A synchronous occurrence of urothelial carcinoma with abundant myxoid stroma and inverted papilloma of the urinary bladder

Abundant myxoid stroma rarely occurs in urothelial carcinomas, and may cause diagnostic challenges when cells with eosinophilic cytoplasm forming nests and cords in a myxoid background are seen, particularly in the absence of typical carcinomatous appearance. Microscopic examination of transurethral resection specimen of a 71-year-old male patient revealed non-cohesive oval or elongated tumor cells with eosinophilic cytoplasm arranged in cord-like filigree pattern in an abundant myxoid stroma. Immunohisto chemically the tumor was positive for cytokeratin 7, cytokeratin 20, and 34BE12. About 90 to 100% nuclear staining was observed with p63, p53, and Ki-67. A second neoplasm with a flat overlying urothelial epithelium and a complete inverted cellular growth pattern was also noted. The neoplasm exhibited less than 2% and 10% nuclear staining with Ki-67 and p53, respectively. Considering histological, histochemical, and immunohistochemical findings, a diagnosis of synchronous urothelial carcinoma with abundant myxoid stroma and inverted papilloma was made

CD10 expression in urothelial carcinoma of the bladder

Background. CD10 antigen is a 100-kDa-cell surface zinc metalloendopeptidase and it is expressed in a variety of normal and neoplastic lymphoid and nonlymphoid tissues. The aim of this study was to evaluate CD10 expression in urothelial carcinoma of the urinary bladder and to determine the correlation between immunohistochemical (IHC) CD10 expression and histopathologic parameters including grade and stage. Methods. 371 cases of urothelial bladder carcinomas, all from transurethral resections, were included in this study. Hematoxylin-eosin (HE) stained sections from each case were reevaluated histopathologically according to WHO 2004 grading system. The TNM system was used for pathologic staging. Selected slides were also studied by IHC and a semiquantitative scoring for CD10 expression based on the percentage of positive cells was performed. Results. 157 cases (42.3%) showed immunostaining while 214 cases (57.7%) were negative for CD10. 1+ staining was seen in 65 CD10 positive cases (41.4%), and 2+ in 92 cases (58.6%). Overall CD10 expression as well as 2+ immunostaining was significantly correlated with high histologic grade. Overall CD10 expression was also significantly higher in invasive pT1 and pT2-3 tumors compared to noninvasive pTa tumors. pT1 and pT2-3 tumors were also significantly correlated with 2+ immunostaining. Conclusion. To date, only a few comparative IHC studies have assessed CD10 expression in urothelial carcinoma of the urinary bladder and this study represents the largest series. Our findings indicate that CD10 expression is strongly correlated with high tumor grade and stage in urothelial carcinoma of the bladder, and that CD10 may be associated with tumor progression in bladder cancer pathogenesis. © 2009 Bahadir et al; licensee BioMed Central Ltd

The Histomorphogenetic Relationship between Melanocytes and Langerhans Cells in Ovarian Mature Cystic Teratomas

Amaç: Biz bu çalışmada; hücre birimleri, organizasyon ve arşitektürel yapılanmalar bakımından orijinaline yakın sayılabilecek genel anlamda bir vücut yapımı gösteren matür kistik teratomlarda epidermisteki melanositler ve Langerhans hücrelerinin varlığı, birbiri ile sayısal ilişkileri ve birlikte bulunmaları halinde embriyolojik kaynakları hakkında fikir yürütebilmeyi amaçladık. Yöntemler: Sağlık Bakanlığı İstanbul Eğitim ve Araştırma Hastanesi Patoloji Bölümü'nde 2006-2009 yılları arasında rapor edilen 45 matür kistik teratom olgusu çalışmaya alındı. İmmünohistokimyasal olarak; melanositler için Human Melanoma Black-45 (HMB-45) ve Melanoma Antigens (Melan-A) recognized by T cells-1), Langerhans hücreleri için Cluster of Differentiation 1a (CD1a) ve Langerin uygulandı. Bulgular: Langerhans hücreleri olguların %100'ünde tespit edilmekle birlikte, melanositler %88,2'sinde mevcuttu. Sonuç: Bizim çalışmamıza göre Langerhans hücrelerinin, melanositlerin köken aldığı bilinen nöral krest dışında bir kaynaktan gelişmiş olabileceği ve bu iki hücre arasında ilişki olamayabileceği sonucuna vardık.Objective: The purpose of this study was to form a view about the existence, numerical relationship and embryological origin of melanocytes and Langerhans cells when they are found together in mature cystic teratomas which have similar cell types and architectural structure to the original vertebrated body. Methods: Forty five mature cystic teratomas cases, diagnosed in the Ministry of Health İstanbul Education and Research Hospital Pathology Department between 2006-2009 were included in the study. Immunohistochemically, Human Melanoma Black-45 (HMB-45) and Melanoma Antigens (Melan-A) recognized by T cells-1) for melanocytes, Cluster of Differentiation 1a (CD1a) and Langerin for Langerhans cells were applied. Results: Although Langerhans cells were detected in 100%, melanocytes were established in 88.2% of cases. Conclusion: According to our study, Langerhans cells could derive from another source except the neural crest where melanocytes evolve and there is no relationship between them

Evaluation of the effect of mitral stenosis severity on the left ventricular systolic function using isovolumic myocardial acceleration

Background: Isovolumic acceleration (IVA) is a new tissue Doppler parameter in the as­sessment of systolic function of both left and right ventricles. It remains unaffected with the changes in pre- and after-load within the physiological range. The aim of our study was to assess the effect of mitral stenosis degree, which is determined by echocardiography, on the left ventricular (LV) function using IVA. Methods: A total number of 62 patients with mitral stenosis (MS) and 32 healthy controls were examined. The severity of MS (mild, moderate, and severe) was determined on the basis of mitral valve area (MVA) and the mean diastolic mitral gradient findings. The peak myocardial velocities during isovolumic contraction, systole, early diastole and late diastole were measured by using tissue Doppler imaging (TDI). Results: All TDI-derived global LV basal wall systolic (peak myocardial isovolumic contra­ction velocity, peak myocardial systolic velocity and IVA), and diastolic velocities (peak early and late diastolic velocities) were significantly decreased in the patients with MS, compared to the healthy patients (p < 0.001, for all). However, IVA was not different when the degree of MS was evaluated (p = 0.114). In addition, IVA was not correlated with the MVA (r = 0.185, p = 0.150). Conclusions: Left ventricular function is impaired in patients with MS regardless of the severity of the disease.

Radiosurgery effects and adverse effects in symptomatic eloquent brain-located Cavernomas

In this study, the dose schedule efficacy, safety and late adverse effects of stereotactic radiosurgery (SRS) were evaluated for patients with symptomatic cavernomas who were not eligible for surgery and treated with SRS. Between January 2013 and December 2018, 53 patients with cavernomas were treated using SRS with the CyberKnife (R) system. Patients' diseases were deeply located or were in subcortical functional brain regions. In addition to bleeding, 23 (43.4%) patients had epilepsy, 12 (22.6%) had neurologic symptoms and 16 patients (30.2%) had severe headaches. The median volume was 741 (range, 421-1351) mm(3), and the median dose was 15 (range, 14-16) Gy in one fraction. After treatment, six (50%) of 12 patients with neurologic deficits still had deficits. Rebleeding after treatment developed in only two (3.8%) patients. The drug was completely stopped in 14 (60.9%) out of 23 patients who received epilepsy treatment, and the dose of levetiracetam decreased from 2000 mg to 1000 mg in four (17.3%) of nine patients. Radiologically, complete response (CR) was observed in 13 (24.5%) patients, and partial responses (PR) were observed in 32 (60.2%) patients. Clinical response of CR was observed in 30 (56.6%) patients, PR was observed in 16 (30.2%), stable disease (SD) was observed in three (5.7%) and four (7.5%) patients progressed. In conclusion, SRS applied in the appropriate dose schedule may be an effective and reliable method in terms of symptom control and prevention of rebleeding, especially in patients with inoperable cavernomas

Comprehensive Analysis of Prognostic Factors Affecting Postoperative Mortality in Adult Patients Undergoing Lower Extremity Amputation due to Diabetic Foot Ulcer

Aim:Mortality is significantly increased in patients undergoing amputation for diabetic foot ulcers (DFUs). The new biomarkers prognostic nutritional index (PNI), C-reactive protein (CRP)/albumin ratio, and comorbidities may help predict prognosis. This study aimed to determine the factors affecting mortality in DFU patients undergoing amputation.Methods:This study is a retrospective case series of patients who underwent lower extremity amputation due to DFU between 2016 and 2018. Data on demographics, clinical information, laboratory test results, comorbidities, hospital stays, re-amputations, and complications were recorded. PNI was calculated using serum albumin concentration and lymphocyte count.Results:A total of 97 patients (21 females and 76 males) were analyzed in the study, with 18 patients having bilateral lower extremity amputations (foot amputation, below-knee amputation, and above-knee amputation). The mean age was 64.48 years, and the mean follow-up period was 34.27 months. The mean length of hospital stay was 19.09 days, with a mean of 1.34 days spent in the intensive care unit. Preoperative laboratory test results showed a mean creatinine level of 1.4 mg/dL, a urea level of 55.22 mg/dL, an albumin level of 2.8 g/L, and a fasting blood glucose level of 168.8 mg/dL. The mean preoperative PNI was 39.31, and the mean CRP/albumin ratio was 42.51. Intensive care unit admission, CRP/albumin ratio, and CRP levels significantly affect 1-year postoperative mortality. The cut-off value for CRP as determined by receiver operating characteristic analysis was 89.9 mg/L. No significant association was found between comorbidities and mortality.Conclusion:We demonstrated that comorbidities and the new biomarker PNI did not affect mortality. CRP levels, intensive care unit admission, and the new predictor CRP/albumin ratio significantly affected 1-year mortality

Effects of Different Applications on Postoperative Seroma Formation and Wound Healing Following Mastectomy and Axillary Dissection in Rats

The most frequent postoperative complication after breast surgery is seroma formation. Seroma occurs due to lymphatic and vascular fluid leakage into the dead space created by surgical dissection. The objective of the research was to evaluate the effects of local fibrin glue, tetracycline, talc applications, and flap fixation technique on reducing seroma formation after mastectomy and axillary dissection. In addition, we aimed to determine the level of efficacy for these applications, as well as to identify the most appropriate method to be used in operations with high risk of seroma formation. Materials and Methods. This experimental study was conducted using a total of 60 female Wistar albino rats. They were allocated into six groups and each comprised ten rats. Unilateral mastectomy and axillary dissection were performed on all the rats. Local applications of fibrin glue, tetracycline, talc, and alcoholic iodine were performed in four separate groups. Flap fixation technique was applied in one group and those rats that did not receive any intervention constituted the control group. On the 10th postoperative day, seroma was aspirated under anesthesia, and the amount of seroma fluid was recorded. Seroma fluid was analyzed for interleukin 1-β, vascular endothelial growth factor, and C-reactive protein levels. Tissue samples were obtained from the skin overlaying the dissection area, the axilla, and the thoracic wall. Wound healing was evaluated with histopathological examination. Results. Seroma volume was lower and the wound healing scores were the highest in the flap fixation group and the tetracycline group as compared to the control group. However, the alcoholic iodine group and the talc group had a greater amount of seroma (p < 0.05). There was no difference between the fibrin glue group and the control group. Conclusions. In our mastectomy model, local application of alcoholic iodine and talc substances caused more wound site problems and postoperative seroma formation. While fibrin glue did not cause wound site problems, it did increase seroma formation. These three substances were determined to be inefficacious in postoperative seroma formation. Local tetracycline application and flap fixation technique were found to reduce postoperative seroma and benefit wound healing

Zależności między występowaniem nowotworów tarczycy a przewlekłym limfocytarnym zapaleniem tarczycy: zmiana zasad leczenia chirurgicznego?

Wstęp: Istnieją kontrowersje na temat zależności między występowaniem nowotworów tarczycy a przewlekłym limfocytarnym zapaleniem tarczycy (CLT). Wykazano, że ogniskowe limfocytarne zapalenie tarczycy rozwija się wtórnie do zmian nowotworowych, jednak nadal nie wyjaśniono, czy osoby z rozsianą postacią limfocytarnego zapalenia tarczycy mają skłonność do zapadania na raka tarczycy. Celem badania było określenie zależności między CLT i złośliwymi nowotworami tarczycy oraz ocena chirurgicznego leczenia CLT. Materiał i metody: Retrospektywnie analizowano dane 917 chorych operowanych z powodu chorób tarczycy. Siedemdziesiąt siedem (8,4%) osób z histopatologicznie zdiagnozowanym CLT (nieswoiste zapalenie tarczycy lub choroba Hashimoto) przebadano pod kątem nowotworów tarczycy. Do analizy włączono 15 chorych, u których stwierdzono współwystępowanie CLT i nowotworu tarczycy. Wyniki: Ocena histopatologiczna 917 przypadków wykazała zmiany nowotworowe tarczycy u 97 (10,6%) chorych, natomiast u 77 osób stwierdzono CLT. U 16 (20,8%) osób z tej grupy rozpoznano chorobę Hashimoto (swoiste CLT), natomiast u 61 (79,2%) chorych — CLT. U 15 pacjentów nowotwór tarczycy współwystępował z CLT. Wśród stwierdzonych nowotworów odnotowano 9 przypadków (60%) raka brodawkowatego, 3 przypadki (20%) raka rdzeniastego, 1 przypadek (6,6%) raka pęcherzykowego, 1 przypadek (6,6%) raka z komórek Hurtle’a i 1 przypadek (6,6%) chłoniaka. W niniejszej analizie częstość rozwoju nowotworu na podłożu CLT wynosiła 19,48%; natomiast w grupie bez CLT nowotwór rozwinął się u 9,76%; różnica między grupami jest statystycznie istotna (p = 0.008). Wnioski: Należy z większą uwagą oceniać chorych z CLT ze względu na możliwość procesów rozrostowych. W przypadku wykrycia guzka u chorego z zapaleniem tarczycy minimalna interwencja chirurgiczna powinna obejmować lobektomię. Totalna tyroidektomia jest lepszym rozwiązaniem niż subtotalna tyroidektomia, ponieważ wiąże się z większymi korzyściami, do których należą kontrola zapalenia tarczycy, eliminacja ryzyka reoperacji i stabilizacja zaburzeń hormonalnych. (Endokrynol Pol 2011; 62 (4): 303–308)Background: The relation between thyroid neoplasms and chronic lymphocytic thyroiditis (CLT) is controversial. While it is accepted that focal lymphocytic thyroiditis develops secondarily to malignancy, it is not clear whether diffuse lymphocytic thyroiditis has a tendency to develop into thyroid cancer. The aim of this study was to investigate the relation between CLT and malignant tumours of the thyroid and evaluate the surgical approach to CLT cases. Material and methods: In this study, 917 patients operated on for thyroid diseases were investigated retrospectively. Seventy-seven (8.4%) patients histopathologically diagnosed as having CLT (either non-specific or Hashimoto’s thyroiditis) were investigated for any concurrent malignant neoplasm. Fifteen patients in whom CLT and thyroid malignancy were coexisting were included in the study. Results: In the pathological evaluation of 917 cases, malignancy in the thyroid was found in 97 (10.6%) cases. Seventy-seven cases were categorised as CLT. Of these 77, 16 (20.8%) were Hashimoto’s thyroiditis (specific CLT) and the other 61 (79.2%) were non-specific CLT. In 15 cases, thyroid malignancy was found to be concurrent with CLT. Of the malignities, nine (60%) were papillary carcinoma, three (20%) medullar carcinoma, one (6.6%) follicular carcinoma, one (6.6%) Hurthle cell carcinoma, and one (6.6%) lymphoma. In our series, the rate of the development of malignancy against the background of CLT was 19.48%, while the rate in the groups without CLT was 9.76%, with a statistically significant difference between the groups (p = 0.008). Conclusions: CLT cases should be evaluated more carefully in terms of malignancy. If a nodule is detected on thyroiditis, the minimal surgical intervention should be lobectomy. Total thyroidectomy should be considered as preferable to subtotal thyroidectomy because of its many advantages such as controlling thyroiditis, removing the probability of reoperation, and hormonal stability. (Pol J Endocrinol 2011; 62 (4): 303–308

B-Type Natriuretic Peptide in Bronchiolitis: Its Relationship with Left Ventricular Systolic Functions and Prognosis

Introduction:We have limited information about the clinical importance of plasma B-type natriuretic peptide (BNP) level and its prognostic value in children with bronchiolitis. In this study, we aimed to determine basal plasma BNP levels and their relationship with left ventricular systolic functions and prognosis in patients hospitalized with moderate to severe bronchiolitis.Methods:The study was conducted prospectively on 37 patients aged 1-24 months with a modified Wang respiratory score of 6 and above and diagnosed with bronchiolitis. The patients with high (>100 pg/mL, n=6) and normal (≤100 pg/mL, n=31) serum BNP levels were compared in terms of left ventricular systolic functions, and vital, laboratory, and radiological findings. The relationship between serum BNP level and prognosis was evaluated.Results:The mean basal plasma BNP level in the patients was significantly higher than in controls (61.75±65 pg/mL vs. 13.99±8.79 pg/mL; p=0.001). There was no significant difference in ejection fraction and fractional shortening values between the patients with normal and high BNP levels and controls (p>0.05). Patients with high BNP levels had higher mean partial carbon dioxide values than patients with normal BNP levels (p=0.037). There was a positive correlation between plasma BNP level and length of hospital stay (r=0.286; p=0.007) and intensive care unit stay (r=0.645; p=0.000).Conclusion:An increase in serum BNP levels may be seen in patients with moderate to severe bronchiolitis without myocardial dysfunction. It was argued that this BNP increase may be related to the degree of deterioration of gas exchange associated with the disease. Plasma BNP level is a potential prognostic factor in moderate to severe bronchiolitis