TOX, TWIST1, STAT4, and SATB1 protein expressions in early-stage mycosis fungoides.

BACKGROUND: Diagnosis of early mycosis fungoides (eMF) is challenging and often delayed as many of its clinical and histopathologic features may mimic various benign inflammatory dermatoses (BIDs). The products of the thymocyte selection-associated high mobility group box (TOX), twist family BHLH transcription factor 1 (TWIST1), signal transducer and activator of transcription 4 (STAT4), and special AT-rich sequence-binding protein 1 (SATB1) genes function as transcription factors and are involved in the pathogenesis of MF. OBJECTIVES: We aim to determine the diagnostic value of TOX, TWIST1, STAT4, and SATB1 protein expressions in eMF. METHODS: This non-randomized, controlled, prospective analytic study was conducted by performing immunohistochemistry staining with TOX, TWIST1, STAT4, and SATB1 polyclonal antibodies in lesional skin biopsies of eMF and BID patients. Nuclear staining of lymphocytes was compared between eMF and BIDs, and the capacity of these antibodies to predict eMF was determined. RESULTS: Immunostainings with anti-TWIST1 showed an increase in protein expression (p = 0.003) and showed a decrease with anti-SATB1 antibodies in eMF compared to BIDs (p = 0.005) while anti-TOX and anti-STAT4 antibodies did not exhibit significant differences (p = 0.384; p = 0.150). Receiver operating characteristic analysis showed that immunohistochemical evaluations of TWIST1 and SATB1 protein expressions can differentiate eMF (area under the curve [AUC]: 0.728, 95% confidence interval [CI]: 0.605-0.851, p = 0.002; AUC: 0.686, 95% CI: 0.565-0.807, p = 0.013). CONCLUSIONS: TWIST1 and SATB1 are potential diagnostic markers for the histologic diagnosis of eMF.

Characteristic ultrasound appearance of a rare testis tumor: Bilateral multiple large-cell calcifying Sertoli cell tumor.

Characteristic ultrasound features of large cell calcifying Sertoli cell tumor (LCCSCT), including hypoechoic masses with amorphous coarse calcifications can aid in differentiating this tumor from other entities. Bilateral multiple LCCSCTs almost always show a benign course; therefore, defining the diagnosis with sonographic findings is crucial to avoid unnecessary orchiectomy.

Pleural mesothelioma metastasis of the scalp.

Mesothelioma is a locally aggressive malignant tumor that arises on the mesothelial surfaces of the pleura, peritoneum and tunica vaginalis. There are three histologic subtypes of mesothelioma: epithelioid, biphasic, and sarcomatoid. Pleural mesothelioma is usually characterized by diffuse pleural thickening. Disease progression is characterized by local invasion of the chest wall and lung. Lymphatic metastasis is rare and hematogenous metastasis is much rarer. The purpose of these case reports is to emphasize that pleural mesothelioma metastases can occur in unexpected places and to contribute to the literature.

Dermatologic manifestations of acromegaly: A case in point and a focused review.

Acromegaly is a systemic syndrome caused by overproduction of growth hormone. Cutaneous, endocrine, cardiovascular, skeletal, and respiratory systems are affected. Cutaneous changes in acromegaly relate to overexpression of growth hormone and insulin-like growth factor 1 on skin cells and adnexa. Dermal glycosaminoglycan accumulation and edema cause skin distention that is most prominent in the face, hands, and feet. Oily skin with large pores, hypertrichosis, and excessive sweating are common features. Pigmented skin tags, acanthosis nigricans, and psoriasis are also encountered. Cutaneous manifestations of acromegaly are various and prominent, and are an important clue for the early diagnosis and treatment of this high-morbidity disorder.

Vesiculobullous dermatomyositis with sensory motor neuropathy.

A 74-year-old man presented with muscle weakness in both legs for a duration of 2 months. Physical examination revealed periorbital edema and erythema, erythema on the neck and chest, erythematous papules on the proximal-distal interphalangeal and metocarpophalangeal joints, crusted plaque lesions on the thighs and around the knees, and bullous and ulcerated lesions in the antecubital and popliteal fossae (Figure 1A and 1B). Some bullous lesions were intact and some were ulcerated. There was severe edema especially in the upper extremities. He had a history of 15-kg weight loss for 4 months. Laboratory findings were remarkable for a white blood cell count of 16.0 K/UL (4.60-10.20 K/UL), a C-reactive protein of 6.93 mg/dL (0-0.5 mg/dL), an erythrocyte sedimentation rate of 50 mm/h (8-15 mm/h), an aspartate aminotransferase level of 213 U/L (10-40 U/L), a lactate dehydrogenase of 447 U/L (< 225 U/L), and a creatine kinase level of 1733 U/L (29-200 U/L). Results from antinuclear antibody at 1:320 titers and anti-smooth muscle antibody were positive. Results from anti-SS A/SS B antibodies, anti Jo-1 antibody, U1-snRNP antibody, and anti-ds DNA antibody tests were negative. A skin biopsy specimen obtained from the right antecubital fossa showed minimal orthokeratosis and subepidermal detachments. There was marked edema in the dermis and lymphocyte infiltration around the skin appendages (Figure 2). Direct immunofluorescence studies demonstrated scattered staining for C3 and IgM at the basal membrane zone. Results for IgG, IgA, and fibrin staining were negative. Muscle biopsy from left deltoid muscle was performed and some muscle fibers were demonstrated to be atrophied. There was remarkable difference between muscle fiber diameters. With Masson staining, there was increased connective tissue and no inflammation. Electromyography (EMG) showed a myogenic pattern. Nerve conduction studies showed tibial, median, ulnar, peroneal motor neuropathy, and median, ulnar, and sural sensory neuropathy. Based on these findings, diagnosis of vesiculo-bullous dermatomyositis (DM) was made. Further investigation of esophagogastroduodenoscopy with biopsy revealed ulcerated lesions on antrum and corpus and these were assessed as Helicobacter pylori-negative atrophic chronic gastritis. No pathologic findings were described on chest, abdomen, and pelvic tomography. Levels of tumor markers were within normal ranges. Overall, no sign of malignancy was detected. Methyl prednisolone treatment of 1 mg/kg/d was started; however, new bullous lesions erupted while the original lesions were healing.

Oxytocin ameliorates remote liver injury induced by renal ischemia-reperfusion in rats.

Renal ischemia-reperfusion (IR) causes remote liver damage. Oxytocin has anti-inflammatory and antioxidant effects. The main purpose of this study was to evaluate the protective function of oxytocin (OT) in remote liver damage triggered by renal IR in rats. Twenty four rats were randomly divided into four different groups, each containing 8 rats. The groups were as follows: (1) Sham operated group; (2) Sham operated+OT group (3) Renal IR group; (4) Renal IR+OT group. OT (500µg/kg) was administered subcutaneously 12 and 24 hours before and immediately after ischemia. At the end of experimental procedure, the rats were sacrificed, and liver specimens were taken for histological assessment or determination of malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS), paraoxonase (PON-1) activity and nitric oxide (NO). The results showed that renal IR injury constituted a notable elevation in MDA, TOS, Oxidative stress index (OSI) and significantly decreased TAS, PON-1 actvity and NO in liver tissue (p<0.05). Additionally renal IR provoked significant augmentation in hepatic microscopic damage scores. However, alterations in these biochemical and histopathological indices due to IR injury were attenuated by OT treatment (p<0.05). These findings show that OT ameliorates remote liver damage triggered by renal ischemia-reperfusion and this preservation involves suppression of inflammation and regulation of oxidant-antioxidant status.

The Similarities and Differences between Liquid-based and Conventional Methods in Evaluation of Thyroid Fine Needle Aspiration Cytologies.

Aims: Thyroid nodules are one of the most frequent medical issues in endocrinology in our country and around the world. The appropriate evaluation of the nodule is critical in the management of patients. Fine needle aspiration cytology (FNAC) is one of the most accurate tools for evaluating these nodules. Conventional and liquid-based (LB) methods are available for thyroid FNAC. In this paper, we aim to determine the best cytological method for the evaluation of thyroid fine needle aspiration materials. Settings and Design: Fine needle aspiration (FNA) materials obtained and prepared by conventional and LB methods from 310 patients were evaluated. These slides were compared in terms of 12 cytological parameters in a three-tiered system, and the kappa coefficient was calculated. Methods and Material: Two slides were prepared from FNA samples, and the rest of the material was left in protective solution for LB cytology. Surepath was used as a LB technique. Conventional slides (CS) were left to dry in the air and stained with May Grunwald Giemsa. Slides prepared by two different techniques were compared in 12 cytomorphological parameters, and Kappa coefficients and correlations were calculated. Statistical Analysis Used: Kappa statistics. Results: In comparison of LB and CS, the highest kappa coefficient was in chromatin texture (ĸ:0.738) and inflammatory cells (ĸ: 0.482). On other parameters, fair or poor agreement was observed. Conclusions: Although there are some superiorities to LB cytology, co-application of these two methods is more favorable in thyroid fine needle aspiration.

Renal Metastatic Melanoma Presenting With Solitary Mass.

The kidney is a rare site of metastatic implantation. Metastases to the kidney most commonly originate from carcinomas in the lungs, breasts, and colon. Melanoma metastasis to the kidney is rare. We present an unusual case of melanoma metastasis to the kidney arising in a 76-year-old male who was diagnosed with melanoma two years ago. We emphasize the importance of thorough patient anamnesis when diagnosing renal cell carcinoma or urothelial carcinoma is challenging. In cases where patients with a history of melanoma present with new masses or lesions, even in atypical areas, considering melanoma metastasis in the differential diagnosis is crucial.

Comparison of Morphological Similarities and Differences between Liquid-Based Cytology and Conventional Techniques of Serous Effusion Cytology Specimens.

INTRODUCTION: The aim of this study is to discover a fast and efficient method for the diagnosis of serous effusion cytology specimens by comparing the cytomorphological features of SurePath (SP) smears and smears prepared by cytospin. After the macroscopic features of the incoming material were recorded, it was divided into 2 for conventional technique (CT) and liquid-based technique. Cytospin was used for CT and SurePath for liquid-based technique in this study. MATERIALS AND METHODS: 243 serous effusions (33 thoracentesis and 92 paracentesis fluids, 118 peritoneal lavage fluids) were investigated. After shaking the effusion gently, it was centrifuged for 5 min at 1,250 rpm for cytospin smear. SP smear was prepared according to the "BD PrepStain slide processor". Two smears were prepared with these 2 methods and then stained with Papanicolaou. The smears were examined under a light microscope in terms of fixation, background, cellularity, nucleus, and structural features. All statistical analysis of the data was performed using the SPSS 17.0 software. For each microscopic feature, the χ2 test was used to assess the significance of the relationship between cytospin and SP, and level of agreement in between the methods was assessed using the kappa statistic. RESULTS: A statistically significant difference was observed between the 2 methods in background (p < 0.001), cellularity (p < 0.001), nucleus features (p < 0.001), and structural features (p < 0.05). There was no significant difference in fixation. Low level of agreement was observed with the kappa statistic in fixation, background, and cellularity. Moderate level of agreement was observed in the nucleus and structural feature groups with the kappa statistic. DISCUSSION/CONCLUSION: Although there are advantages of liquid-based technique such as standardized fixation and cleaner background, since the cellular and background components required for morphological analysis and diagnosis are better preserved in cytospin, it is considered to be better to use liquid-based technique not alone but together with CT.

Erratum to: Evaluation of gene expression levels in the diagnosis of lung adenocarcinoma and malignant pleural mesothelioma.

[This corrects the article DOI: 10.5606/tgkdc.dergisi.2020.17279.].

Etiological factors and histopathological features in erythema nodosum: a 6-year retrospective cross-sectional study.

INTRODUCTION: Erythema nodosum (EN) is the most common type of panniculitis. The most frequent etiological factors are streptococcal pharyngitis, sarcoidosis, Behçet's disease, and tuberculosis. Our objective was to identify the etiological factors and to evaluate the patients' clinical, laboratory, and histopathological findings. METHODS: Eighty-eight patients diagnosed with EN at our clinic between 2013 and 2019 were evaluated retrospectively. Sixty-five patients were evaluated histopathologically. RESULTS: The patients' ages ranged between 17 and 76 (mean age: 41.91 ± 13.07 years). EN was 7.8 times more frequent in women. Patients presenting with idiopathic EN were significantly older than secondary cases (p < 0.05). Sixty-one patients (69.3%) had an underlying disease (secondary EN). The most common etiological factors were upper respiratory tract infections (n = 26), followed by Behçet's disease (n = 20). Septal panniculitis was present in 89.2% of cases evaluated histopathologically. Mixed or lobular panniculitis was present in 35.7% of Behçet's disease patients with EN-like lesions. Vasculitis was also noted in 35.7% of Behçet's disease patients. CONCLUSIONS: Our data confirm the predominance of upper respiratory tract infections and Behçet's disease among patients with EN in Turkey. Behçet's disease patients presenting with EN-like lesions may show mixed panniculitis and vasculitis, whereas classic EN patients predominantly show septal panniculitis.

Evaluation of gene expression levels in the diagnosis of lung adenocarcinoma and malignant pleural mesothelioma.

BACKGROUND: This study aims to evaluate gene expression levels in the diagnosis of lung adenocarcinoma and malignant pleural mesothelioma both which have a distinct treatment and prognosis. METHODS: Between January 2012 and January 2014, 12 newly diagnosed patients with a lung adenocarcinoma, 12 patients with malignant pleural mesothelioma, and eight healthy individuals as the control group were included. After treatment of the fresh samples of lung adenocarcinoma stored at -80°C for ribonucleic acid isolation, and paraffin-embedded tissues of patients with malignant pleural mesothelioma were deparaffinized, complementary deoxyribonucleic acid synthesis and expression of 84 genes associated with deoxyribonucleic acid repair were analyzed via real-time polymerase chain reaction assay. According to the expression of tumor cells, expression of each fold change was calculated. RESULTS: The BRCA1, BRCA2, CDK7, MLH3, MSH4, NEIL3, SMUG1, UNG, XRCC2, and XRCC4 genes showed more than five-fold higher expression in the patients with lung adenocarcinomas, compared to the control group. The patients with malignant pleural mesothelioma showed a five-fold higher expression in the APEX2, BRCA1, BRCA2, CDK7, MLH1, MLH3, MSH3, MSH4, NEIL3, PARP2, PARP3, PMS1, RAD50, RAD51, RAD51B, RAD51D, RAD52, RPA3, SMUG1, UNG, XPA, XRCC2, and XRCC4 genes, compared to the control group. Comparing malignant pleural mesothelioma with lung adenocarcinoma cases, we found that CDK7, MLH1, TREX1, PRKDC, XPA, PMS1, UNG, and RPA3 genes were overexpressed. CONCLUSION: Our study results showed differences between expression profiles of deoxyribonucleic acid repair genes in lung adenocarcinoma and malignant pleural mesothelioma cells. Based on our study results, we suggest that TREX1, PRKDC, and PMS1 genes may play a key role in the differential diagnosis of these two entities.

Efficacy of topical cyclosporin A 0.05% in conjunctival impression cytology specimens and clinical findings of severe vernal keratoconjunctivitis in children.

PURPOSE: To evaluate the efficacy of topical cyclosporin A 0.05% in managing the symptoms of severe vernal keratoconjunctivitis (VKC). METHODS: Fifty-four children with severe VKC were included in this study. All 54 patients were treated with topical cyclosporin A (CsA) 0.05% for 3 months. Ocular signs and symptoms were scored in all patients at entry and after 3 months. Conjunctival impression cytology specimens were examined on the day of enrollment and at the end of the treatment period. RESULTS: The mean scores for severity of signs and symptoms significantly decreased after 3 months compared with those at entry (P<0.001). The density of inflammatory cells in the conjunctival impression cytology specimens decreased significantly. No side effects of the treatment with CsA 0.05% eyedrops were observed. CONCLUSIONS: Topical CsA 0.05% eyedrops were found to be safe and effective in the treatment of patients with VKC. Consistent with these results, topical CsA may efficiently reduce conjunctival inflammation in severe VKC.

Acral angioosteoma cutis: A rare case.

Acral angioosteoma cutis is a rare and benign cutaneous lesion clinically characterized by an exophytic growth resembling pyogenic granuloma on the acral skin; first described in 2006. Its pathogenesis is still unclear while well-formed capillaries, pale stroma, bland fibroblast-like cells, and multiple tiny spicules of woven bone constitute the histological hallmarks. Here, we present a case of acral angioosteoma cutis in a 34-year-old man to increase awareness regarding this rare condition.

A Comparative Study of Activity-Based Costing vs. Current Pricing System for Pathology Examinations at Okmeydani Training and Research Hospital, Turkey.

OBJECTIVE: To provide real cost data for pathology examinations by using activity-based costing method, in order to provide means to departments, health administrators and the social security institution to achieve improvements in financial planning, quality and cost control. MATERIAL AND METHOD: The cost of the histopathological examinations, which were accepted by the Department of Pathology at Okmeydani Training and Research Hospital during August 2014, was calculated using the activity-based costing method. The costs were compared with the amounts specified in the Healthcare Implementation Notification Tariff and the conventional volume-based costing. RESULTS: Most pathology examinations listed within a given band in the Healthcare Implementation Notification Tariff show variations in unit costs. The study found that the costs of 77.4% of the examinations were higher than the prices listed in the Healthcare Implementation Notification Tariff. CONCLUSION: The pathology examination tariffs specified in the Healthcare Implementation Notification do not reflect the real costs of the examinations. The costs that are calculated using the activity-based costing system may vary according to the service types and levels of health care institutions. However, the main parameters of the method used in the study reflect the necessity of a more accurate banding of pathology examinations. The banding specified by the Healthcare Implementation Notification Tariff needs to be revised to reflect the real costs in Turkey.

Expression of p53 oncoprotein and bcl-2 in renal cell carcinoma.

OBJECTIVE: The aim of the present study was to investigate the significance of p53 and bcl-2 as prognostic factors among others in renal cell carcinoma patients. METHODS: We evaluated the stages, histological grades, tumor diameters, cellular patterns and the presence of mutant p53 protein and bcl-2 overexpression in 57 cases of renal cell carcinoma (RCC). Kaplan-Meier and log-rank tests estimated the survival function of each parameter. The study was carried out in the Department of Pathology and the Department of Urology, Faculty of Medicine, Dicle University Hospital, Diyarbakir, Turkey, in 2003. RESULTS: The p53 mutation was 35% and bcl-2 overexpression incidence was 89.4% in the RCC cases included in the study. The 5-year disease specific survival rates of mutant p53 positive was 46.6% and p53 negative cases were 83.3%, (p=0.0063). There was no pathological parameter associated in bcl-2, and it has no prognostic significance. CONCLUSION: The tumor stage, grade, diameter and p53 mutations affect the survival of RCC cases. The bcl-2 staining did not play any role to estimate patients at high risk of the disease progression.

Does the histopathologic pattern of the ureteropelvic junction affect the outcome of pyeloplasty.

PURPOSE: To investigate the effects of the histopathologic pattern of obstructed ureteropelvic junction (UPJ) specimens, including collagen type 3, elastin, fibrosis and Cajal cells, on the outcome of pyeloplasty. MATERIALS AND METHODS: Histopathological specimens obtained following Anderson-Hynes pyeloplasty from 52 patients with intrinsic ureteropelvic junction obstruction (UPJO) between January 2005 and January 2008 were evaluated histopathologically. Patients with extrinsic or secondary UPJO were excluded. Preoperative and postoperative radiographic evaluations were performed either via diuretic renography or intravenous pyelography, or both. Six months post-surgery the patients were divided into 2 groups, as successful surgery (group 1) and unsuccessful surgery (group 2). Histopathological findings (collagen type 3, elastin, fibrosis and Cajal cells) in each group were statistically compared. RESULTS: The study included 52 patients (21 female and 31 male). Mean age of the entire study population was 39.42 ± 14.5 years, versus 39.63 ± 14.9 years in group 1 (n = 47) and 37.4 ± 10.0 years in group 2 (n = 5). Median follow-up was 18 months. There weren't any significant differences in collagen type 3, elastin, fibrosis, or Cajal cells between the 2 groups (P > .05). CONCLUSION: The histopathologic pattern of UPJ was not a factor associated with the success of pyeloplasty. Based on the present findings, we conclude that surgical technique is more important than the histopathologic pattern of UPJ for the successful treatment of UPJO.