Diagnostic and prognostic significance of claudin expression in renal cell carcinomas.

TEZ8013Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2010.Kaynakça (s. 70-74) var.vii, 75 s. : rnk. res., tab. ; 29 cm.Objective: Renal cell carcinomas consist % 2-3 of all cancers and more than % 90 of the renal masses. Eosinophilic and granuler cytoplasmic tumors of kidney are oncocytomas and eosinophilic variants of the cromophobe, papillary and clear cell subtypes of renal cell carcinomas. Currently, there are studies to differentiate these tumors by markers. In our study, we performed claudin 1, 3, 4, 7 and 8 on renal cell carcinoma types and oncocytoma. The results were compared with grade, stage, prognosis and diagnostic impact. Material and Method: Excision materials of 134 renal cell carcinoma cases which were diagnosed at the Pathology Department of Çukurova University Medical Faculty were studied. The material was consisted of 72 clear cell, 26 chromophobe, 24 papillary renal cell carcinoma and 12 oncocytoma cases. Specimens were fixed in % 10 formaldehide solution, parafin embedded and were stained by hematoxylin eosine. Immunohistochemically, Claudin 1, 3, 4, 7 and 8 were evaluated acording to their staining intesity, diffusiveness and location. Results: By Claudin 1; % 73.1 of chromophobe renal cell carcinoma cases were stained membranous and % 91.7 of the oncocytomas were stained cytoplasmically positive. By Claudin 3; % 81.9 of the clear cell renal cell carcinoma were negative, % 100 of oncocytomas were stained cytoplasmically positive. By Claudin 4; % 95.8 of clear cell renal cell carcinoma, % 75 of papillary renal cell carcinoma, % 34.6 of chromophobe renal cell carcinoma were stained negative, % 100 of the oncocytoma cases were cytoplasmically positive. By Claudin 7; % 84.6 of chromophobe renal cell carcinoma were stained membranous positive, % 91.7 of oncocytoma cases were cytoplasmically positive. By Claudin 8; % 73.6 of clear cell renal cell carcinoma and % 44.4 of papillary renal cell carcinoma were negative, % 100 of oncocytomas were cytoplasmically positive. The specifity of cytoplasmic positivity for oncocytoma and membranous positivity for chromophobe renal cell carcinoma was % 91 and the sensitivity was % 92 with claudin 7. Where as the specifity of membranous staining for chromophobe and cytoplasmic positivity for oncocytoma was % 91 and the sensitivity was % 84. Conclusion: As a result, we found out that claudin 1, 7, 8 can be use at the differential diagnosis of oncocytoma and chromophobe renal cell carcinoma, on the other hand claudin 3, 4 can be useful to differentiate oncocytoma from eosinophilic variant of clear cell renal cell carcinoma. Additionally, we also showed the prognostic impact of claudin 1, 3 and 8 especially at the papillary renal cell carcinoma. Our results pointed out that claudins can be used in a panel as a prognostic parameter and diagnostic marker at the differential diagnosis of the renal cell carcinoma types. Further studies with larger series are needed to evaluate their supports at the treatment strategies.Amaç: Renal hücreli karsinom tüm kanserlerin % 2-3' ünü, böbrekte izlenen kitlesel lezyonların % 90'dan fazlasını oluşturur. Böbreğin eozinofilik ve granüler sitoplazmalı tümörleri arasında onkositom, renal hücreli karsinomun kromofob, papiller ve şeffaf hücreli tiplerinin eozinofilik varyantları sayılabilir. Bu tümörlerin birbirinden ayrımında kullanılabilecek markır arayışları devam etmektedir. Bu amaçla çalışmamızda renal hücreli karsinom tipleri ile onkositom olgularına claudin 1, 3, 4, 7 ve 8 uygulandı. Sonuçlar grade, evre, prognostik ve tanısal değer açısından karşılaştırıldı. Gereç ve yöntem: Çalışmaya Çukurova Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı'nda tanı almış 134 adet renal hücreli karsinom olgusuna ait eksizyon örnekleri alındı. Olguların 72'si şeffaf, 26'sı kromofob, 24'ü papiller ve 12'si onkositom idi. Doku örnekleri % 10'luk formaldehitte tespit edilerek, parafine gömüldü ve histolojik kesitler hazırlandı. Hematoksilen eozin boyası uygulanarak ışık mikroskobik inceleme yapıldı. İmmünohistokimyasal yöntem ile uygulanan claudin 1, 3, 4, 7 ve 8'in boyanma şiddeti, yaygınlığı ve lokalizasyonu değerlendirildi. Bulgular: Claudin 1 ile kromofob renal hücreli karsinom'da % 73,1 membranöz, onkositomda % 91,7 sitoplazmik boyanma izlendi. Claudin 3 ile şeffaf hücreli renal hücreli karsinom'un % 81,9' unda boyanma izlenmezken, onkositomlarda % 100 sitoplazmik boyanma izlendi. Claudin 4 ile şeffaf hücreli renal hücreli karsinom'da % 95,8, papiller renal hücreli karsinomun % 75, kromofob renal hücreli karsinomun % 34,6'sında boyanma izlenmezken, onkositom vakalarının % 100'ü sitoplazmik boyandı. Claudin 7 ile kromofob renal hücreli karsinom'da % 84,6 membranöz, onkositomda % 91,7 sitoplazmik boyandı. Claudin 8 ile şeffaf hücreli renal karsinomda % 73,6, papiller renal hücreli karsinomda % 44,4 boyanma yokken, kromofob renal hücreli karsinomun % 47,4 membranöz, onkositomda ise % 100 sitoplazmik boyanma izlendi. Onkositom'da sitoplazmik boyanma, kromofob'da membranöz boyanma kabul edildiğinde spesifite claudin 7 için % 91, sensitivite % 92 idi. Kromofob membranöz, onkositom sitoplazmik boyandığında ise spesifite % 91, sensitivite % 84 idi. Sonuç: Sonuç olarak çalışmamızda, claudin 1, 7, 8' in onkositom ve KRH ayrımında kullanılabileceğini, claudin 3 ve 4'ün ise ŞHRHK'un eozinofilik varyantı ile onkositom ayrımında yardımcı olabileceğini saptadık. Claudin 1, 3 ve 8'in ise özellikle papiller renal hücreli karsinomda prognostik önemini tespit ettik. Bulgularımız claudin'lerin renal hücreli karsinom tiplerinin ayırıcı tanısında ve prognostik parametre olarak panel içinde kullanılabileceğini göstermektedir. Bu konuda daha geniş serilerde çalışmalar yapılıp, tedaviye olan katkıları da değerlendirilmelidir.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: TF2007LTP19

Anastomotic Leakage in a Patient with Acute Intestinal Obstruction Secondary to Appendiceal and Ileal Endometriosis: A Case Report

Endometriosis is a commonly encountered problem in women of reproductive age. It usually causes chronic abdominal pain. However, it rarely causes complications such as intestinal obstruction. The most commonly performed procedure for these patients is bowel resection and anastomosis. Unless it is complicated with anastomotic leakage. We present a 39-year-old woman presented with intestinal obstruction due to appendiceal and ileal endometriosis complicated with anastomotic leakage after surgery

The changes in the incidence of thyroid gland diseases: Data from Cukurova region of Turkey

WOS: 000249454600754

Retroperitoneal Schwannoma: A Case Report

Schwannomas are benign tumors originating from Schwann cells of the neural sheaths. Only 0.3% to 3% of the schwannomas are located the retroperitoneal space. Most schwannomas are asymptomatic and often found incidentally. The ideal treatment is complete surgical excision. Here, we report a case of a 49-year-old woman with retroperitoneal schwannoma

An Unusual Gastrointestinal Stromal Tumor Presentain: Breast, Liver and Lymph Node Metastasis

Gastrointestinal Stromal Tumors (GIST) are the common mesenchymal tumors of gastrointestinal tract. They can display benign and malignant clinical behavior. The most common metastasis sites of malignant stromal tumor are liver, peritoneum, lung and bones. Metastasis to breast is extremely rare. Here, we present a case of GIST with liver, bone, lymph node and breast metastasis by reviewing the literature

Expression of p53, Ki67, epidermal growth factor receptor, transforming growth-factorα, and p21 in primary and secondary hyperparathyroidism

Background: Secondary hyperparathyroidism (SH) is major problem in chronic renal failure. There are studies to examine proliferation and apoptosis associated biomarkers expressions in parathyroid lesions to reveal specific features. In this study, we evaluated the expression of some growth factors and their receptors in parathyroid gland of patients with SH or primary hyperparathyroidism (PH). Materials and Methods: A total of 49 patients had been operated for PH and 26 for SH. Parathyroid tissue samples were evaluated histopathologically and immunohistochemically using antibodies to human p53, Kİ-67, anti-human p21, antitransforming growth factor (TGF) α, CPP32 (caspase 3), and epidermal growth factor receptor (EGFR). Results: Adenoma was higher in PH compared with SH as 48/49 and 3/26, respectively (P = 0.000). Parathyroid hyperplasia was found in 23/26 patients with SH and 1/49 patient with PH. In parathyroid tissue there were no difference between PH and SH for p53, Ki-67, caspase, EGFR expressions; while there were significantly difference for TGFα (P = 0.047) and borderline significant difference for p21 (P = 0.06) expressions. Conclusion: Adenoma was priority present in PH patients, hyperplasia was present in SH. There were no differences between primary and SH or adenoma and hyperplasia for expressions of cycline-dependent kinase inhibitor p21, p53, EGFR, Ki67, caspase; while TGFα expression was found to be different