Clinical and pathological features of adrenal myelolipoma and myelolipomatous metaplasia cases in our hospital over 13 years

BACKGROUND/AIMS: The development and widespread use of abdominal imaging techniques has increased the incidence of unexpected adrenal tumors called adrenal incidentaloma. Adrenal myelolipomas are the second most common incidentalomas. Similar myelolipomatous morphology appears as a secondary degenerative change in other adrenal lesions and is called myelolipomatous metaplasia. This study investigated the adrenal entities of the last 13 years which had myelolipomatous components.MATERIALS AND METHODS: In this retrospective observational study, cases diagnosed as adrenal myelolipoma or myelolipomatous metaplasia between January, 2009 and January, 2022 were re-examined regarding their age, gender, localization, lesion size, and secondary histopathological changes, accompanying pathological diagnoses as well as clinical and radiological data.RESULTS: Eleven adrenal myelolipoma cases and 6 myelolipomatous metaplasia cases were detected. In myelolipomas, the mean age was 55.45 years, 73% were female and 82% were located on the right side. The lesions were encapsulated and their mean size was 7 cm. One case had a diagnosis of subclinical Cushing's syndrome and the others were hormonally inactive. Some cases were accompanied with hypertension (27%), type 2 diabetes (18%), and asthma (18%). All myelolipomatous metaplasias, which are non-encapsulated, were detected in adrenocortical adenomas. The mean age was 58 years; nonencapsulated and 67% were located on the right side with no gender predilection. Concomitant hypertension (50%), diabetes /33%, and asthma (33%) were frequent.CONCLUSION: Adrenal myelolipoma and myelolipomatous metaplasia both contain adipose and myeloid components. Myelolipoma is a benign and encapsulated neoplasia which is usually detected incidentally. They frequently coexist with chronic diseases such as hypertension, diabetes and asthma

Cavernous Hemangioma-Like Kaposi Sarcoma: Histomorphologic Features and Differential Diagnosis

Aim. Cavernous hemangioma-like Kaposi sarcoma is a rare morphologic type of Kaposi sarcoma. So far there are no cases in the literature defining the histological features of this morphologic spectrum in detail. In this study we presented two classical-type cutaneous Kaposi sarcoma cases with histologic findings resembling cavernous hemangioma in company with clinical and histopathological data. Cases. One hundred and eighty-five classical-type cutaneous Kaposi sarcoma lesions in 79 patients were assessed retrospectively in terms of histopathological features. Findings of two cases showing features of cavernous hemangioma-like Kaposi sarcoma whose clinical data could be accessed were presented in accompany with the literature data. Both cases were detected to have bluish-purple, protruded, irregularly bordered cutaneous lesions. Histopathological examination revealed a lesion formed by cavernous hemangioma-like vascular structures organized in a lobular pattern that became dilated and filled with blood. Typical histological findings of early-stage KS, consisting of mononuclear inflammation, extravasated erythrocytes, and a few immature vascular structures in superficial dermis, were observed. All cases were serologically HIV-1 negative. A positive reaction with HHV-8, CD31, CD34, and D2-40 monoclonal antibodies was identified at both cavernous hemangioma-like areas and in immature vascular structures. Results. Cavernous hemangioma-like Kaposi sarcoma is a rare Kaposi sarcoma variant presenting with diagnostic challenges, that may be confused with hemangioma. As characteristic morphological features may not be observed in every case, it is important for diagnostic purposes to show immunohistochemical HHV-8 positivity in this variant

Histological Subgroups in Classic Kaposi Sarcoma: A Preliminary Study

Background and Design: Kaposi sarcomas (KS) are vascular tumors with a low malignant potential which include overlapping infectious, immunologic, and neoplastic processes. Recently, many histological subtypes have been defined. Material and Method: In the present study, 151 cutaneous classic KS lesions in 56 patients were retrospectively evaluated with regard to histological subtypes. Determination of the subtypes was based on the predominant histopathological component in the lesion. We examined changes in epidermis and dermis along with intratumoral inflammatory response characteristics in the lesions. By defining histopathological variants of the cases, differences regarding subtypes were investigated. Results: Cases that bear the ordinary characteristics of KS and those that can not be classified otherwise, comprised 82..8% of the study group. Twenty-six cases showed consistency with the subtypes outlined in the literature in terms of their histopathological properties. The most common histological subtype was the lymphangiectatic variant in 7.3% of the cases. Bullous (2.6%), lymphangioma like (2.6%), intravascular (2%), and pyogenic granuloma like (2%) variants were less common. The most uncommon histological subtype was micronodular (0.6%) type. Lymphangiectatic, bullous, intravascular, and pyogenic granuloma like variants were frequently observed in the nodular stage of KSs. Lympangioma like changes were seen to be present in the early KS lesions. Lymphangiectatic type was oftenly associated with bullous component, whereas pyogenic granuloma like type demonstrated superficial ulceration and intense inflammatory response. Lymphangioma like and intravascular types exhibited a characteristic appearance, while other variants were accompanied by components belonging to different subtypes. Conclusion: In KS, histopathological subtypes can develop as a result of different pathological processes. The next stage of the current study, which is one of the largest case series in the literature, will be investigation of the clinical and prognostic characteristics of the variants

Unusual reason of a neck mass: Secondary hydatid cyst

Hydatic cyct is a common parasitic infestation caused by the parasite Echinococcus granulosus. It may affect any organ and tissue in the body, in particular the liver and lung. Hydatid cyst in the head and neck region is very rare, even in countries where echinococcus infestation is endemic. We report the case of a 52-year-old female patient presenting with a hydatid cyst in supraclavicular region with hepatic involvement. The definitive therapy comprised excision of the cystic mass and postoperative medical treatment

Tümörü taklit eden primer hepatik aktinomikoz (Inflamatuar Psödotümör): Olgu sunumu ve literatür derlemesi

Actinomycosis often manifests with abscesses in the cervicofacial region. Hepatic involvement occurs usually secondary to an intraabdominal infection. "Isolated or primary hepatic actinomycosis (PHA) defines actinomycosis in which the source of infection cannot be demonstrated elsewhere. Herein, we aimed to highlight hepatic actinomycosis in the differential diagnosis of hepatic mass lesions, and also its occurrence even in patients without underlying risk factors. A 24-year-old man, who presented with epigastric and right-upper-quadrant abdominal pain, fever, weight loss, and had a tumor-like mass in the liver was admitted to our hospital. He had no predisposing risk factors or comorbidities. We reviewed all the cases with PHA, who had no predisposing risk factors, in English medical literature from 1993 to 2014. Actinomycotic hepatic pseudotumors should be considered in the differential diagnosis of solitary liver lesions even in patients without any predisposing factors. Multi-disciplinary approach is important in the diagnosis and management.Aktinomikoz genellikle servikofasiyal bölgede abseler şeklinde ortaya çıkar. Karaciğer tutulumu çoğunlukla batın içi enfeksiyonlara ikincil olarak gelişir. "İzole veya Primer Hepatik Aktinomikoz (PHA)" başka bir enfeksiyon odağının gösterilemediği karaciğer yerleşimli aktinomikozu tanımlar. Burada, hepatik aktinomikozun karaciğerde saptanan kitle lezyonlarının ayırıcı tanısında yer alması gerektiğini ve risk faktörü olmayan hastalarda da gelişebileceğini vurgulamayı amaçladık. Epigastrik hassasiyet, sağ üst kadran ağrısı, ateş, kilo kaybı yakınmalarıyla başvuran 24 yaşında erkek hasta, görüntülemede karaciğerde tümör-benzeri kitle saptanması nedeniyle hastanemize yatırıldı. Hastanın, Aktinomikoz için herhangi bir risk faktörü veya eşlik eden hastalığı yoktu. İngilizce tıp literatüründeki 1993-2014 yılları arasındaki tüm benzer PHA olgularını derledik. Aktinomikotik karaciğer psödotümörleri, hiçbir risk faktörü veya ek hastalığı olmayan hastalarda bile soliter karaciğer lezyonlarının ayırıcı tanısında hatırlanmalıdır. Tanı ve tedavide multidisipliner yaklaşım çok önemlidir

Primary hepatic actinomycosis mimicking a tumor (inflammatory pseudotumor): Case report and literature review

Actinomycosis often manifests with abscesses in the cervicofacial region. Hepatic involvement occurs usually secondary to an intraabdominal infection. “Isolated or primary hepatic actinomycosis (PHA) defines actinomycosis in which the source of infection cannot be demonstrated elsewhere. Herein, we aimed to highlight hepatic actinomycosis in the differential diagnosis of hepatic mass lesions, and also its occurrence even in patients without underlying risk factors. A 24-year-old man, who presented with epigastric and right-upper-quadrant abdominal pain, fever, weight loss, and had a tumor-like mass in the liver was admitted to our hospital. He had no predisposing risk factors or comorbidities. We reviewed all the cases with PHA, who had no predisposing risk factors, in English medical literature from 1993 to 2014. Actinomycotic hepatic pseudotumors should be considered in the differential diagnosis of solitary liver lesions even in patients without any predisposing factors. Multi-disciplinary approach is important in the diagnosis and management. J Microbiol Infect Dis 2015;5(2): 79-8

Kompozit mantle hücreli lenfoma ve EBV pozitif klasik hodgkin lenfoma: Olgu sunumu

Composite lymphomas are two different lymphomas existing in the same location, syn- chronously. In the literature, composite lymphomas developed from different clones are rarely found as case reports. The coexistence of mantle cell lymphoma and classical Hodgkin lymphoma (HL) is very uncommon. The case we present was a 53-year-old male patient with a lymphocyte-rich HL in the left inguinal lymph node biopsy and a mantle cell lymphoma in the bone marrow. The diagnosis was composite lymphoma (mantle cell lymphoma + lym- phocyte-rich HL) in the re-evaluation of the lymph node biopsy. Our case shows composite lymphoma developing from two separate clones (EBV positive classical HL and mantle cell lymphoma) in the lymph node and mantle cell lymphoma in the spleen and bone marrow. This case was presented and discussed because of its rarity and misleading morphology and because it is the youngest biclonal composite lymphoma with the longest survival.Kompozit lenfomalar iki farklı lenfomanın aynı anda tek lokalizasyonda bulunmasıdır. Literatürde farklı klonlardan gelişmiş kompozit lenfomalar nadir olup olgu sunumu şeklindedir. Mantle hücreli lenfoma ve Klasik Hodgkin lenfoma (HL) birlikteliği çok nadir bildirilmiştir. Olgumuz 53 yaşında erkek hastadır. Sol kasığındaki lenf nodu biyopsisinde lenfositten zengin Hodgkin lenfoma, kemik iliğinde mantle hücreli lenfoma saptanmıştır. Lenf nodunun tekrar değerlendirilmesinde kompozit lenfoma (mantle hüceli lenfoma+ lenfositten zengin Hodgkin lenfoma) tanısı almıştır. Olgumuz lenf nodunda iki ayrı klondan gelişim gösteren kompozit lenfoma (EBV pozitif klasik HL ve mantle hücreli lenfoma), dalak ve kemik iliğinde ise mantle hücreli lenfoma tutulumu göstermektedir. Literatürde çok nadir olması yanıltıcı morfolojiye sahip olması, en genç ve en uzun sağ kalım gösteren biklonal kompozit lenfoma olması nedeniyle olgumuzu literatür bilgileri ışığında sunduk

Extramedullary myeloma in ectopic parathyroid adenoma: A case report

Extramedullary myeloma, a subgroup of multiple myeloma, is a rare condition characterised by extra-skeletal infiltration of clonal plasma cells. Although parathyroid adenoma's co-morbidity with multiple myeloma is common, extramedullary myeloma, an ectopic parathyroid adenoma has not been reported in the literature. This is the first study in literature that presents extramedullary myeloma that infiltrated ectopic parathyroid adenoma in the mediastinum after multiple myeloma treatment. In its course of relapse, the extramedullary myeloma created mass effect and no laboratory findings were present due to its non-secretory nature

Endobronşiyal ultrasonografi eşliğinde transbronşiyal ince iğne aspirasyonu: Yeterliliğin belirleyicileri

WOS: 000438747600018Background: This study aims to evaluate the factors influencing the adequacy of endobronchial ultrasound-guided transbronchial fine needle aspiration specimens. Methods: A retrospective analysis of 1,700 endobronchial ultrasound-guided transbronchial fine needle aspiration samples obtained from 822 patients (500 males, 322 females; mean age 56 +/- 13 years; range 16 to 83 years) was performed between March 2011 and March 2014 at our center. Variables potentially associated with sampling adequacy, such as all cytological materials and procedure notes (lymph node and/or lesion size, localization, needle pass number, and slide number) were examined. Results: The overall specimen adequacy was 79.8%. The specimen adequacy was associated with needle pass number (P <= 0.001). Adequacy rate was 66.9% for one needle pass and 85.8% for three needle passes. According to the sampling regions, adequacy rates showed a difference [69.2%-85.8%; (p <= 0.005)]. In the multivariate logistic regression analysis of subcarinal (7) lymph node station, patient age (odds ratio, 0.983; 95% confidence interval, 0.966-1.000; p=0.049) and number of slides (odds ratio, 1.240; 95% confidence interval, 1.062-1.448; p=0.006) were independent determining factors of specimen adequacy. While independent determinants of specimen adequacy for the right paratracheal (4R) region were lymph node size (odds ratio, 1.486; 95% confidence interval, 0.973-2.268; p=0.067) and number of slides (odds ratio, 1.418; 95% confidence interval, 1.146-1.756; p=0.001), they were lymph node size (odds ratio, 1.594; 95% confidence interval, 0.960-2.645; p=0.071) and number of needle passes (odds ratio, 2.277; 95% confidence interval, 1.360-3.811; p=0.002) for the right interlobar (11R) region. Independent determinant of specimen adequacy for the left paratracheal (4L) lymph node station was the number of needle passes (odds ratio, 1.656; 95% confidence interval, 0.955-2.869; p=0.072). Conclusion: During endobronchial ultrasound-guided transbronchial fine needle aspirations, particularly when rapid on site evaluation cannot be applied, consideration of factors affecting adequacy according to lymph node localizations may increase the chance for obtaining materials with suitable quality for cytologic evaluation.Amaç: Bu çalışmada endobronşiyal ultrasonografi eşliğinde transbronşiyalince iğne aspirasyonu örneklerinde yeterliliği etkileyen faktörlerdeğerlendirildi.Ça­lış­ma pla­nı: Merkezimizde Mart 2011 - Mart 2014 tarihleri arasında822 hastadan (500 erkek, 322 kadın; ort. yaş 56±13 yıl; dağılım 16-83 yıl)edinilen 1700 endobronşiyal ultrasonografi eşliğinde transbronşiyal inceiğne aspirasyonu örneği retrospektif olarak analiz edildi. Tüm sitolojikmateryaller ve işlem notları (lenf nodu veya lezyon boyutu, yerleşim yeri,iğne girişimi sayısı ve yayma preparat sayısı) gibi örnek yeterliliği ile ilişkiliolabilecek değişkenler incelendi.Bulgular: Genel örnek yeterliliği %79.8 idi. Örnek yeterliliği iğne girişimisayısı ile ilişkili idi (p≤0.001). Yeterlilik oranı tek iğne girişimi için%66.9, üç iğne girişimi için %85.8 idi. Yeterlilik oranları örneklem almabölgelerine göre farklılık gösterdi [%69.2-%85.8; (p≤0.005)]. Subkarinal(7) lenf nodu istasyonunun çok değişkenli lojistik regresyon analizinde,hasta yaşı (göreceli risk oranı, 0.983; %95 güven aralığı, 0.966-1.000;p=0.049) ve yayma preparat sayısı (göreceli risk oranı, 1.240; %95 güvenaralığı, 1.062-1.448; p=0.006) örnek yeterliliğinin bağımsız belirleyicifaktörleri idi. Sağ paratrakeal (4R) bölge için örnek yeterliliğinin bağımsızbelirleyici faktörleri lenf nodu boyutu (göreceli risk oranı, 1.486; %95güven aralığı, 0.973-2.268; p=0.067) ve yayma preparat sayısı (göreceli riskoranı, 1.418; %95 güven aralığı, 1.146-1.756; p=0.001) iken sağ interlober(11R) bölge için lenf nodu boyutu (göreceli risk oranı, 1.594; %95 güvenaralığı, 0.960-2.645; p=0.071) ve iğne girişimi sayısı (göreceli risk oranı,2.277; %95 güven aralığı, 1.360-3.811; p=0.002) idi. Sol paratrakeal (4L)lenf nodu istasyonu için örnek yeterliliğinin bağımsız belirleyici faktörüiğne girişimi sayısı (göreceli risk oranı, 1.656; %95 güven aralığı, 0.955-2.869; p=0.072) idi.So­nuç: Endobronşiyal ultrasonografi eşliğinde transbronşiyal ince iğneaspirasyonlarında, özellikle yerinde hızlı değerlendirme yapılamadığında,lenf nodu yerleşim yerlerine göre yeterliliği etkileyen faktörlerin göz önüne alınması sitolojik değerlendirme için uygun nitelikte materyaller elde edilmesi şansını artırabilir