectivos , Prostatectomia/métodos , Neoplasias da Próstata/metabolismo , Fatores de Transcrição da Família SnailRESUMO
Aneurysmal bone cysts are rare entities which causes expansile and destructive bone lesions characterized by reactive proliferation of connective tissue. They usually grow rapidly with hypervascularity. In clinical practice they can be easily misdiagnosed due to the rare occurance and having no such typical findings as radiologically. Most cases have uncommon pain symptoms, but rarely, if fractures occur, neurological findings can be seen and the surgical treatment, if needed, could be difficult. We will discuss our evaluations to two cases that we experienced in our clinic in this report.
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BACKGROUND: Ankaferd (Ankaferd blood stopper®, ABS) is a recently developed topical hemostatic agent. ABS is a standardized mixture of the plants Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica. Through its effects on the endothelium, blood cells, angiogenesis, cellular proliferation, vascular dynamics, and cell mediators; Ankaferd plays a part in inflammation and hemostasis processes. The aim of this experimental study is to assess the effects of ABS on the left colonic anastomoses under normal, septic, and ischemic conditions. METHODS: Forty-eight Wistar Albino male rats were divided into six weight-matched equal groups: A, anastomosis in normal condition (n = 8); AA, anastomosis with ABS in normal condition (n = 8); AS, anastomosis in septic condition (n = 8); AAS, anastomosis with ABS in septic condition (n = 8); AI, anastomosis in ischemic condition (n = 8); and AAI, anastomosis with ABS in ischemic condition (n = 8). Blood and tissue samples were taken for the histopathological and biochemical studies after the anastomotic bursting pressures were measured. RESULTS: Higher hydroxyproline levels (p = .048) and angiogenesis (p = .038) were observed in the sepsis-induced rats compared to the control group. The inflammatory activity, fibrosis, and granulation were comparable in all experimental groups. Ankaferd improved the angiogenesis under septic conditions (AAS) when compared to the control group (AI; p = .038). CONCLUSIONS: ABS may support anastomotic healing in septic conditions. Topical ABS application controlling the mucosal bleeding at the cut ends of the colon may also improve the anastomotic wound healing by means of increasing mechanical strength and positively affecting angiogenesis. Further studies shall focus on the clinical importance of those findings.
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Anastomose Cirúrgica , Colo/cirurgia , Hemostáticos/farmacologia , Extratos Vegetais/farmacologia , Cicatrização/efeitos dos fármacos , Animais , Fenômenos Biomecânicos/efeitos dos fármacos , Fenômenos Biomecânicos/fisiologia , Colo/irrigação sanguínea , Colo/fisiopatologia , Masculino , Modelos Animais , Neovascularização Fisiológica/efeitos dos fármacos , Neovascularização Fisiológica/fisiologia , Ratos , Ratos Wistar , Sepse/fisiopatologia , Cicatrização/fisiologiaRESUMO
PURPOSE: Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) participate in tumorigenesis, and their association with disease outcome is highly controversial. The present study investigates the influence of MMP-1, MMP-9 and TIMP-2 on different clinicopathologic variables and disease-free survival (DFS) of patients with prostate carcinoma. METHODS: Hundred and forty-five cases are included in the study, and levels of MMP/TIMP expressions are assessed in three tissue compartments (i.e., tumor, stroma and normal glands) with immunohistochemistry. RESULTS: Matrix metalloproteinase-1 expression in tumor cells was associated with lower Gleason scores, pretreatment prostate-specific antigen levels and lower incidence of vascular, perineural and extracapsular invasions. Moreover, MMP-9 positivity and TIMP-2 expression in normal glands were correlated with lower Gleason patterns and early stage at presentation. Expression of MMP in tumor cells and the presence of TIMP-2 in normal glands were associated with better DFS. CONCLUSION: Variability of MMP/TIMP expressions from case to case makes it difficult to evaluate their impact on clinical outcome. However, these proteins might be new and promising targets for prostate cancer therapy in the future.
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Biomarcadores Tumorais/análise , Carcinoma/enzimologia , Metaloproteinase 1 da Matriz/biossíntese , Metaloproteinase 9 da Matriz/biossíntese , Neoplasias da Próstata/enzimologia , Inibidor Tecidual de Metaloproteinase-2/biossíntese , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Carcinoma/patologia , Intervalo Livre de Doença , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Metaloproteinase 1 da Matriz/análise , Metaloproteinase 9 da Matriz/análise , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Prognóstico , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Análise Serial de Tecidos , Inibidor Tecidual de Metaloproteinase-2/análiseRESUMO
Gastrointestinal stromal tumors are very rare mesenchymal tumors of the gastrointestinal tract with variable clinical presentations depending on the tumor size and anatomic site. The currently used diagnostic modalities cannot establish a preoperative diagnosis with 100% certainty. The treatment of choice includes complete surgical excision and/or chemotherapy. In this paper, we present a very rare case of gastrointestinal stromal tumor presenting with closed perforation of the small intestine. The patient was successfully managed with surgical excision of the tumor with segmental bowel resection and adjuvant chemotherapy. Although rare, it must be kept in mind that gastrointestinal stromal tumors can also present with closed bowel perforation.
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Neoplasias Gastrointestinais/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Perfuração Intestinal/diagnóstico , Intestino Delgado/patologia , Antineoplásicos/uso terapêutico , Benzamidas , Quimioterapia Adjuvante , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib , Intestino Delgado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
Background/Aim: Gastric cancer causes the second highest number of cancer related deaths. The purpose of this study is to evaluate the survival of patients who are T3, T4, lymph node positive postoperatively and have undergone adjuvant chemoradiotherapy (CRT). We also examined the toxicities of CRT. Materials and Methods: Included in this retrospective study were one hundred six, stage IIA, IIB, IIIA, IIIB and IIIC gastric cancer patients undergoing adjuvant chemoradiotherapy after four weeks of surgery presenting at our hospital between 2009 and 2013. Statistical analysis was done with the SPSS (version 19) programme and survival analysis was done by using the Kaplan-Meier method. Results: The median follow-up of patients was 25 months (range; 7-38). There were local recurrences in 25.9% (n=22) of patients and liver metastasis in 20% (n=17), lung metastasis in 16.5% (n=14) and peritoneal metastasis in 5.9% (n=5). There were no recurrences in 31.8% (n=27) of patients. The median disease free survival (DFS) of the patients was 11 months (8.4- 13.5) and overall surival (OS) was 29 months (24.3-33.6). Conclusion: Survival rates were found to be lower than expected, this could be due to ongoing dietary habits and the low socioeconomic status of the patients. Toxicities were manageable.