Normocalcemic brown tumor mimicking metastatic bone disease: report of a case

Kemik sintigrafisi oldukça yaygın kullanılan bir tarama yöntemidir. Brown tümör ilerlemis hiperparatiroidinin oldukça nadir görülen bir bulgusudur. Primer hipertroidi, hiperkalsemi ve hipofosfatemi ile seyreden bir hastalıktır ve sintigrafik görüntülemede metastatik kemik hastalıgını taklit edebilir. Biz bu yazımızda yaygın kemik agrısı yakınması ile basvuran ve çekilen tüm vücut kemik sintigrafisinde kostalarda ve sol femur proksimalinde metastatik olarak degerlendirilen aktivite artısları saptanan 65 yasında bir kadın hastayı sunuyoruz. Ancak, yapılan tetkiklerinde serum kalsiyum ve fosforu normal sınırlardaydı. Paratiroid sintigrafisinde sag alt bölgede paratiroid adenomu ile uyumlu artmıs tutulum saptandı ve paratiroidektomi yapıldı.Bone scintigraphy is a commonly used screening tool in medicine. Brown tumor can be a rare skeletal manifestation of advanced hyperparathyroidism. Primer hyperparathyroidism presents with hypercalcaemia and hypophosphatemia and it can mimic metastatic bone disease. We described a 65-year-old woman who has referred for generalized pain exacerbating on movement and increased uptake in the ribs, proximal of the left femur neck suggestive of metastatic lesions by whole body bone scintigraphy. However, serum calcium and phosphorus levels were normal. Parathyroid scintigraphy revealed extensive uptake in the right lower neck regions consistent with parathyroid adenoma. Parathyroidectomy was performed

Effects of Bevacizumab, an Anti Vascular Endothelial Growth Factor Monoclonal Antibody, on Kidney Function and Morphology

AimTo constitute an experimental rat model by using human VEGF monoclonal antibody bevacizumab, for observation of renal side effects of this treatment.Materials and MethodsThirtysix adult female Wistar albino rats has been divided as two main groups: “3 days” and “21 days” . Each group has been divided in three; bevacizumab 10 mg/kg and 20 mg/kg were administered intravenously from the tail veins of the two subgroups and 1 mg/kg saline was administered to the third subgroup as control. Urine for 24 hours for detection of proteinuria and blood samples for detection of renal funtions were collected before, third day and 21st day of the drug administration and rats were sacrified at third and 21st days for pathological examination of kidneys.ResultsTwenty four hours urine protein excretion, creatinin excretion and urine protein/creatinin ratio were demonstrated as significantly increased on the third day of the rats administered 10 mg/kg bevacizumab; however, any significant increase of proteinuria couldn’t be shown on the 21 days group rats administered neither 10 mg/kg or 20 mg/kg. Pathological examination of rats sacrified on third day demonstrate the significant increase of bowman capsule gap and interstitial inflamation as correlated with the dosage of the drug. The thickness of vessel wall was observed on the pathological examination of rats sacrified on 21st day.ConclusionIt has been shown that bevacizumab administration of 10 mg/kg for three days is proper for constitution of an experimental rat model

Kolorektal adenomlar ve adenokarsinomlarda hücre siklusunu düzenleyen proteinlerin ve apopitozla ilgili belirteçlerin ekspresyonu

OBJECTIVE: Tumor growth is regulated by a balance between proliferation, growth arrest and cell death. In this study, we have examined the expression of p27, cyclin D1, bcl-2, and bcl-x for evaluation of their roles in colon carcinoma progression. MATERIALS and METHODS: The levels of p27, cyclin D1, bcl-2, and bcl-x expression were examined by immunohistochemistry in transitional normal mucosa adjacent to adenomas (n=30), adenomas (n=30), transitional normal mucosa adjacent to adenocarcinomas (n=63), adenocarcinomas (n=63) and metastasis (n=16). Standard streptavidin-biotin immunperoxidase method was used for immunostaining and the stained slides were examined microscopically using semiquantitative criteria. RESULTS: Normal mucosa expressed p27 protein and adenocarcinomas displayed a decrease in the expression of this protein. Decreased expression of p27 was associated with tumor progression (p=0.026). Cyclin D1 staining was prominent in most of the adenocarcinomas and metastasis (p=0.042). Meanwhile, we could not find any relation between p27 and cyclin D1 expression. Bcl-2 and bcl-x expression also did not show any statistically significant correlation in tumor progression. CONCLUSION: The results of this study indicate that reduced p27 and cyclin D1 protein levels play an important role in progression of colon cancer. Bcl-2, and bcl-x expression were of no role.AMAÇ: Tümör gelişimi proliferasyon, büyümede durma ve hücre ölümü arasındaki denge ile düzenlenir. Bu çalışmada, kolon karsinomunun gelişimindeki rollerinin değerlendirilmesinde p27, siklin D1, bcl-2 ve bcl-x expresyonunu inceledik. GEREÇ ve YÖNTEM: p27, siklin D1, bcl-2 ve bcl-x expresyonunun düzeyleri, adenomlara komsu normal mukozada (n=30), adenomlarda (n=30), adenokarsinomlara komsu normal mukozada (n=63), adenokarsinomlarda (n=63) ve metastazlarda (n=16) immünohistokimyasal olarak incelendi. Immün boyama için standart streptavidin-biotin immünperoksidaz metodu kullanıldı ve boyanan slaytlar yarı kantitatif kriterler kullanarak mikroskopik olarak incelendi. BULGULAR: Normal mukozada p27 protein ekspresyonu saptandı, adenokarsinomlar ise bu protein ekspresyonunda azalma gösterdi. p27 ekspresyonunda azalma tümör progresyonu ile ilişkili idi (p=0,026). Siklin D1 boyaması adenokarsinom ve metastazların çoğunda belirgindi (p=0,042). Bu arada, p27 ve siklin D1 ekspresyonu arasında herhangi bir iliski saptamadık. Bcl-2 ve bcl-x ekspresyonu da tümör progresyonunda istatistiksel olarak belirgin anlamlılık göstermedi. SONUÇ: Bu çalışmanın sonucu p27 ve siklin D1 protein düzeylerinin kolon kanserinin progresyonununda önemli rolü oldugunu göstermektedir. Bcl-2 ve bcl-x ekspresyonunun ise rolü saptanmamıştır

NF-KappaB expression correlates with apoptosis and angiogenesis in clear cell renal cell carcinoma tissues

<p>Abstract</p> <p>Background</p> <p>Clear cell renal cell carcinoma (ccRCC) is the most frequently encountered tumor in the adult kidney. Many factors are known to take part in the development and progression of this tumor. Nuclear factor kappa B (NF-κB) is a family of the genes that includes five members acting in events such as inflammation and apoptosis. In this study, the role of NF-κB (p50 subunit) in ccRCC and its relation to angiogenesis and apoptosis were investigated.</p> <p>Methods</p> <p>Formalin-fixed and paraffin embedded tissue blocks from 40 patients with ccRCC were studied. Expressions of NF-κB (p50), VEGF, EGFR, bc1-2 and p53 were detected immunohistochemically. The relationship of NF-κB with these markers and clinicopathological findings were evaluated.</p> <p>Results</p> <p>The expression of NF-κB was detected in 35 (85%), VEGF in 37 (92.5%), EGFR in 38 (95%), bc1-2 in 33 (82.5%) and p53 in 13 (32.5%) of 40 ccRCC patients. Statistical analyses revealed a significant relation between NF-κB expression and VEGF (p = 0.001), EGFR (p = 0.004), bc1-2 (p = 0.010) and p53 (p = 0.037). There was no significant correlation between NF-κB and such parameters as tumor grade, stage, age and sex.</p> <p>Conclusion</p> <p>The results of this study indicated that in ccRCC cases NF-κB was associated with markers of angiogenesis and apoptosis such as VEGF, EGFR, bc1-2 and p53. In addition, the results did not only suggest a close relationship between NF-κB and VEGF, EGFR, bc1-2 and p53 in ccRCC, but also indicate that NF-κB was a potential therapeutic target in the treatment of ccRCC resistant to chemotherapy.</p

Multipl skleroza benzer multisentrik gliomun magnetik rezonans görüntüleme bulguları

Multiple gliomas are relatively uncommon. Demyelinating disease may represent with similar radiological findings with multiple gliomas. We present the magnetic resonance (MR) and computed tomography (CT) findings of a 70-year old female patient. Initial MR examination showed gadolinium enhanced ovoid lesions in the frontal white matter and corpus callosum. These lesions thought to be active multiple sclerosis (MS) plaques when assessed with clinical picture. But after a week, enlargement of the lesions in size and hemorrhage were observed. Histopathological examination of these lesions revealed malignant glioma.Multipl gliomalar nispeten nadirdir. Demiyelinizan hastalık, multipl gliomalarla benzer radyolojik bulgularla temsil edilebilir. 70 yaşındaki bayan hastanın manyetik rezonans (MR) ve bilgisayarlı tomografi (BT) bulgularını sunuyoruz. İlk MR muayenesinde frontal beyaz cevher ve korpus kallosumda gadolinyum gelişmiş oval lezyonlar mevcuttu. Bu lezyonların klinik tabloyla değerlendirildiğinde aktif multipl skleroz (MS) plakları olduğu düşünülmektedir. Ancak bir hafta sonra lezyonların boyut ve kanamada genişledikleri gözlendi. Bu lezyonların histopatolojik incelemesinde malign glioma tespit edildi

Arterial Stiffness in Breast Cancer Patients Treated with Anthracycline and Trastuzumab-Based Regimens

Aims. Cardiovascular diseases are the primary cause of premature morbidity and mortality in early breast cancer patients after treatment with cardiotoxic chemotherapeutic agents. Arterial stiffness is an independent risk factor for future cardiovascular diseases and can be used as a predictive marker of subclinical cardiac damage. The aim of this study is to analyze the arterial stiffness in breast cancer patients who are in the follow-up period after receiving anthracycline-based chemotherapy regimens with trastuzumab. Methods and Material. We enrolled 45 HER2-positive breast cancer patients who are on follow-up at least for six months after completion of adjuvant chemotherapy with trastuzumab, and cardiovascular risk matched 30 control volunteers. The measurements were done with pulse wave analyzing machine. Results. Mean pulse wave velocity was higher in breast cancer patients compared to controls. The pulse wave velocity was significantly higher in patients receiving aromatase inhibitors compared to patients under tamoxifen. It was also significantly higher in postmenopausal breast cancer patients than postmenopausal controls. Conclusions. Arterial stiffness measurements may predict the breast cancer survivors with higher risk for cardiovascular events earlier in the follow-up period, and necessary preventive approaches and/or treatments can be applied

Küçük Hücreli Dışı Akciğer Kanseri Hastalarında Onkogen Mutasyonlarının Araştırılması

Objective: Non-small-cell lung cancer (NSCLC) having a high incidence rate remains importance as cancer subtype with the highest mortality. Mostly, the manifestation of symptoms in advanced stages severely restrict treatment success. In the recent years, the suppression of onco-proteins occuring as a result of genetic alterations provide an important contribution to the success of treatment. Detection of molecular changes in the tumor has contributed person-specific treatments to come into prominence. Revealing the frequency and the correlations with the aim of increasing treatment success of these moleculer variations which can vary from society to society and person to person in each country are important. There are insufficient data related to (NSCLC) oncogene frequencies and the correlations in our country. Diagnosis and treatments have been arranged and assumed to be similar to the western societies. The forming of national data belonging to our country is likely to increase treatment success and clinician benefit in terms of diagnosis and treatment strategies. In the present study, it was aimed to determine frequencies of observed mutations inducing formation of oncogene in tumor paraffin blocks and correlations of (NSCLC) diagnosed cases. Material-Method: Genomic DNA isolation was performed using the paraffin block sections belonging to a total of 80 patients, whose diagnosis were NSCLC. Epidermal growth factor receptor (EGFR), kirsten rat sarcoma viral oncogene homolog (KRAS), v- RAS neuroblastoma viral oncogene homolog (NRAS), v-raf murine sarcoma viral oncogene homolog (BRAF), phosphatidyl inositol-3-kinase catalytic alpha polypterid (PIK3CA), human epidermal growth factor receptor 2 (HER2) mutations were searched using Cobas z (Roche Diagnostic) RT-PCR devices and commercial mutation kits (Roche Diagnostics, Amoy Diagnostics). Findings: EFGR, KRAS, PIK3CA, BRAF and NRAS mutations were determned in 7, 23, 6, 1 and 1 of the cases, respectively. HER2 mutation was not detected in any case. PIK3CA mutation togetherness at the one case, having KRAS mutation, has been revealed. Results: Our results show that we have a profile similar to the mutation profile of the western societies apart from PIK3CA frequency in our country. PIK3CA mutation frequency was found to be 7,5%, which is greater than the 1-4% range shown in the literature Taking PIK3CA mutations in diagnosis and treatment into account more can contribute to the success of treatment.Amaç: Yüksek insidansa sahip olan Küçük Hücreli Dışı Akciğer Kanseri (KHDAK) en yüksek mortaliteye sahip kanser alt tipi olarak önemini korumaktadır. Çoğunlukla belirtilerin ileri evrelerde kendini göstermesi tedavi başarısını önemli ölçüde kısıtlamaktadır. Son yıllarda, tümör dokusunda meydana gelen genetik değişiklikler sonucu ortaya çıkan onko-proteinlerin baskılanabilmesi tedavi başarısına önemli katkı sağlamıştır. Tümördeki bu moleküler değişimlerin tespiti kişiye özgü tedavilerin ön plana çıkmasına katkı sağlamıştır. Toplumdan topluma ve kişiden kişiye farklılık gösterebilen bu moleküler değişimlerin tedavi başarısını artırmak amacıyla her ülkedeki sıklık ve korelasyonlarının ortaya konması önem arz etmektedir. Ülkemizde KHDAK onkogen sıklık ve korelasyonlarına dair yeterli veri bulunmamaktadır, tanı ve tedavi batılı toplumlara benzer olduğu varsayılarak düzenlenmektedir. Ülkemize ait verilerin oluşturulması, tanı ve tedavi stratejileri açısından klinisyene fayda sağlaması ve böylece tedavi başarısını artırabilmesi bakımından önemlidir. Bu amaçla çalışmamızda KHDAK tanılı olguların tümör parafin bloklarında onkogen oluşumuna sebep olan ve sık gözlemlenen mutasyonların sıklıklarının ve korelasyonlarının belirlenmesi amaçlanmıştır. Materyal-Metot: Tanısı KHDAK olan toplam 80 hastaya ait parafin blok kesitlerinden genomik DNA izolasyonu yapılmıştır. Ticari mutasyon kitleri (Roche Diagnostics, Amoy Diagnostics) kullanılarak Cobas z (Roche Diagnostics) RT-PCR cihazında Epidermal Büyüme Faktörü Reseptörü (EGFR), Kirsten sıçan sarkoma viral onkogen homoloğu (KRAS), v-Ras Nöroblastom viral onkogen homoloğu (NRAS), v-Raf Murine sarkoma viral onkogen homoloğu (BRAF), Fosfatidil inozitol-3-kinaz katalitik alfa polipertid (PIK3CA), İnsan Epidermal Büyüme Faktör Reseptörü 2 (HER2) mutasyonları araştırılmıştır. Bulgular: 80 olgunun 37’sinde toplam 38 mutasyon saptanmıştır. Olguların 7’sinde EGFR, 23’ünde KRAS, 6’sında PIK3CA, 1’inde BRAF ve 1’inde NRAS mutasyonu saptanmıştır. HER2 mutasyonu hiçbir olguda saptanmamıştır. KRAS mutasyonu bulunan bir olguda PIK3CA mutasyonu birlikteliği saptanmıştır. Sonuç: Sonuçlarımız; Ülkemizde PIK3CA mutasyon sıklığı dışında batılı toplumların mutasyon profiline benzer bir profile sahip olduğumuzu göstermektedir. Elde ettiğimiz PIK3CA mutasyon sıklığı %7,5’tir ve literatürdeki gösterilen %1-4 aralığının üzerindedir. Sonuçlarımız doğrultusunda PIK3CA mutasyonlarının tanı ve tedavide daha fazla dikkate alınmasının tedavi başarısına katkı sağlayabileceğini düşünmekteyiz