Inflammatory myofibroblastic tumor of the small-bowel mesentery: A case report of nonspecific clinical presentation and a review of the literature

INTRODUCTION: Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of various anatomical sites, which is histopathologically characterized by spindle-shaped cells with myofibroblastic proliferation and inflammatory infiltration. PRESENTATION OF CASE: In this case report, a 37-year-old man presented with nonspecific systemic symptoms, including abdominal pain and weakness, which was diagnosed by multislice computed tomography and ultrasonography. An 8 cm × 5 cm × 5 cm nodular gray-white firm noninfiltrative mass, which was well localized in the mesentery tissues of small bowel, was observed and the patient underwent surgical resection. DISCUSSION: A review of the literature on IMT of the small-bowel mesentery yielded a small number of previously described cases. This tumor most frequently involves the lungs and arises most commonly in extrapulmonary locations such as the mesentery and omentum. The etiopathogenesis and the clinical course of the disease are unclear. The histological and clinical differential diagnosis of IMT also includes reactive processes and mesenchymal tumors of the gastrointestinal tract. Follow-up after surgical removal documented local recurrence and metastasis. CONCLUSION: The preferred primary treatment is complete surgical excision, and patients require close clinicoradiological follow-up. In general, cases treated with complete surgical resection have a good prognosis

Clinicopathological and molecular features of sporadic colorectal cancers with DNA mismatch repair deficiency: A single center experience

DNA mismatch repair (MMR) proteins may play an important role in colorectal carcinogenesis. In our study, the clinicopathological features of defective MMR in sporadic colorectal adenocarcinomas (CRCs) cases were examined. This is a retrospective study, 457 consecutive cases of colorectal carcinoma with immunohistochemical (IHC) studies for DNA MMR were included.The immunohistochemically (IHC) MMR results of 457 cases were; nuclear expression was intact (proficient, pMMR) in 401 (87.7%) cases and loss of nuclear expression (deficient, dMMR) was found in 56 cases (12.3%). High probability of Lynch syndrome ratio was 2.4% (11/457) in all cases. The loss of PMS2 was predominantly detected in dMMRcases (78.6%). Seventy eight percent of dMMR tumors were located in the proximal colon. In dMMR tumors, prominent peritumoral lymphoid aggregates (LAs) (85.7%) and tumor-infiltrating lymphocytes (TILs) (78.6%) were observed. Among 56 colorectal cancers, we observed expanding /pushing growth pattern in 41 tumors (73.2%), and infiltrative growth pattern in 15 cancers (16.8%). Medullary, mucinous and signet ring cell carcinomas were observed in approximately half of the cases, but there was no statistically significant relationship. Eighty nine percent of dMMR cases had advanced pathologic tumor stage (pT3 or pT4), and this rate was 82.5% in pMMR cases. The average number of positive lymph nodes in cases with dMMR was higher than in pMMR. KRAS mutations were detected in 7.2% (4/13) patients and 14.3% (8/13) patients with MLH1 promoter methylation was observed. Seventy percent of patients with dMMR were alive (n=44) and the mean age of the patients who died was higher. A statistically significant relationship was found between the patients who died and the mean age of surviving patients (p = 0.036). We conclude that the dMMR patients constitutes have a number of distinctive clinicopathological features subtype of sporadic CRC. The overall frequency of defective MMR in colorectal carcinoma cases was found to be Turkish population similar to western studies. dMMR in CRCs were more likely to be of advanced pathologic tumor stage to have a mucinous tumor component and positive LN to show PMS2 loss and to harbour higher numbers of both peritumoral LAs and TILs. They were also more likely to be proximal colon and to occur in male. [Med-Science 2020; 9(4.000): 1014-22

A rare case of giant gastrointestinal stromal tumor of the stomach involving the serosal surface

Introduction: Although rare, gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors affecting the gastrointestinal tract. Presentation of case: Here we report the case of a 43-year-old man complaining of abdominal pain along with a painless and palpable mass, which was confirmed on magnetic resonance and multislice computed tomography. Laparotomy revealed a nodular grayish-white firm noninfiltrative mass (39 × 27 × 14 cm, 6109 g) that was well localized within the extramuscular and peritoneal surface of the anterior wall of the stomach; complete tumor resection was performed. Histopathological examination revealed features typical of GIST, including increased cellularity, increased mitotic activity, and spindle shaped cells as well as positive immunoreactivity for KIT, CD34, and vimentin. Discussion: A review of literature revealed that GISTs of the size and weight similar to the present case has been rarely reported. GIST most frequently involves the stomach. Although the etiopathogenesis of this disease remains unclear, few well-documented familial cases have been associated with GIST syndromes. Conclusion: The primary treatment preferred is complete surgical excision of the tumor

Do histopathologic findings improve by increasing the sample size in cholecystectomies?

BACKGROUND: Gallbladder diseases present with cholelithiasis in a wide spectrum of adenomas and cancers. Two or three specimens are sampled in cholecystectomies in routine pathology practice. The aim of this study was to investigate the increase in frequency of histologic alterations in cholecystectomies, particularly precancerous lesions, by increasing the sample size to understand the carcinoma pathway. METHODS: Cholecystectomies of 432 patients with pathology records and materials from two medical centers were collected, and two groups were created. Initial data with two or three samples were allocated to Group 1 and the new six samples with the initial ones were allocated to Group 2. Hematoxylin and eosin (H&E) sections were examined for histopathologic alterations, and periodic acid–Schiff (PAS) Alcian blue (pH 2.5) and high iron diamine (pH 2.5) stains were used to signify the mucin profile in case of metaplasias. For the comparison of findings, non-parametric tests, McNemar’s tests, chi-squared tests and Fisher’s exact test were performed. RESULTS: Of the 432 patients, 308 (71.3%) patients were female and 124 (28.7%) patients were male. The mean age of patients was 47.9 ± 14.6 years. Cholesterolosis was observed in 95 (22%) patients in Group 1 and 108 (25%) patients in Group 2. Gallstones were detected in 255 (59%) of the cholecystectomies. There was a significant difference between Group 1 and Group 2 by increasing the sample size when we compared cholesterolosis, metaplasia and polyps (P <0.05). Cholecystitis and dysplasia rates were the same in both of the groups. There was no cancer determined. CONCLUSION: Increasing the sample size in cholecystectomies increased the diagnosis of some histologic alterations, but further studies with a larger number of samples over a longer period time might increase the ability to determine precancerous lesions and concomitants

PREOPERATIVE AND POSTOPERATIVE MANAGEMENT IN CHILDREN WITH SICKLE CELL ANEMIA UNDERGOING SURGERY: A SINGLE-CENTER EXPERIENCE

AMAÇ: Orak hücre anemisinde (OHA) cerrahi işlemler sıkça gereklidir. OHA’li hastaların postoperatif kompli-kasyonlar için nispeten daha yüksek riske sahip olduğu kabul edilmektedir. Bu çalışmanın amacı, ameliyat olan OHA’lı hastaların ameliyat öncesi ve sonrası yönetimini değerlendirmektir. GEREÇ VE YÖNTEM: Hastanemizde ameliyat olan tüm OHA’li çocukların yaş, cinsiyet, preoperatif incelemeler ve postoperatif komplikasyon bilgilerine geriye dönük olarak tıbbi kayıtları incelenerek ulaşıldı. BULGULAR: 2012-2014 yılları arasında, OHA’li 12 çocuk hasta hastanemizde ameliyat oldu. Hastaların ortalama yaşı 12.1 yıl (aralık, 6–17) idi. Beşi kız çocuktu. Cerrahi işlemler kolesistektomi (n=6), tonsillektomi/adenoidek-tomi (n=3), splenektomi (n=2) ve over kist eksizyonu (n=1) idi. Splenektomi olan bir hastaya eş zamanlı olarak kolesistektomi uygulandı. Hastalar ameliyattan önce ba-sit eritrosit transfüzyonu (n=1) veya total kan değişimi (n=10) tedavisi aldı. Bir hasta kronik transfüzyon progra-mına kayıtlı olduğu için transfüzyon almadı. Tüm hastalar ameliyat öncesi geceden başlayarak ve ameliyat sonra-sıda devam eden intravenöz hidrasyon aldı. Ameliyat sonrası ortalama hastanede kalış süresi 5,3 gün (dağılım, 3–10) idi. Hiç vazooklüziv kriz ya da ölüm saptanmadı. SONUÇ: OHA’lı hastalara elektif cerrahi öncesi, postope-ratif komplikasyonları azaltmak amacı ile Hemoglobin S oranını %40’ın altına düşürmek için transfüzyon yapılma-lıdır. İyi preoperatif ve postoperatif yönetim ile cerrahi OHA’lı çocuklarda etkili ve güvenlidir.OBJECTIVE: Surgical procedures are often required in si-ckle cell anemia (SCA). Patients with SCA are recognized as having a relatively higher risk for postoperative comp-lications. The aim of the present study was to evaluate the preoperative and postoperative management of pa-tients with SCA undergoing surgery. MATERIALS AND METHODS: The medical records of all children with SCA who had surgery at our hospital were retrospectively reviewed for the following: age, gender, preoperative investigations, and postoperative compli-cations. RESULTS: From 2012 to 2014, 12 children with SCA had surgery at our hospital. The patients’ mean age was 12.1 years (range, 6–17). Five patients were female. The surgical procedures were cholecystectomy (n=6), tonsillectomy/ adenoidectomy (n=3), splenectomy (n=2) and excision of ovarian cyst (n=1). In a patient who had undergone sple-nectomy, concomitant cholecystectomy were also per-formed. Patients received simple packed red blood cell transfusion (n=1) or total exchange transfusion (n=10) before the surgery. One patient was not transfused which was already enrolled in a chronic transfusion program. All patients received intravenous hydration the night before the surgery and postoperatively. The mean postoperati-ve hospital stay was 5.3 days (range, 3-10). There were no vaso-occlusive crises or deaths. CONCLUSIONS: Children with sickle cell disease presen-ting for elective surgery should be given a transfusion for a hemoglobin S ratio less than 40% in an attempt to redu-ce postoperative complications. With good preoperative and postoperative management, surgery is both safe and effective for children with SC

Preoperative and postoperative management in children with sickle cell anemia undergoing surgery: A single-center experience

AMAÇ: Orak hücre anemisinde (OHA) cerrahi işlemler sıkça gereklidir. OHA’li hastaların postoperatif komplikasyonlar için nispeten daha yüksek riske sahip olduğu kabul edilmektedir. Bu çalışmanın amacı, ameliyat olan OHA’lı hastaların ameliyat öncesi ve sonrası yönetimini değerlendirmektir. GEREÇ VE YÖNTEM: Hastanemizde ameliyat olan tüm OHA’li çocukların yaş, cinsiyet, preoperatif incelemeler ve postoperatif komplikasyon bilgilerine geriye dönük olarak tıbbi kayıtları incelenerek ulaşıldı. BULGULAR: 2012-2014 yılları arasında, OHA’li 12 çocuk hasta hastanemizde ameliyat oldu. Hastaların ortalama yaşı 12.1 yıl (aralık, 6–17) idi. Beşi kız çocuktu. Cerrahi işlemler kolesistektomi (n=6), tonsillektomi/adenoidektomi (n=3), splenektomi (n=2) ve over kist eksizyonu (n=1) idi. Splenektomi olan bir hastaya eş zamanlı olarak kolesistektomi uygulandı. Hastalar ameliyattan önce basit eritrosit transfüzyonu (n=1) veya total kan değişimi (n=10) tedavisi aldı. Bir hasta kronik transfüzyon programına kayıtlı olduğu için transfüzyon almadı. Tüm hastalar ameliyat öncesi geceden başlayarak ve ameliyat sonrasıda devam eden intravenöz hidrasyon aldı. Ameliyat sonrası ortalama hastanede kalış süresi 5,3 gün (dağılım, 3–10) idi. Hiç vazooklüziv kriz ya da ölüm saptanmadı. SONUÇ: OHA’lı hastalara elektif cerrahi öncesi, postoperatif komplikasyonları azaltmak amacı ile Hemoglobin S oranını %40’ın altına düşürmek için transfüzyon yapılmalıdır. İyi preoperatif ve postoperatif yönetim ile cerrahi OHA’lı çocuklarda etkili ve güvenlidir.OBJECTIVE: Surgical procedures are often required in sickle cell anemia (SCA). Patients with SCA are recognized as having a relatively higher risk for postoperative complications. The aim of the present study was to evaluate the preoperative and postoperative management of patients with SCA undergoing surgery. MATERIALS AND METHODS: The medical records of all children with SCA who had surgery at our hospital were retrospectively reviewed for the following: age, gender, preoperative investigations, and postoperative complications. RESULTS: From 2012 to 2014, 12 children with SCA had surgery at our hospital. The patients’ mean age was 12.1 years (range, 6–17). Five patients were female. The surgical procedures were cholecystectomy (n=6), tonsillectomy/ adenoidectomy (n=3), splenectomy (n=2) and excision of ovarian cyst (n=1). In a patient who had undergone splenectomy, concomitant cholecystectomy were also performed. Patients received simple packed red blood cell transfusion (n=1) or total exchange transfusion (n=10) before the surgery. One patient was not transfused which was already enrolled in a chronic transfusion program. All patients received intravenous hydration the night before the surgery and postoperatively. The mean postoperative hospital stay was 5.3 days (range, 3-10). There were no vaso-occlusive crises or deaths. CONCLUSIONS: Children with sickle cell disease presenting for elective surgery should be given a transfusion for a hemoglobin S ratio less than 40% in an attempt to reduce postoperative complications. With good preoperative and postoperative management, surgery is both safe and effective for children with SCA

Immunohistochemical expression of p63, p53 in urinary bladder carcinoma

Background: Urothelial carcinomas (UC) is of the most common cancers urinary bladder. Aim: The aim of the study is to assess the immunohistochemical staining differences between p63 and p53 according to the pathological stage and histological grade of the tumor in urinary bladder carcinomas. Materials and Methods: Totally 62 urinary bladder transurethral resection materials diagnosed with urothelial carcinoma in the pathology department of our hospital were included in the study. On pathological examination, cases were dichotomized as noninvasive and invasive, whereas noninvasive cases were dichotomized as low grade and high grade and invasive cases were dichotomized as pT1 and pT2. Subsequently, the cases were evaluated by means of p63 and p53 immunohistochemical staining. Statistical analyses were performed by SPSS program, and Chi-square and Fisher′s exact tests. Results: When pTa was evaluated in terms of p63 immunoreactivity, no statistically significant difference was observed between LGPUC and HGPUC, noninvasive papillary UC, regarding staining percentages ( P > 0.05), whereas statistically significant relation was observed for pT1 and pT2 regarding p63 staining percentages ( P < 0.05). For pTa, no statistically significant relation was observed between LGPUC and HGPUC, noninvasive papillary UC, in terms of p53 staining percentages ( P > 0.05). However, highly significant relationship was observed for pT1 and pT2 in terms of p53 staining percentages ( P < 0.01). No significant relationship was observed between the staining percentages of p53 and p63 ( P > 0.05). Conclusion: The role of p53 and p63 immunoreactivities in the differential diagnosis and prognosis of urinary bladder carcinomas according to the pathological stage and histological grade of the tumor will be understood better with the increasing number of long term investigations performed with large series at a molecular level