Mikozis fungoides tanısında histomorfolojik, immünofenotipik (cd3, cd4, cd8) ve t hücre reseptörü y gen yeniden düzenlenmesinin değerlendirilmesi

TEZ6115Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2006.Kaynakça (s.45-50) var.vi, 51 s. : rnk. ; 29 cm.Mycosis fungoides is characterized with neoplastic infiltration of dominant CD4 positive T lymphocytes. The diagnosis may be diffucult in early lesions, both clinically and histomorphologically. Immunohistochemistry and molecular biology techniques have been researched as an adjunct to the diagnosis of mycosis fungoides. Our aim was to determine the help of immunophenotyping and T cell receptor ã gene rearrengement studies to the histomorphological diagnosis of mycosis fungoides. In this study, immunohistochemically, antibodies to CD3, CD4, CD8 and T cell receptor ã gene rearrengement analysis with a polymerase chain reaction were performed on formalline fixed, paraffin-embedded tissues of 73 cases (39 mycosis fungoides with classical histomorphology, 16 with suspicious histology for mycosis fungoides, 18 benign inflammatory dermatoses as control group). In mycosis fungoides and suspicious for mycosis fungoides groups, CD4 percentage, CD4/CD8 ratio, clonality were statistically significantly different. CD8 percentage was not statistically different between three groups. Histomorphological features -if there is- are gold standart for diagnosis of mycosis fungoides. However, in early mycosis fungoides and the suspicious cases; when the histomorphological features are inadequate, immunophenotypical evaluation and T cell receptor ã gene rearrengement with polymerase chain reaction analysis may help to the diagnosis of mycosis fungoides.Mikozis fungoides, baskın olarak CD4 pozitif T lenfositlerin deride neoplastik infiltrasyonu ile karakterizedir. Mikozis fungoidesin erken lezyonlarının tanısı, klinik ve histomorfolojik olarak zorluk arzeder. Mikozis fungoides tanısında yardımcı yöntemler; immünohistokimya ve moleküler biyoloji tekniklerinin konvansiyonel yöntemlere katkısı araştırılmaktadır. Çalışmamızda, immünofenotipik özellikler ve polimeraz zincir reaksiyonu ile Thücre reseptörü ã gen yeniden düzenlenmesinin tanıdaki yerini saptamayı amaçladık. Çalışma grubuna, 73 olgu (39 klasik histomorfolojiye sahip mikozis fungoides , 16 mikozis fungoides şüphesi, 18 benign inflamatuar dermatozdan oluşan kontrol grubu olgular) dahil edildi. %10'luk formaldehitte tespit edilmiş, parafine gömülü dokulardan elde edilen histolojik kesitlerde rutin hematoksilen eozin boyası ve ışık mikroskobik inceleme yanısıra, immünohistokimyasal yöntemle CD3, CD4, CD8'e karşı antikorlar ile immünofenotipik özellikler, polimeraz zincir reaksiyonu ile T hücre reseptörü ã gen yeniden düzenlenmesi değerlendirildi. Mikozis fungoides ve mikozis fungoides şüphesi olan grupta, CD4 yüzdesi, CD4/CD8 oranı, klonalite varlığı istatistiksel olarak anlamlı bulundu. CD8 yüzdesi ise üç grup arasında istatistiksel olarak anlamlı bulunmadı. Mikozis fungoides'te, histomorfolojik bulgular -tipik olduğunda- altın standart tanı yöntemidir. Ancak, erken lezyonlarda ve mikozis fungoides şüphesi olan olgularda; histomorfolojik bulguların yetersiz kaldığı durumlarda, immünofenotipik değerlendirme ve polimeraz zincir reaksiyonu aracılı T hücre reseptörü ã gen yeniden düzenlenmesi ile klonalite saptanması, mikozis fungoides tanısında yardımcı yöntemler olarak kullanılabilir.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi Tarafından Desteklenmiştir. Proje No:TF2004LTP2

Diagnostic values of KOH examination, histological examination, and culture for onychomycosis: a latent class analysis

Background In the absence of a real gold standard, comparative studies are still done on diagnostic methods for onychomycosis. There are only a few attempts using latent class analysis to determine the value of polymerase chain reaction in comparison to conventional methods. We aimed to determine the value of histological examination in such a way for the diagnosis of onychomycosis. Methods Potassium hydroxide mount (KOH), culture and histological examination with periodic acid-Schiff (PAS), and Gomori's methenamine silver (GMS) stains were done in 106 patients having clinically suspected toenail onychomycosis. Results KOH was positive in 74% of the patients; culture in 14%; PAS in 30%; and GMS in 66%. According to the results of the latent class analysis, culture and PAS were highly specific but poorly sensitive; KOH, highly sensitive but poorly specific; and GMS, both highly sensitive and specific. Conclusions Based on these results, we have proposed KOH as a screening test and GMS as a confirmatory test for the diagnosis of onychomycosis in our own practice. However, since positivity rates of different diagnostic methods vary widely in different centers, it is more suitable that every center should determine their own diagnostic strategy by evaluating their own results with latent class analysis.Research Fund of Cukurova University Project TSA-2015-503

Congenital Peribronchial Myofibroblastic Tumor: A Case Report and Review of the Literature

Background: Congenital peribronchial myofibroblastic tumor is a rare, solid mesenchymal tumor of the neonate, usually associated with non-immune hydrops fetalis. Case Report: We present a case of congenital peribronchial myofibroblastic tumor, in whom a right lung mass was detected in intrauterine life. 12 days after delivery by caesarean section, right lobectomy was performed. The tumor was limited to the lung, and was composed of spindle cells, proliferating around a bronchial unit. Central necrosis and 4-5 mitoses per 10 high power fields were present. The patient is well 26 months after surgery. Conclusion: We report this rare tumor with clinical, radiological and pathologic findings and a review of the literature.Background: Congenital peribronchial myofibroblastic tumor is a rare, solid mesenchymal tumor of the neonate, usually associated with non-immune hydrops fetalis. Case Report: We present a case of congenital peribronchial myofibroblastic tumor, in whom a right lung mass was detected in intrauterine life. 12 days after delivery by caesarean section, right lobectomy was performed. The tumor was limited to the lung, and was composed of spindle cells, proliferating around a bronchial unit. Central necrosis and 4-5 mitoses per 10 high power fields were present. The patient is well 26 months after surgery. Conclusion: We report this rare tumor with clinical, radiological and pathologic findings and a review of the literature

Erythema elevatum diutinum coexisting with ankylosing spondylitis

A 43-year-old woman presented to our hospital with the complaint of a reddish-purple rash on the extensor sides of her forearms. She had been diagnosed with ankylosing spondylitis 7 years ago. On physical examination, reddish-purple nodules were detected on the pretibial areas of both legs and extensor sides of both hands and forearms. Neutrophil, eosinophil, lymphocyte, and mixed-type leukocyte infiltration and erythrocyte extravasation were observed in skin biopsy. Erythema elevatum diutinum (EED) was diagnosed. For treatment, sulphasalazine, colchicine, and diclofenac were started. After 3 months of treatment, the lesions were healed. To the best of our knowledge, this is the first report of EED coexisting with ankylosing spondylitisA 43-year-old woman presented to our hospital with the complaint of a reddish-purple rash on the extensor sides of her forearms. She had been diagnosed with ankylosing spondylitis 7 years ago. On physical examination, reddish-purple nodules were detected on the pretibial areas of both legs and extensor sides of both hands and forearms. Neutrophil, eosinophil, lymphocyte, and mixed-type leukocyte infiltration and erythrocyte extravasation were observed in skin biopsy. Erythema elevatum diutinum (EED) was diagnosed. For treatment, sulphasalazine, colchicine, and diclofenac were started. After 3 months of treatment, the lesions were healed. To the best of our knowledge, this is the first report of EED coexisting with ankylosing spondyliti

A Unique Case of Merkel Cell Carcinoma with Ovarian Metastasis

Background: Merkel cell carcinoma (MCC) is a rare cutaneous/mucosal malignancy with very aggressive biology and increasing incidence. Ovarian metastasis is an exceptionally rare site for MCC, and only two cases have been reported in the literature. Case Report: We report MCC with ovarian metastasis. A 34 year-old female with previously excised MCC from preauricular skin presented with a pelvic mass 15 months after first diagnosis. Anti-cytokeratin (CK) 20 positivity, LCA (leucocyte common antigen), and TTF-1 (Thyroid transcription factor-1) negativity confirmed metastatic ovarian MCC. There was no evidence of recurrence or metastasis at 12 months after salpingo-oopherectomy. Conclusion: MCC should be considered in the differential diagnosis of primary and metastatic undifferentiated small round cell tumors of the ovary

İmmünohistokimyasal Çalışma ile Prostat Karsinomunda Siklooksijenaz-2 Ekspresyonunun: Apopitozis ve Anjiyogenezis ile İlişkisi

Amaç: Prostat karsinomu (PK) önemli oranda ölümcül ve morbiditesi olan, sık görülen kanser türlerinden biridir. PK'nin etiyolojisi net değildir. Enflamatuvar yolaktaki sitokin ve mediatörler; kronik enflamasyon ve kanser arasındaki ilişkide, çeşitli basamaklarda rol oynamaktadır. Bu çalışmanın amacı, PK'li hastalarda siklooksijenaz-2 (COX), apopitozis ve anjiyogenezis arasında ilişki olup olmadığını belirlemektir.Gereç ve Yöntem: 2005-2010 yılları arasında, patolojik evresi pT2 olup radikal prostetektomi uygulanan 49 olgu, Çukurova Üniversitesi Tıp Fakültesi Patoloji arşivinden retrospektif olarak seçilmiştir. Histolojik slaytlar tanısal açıdan tekrar gözden geçirilmiş ve Gleason skorlama sistemine göre derecelendirilmiştir. Olgulara immünohistokimyasal olarak COX-2, vasküler endotelyal büyüme faktörü (VEBF), monoklonal antikor (M30), bcl-2 uygulanarak değerlendirilmiştir. Bulgular: Hastaların ortalama yaşı 63,8 idi. Yirmi bir hasta Gleason skor =7 olarak derecelendirildi. COX-2 ekspresyonu %81,6 hastada tespit edildi. COX-2 ekspresyonu bcl-2 ekspresyonu ile korele olarak bulunurken, VEBF ile COX-2 arasında korelasyon saptanmadı. Gleason skor ile M30 arasında negatif korelasyon saptandı. Ortalama yaşam ve COX-2 arasında negatif korelasyon saptandı. COX-2 ekspresyonu arttıkça sağkalım süresinin anlamlı olarak azaldığı saptandı.Sonuç: Çalışmamız PK karsinogenezisinde COX-2'nin anjiyogenezisi arttırmaktan çok apopitozisi inhibe ederek etki ettiğini düşündürmektedir. Bu sonuçların, tedavi stratejilerine yeni bakış açıları sunabileceği gibi, hastaların klinik takiplerinin sonuçlarını öngörmede faydalı olabileceğini düşünmekteyiz.Objective: Prostate carcinoma (PC) is one of the most commonly diagnosed cancer types with significant rates of mortality and morbidity. The etiology of PC is not clear. Cytokine and mediators at the inflammatory pathway plays role at the various steps of the relation between chronic inflammation and cancer. The objective of this study is to determine if there is relationship between cyclooxygenase-2 (COX) apoptosis and angiogenesis in patients with PC.Materials and Methods: Sample of 49 cases who were at pathologic stage pT2 and underwent radical prostatectomy, were selected retrospectively between 2005-2010, from the archives of Pathology Department of Çukurova University Faculty of Medicine. Histologic slides of each case were reviewed for the diagnostic reassessment and graded by the Gleason scoring system. COX-2, vascular endothelial growth factor (VEGF), monoclonal antibody (M30) and bcl-2 were immunohistochemically applied to the cases and they were evaluated.Results: The mean age of the patients were 63.8. Twenty-one cases had their Gleason score =7. COX-2 expression was detected in 81.6% of cases. While COX-2 expression was significantly correlated with bcl-2 expression, there was no correlation between VEGF and COX-2 expression. Gleason score was negatively correlated with M30. It was detected that as COX-2 expression increased mean survival time significantly decreased.Conclusion: This study makes us think that in the PC carcinogenesis COX2 inhibits apoptosis rather than promoting angiogenesis. These results may offer new insights for the treatment strategies, also they may be useful for the prediction of clinical outcomes

Erythema elevatum diutinum coexisting with ankylosing spondylitis

A 43-year-old woman presented to our hospital with the complaint of a reddish-purple rash on the extensor sides of her forearms. She had been diagnosed with ankylosing spondylitis 7 years ago. On physical examination, reddish-purple nodules were detected on the pretibial areas of both legs and extensor sides of both hands and forearms. Neutrophil, eosinophil, lymphocyte, and mixed-type leukocyte infiltration and erythrocyte extravasation were observed in skin biopsy. Erythema elevatum diutinum (EED) was diagnosed. For treatment, sulphasalazine, colchicine, and diclofenac were started. After 3 months of treatment, the lesions were healed. To the best of our knowledge, this is the first report of EED coexisting with ankylosing spondylitis

Over Tümörlerinde İntraoperatif Frozen İncelemenin Tanısal Yeri; Tek Merkez Deneyimi

Amaç: Jinekolojik tümörler için frozen kesit inceleme bazı tanısal tuzaklara karşın yeterli bir tanısal yöntemdir. Bu çalışmada, over tümörlerinde frozen incelemenin tanısal değerini ve tanısal yanlışlıkların nedenlerini tespit etmeyi amaçladık. Gereç ve Yöntem: Kurumumuzda Haziran 2006 ve Ocak 2013 yılları arasında over tümörü nedeni ile frozen inceleme yapılmış olan toplam 282 hastaya ait sonuçlar yeniden değerlendirildi. Tanılar benign, borderline (epitelyal tümörler için) ve malign olmak üzere üç alt gruba ayrıldı. Frozen ve parafin kesit sonuçları istatistiksel olarak karşılaştırıldı. Bulgular: Frozen incelemenin genel tanısal doğruluk oranı %96,5 idi. Benign, borderline ve malign tümörler için frozen incelemenin duyarlığı sırasıyla %97,5, %95,8 ve %95,6 idi. Özgüllük ise aynı sırayla, %97,5, %97,6 ve %100 idi. En düşük pozitif prediktif değer borderline grubunda saptandı (%79,3) ve hataya neden olan tüm olgular müsinöz tip epitelyal tümörler idi. Tanı uyumsuzluğu bulunan ikinci tümör grubu ise immatür teratom idi. Sonuç: Frozen incelemenin kısıtlılıkları yanısıra, patoloğun frozen incelemenin teknik veya tümör tipi ile ilgili tuzaklarını bilmesi, özel- likle müsinöz tümörler ve teratom olgularında solid görünen alan- lardan örneklenmesi yetersiz veya gereksiz operasyon yapılmasını önlemek adına yararlı olacaktır.Objective: Frozen section is an accurate diagnostic tool with some unavoidable pitfalls in gynecologic tumors. We aimed to evaluate the diagnostic value of frozen section, and to detect the factors causing erroneous diagnosis in ovarian tumors. Material and Method: Frozen section and paraffin section reports of 282 patients with ovarian neoplasms diagnosed between July 2006 and January 2013 in our institute were re-analyzed. Results were grouped into benign, borderline (for epithelial tumors) and malignant categories and compared between frozen section and paraffin section diagnosis, statistically. Results: Overall diagnostic accuracy of frozen section was 96.5%. Sensitivity of frozen section for benign, borderline and malignant tumors were 97.5%, 95.8%, and 95.6% and the related specificities were 97.5%, 97.6%, and 100%, respectively. We found the lowest positive predictive value in borderline group (79.3%), all of them with mucinous type epithelium. Second frequent discordant tumor type was immature teratoma. Conclusion: Apart from the limitations of frozen section, pathologists should be aware of the pitfalls of technique and tumor types and tend to sample from the solid areas particularly in mucinous tumors and teratomas to avoid inappropriate surgery