Comparison of p57, c-erbB-2, CD117, and Bcl-2 expression in the differential diagnosis of hydatidiform mole and hydropic abortion.

PURPOSE: To explore the utility of p57, c-erbB-2, CD 117, and Bel-2 immunostaining in the differential diagnosis of complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), and hydropic abortion (HA). MATERIALS AND METHODS: Immunohistochemical expression of the p57, c-erbB-2, CD117, and Bel-2 proteins were investigated semi-quantitatively using paraffin-embedded tissue sections from histologically unequivocal cases of CHM (n = 20), PHM (n = 23), and HA (n = 17). RESULTS: All cases of CHM exhibited a striking absence of p57 expression. The percentage of positive p57 staining was similar between PHMs (73.9%) and HAs (76.5%) (p >0.05). The comparison of c-erbB-2 expression revealed a significantly higher percentage of positive c-erbB-2 staining in CHMs (45%) compared with that in PHMs (8.7%) and HAs (5.9%) (p = 0.006 and 0.01, respectively). The CD 117 expression pattern (immunoreactivity score, percentage of positive cells, and staining intensity) was significantly lower in HAs compared with that in PHMs and CHMs (p < 0.05 for all). A significantly increased Bel-2 expression pattern was observed in HAs compared with that in PHMs and CHMs (p < 0.05 for all). CONCLUSION: Immunohistochemical examination of p57, c-erbB-2, CD 117, and Bel-2 expression represents a relatively simple, reliable, and cost-efficient procedure to definitively distinguish among CHM, PHM, and HA.

Serum level and placental expression of resistin in pregnancies complicated by preeclampsia: relationship with disease severity.

The authors aimed to compare the maternal serum level and placental expression of resistin in pregnancies complicated by preeclampsia and clarify their relationship with disease severity. This cross-sectional study included 50 healthy pregnant women, 50 women with mild preeclampsia, and 48 women with severe preeclampsia. Serum resistin levels were measured by enzyme immunoassay and placental resistin expression was determined by immunohistochemistry. Resistin levels were significantly higher in women with mild and severe preeclampsia than in the healthy controls (p = 0.012 andp < 0.001, respectively). Placental resistin expression was significantly higher in women with severe preeclampsia compared to women with mild preeclampsia (p = 0.003) and healthy controls (p < 0.001). Serum resistin levels were positively correlated with gestational age and umbilical and uterine artery Doppler indices, as well as systolic and diastolic blood pressure, but negatively correlated with birth weight (p < 0.05). On the other hand, placental resistin expression was positively correlated with systolic blood pressure and uterine artery indices, but negatively correlated with birth weight (p < 0.05). In conclusion, increased cir- culating levels and placental expression of resistin in pregnancies complicated by preeclampsia were correlated with disease severity.

Histopathological evaluation of dental follicles of clinically symptomatic and asymptomatic impacted third molars.

BACKGROUND AND AIMS: Surgical removal of impacted teeth is a common operation in oral surgery. Thus, pathological potential of impacted third molars is extensively studied. However, many of those studies based on data collected from analysis of radiographs only. The purpose of this retrospective study was to compare the follicles of symptomatic and asymptomatic impacted third molars histopathologically for a number of characteristics. MATERIALS AND METHODS: Records of the patients who had been previously operated for impacted third molars were reviewed. Eighty-three patients were selected and divided into two groups, clinically symptomatic and clinically asymptomatic. None of the patients had a radiographic pericoronal radiolucency of wider than 2.5 mm. Histopathological samples of the patients were obtained and re-examined by two pathologists. Two groups were statistically compared for 12 histological parameters. RESULTS: Eleven of the 12 parameters had statistically significant differences (P < 0.05), whereas one parameter (odontogenic remnants) was found not to be significantly different between the groups. CONCLUSION: A delay in impacted third molar surgery can lead to further pathological changes in dental follicles and can increase severity of the inflammation. Moreover, dimensions of the pericoronal radiolucency may not provide a correct interpretation of the pathological changes in the region.

Submandibular lateral epidermoid cyst: imaging findings of a rare case.

Epidermoid cysts (EC) represent less than 0.01% of all oral cavity cysts. Lateral epidermoid cysts in the neck are very rare. A male patient aged forty-five had a complaint of painless swelling in the neck. A well-circumscribed hypo-echoic mass with internal echoes was detected in the right submandibular regionby ultrasonography. There were round areas inside the cyst with acoustic shadowing. The tissue hardness and the internal nature of the mass were evaluated with sono-elastography. Magnetic resonance imaging showed the mass's location and tissue properties in more detail. Magnetic resonance images revealed a well-circumscribed mass--hyperintense on T2-weighted images, hypo-intense on T1-weighted images--in the right submandibular region that had displaced the submandibular gland and mylohyoid muscle. There was no contrast enhancement in the mass on the contrast-enhanced fat-suppressed T1-weighted MR images. In this case report, we present the imaging features of a rare lateral EC in the submandibular region.

CDC25B, Ki-67, and p53 expressions in reactive gliosis and astrocytomas.

PURPOSE: To investigate the expression of CDC25B, which is a member of the cyclin-dependent kinase activating phosphatase family, in diffuse astrocytoma (DA), anaplastic astrocytoma (AA), glioblastoma multiforme (GBM), pilocytic astrocytoma (PA) and reactive gliosis (RG). Also, to study the relationship of the expression level of CDC25B with clinical parameters and with p53 and Ki-67 proliferation index (PI). METHODS: Tissues were collected from 36 cases diagnosed with astrocytoma (10 DA, 6 AA, 20 GBM), 10 PA, 10 RG and 10 normal brain tissues for controlling purposes. The sections were immunohistochemically stained with CDC25B, Ki-67 and p53. For each marker, 1000 tumor cells were counted and the ratio of positive tumor cells was calculated. RESULTS: The average CDC2B staining index (CSI) was 0.6% in PA, 0.4% in DA , 7.7% in AA and 25.5% in GBM. The increase of CSI in parallel with the increase of WHO grade was significant (p=0.001). No expressions were identified in RG and normal brain. There was also significant relationship between the tumor size and CSI (p=0.027) and also between Ki-67 PI and CSI (p=0.001). Among the groups with low and high CSI in astrocytoma cases, the disease free survival (DFS) was significantly higher in the low CSI group (p=0.0001). CONCLUSIONS: Positive expression of CDC25B in astrocytoma affects the prognosis in an adverse manner. CSI can be used as a diagnostic method and CDC25B may be a possible target molecule for treatment.

AKAP12/Gravin gene expression in colorectal cancer: clinical importance and review of the literature.

PURPOSE: : Colorectal cancer (CRC) is a common and potentially lethal disease. A number of genetic aberrations is known to take place in colorectal carcinogenesis, which leads to progressive alteration of normal mechanisms controlling cell growth. A-kinase-anchoring protein 12 (AKAP12) plays a role in cell proliferation, angiogenesis and cytoskeletal remodeling. The purpose of this study was to demonstrate the role of the AKAP12 gene expression in CRC patients and to determine its relationship (if any) with prognosis. METHODS: AKAP12 gene expression was investigated by immunohistochemistry. RESULTS: A total of 55 patients (63.6% males, 36.4% females) with histologically confirmed CRC were studied. Normal intestinal epithelium showed weak basal staining, dysplastic areas were stained mildly, whereas all of the cancer cells were stained completely with AKAP12. CONCLUSION: AKAP12 gene seems to play a role in colorectal carcinogenesis.

The predictive role of Bcl-2 expression in operable locally advanced or metastatic gastric carcinoma.

PURPOSE: Gastric carcinoma is an aggressive disease with different epidemiologic and clinical profiles. Combination chemotherapy containing docetaxel, cisplatin and 5-fluorouracil/5-FU (DCF) is a frequently used regimen in metastatic gastric cancer. We studied the role of B-cell lymphoma 2 (Bcl-2) expression in predicting the response to DCF combination chemotherapy in metastatic gastric carcinoma. METHODS: This study included patients with pathologically confirmed locally advanced, surgically inoperable gastric carcinoma, or with metastatic disease. For immunohistochemical staining of Bcl-2 oncoprotein, lyophilized mouse monoclonal antibody (clone100/D5, 1:50, Thermo Scientific, Fremont, ABD) was used. Bcl-2 expression was evaluated with respect to the nuclear and cytoplasmic staining of the cells. Staining > 10% was accepted as positive and ≤ 10% as negative. RESULTS: Bcl-2 expression was positive in 5 (23.8%) patients and negative in 16 (76.2%), while partial response was achieved in 12 (57%) patients. No complete response was seen in any patient. The effect of positive Bcl-2 expression on survival was statistically significant by log-rank test (p=0.035). CONCLUSION: The patient group that expressed Bcl-2 survived longer confirming that Bcl-2 expression is a good prognostic factor in advanced-stage patients. We believe that Bcl-2 expression has an additional contribution in predicting response to this chemotherapy combination.

Evaluation of posttransplantation malignancies compared with de novo tumors.

It is uncertain whether tumors arising in transplant patients resemble ones that develop de novo in pathogenesis, morphology, and behavior. This study sought to investigate some clinical, morphological, and immunohistochemical features of several posttransplantation malignancies compared with similar de novo tumors. The study group consisted of 40 malignant tumors encountered in 1350 transplant patients (1229 kidneys, 113 livers, 8 hearts) between 1986 and 2006. Tumors with 3 or more examples were compared with randomly selected controls. These included Kaposi's sarcoma (n=14); extranodal lymphoma (n=9); squamous cell carcinoma (n=6); and nodal lymphoma (n=3). The variables that were analyzed were the localization, predisposing lesions, degree of differentiation, and host response. For lymphomas, we also determined histological subtype, origin, and Ki-67 proliferation index. Most tumors (36/40, 90%) occurred in patients with renal transplants. However, the relative frequency was higher among liver transplant cases (3.53% vs 2.92% for kidney transplants). No malignancy was seen in heart transplant cases. Squamous cell carcinomas were better differentiated (P<.05) compared with controls and they were more frequently associated with precursor lesions (P<.05). Kaposi's sarcomas involved internal organs more frequently in posttransplant patients, and the Ki-67 proliferation index was higher in posttransplantation nodal lymphomas. However, these factors were not significantly different (P>.05). Our findings suggested that certain posttransplantation malignancies display unique characteristics compared with their de novo counterparts.

Spectrum of gastric histopathologies in morbidly obese Turkish patients undergoing laparoscopic sleeve gastrectomy.

OBJECTIVE: In this study, we aimed to describe the findings associated with gastric pathology and to identify the prevalence of Helicobacter pylori (H. pylori) in patients undergoing laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS: Gastric specimens of a total of 291 patients (225 females, 66 males; mean age: 42 years; range: 18 to 60 years) who underwent LSG for the treatment of morbid obesity were analyzed. Histopathologic diagnoses and their relation with body mass index (BMI), age and gender were evaluated. RESULTS: In the histopathological examination of sleeve specimens, 58 patients (19.93%) had chronic gastritis, 102 patients (35.05%) had chronic active gastritis, 27 patients (9.27%) had follicular gastritis, 47 patients (16.15%) had active follicular gastritis, one patient (0.34%) had a glomus tumor, and one patient (0.34%) had a gastrointestinal stromal tumor. The gastric mucosa was normal in 55 patients (18.90%). Intestinal metaplasia was detected in eight patients (2.74%). The H. pylori test result was positive in 126 patients (43.29%). There was no statistically significant difference between the pathological diagnoses and age and sex of the patient. CONCLUSIONS: Our study results suggest that the prevalence of chronic active gastritis and H. pylori positivity is high in morbidly obese Turkish patient population. No significant difference was found between the pathological diagnosis in obese patients with LSG operation in terms of age and sex.

Differentiation between idiopathic granulomatous mastitis and malignant breast lesions using strain ratio on ultrasonic elastography.

PURPOSE: The goal of this study was to investigate the strain elastography imaging characteristics of idiopathic granulomatous mastitis (IGM) and compare strain ratio values of IGM with those of breast cancer. MATERIAL AND METHODS: Twenty-three consecutive women with IGM (mean age, 37.9±6.6 [SD] years; range: 26-52 years) and 45 women with malignant breast tumor (mean age, 52.8±12.0 [SD], range, 32-77 years) who had been scheduled for ultrasound-guided core biopsy were recruited to the study. All had ultrasonography with elastography before biopsy. The strain ratios of lesions were calculated using surrounding normal breast tissue as the reference in both groups and compared between the two groups. Receiver-operating-characteristics (ROC) curves were formed. Sensitivity, specificity, cut-off, and area under curve (AUC) values were calculated. RESULTS: The mean strain ratio on sonoelastography was 1.5±0.8 (SD) (range: 0.2-4.0) for IGM and 5.3±5.2 (SD) (range: 1.4-33) for malignant lesions. Strain ratio values in IGM lesions were significantly lower than in malignant lesions (P˂0.05). ROC test yielded an AUC value of 0.939 (95% confidence interval, 0.882-0.995; P<0.0001). Optimal cut-off value for strain ratio value was 2.5 yielding 87% sensitivity and 96% specificity for the diagnosis of IGM. CONCLUSION: Sonoelastographic strain ratio contributes to differentiate IGM from malignant breast lesions, thus has potential to influence clinical decision making for further biopsies.

Posttransplant tubulointerstitial nephritis: clinicopathological correlation.

As a cause of graft dysfunction, tubulointerstitial nephritis (TIN) seems to be the third most common pathology after rejection and cyclosporine nephrotoxicity. Among 540 needle biopsies obtained from 280 renal transplant patients between 1996 and 1999, acute TIN was detected in 23 patients (8%). The cause of acute TIN was secondary to bacterial infection in 17 patients and secondary to cytomegalovirus (CMV) infection in three patients. The remaining three cases showed granulomatous pyelonephritis due to Mycobacterium tuberculosis (n = 2) and Candida albicans (n = 1). During follow-up, 13 of 23 patients (56.5%) showed at least one acute rejection episode. The average number of urinary tract infection (UTI) episodes in the 23 patients was 1.4 +/- 07. We observed that the number of UTI episodes showed a significant association with the development of chronic allograft nephropathy (P = .03) and graft loss (P < .01). Twelve patients (52.2%) lost their grafts during 5 years posttransplantation. Only 6 of 17 patients with bacterial TIN lost their graft at a mean time of 52.5 +/- 14 months. But all patients with CMV TIN or granulomatous TIN lost their grafts at a mean time of 31 +/- 3.1 months and 39 +/- 3 months, respectively (P < .05). In conclusion, these results support the pathological role of tubulointerstitial nephritis as a pathway of graft rejection or renal allograft deterioration among recipients after transplantation.

Bardet-Biedl syndrome with vulva carcinoma presented with acute renal failure: a case report.

BACKGROUND: Bardet-Biedl syndrome is a rare disorder characterized by retinal dystrophy, obesity, kidney dysfunction, polydactyly, hypogonadism and cognitive impairment. It can be accompanied by systemic findings such as malignancy, hypertension, diabetes mellitus, constitutional and functional disorders of urogenital system and liver fibrosis. CASE REPORT: A 35-year-old woman with Bardet-Biedl syndrome was referred to our outpatient nephrology clinic with dysuria, acute renal failure, and urinary tract infection. A sized 2 x 1 cm mass between labia major and minor was noted, while CT scan showed a lesion that encompassed uterus and extended to the posterior side of the bladder in the left adnexal region and a 3 cm lesion in the liver. Excisional biopsy of the mass revealed a well-differentiated, squamous cell carcinoma. Dysuria resolved with insertion of urinary catheter after bougie dilatation and the patient was referred for radiotherapy. CONCLUSION: It should be kept in the mind that renal failure may develop due to constitutional urogenital anomalies such as vulva carcinoma. This can be an important cause of morbidity and mortality in patients with Bardet-Biedl syndrome.Hippokratia 2015; 19 (2):176-178.

Gaucher disease with communicating hydrocephalus and cardiac involvement.

A 14-year-old female with Gaucher disease presented with hydrocephalus, corneal opacities, cirrhosis, and cardiac valvular involvement. A homozygous D409H mutation was identified. She underwent surgery for aortic and mitral valve replacement. Because of severe calcification of the aortic root, no successful valve replacement was performed. She died on the third day after the explorative cardiac surgery. Cardiac abnormalities represent a life-threatening presentation of the homozygous D409H mutation. Identification of this type is essential prior to initiating appropriate therapy with enzyme replacement and cardiac corrective surgery.