Comparison of Gram stain and Pap smear procedures in the diagnosis of bacterial vaginosis.

OBJECTIVE: The purpose of this study was to examine the characteristics of Gram stain versus Pap smear in diagnosis of bacterial vaginosis (BV). METHODS: One-thousand and sixty women were enrolled in this study. All cases with symptoms of BV were determined by Amsel's criteria, which were accepted as the gold standard for diagnosis of BV. Pap smear and Gram stain evaluations were compared according to Amsel's criteria, without viewing the clinical results of the patients. Gram stain and Pap smear results were determined as negative or positive according to Amsel's criteria. Sensitivity, specifity and positive predictive values were calculated. RESULTS: After accepting the cases that were diagnosed as BV according to Amsel's criteria as reference cases, the sensitivity of the Gram stain method was calculated as 97% and the sensitivity of the Pap smear method as 93%. Similar specificity rates were obtained with both methods in diagnosis of BV related to the clinical results. There were no statistically significant differences in diagnosis of BV between these two groups. CONCLUSION: If Amsel's criteria are accepted as the gold standard for diagnosis of BV, Gram stain and Pap smear methods will give similar results in diagnosis

A Rare Tumour of the Breast: Carcinosarcoma

Carcinosarcoma of the breast, also known as metaplastic carcinoma, is rare with very few cases reported in the literature. A 46-year old female patient presented with a mass in her left breast. Physical examination, ultrasonography and mammography findings were consistent with malignancy. The mass was totally removed. Histopathological examination revealed carcinosarcoma of the breast. Histologic grade of the tumour was III. Ki67 proliferation index was found 40% positive. Tumour cells were positive for p53 (70% positive), c-erb-B2 (5% positive), pancytokeratin and EMA in carcinomatous areas, and vimentin in sarcomatous areas. There was no metastasis in axillary lymph node and distant metastasis. The patient is receiving chemotherapy and is under follow-up in the 54th month. Along with a review of the literature, we present the information regarding the clinical and histological findings and treatment of the patient who was operated due to breast carcinosarcoma

EVALUATION OF HISTOPATHOLOGIC PARAMETERS AND NEOANGIOGENESIS IN PROSTATE CARCINOMA

Introduction: Prostate cancer is the most commonly diagnosed cancer among men in the world. Primary options for treatment include observation only, hormonal ablation, radiation therapy, and radical prostatectomy. Prostate carcinoma detection has been increased with the use of prostate specific antigen. Successful attempts were made to establish useful prognostic factors for the outcome of prostate carcinoma, like TNM stage, Gleason's grade and serum PSA level. However despite current clinical, serologic and radiologic evaluations of patients, as many as 30% of patients are found to have disease that has penetrated the capsule and/or seminal vesicles on final pathologic analysis after radical prostatectomy. Various new prognostic factors that have been suggested to provide additional prognostic information include proliferative activity, overexpression of the apoptosis-inhibiting oncogene Bcl-2, neoangiogenesis and inactivation of the P53 tumor suppressor gene. Angiogenesis, the formation of new blood vessels, has been suggested to provide important prognostic information in prostate cancer. The goal of this study was to evaluate of histopathologic parameters and neoangiogenesis in men undergoing radical prostatectomy. Materials and Methods: We analyzed between 1996 and 2002, 40 consecutive patients with prostate cancer who underwent lymphadenectomy and radical prostatectomy (RP). The patients who qualified for the study had a preoperative serum PSA level, age, preoperative histologic grade according to the Gleason histological scoring system and the other prognostic histopathologic parameters (surgical margin of resection, extraprostatic extent of cancer, lymph node metastases and seminal vesicle involvement) and microvascular density (MVD) in RP. Cases were categorized into groups of s-PSA < 4 ng/ml, 4.1-10, 10.1-20 and greater than 20. All prostate biopsies were reviewed and Gleason score, percent cores positive for carcinoma, and perineural invasion were recorded for each specimen. Positive surgical margins were those showing tumor in the shave bladder neck tissues, in distal urethral shave tissues, or in the inked edges of the remaining portions of the RP. Seminal vesicle invasion was defined as infiltration of the muscular coat of one or both seminal vesicle. Invasion of the periprostatic soft tissue was defined as extraprostatic extention. The hematoxylin-andeosin-stained slides (needle biopsy and radical prostatectomy) were examined, and the tumors were graded by assigning both a primary and secondary Gleason score. A single representative block from each prostate specimen was selected and 3 micron thick sections were used for the CD 34 immunostaining. Microvascularity density quantification was performed using CD 34 antigen immunohistochemistry as previously defined. All slides were evaluated for immunostaining in a blinded fashion without any clinicopathologic data. The immunoreactivity was evaluated at 400x magnification and 10 most vascular areas were assessed. Any positive cell or cell cluster, clearly separate from adjacent microvessels, tumor cells and other connective tissue elements, was considered a single, countable microvessel. Microvessel density was then recorded as the mean of 10 high power fields. We used the Pearson correlation test, chi-square test and Mann-Whitney U test for statistic analysis. Results: The mean age was 65.5 years (range: 57-73). Serum PSA ranged from 2 to 58 ng/ml. The mean MVD for CD 34 ranged from a minimum of 28 to a maximum of 180. We were able to demonstrate a high degree of correlation between microvascularity in radical prostatectomy and that in the corresponding involvement seminal vesicle and extraprostatic extention. MVD was not significantly associated with Gleason grade in RP specimens in this study. Conclusion: Angiogenesis is essential for tumor growth and metastasis and has been proposed as a marker for tumor aggressiveness in several cancers. Angiogenic factors can be secreted by tumor cells, inflammatory cells and stromal cells. Histological evaluation of MVD in prostatic adenocarcinomas may improve the prediction of involvement of seminal vesicle and surgical margins. Additional data defining the positive predictive value of MVD and its relationship to other preoperative and postoperative parameters can provide a useful addition to our staging procedures. Obviously larger series may provide information that can help predicting the effectiveness of therapy in a particular patient

Small cell carcinoma of the urinary bladder: KIT and PDGFRA gene mutations

Primary small cell carcinoma of the urinary bladder is very rare. A 72-year-old was admitted to our hospital because of hematuria and dysuria. Cystoscopy revealed a bladder full of multiple, solid and papillary tumors. Biopsies from the deep and papillary tumors were taken. Histologically, tumor was pure small cell carcinoma. Immunohistochemically, the tumor cells were positive for cytokeratin, chromogranin, synaptophysin, neuron-specific enolase, CD56, CD117 and Ki67 (labeling 70%). The tumor cells were negative for CK7, CK20, CD3, CD20, LCA, CDX2, uroplakin, thyroid transcription factor 1, PSA and p63. Metastatic workup was performed an no primary or metastatic lung lesions were noted. Due to the clinical, radiologic and immunohistochemical findings, the patient was diagnosed as primary small cell carcinoma of bladder. A molecular genetic analysis for KIT (exons 9, 11, 13 and 17) and PDGFRA (exons 12 and 18) genes was performed, in paraffin micro dissection specimens, by the PCR-direct sequencing method. According to the sequencing analyses, two mutations were found at positions 558 (p.K558N) and 562 (p.E562D) in KIT gene exon 11 in our case. The another hand the same case presented two mutations in PDGFRA gene exon 14 at position 631 (p.P631A) and 638 (p.638Q_639AinsC). The disease process was fulminant and the patient was lost due to several complications prior to any chemotherapy

Diffuse Large B-Cell Lymphoma Arising in Warthin's Tumor: Case Study and Review of the Literature

WOS: 000329533600012PubMed ID: 24421853Warthin's tumor is the second most common type of salivary gland tumor. Microscopically, Warthin's tumor displays a proliferative epithelial component and lymphoid stroma. Carcinomas arising from the epithelial component are well known, but malignant transformations of the lymphoid stroma are rare. When they do occur, they are most commonly B-cell type non-Hodgkin lymphomas. A 60-year-old male patient underwent surgical resection of a parotid mass. After superficial parotidectomy, microscopic examination indicated that the tumor was of epithelial components with basaloid and oncocytic columns of cells neighboring lymphoid components. In addition to the lymphoid follicles with distinct germinal centers, there were large, bizarre and extremely atypical neoplastic cells seen in the lymphoid component. Large neoplastic cells were diffusely CD20 and CD30 positive. The patient was diagnosed with "Warthin's tumor and diffuse large B-cell lymphoma with expression of CD30." The histopathologic and clinical features are discussed along with a review of the literature

Molecular subtyping of breast cancer patients with long time follow up and its prognostic value on survival: a single center analysis

The importance of molecular subtyping in breast cancer is an unresolved issue. In this study we aimed to evaluate the significance of molecular subtyping, and the correlation between the disease-free, and overall survival in breast cancer based on molecular subtypes. A total of 536 patients with the diagnosis of breast cancer between the years 1980 and 2014 were included in the study. Tumors were divided into five molecular subtypes according to their expression profiles as follows: Luminal A: (n=220; 41%); Luminal B: (n=72; 13.4%); Luminal B-like: (n=97, 18.1%); HER2: (n=44; 8.2%); and Triple-negative (n=103; 19.2%). We found significant differences between molecular subtypes, and histological subtype of the tumor (P=0.004) in terms of local recurrence (P=0.043), and metastasis (P=0.006). A statistically significant difference was found between the number of metastases, and molecular subgroups. (P=0.037). Among all molecular subtypes, local recurrences (11.4%), and metastasis (38.6%) were most frequently seen in the HER2 subtype, while the least number of metastases (15.3%) were detected in the Luminal A subtype. A statistically significant difference was found between Luminal A, and HER2 subgroups as for incidence of metastatic lesions (P=0.007). However in the Luminal A subgroup metastases developed in the long term (at the end of 50 months after onset of the disease). Overall, and disease-free survival curves in the Luminal A subgroup indicated risk of mortality in the long run. Based on molecular subtyping the worst, and the most favourable survival rates were observed in the HER2, and Luminal A subgroups, respectively. Impact: In this study which encompassed multiple number of breast cancer patients encountered within 30 years, HER2 tumors had the worst survival rates Interestingly, Luminal A subgroup which displayed a very favourable prognosis during the early stage of the follow-up period, demonstrated a bad prognosis in the long term