Histopathological and Clinical Analysis of Skin Rashes in Children With Multisystem Inflammatory Syndrome Associated With COVID-19.

INTRODUCTION: A new entity, which occurs a few weeks after SARS-CoV-2 infection and resembling incomplete Kawasaki disease or toxic shock syndrome, has been defined and named multisystem inflammatory syndrome (MIS-C) associated with COVID-19 in children. The aim of our study was to describe histopathological characteristics of skin lesions of MIS-C patients to reveal whether there is a relationship between histopathological features and clinical manifestations. MATERIALS AND METHODS: Seventeen who had skin involvement of 57 patients who were diagnosed with MIS-C between December 2020 and February 2021 were included in this prospective study. Demographic information, laboratory findings, and patients' managements were recorded. Skin biopsies were taken simultaneously of each patient. Formalin-fixed, paraffin-embedded skin samples were examined microscopically. RESULTS: The rate of skin rash was 30% in patients with MIS-C and was predominantly the maculopapular type. The anatomical distribution of the rash was evaluated as localized in 10 and generalized in 7 patients. In patients with myocarditis, C-reactive protein and fibrinogen were found to be significantly higher, and lymphocyte and albumin values were found to be low. Herpes-like inclusions were found in the microscopic examination of 2 patients with a history of zona zoster in themselves or in their mother. There was a significant difference between keratinocyte necrosis and some clinical parameters. DISCUSSION: Localized skin lesions appear to be associated with a more severe inflammatory.

68Ga-citrate positron emission tomography/computed tomography findings in an experimental model of acute appendicitis in rabbits.

OBJECTIVE: Acute appendicitis (AA) is a common urgent surgical situation of the gastrointestinal tract. Gallium-68 (68Ga)-citrate has been recently investigated as a radiopharmaceutical for infection and inflammation imaging. Aim of the study was to determine the effectiveness of 68Ga-citrate positron emission tomography/computed tomography (PET/CT) imaging in rabbits with experimentally induced AA. MATERIALS AND METHODS: In the AA group (n=6), the appendices of the rabbits were surgically ligated. The sham group (n=6) was used as control. Gallium-68-citrate was synthesized. All rabbits were imaged using 68Ga-citrate PET/CT at 36th following the establishment of experimental models, and at 36th h, all rabbits were appendectomised. Appendices were examined histopathologically. Blood samples were drawn from all rabbits at the beginning and end of the experimental process. Interleukin-6 (IL-6) and procalcitonin (Pct) levels were measured. Acute appendicitis was confirmed histopathologically and biochemically. RESULTS: Gallium-68-citrate PET/CT showed acute appendicitis in all rabbits. The sensitivity, specificity and accuracy of 68Ga-citrate PET/CT in AA were 100%, 83.3% and 91.7%, respectively. CONCLUSION: Acute appendicitis is accurately imaged in an experimental rabbit model by using 68Ga-citrate with PET/CT.

Eosinophilic granulomatosis with polyangiitis without respiratory symptoms or asthma in an adolescent: case report and literature review.

Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a systemic necrotizing vasculitis of the small and medium vessels. It is primarily associated with respiratory conditions such as asthma and sinusitis as well as eosinophilia, neuropathy, pulmonary infiltrates, and vasculitis. EGPA is extremely rare in the pediatric age group, and respiratory system disorders are usually predominant in EGPA patients. A 14-year-old boy presented with rash and severe extremity pain. He had eosinophilia, and electroneuromyography demonstrated sensorimotor polyneuropathy. His skin biopsy revealed necrotizing eosinophilic vasculitis and eosinophilic panniculitis. Although he had no respiratory symptoms or history of asthma, prominent pulmonary involvement was evident on thoracic MRI. After treatment, his complaints of pain improved but mild neuropathy persisted. After 4 years of follow-up, he had minimal hypoesthesia in his right hand but had not experienced any relapses. This case highlights the fact that in cases suspected of EGPA, even without respiratory symptoms or asthma, detailed imaging should be performed for a definitive diagnosis. In addition, mild neurological findings may persist despite treatment in EGPA. The relevant literature on EGPA, with specific reference to pediatric cases, is reviewed.

Could serum pentraxin 3 levels and IgM deposition in skin biopsies predict subsequent renal involvement in children with Henoch-Schönlein purpura?

BACKGROUND: The aim of this study was to evaluate the potential of serum pentraxin 3 (PTX3) values as an early predictor of subsequent renal involvement in patients with Henoch-Schönlein purpura (HSP) with no abnormalities on urinary examination and in renal function tests at disease onset. METHODS: This was a prospective cohort study which included 60 pediatric patients with HSP (age range 3-15 years) who were diagnosed between February 2011 and October 2012 and 60 age- and sex-matched healthy controls. The patients were followed up for at least 18 months. Clinical findings were recorded for all patients at first examination, and blood samples for routine laboratory parameters and PTX3 value as well as skin biopsy specimens were obtained from each subject. RESULTS: Of the 60 patients with HSP, 29 (48.3 %) developed subsequent renal involvement, of whom four underwent kidney biopsy. The mean serum PTX3 level of patients with subsequent renal involvement was significantly higher than those of patients without renal involvement and of the controls (2.20 ± 1.30 vs. 1.36 ± 0.85 and 1.03 ± 0.7 ng/ml, respectively; p = 0.004). Immunofluorescence evaluation of skin biopsy revealed that in addition to immunoglobulin A (IgA) deposition, the IgM deposition was significantly associated with subsequent renal involvement (p = 0.008). CONCLUSIONS: A high PTX3 level and IgM staining in skin biopsies from HSP patients may be harbingers of subsequent renal involvement.

Dermoscopic Features of Cutaneous Vasculitis.

INTRODUCTION: Dermoscopy has become widespread in the diagnosis of inflammatory skin diseases. Cutaneous vasculitis (CV) is characterized by inflammation of vessels, and a rapid and reliable technique is required for the diagnosis. OBJECTIVES: We aimed to define CV dermoscopic features and increase the diagnostic accuracy of dermoscopy with machine learning (ML) methods. METHODS: Eighty-nine patients with clinically suspected CV were included in the study. Dermoscopic images were obtained before biopsy using a polarized dermoscopy. Dermoscopic images were independently evaluated, and interobserver variability was calculated. Decision Tree, Random Forest, and K-Nearest Neighbors were used as ML classification models. RESULTS: The histopathological diagnosis of 58 patients was CV. Three patterns were observed: homogeneous pattern, mottled pattern, and meshy pattern. There was a significant difference in background color between the CV and non-CV groups (P = 0.001). The milky red and livedoid background color were specific markers in the differential diagnosis of CV (sensitivity 56.7%, specificity 96.3%, sensitivity 29.4%, specificity 99.2%, respectively). Red blotches were significantly more common in CV lesions (P = 0.038). Red dots, comma vessels, and scales were more common in the non-CV group (P = 0.002, P = 0.002, P = 0.003, respectively). Interobserver agreement was very good for both pattern (κ = 0.869) and background color analysis (κ = 0.846) (P < 0.001). According to ML classifiers, the background color and lack of scales were the most significant dermoscopic aspects of CV. CONCLUSIONS: Dermoscopy may guide as a rapid and reliable technique in CV diagnosis. High accuracy rates obtained with ML methods may increase the success of dermoscopy.

Familial Actinic Lichen Planus: Three Cases from the Same Family.

Actinic lichen planus (ALP) that affects sun-exposed areas of the skin is an uncommon variant of lichen planus. While ALP is commonly triggered by ultraviolet radiation exposure, genetic predisposition may also be important in the pathogenesis of the disease. Herein, we report three patients with ALP from the same family, which supports the genetic etiopathogenetic factors of ALP.

The Effect of Continuing Chemotherapy after Chemoradiotherapy during the Time to Surgery on Tumor Response and Survival for Local Advanced Rectal Cancer.

Aim: The current standard treatment of locally advanced rectal carcinoma is total mesorectal excision and postoperative adjuvant chemotherapy after neoadjuvant concurrent chemoradiotherapy (NCRT). Many studies have shown that pathological complete response (pCR) is an important prognostic factor for patients receiving NCRT. Many studies have therefore been conducted to increase pCR rates by changing the perioperative treatment strategies. Prolonging the chemotherapy time may be a reasonable way to increase the effectiveness of NCRT, pCR, and survival rates. We investigated whether neoadjuvant consolidation chemotherapy had an effect on tumor response and survival. Methods: The data of 163 patients diagnosed with locally advanced rectal carcinoma were evaluated. The data of 107 patients (Group 1) who were radiologically T3-T4 and/or N+ and received chemotherapy after NCRT until their operations were compared with the data of 56 patients (Group 2) who were operated after NCRT. Results: Group 1 patients had tumor and node downstaging. Their pCR was found significantly higher than in Group 2 (p = 0.005). In Group 1 patients with T3, pCR was significantly higher than for those with T4. The elapsed time between NCRT and surgery was significantly longer in patients with pCR (respectively, p = 0.012 and p = 0.008). Conclusion: Neoadjuvant consolidation chemotherapy after NCRT is a safe approach that can lead to higher pathological complete response rates. The time until surgery with neoadjuvant consolidation chemotherapy may provide the chance to follow the patient without surgery in addition to increasing pCR.

Effect of bevacizumab and everolimus combination treatment on peritoneal sclerosis in an experimental rat model.

The aim of this study was to investigate whether bevacizumab and everolimus combination therapy is superior to bevacizumab treatment alone as a treatment for peritoneal sclerosis. Forty Wistar albino rats were divided into five equal groups. The control group received isotonic saline solution (2 mL/day) intraperitoneal (IP) daily for 3 weeks. The CG group received 2 mL 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline IP daily for 3 weeks. Peritoneal tissue samples were taken at the end of 3 weeks. The resting group received CG (weeks 0-3), plus isotonic saline solution (2 mL/day) IP daily and tap water (2 mL/day) via a feeding tube daily (weeks 3-6).The bevacizumab group received CG (weeks 1-3) plus bevacizumab at 2.5 mg/kg/day (2 mL) IP daily and tap water (2 mL/day) via a feeding tube daily (weeks 3-6). The bevacizumab+everolimus group received CG (weeks 1-3) plus bevacizumab at 2.5 mg/kg/day (2 mL) IP daily and everolimus at 0.3 mg/kg/day (2 mL) via a feeding tube daily (weeks 3-6). Peritoneal tissue samples were taken from these three groups at the end of 6 weeks and were examined after staining with hematoxylin-eosin and Masson's trichrome. Inflammation, vasculopathy, fibrosis, and peritoneal thickness were evaluated under light microscopy. The samples were also stained with anti-TGF-ß and anti-MMP-2. Inflammation and vasculopathy scores were significantly decreased in the VEGF-i group compared to the CG group. The addition of everolimus to VEGF-i showed significantly lower inflammation, vasculopathy, fibrosis scores, and an evident decrease in peritoneal thickening (respectively, 2.29 ± 0.76 vs 0.57 ± 0.53, P = .003; 2.71 ± 0.76 vs 1.43 ± 0.53, P = .008; 2.57 ± 0.79 vs 1.57 ± 0.79, P = .04; 247.5 ± 136.1 vs 84.5 ± 48.6, P = .048). MMP-2 levels were lower in the combination group compared to the resting group (2.63 ± 0.74 vs 1.86 ± 0.38, P = .019). The study results demonstrated that bevacizumab and everolimus combination therapy was more effective than bevacizumab therapy alone.

Effects of retinoic acid and zinc on the treatment of caustic esophageal burns.

PURPOSE: An experimental study was carried out to investigate the efficacy of an anti-inflammatory and antiproliferative agent all-trans retinoic acid (ATRA) and an antioxidant agent zinc sulphate (ZnSO(4)) in the prevention of stricture after caustic esophageal burn in rats. METHODS: Esophageal burn was induced using 50% NaOH. Rats were divided into four groups as follows: group A (sham; n = 8), group B (control; n = 8), group C (treated with ATRA; n = 8) and group D (treated with ZnSO(4); n = 8). All rats were killed on the 28th day and esophageal tissues were evaluated for histopathologic damage score, hydroxyproline (HP) content and TGF-beta1 expression. RESULTS: Significant difference was detected in terms of histopathologic damage score between groups B and C (p = 0.002). Although mean HP levels of groups C and D were lower than group B, statistical comparison was not significant. TGF-beta1 expression in group C was significantly lower than group B. CONCLUSION: Zinc has not been found effective in the prevention of stricture formation. The results indicate that ATRA has a preventive effect in the development of fibrosis in an experimental model of caustic esophageal burns in rats.

Comparing human epidermal growth factor receptor 2 amplification and expression using immunohistochemistry and silver in situ hybridisation in gastric carcinoma and lymph node metastasis.

Detecting the amplification and expression of human epidermal growth factor receptor (HER2) is important for planning trastuzumab treatment for patients with gastric carcinoma. The present study aimed to analyse HER2 amplification and expression in primary gastric adenocarcinoma tumours and metastatic lymph nodes using microarray methods, and to assess the potential contribution of these methods to treatment planning. In total, 60 patients with lymph node metastasis were included in the present study. Microarray blocks were obtained from the tissue blocks of primary tumours and metastatic lymph nodes. HER2 expression and amplification were investigated using immunohistochemical and silver in situ hybridisation (SISH) methods, respectively. Following immunohistochemical evaluation of HER2 in primary tumours, the sensitivity and specificity of the microarray method relative to the single block method were 69 and 100%, respectively. For HER2 detection in microarray block sections from primary tumours, the sensitivity and specificity of the SISH method relative to immunohistochemistry were 56 and 100%, respectively. When using SISH in microarray blocked sections, there was a high degree of concordance (98% concordance rate) between HER2 amplification in the primary tumour and the metastatic lymph node. Furthermore, the sensitivity and specificity of metastatic lymph node results relative to those of the primary tumour were 100 and 98%, respectively. Overall, the single block method was more reliable compared with the microarray method for planning treatment. When microarray blocking was used, a large number of samples must be tested to ensure reliable results. The immunohistochemical method is recommended as the first step as SISH alone increases the risk of false-negative results. Assessing HER2 amplification for treatment planning would be beneficial for primary tumours, as well as metastatic lymph nodes.

Effects of tempol, a membrane-permeable radical scavenger, on local and remote organ injuries caused by intestinal ischemia/reperfusion in rats.

BACKGROUND: Tempol is a stable piperidine nitroxide of low molecular weight that permeates biological membranes and scavenges superoxide anions in vitro. In a variety of animal models, deleterious effects of reperfusion injury on both local and remote organs have been demonstrated. In this study, we aimed to investigate the effects of a membrane-permeable radical scavenger, Tempol, on local and remote organ injuries caused by intestinal ischemia/reperfusion (I/R) in rats. MATERIALS AND METHODS: Male Wistar-albino rats were randomized into three groups: (I) Sham-operated control group, laparotomy without I/R injury (n = 12); (II) Intestinal I/R group, 60 min of ischemia by superior mesenteric artery occlusion followed by 2-h of reperfusion (n = 12); and (III) I/R + Tempol-treated group, identical to I/R group except for Tempol administration, 30 mg/kg bolus injection 5 min before reperfusion, followed by an infusion of 30 mg/kg/h intravenously (n = 12). Histopathologically, intestinal mucosal lesions were assessed by Chiu's classification, and pulmonary parenchymal damage was appraised by pulmonary neutrophil infiltration and acute lung injury scaling. Biochemically, myeloperoxidase activity, malondialdehyde, glutathione, and nitrite/nitrate (NO(x)) levels were determined in both intestinal mucosa and lung parenchyma. Evans blue dye concentration and organ wet/dry weight ratios were used as a marker of organ edema. Animal survival was observed up to 1 week. RESULTS: Intestinal mucosal lesions and pulmonary parenchymal damage were significantly attenuated with Tempol treatment, histopathologically (P < 0.05). Tempol administration significantly reduced myeloperoxidase activity and malondialdehyde levels, and also significantly increased glutathione and NO(x) levels of both intestinal and lung tissues, biochemically (P < 0.05). Evans blue dye extravasation and wet/dry weight ratios of organs were significantly reduced with Tempol injection (P < 0.05). The survival rates of rats in Tempol-treated group were significantly higher than that of I/R-treated group (P < 0.05). CONCLUSIONS: The present study suggests that Tempol administration significantly reduces both local and remote organ injuries caused by intestinal I/R before and throughout the reperfusion period. Further clinical studies are needed to clarify whether Tempol may be a useful therapeutic agent to use in particular operations where the reperfusion injury occurs.

Conjunctival melanoma in a six-year-old female.

Conjunctival melanoma (CM) is a highly malignant tumor that derives from melanocytes and is rarely seen in children. This report describes a 6-year-old female diagnosed with CM.

Crohn's disease complicated by multiple stenoses and internal fistulas clinically mimicking small bowel endometriosis.

We report a 31-year-old woman with Crohn's disease complicated by multiple stenoses and internal fistulas clinically misdiagnosed as small bowel endometriosis, due to the patient's perimenstrual symptoms of mechanical subileus for 3 years; at first monthly, but later continuous, and gradually increasing in severity. We performed an exploratory laparotomy for small bowel obstruction, and found multiple ileal strictures and internal enteric fistulas. Because intraoperative findings were thought to indicate Crohn's disease, a right hemicolectomy and partial distal ileum resection were performed for obstructive Crohn's ileitis. Histopathology of the resected specimen revealed Crohn's disease without endometrial tissue. The patient made an uneventful recovery from this procedure and was discharged home 10 d post-operatively. The differential diagnosis of Crohn's disease with intestinal endometriosis may be difficult pre-operatively. The two entities share many overlapping clinical, radiological and pathological features. Nevertheless, when it is difficult to identify the cause of intestinal obstruction in a woman of child-bearing age with cyclical symptoms suggestive of small bowel endometriosis, Crohn's disease should be included in the differential diagnosis.

Are there any differences in the expression of hormonal receptors and proliferation markers between uterine and extrauterine leiomyomas?

The aim of this study is to determine the immunohistochemical expressions of estrogen receptor, progesterone receptor, and Ki-67 proliferation marker in 8 extrauterine leiomyomas and to compare these values with their uterine counterparts. In all, 8 patients with extrauterine leiomyomas and 20 patients with uterine leiomyomas as a control group were studied. Sections were immunohistochemically stained with estrogen receptor, progesterone receptor, and Ki-67 antibodies. Labeling indices for estrogen receptor, progesterone receptor, and Ki-67 were found to be 33.05%+/-31.70%, 14.18%+/-18.80%, and 0.52%+/-1.32% for extrauterine leiomyomas and 65.09%+/-26.65%, 32.53%+/-32.80%, and 0.37%+/-0.71% for uterine leiomyomas, respectively. The difference of labeling indices for progesterone receptor between uterine leiomyomas and extrauterine leiomyomas was statistically significant (P=.002). This study shows that increased expression of progesterone receptor is observed only in uterine leiomyomas during the reproductive period. However, it seems that additional factors to hormone receptors contribute to the development of extrauterine leiomyomas.

Potential utility of dermoscopy in the examination of ocular pigmentations.

BACKGROUND: Dermoscopy is a fundamental method in the examination of melanocytic neoplasms. Limited data exist about the dermoscopic features of ocular pigmentations (OPs). OBJECTIVES: We aimed to investigate the usefulness of dermoscopy in the examination of OPs. METHODS: Dermoscopic images of OPs of 20 consecutive patients were recorded. Impression cytology (IC) was performed to these lesions. Dermoscopic images were evaluated for specific dermoscopic structures and patterns without knowing the cytological examination results. RESULTS: Fifteen percent (3/20) of the lesions presented with suspicious cytological findings. More of the suspicious lesions had 4 colors compared to benign lesions (66.7% vs 11.8%, p=0.088). This was also determined for blue-gray (66.7% vs 11.8%, p=0.088) and white (66.7% vs 17.7%, p=0.14) colors. At least 3 structures were observed in all suspicious lesions (100%), but were observed in only in 41.2% of benign lesions (p=0.105). Besides, two-thirds of suspicious lesions had more than 4 structures, but none of the benign lesions reported this (p=0.016). Most of the benign lesions showed asymmetry in one axis (93.3%), whereas all suspicious lesions showed asymmetry in 2 axes (p=0.004). CONCLUSIONS: Dermoscopy seems to be a useful method in the evaluation of OPs. The existence of dermoscopic patterns, colors, and dermoscopic structure plurality and asymmetry raise suspicion in OPs, similarly to skin pigmentations. Dermatologists should be aware of the ocular area, and closer collaboration should be developed between dermatologists and ophthalmologists in the management of pigmented lesions.

Apoptotic cell death and its relationship to gastric carcinogenesis.

AIM: To investigate the apoptotic process of cells within the intestinal metaplasia areas co-localizing with chronic gastritis and gastric carcinomas and to analyze the involvement of proteins regulating apoptosis in the process of intestinal metaplasia related gastric carcinogenesis. METHODS: Forty-two gastric carcinoma and seventeen chronic gastritis cases were included in this study. All cases were examined for the existence of intestinal metaplasia. Ten cases randomly selected from each group were processed for TUNEL assay. TUNEL positive cells within the intestinal metaplasia areas, co-localizing either to gastric carcinoma or chronic gastritis, were counted and converted to apoptotic indices. In addition, p53, bcl-2 and bax expression patterns within these tissues were analyzed on the basis of immunohistochemistry. RESULTS: Twenty-eight of the cases were intestinal and 14 of the cases were diffuse type adenocarcinomas. 64% (27/42) of the gastric carcinoma cases had intestinal metaplasia. Intestinal metaplasia co-localized more with intestinal type carcinomas compared with diffuse type carcinomas [75% (21/28) vs 42% (6/14), respectively; P