Astrositik tümörlerde ve reaktif gliozis olgularında CDC25B ekspresyonu ve prognostik önemi: (potansiyel bir grade'leme aracı olarak kullanılabilmesi ve yeni tedavi metotlarına ışık tutuması amacıyla)

Bu çalısmanın hedefi; astrositik tümörlerin histopatolojik tanısı, grade’lenmesi ve prognozu öngörebilme amacıyla; invaziv potansiyeli olan diffüz astrositoma (WHO grade II), anaplastik astrositoma (WHO grade III) ve glioblastoma multiforme (WHO grade IV) ile non-invaziv potansiyele sahip pilositik astrositoma (WHO grade I) ve reaktif gliozisde CDC25B ekspresyonun arastırılmasıdır. Ayrıca CDC25B ekspresyon düzeyi ile klinikopatolojik parametrelerin (yas, cinsiyet, tümör boyutu ve sag kalım süreleri) iliskisini degerlendirmeyi amaçladık. Bu çalısma için 1995-2006 yılları arasında Baskent Üniversitesi, Ankara ve Adana Uygulama ve Arastırma merkezlerinin arsivleri kullanılarak; astrositoma tanısı almıs olgular yeniden gözden geçirilmis ve WHO 2000 beyin tümörleri sınıflamasına göre tekrar grade’lenmistir. Çalısma kapsamına, diffüz infiltrasyon gösteren astrositoma tanısı almıs 36 olgu (10 DA, 6 AA, 20 GM), PA tanısı almıs 10 olgu, tümör dısı nedenler ile opere edilen ve histopatolojik tanısı reaktif gliozis ile uyumlu 5 olgu ile kontrol amacı ile 10 adet normal beyin dokusu immünohistokimyasal olarak CDC25B, Ki-67 ve p53 primer antikoru ile boyanmıstır. Boyanma oranları, grid altında 1000 tümör hücresi sayılarak; nükleer boyanma gösteren tümör hücrelerinin, sayılan 1000 tümör hücresine oranı hesaplanarak yüzde olarak saptanmıstır. CDC25B için ara deger %20 olarak belirlenip; boyanma indeksi %20 ise yüksek CDC25B boyanma indeksi (CB ) , <%20 ise düsük CB olarak kabul edilmistir. PA grubunda CB ortalama %0,6, DA grubunda %0,4, AA grubunda %7,7 ve GBM grubunda ise %25,5 olarak saptanmıstır (p=0,001). Reaktif gliozis ve tümör içermeyen normal beyin dokusunda ekspresyon saptanmamıstır. WHO grade’i arttıkça CB ’nin artım göstermesi istatistiksel olarak anlamlı bulunmustur (p=0,001). Sonuç olarak, çalısmamızda, CDC25B ekspresyonunun astrositomalarda grade ile artım gösterdigini ve prognozu olumsuz yönde etkiledigini gördük. CDC25B grade’lemenin özgün bulgularının olmadıgı biyopsi örneklerinde ve tanısal olarak sorunlu olan küçük stereotaktik beyin biyopsi materyallerinde tanı koydurucu yöntem olarak kullanılabilir. Ayrıca astrositik tümörlerin hastalık olusmadan genetik düzeyde erkenden tanınmasına ve tedavisine olanak saglayabilmesi yanı sıra, hastalık olustuktan sonra teshis edildiginde, tedavide olası hedef molekül olabilir

Ultrasonografia w przewidywaniu rozległości nacieku trofoblastu w obręb ściany jajowodu w ciąży bańkowej

Objective: Predictive factors of damage to the Fallopian tube may guide the treatment for patients with tubal pregnancy. The purpose of this study was to evaluate the predictive value of ultrasonographic findings in patients affected by ampullary pregnancy for the determination of the depth of trophoblastic infiltration into the tubal wall on histological examination. Material and methods: 38 patients with ampullary pregnancy undergoing salpingectomy were enrolled into the study. The patients were divided into two subgroups depending on their transvaginal sonography (TVS) findings; either an ectopic gestational sac containing an embryo with cardiac activity or those with a tubal ring. The ampullary pregnancies were histologically classified according to the depth of infiltration of trophoblastic tissue into the tubal wall as follows: stage I: limited to mucosa; stage II: extension to the muscularis layer; stage III: complete infiltration of the tubal wall with or without rupture of the serosa. The association between findings on TVS and stage of trophoblastic invasion, serum beta-human chorionic gonodatropin (β-hCG) levels was evaluated. Results: Although there was no significant difference among two groups in terms of histological stage of trophoblastic infiltration (p=0.257), patients in whom an embryo with cardiac activity had been identified were found to have higher percentage of stage II (47.8%) or stage III (8.7%) invasion. However, there was a significant difference in serum β-hCG levels on the day of surgery among the two groups (p=0.028). Conclusions: Ultrasonographic aspect of ampullary pregnancy is associated with depth of trophoblastic infiltration into the tubal wall and serum β-hCG levels.Cel: Czynniki predykcyjne zniszczenia jajowodu mogą być pomocne w leczeniu pacjentek z ciążą jajowodową. Celem badania była ocena wartości prognostycznej badania ultrasonograficznego u pacjentek z ciążą bańkową dla określenia rozległości naciekania trofoblastu w obręb ściany jajowodu potwierdzonego w badaniu histopatologicznym. Materiał i metoda: Do badania włączono 38 pacjentek z ciążą bańkową, u których wykonano usunięcie jajowodu. Pacjentki podzielono na dwie podgrupy pod względem różnych obrazów ultrasonograficznych; jeden z widocznym pęcherzykiem ciążowym i z zarodkiem z czynnością serca, drugi z widocznym pierścieniem jajowodowym. Ciąże bańkowe podzielono na podstawie wyniku histopatologicznego, pod względem głębokości nacieku trofoblastu w ścianę jajowodu: stopień I: ograniczone do śluzówki, stopień II: przechodzące na mięśniówkę, stopień III: całkowite nacieczenie ściany jajowodu z /bez pęknięcia surowicówki. Oceniono związek pomiędzy obrazem ultrasonograficznym, stopniem nacieczenia ściany jajowodu oraz poziomem surowiczego beta hCG. Wyniki: Nie znaleziono istotnych różnic pomiędzy badanymi grupami pod względem histologicznie ocenionego nacieku trofoblastu (p=0,257). Jednak kobiety, u których stwierdzano żywy zarodek częściej miały stopień II (47,8%) lub III (8,7%) inwazji trofoblastu. Znaleziono również istotną różnicę poziomu beta-hCG w dniu operacji pomiędzy dwoma grupami (p=0,028). Wnioski: Pewne ultrasonograficzne aspekty ciąży bańkowej są związane z głębokością inwazji trofoblastu w ścianę jajowodu oraz surowiczym beta-hC

FOXA1 is associated with high tumor grade, myometrial invasion and lymph node invasion in endometrial endometrioid carcinoma

Objectives: FOXA1 expression has been demonstrated in several hormone-dependent cancers. However, data are limited concerning the role of FOXA1 in endometrial cancers. The present study aimed to investigate FOXA1 expression via the microarray technique in benign hyperplasia, endometrial intraepithelial neoplasia, and endometrial endometrioid carcinoma. We also aimed to determine whether there were any associations between FOXA1 expression, tumor grade, myometrial invasion and lymphatic invasion.Material and methods: Paraffin-embedded sections prepared from samples obtained from 114 patients who underwent surgical hysterectomy or curettage were analyzed. Data were retrieved from digitally-stored medical records. Tissue microarrays were prepared from formalin-fixed, paraffin-embedded tissue blocks. Full tumor sections were used for immunohistochemical analysis performed.Results: Carcinomas with nuclear grade 3 had higher FOXA1 values than others, while grade 2 carcinomas also had higher FOXA1 values relative to grade 1 (p &lt; 0.001). FOXA1 values of FIGO stage III carcinomas were significantly higher than others and stage II values were also significantly higher than stage I FOXA1 values (p &lt; 0.001). Patients with myometrial and lymph node invasion had significantly higher FOXA1 values than others (p &lt; 0.001 and p = 0.047, respectively). FOXA1 had 91.30% sensitivity, 63.60% specificity and 77.78% accuracy for predicting the presence of myometrial invasion with a cut-off value of 9.Conclusions: FOXA1 expression is higher in endometrial endometrioid carcinoma compared to benign endometrial hyperplasia or intraepithelial neoplasia. In patients with endometrial endometrioid carcinoma, high FOXA1 expression is associated with high tumor grade, myometrial and lymph node invasion. However, FOXA1 expression is not associated with lymphovascular or cervical invasion

Prenatal Diagnosis of Adrenal Neuroblastoma: A Case Report with a Brief Review of the Literature

A case of adrenal cystic neuroblastoma detected at 37 weeks of gestation is reported. Postnatal ultrasonographic examination showed slightly increased in size demonstrating marked septations within the cyst. After the tumor was resected, histopathological examinations confirmed the diagnosis. The patient is developing normally at 1 year of age

MALIGNANT ECCRINE SPIRADENOMA ON THE LATERAL MARGIN OF NOSE AS AN INFREQUENT LOCALIZATION

Malignant eccrine spiradenomas are exceedingly rare tumors. They can arise from a preexisting eccrine spiradenoma or occur as a primary malignant tumor. Clinical features of these tumors may include a history of enlargement in a previously stable lesion. Tumor can be of low or high grade. Low-grade malignant eccrine spiradenoma has a better prognosis. We present a malignant eccrine spiradenoma arising from a preexisting eccrine spiradenoma, which has an infrequent localization between lateral edge of nose and medial canthus

Uterine adenosarcoma: A case report

Uterus adenosarkomları nadir görülen malignitelerdendir. Genelde postmenopozal dönemde görülmekte ve düşük malignite potansiyeli taşımaktadır. Malingnite potansiyeli düşük olmasına rağmen cerrahi tedavi sonrası pelvik rekürrens sıklığı %20-25 oranında bildirilmektedir. Pelvik rekürrenslerin hemen hemen hepsinde myometrium invazyonu ya da sarkomatöz büyüme saptanmaktadır. Bu nedenle bu malignitelerin uterus malignitlerinin ayırıcı tanısında göz önünde bulundurulması ve yüksek rekürrens oranı nedeni ile yakın takip edilmesi gerektiğini düşünüyoruz.Uterin adenosarcoma is a rare neoplasm. It usually seen in postmenoposal women and has low malignant potential. Despite its low malignant potential, 5 years pelvic recurrense rate is %25-30. Most of these recurrence have either myometrial invasion or sarcomatous growth. So, it must be keep in mind in the differential diagnosis of any uterin malignancies and close follow up is recommend its high recurrence rate

Distinctive Characteristic Features of Intramedullary Hemangiopericytomas

Study DesignThe retrospective analysis of intramedullary hemangiopericytomas (HPCs) was performed, and the entity was discussed in accordance with the literature findings.PurposeThis study aimed at defining distinctive characteristic features of intramedullary HPC with respect to surgical approach and prognosis.Overview of LiteratureIntramedullary HPCs are extremely rare tumors. They originate from capillary pericytes, supposedly follow the vessels over the spinal cord, and infiltrate deep into the spinal cord without a distinct plane. Their treatments and prognosis are not well-defined in the literature.MethodsOur database was retrospectively reviewed for the cases of HPCs. Later on, a literature search was performed to reveal all reported cases of intramedullary HPCs. The following key words were searched in PubMed databases: "hemangiopericytoma and intramedullary," "hemangiopericytoma and spine (spinal) and intradural," and "hemangiopericytoma and spinal cord." The articles were reviewed for patients' demographics features, imaging characteristics, tumor-specific factors (surgical technique, pathological descriptions, and world health organization grades), and postoperative course and prognosis (adjuvant therapies, recurrences, complications, and mortalities).ResultsA total of seven patients (three male and four female) was reached, with their ages ranging from 15 to 80 years (mean, 32.5 years). The tumors were located majorly in thoracic region (5/7, 71.4%), and only two cases were in the cervical region (2/7, 28.6%). All tumors were completely removed, and only two cases received radiotherapy. No recurrence was reported.ConclusionsComplete resection of the intramedullary HPCs seems to be the best management strategy for long-term and recurrence-free survival and in alleviating further need for radiotherapy

Her-2 Durumu İmmünohistokimya ile Negatif olan İnvaziv Meme Karsinomlarında İn Situ Hibridizasyon Yöntemi ile Değerlendirme (Ulusal Çok Merkezli Çalışma)

Amaç: Bu çalışmada, Her-2 durumları önceden immünohistokimyasal olarak skor 0 veya 1+ olarak tanımlanmış meme karsinomu olgularında silver in situ hibridizasyon ile tekrar test yapılarak Her-2 pozitiflik oranının tespit edilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmada 9 merkezin katkısıyla, 552 olgu değerlendirildi. Çalışmaya, Her-2 immünohistokimya sonucu 0/1+ bulunmuş meme kanseri olguları alındı. Bu olgulara ait parafin blok kesitlerinde merkez laboratuvarında Her-2 durumu silver in situ hibridizasyon yöntemiyle yeniden değerlendirildi. Her-2 gen amplifikasyonu, Her-2/ CEP 17 oranının 2,2’den fazla olması şeklinde tanımlandı. Her-2/CEP 17 oranı 1,8-2,0 arasındaki olgular şüpheli ve 1,8’in altındaki olgular ise negatif olarak değerlendirildi. Bulgular: 552 olgunun in situ hibridizasyon ile tekrar değerlendirmesinde skor 0 olan olguların 11’i (%3,2) ve skor 1+ olanların 11’i (%5,3) olmak üzere toplam 22 olguda Her-2 gen amplifikasyonu saptandı. Skor 0 ve 1+ olan olgulardaki Her-2 gen amplifikasyon saptama oranları çalışma merkezlerinde %0 ile %10,48 arasında değişmekteydi. Skor 0 olan olguların 28’inde (%8,1) ve skor 1+ olan olguların 25’inde (%12,1) polizomi görüldü. Polizomi olan olgulardan 5’inde (%9,4) Her-2 gen amplifikasyonu olduğu, 48’inde ise (%90,6) olmadığı belirlendi. Sonuç: Çalışmanın bulguları, anti- Her-2 tedaviden yararlanma potansiyeli olan bir popülasyonun (%3,98) immünohistokimya yöntemi ile gözden kaçabileceğini göstermektedir. Bu sonuç, özellikle de çok sayıda meme kanseri olgusuyla karşılaşılan merkezi laboratuvarlarda kalite güvencesinin önemini ortaya koymaktadır.Objective: The aim of this study was to determine the rate of Her-2 gene amplification in breast cancer cases with a previous negative Her-2 result as determined by immunohistochemistry (score 0 or 1). Material and Method: 552 cases of invasive breast carcinoma were assessed with the contribution of 9 centers. Previous immunohistochemistry score was either 0 or 1+ in all cases. These cases were re-tested by Her-2 silver in situ hybridization in the central laboratory. Her-2 gene amplification was defined as Her-2/CEP 17 ratio of more than 2.2. Cases with a ratio between 1.8 and 2.0 were defined as equivocal and cases with a ratio of less than 1.8 were defined as negative. Results: Re-testing of the 552 cases with silver in situ hybridization showed a total of 22 cases with Her-2 gene amplification, of which 11 (3.2%) were found to be score 0, and 11 were found to be score 1+ (5.3%) by immunohistochemistry previously. Her-2 gene amplification rate of cases (score 0 and 1+) ranged from 0% to 10.48% among the centers. Polysomy was found in 28 (8.1%) of the score 0 cases and 25 (12.1%) among the score 1+ cases. Five (9.4%) of the cases with polysomy were found to be amplified, and 48 (90.6%) were not. Conclusion: The results of the study show that a group of cases (3.98%) with a potential to benefit from anti-Her-2 therapy may be missed with the immunohistochemical method. This indicates the importance of quality assurance, especially in central laboratories with many breast cancer cases in daily practice

In Situ Hybridization Analysis of Invasive Breast Carcinomas with Immunohistochemically Negative Her-2 Status (A National Multicenter Study)

Objective: The aim of this study was to determine the rate of Her-2 gene amplification in breast cancer cases with a previous negative Her-2 result as determined by immunohistochemistry (score 0 or 1). Material and Method: 552 cases of invasive breast carcinoma were assessed with the contribution of 9 centers. Previous immunohistochemistry score was either 0 or 1+ in all cases. These cases were re-tested by Her-2 silver in situ hybridization in the central laboratory. Her-2 gene amplification was defined as Her-2/CEP 17 ratio of more than 2.2. Cases with a ratio between 1.8 and 2.0 were defined as equivocal and cases with a ratio of less than 1.8 were defined as negative. Results: Re-testing of the 552 cases with silver in situ hybridization showed a total of 22 cases with Her-2 gene amplification, of which 11 (3.2%) were found to be score 0, and 11 were found to be score 1+ (5.3%) by immunohistochemistry previously. Her-2 gene amplification rate of cases (score 0 and 1+) ranged from 0% to 10.48% among the centers. Polysomy was found in 28 (8.1%) of the score 0 cases and 25 (12.1%) among the score 1+ cases. Five (9.4%) of the cases with polysomy were found to be amplified, and 48 (90.6%) were not. Conclusion: The results of the study show that a group of cases (3.98%) with a potential to benefit from anti-Her-2 therapy may be missed with the immunohistochemical method. This indicates the importance of quality assurance, especially in central laboratories with many breast cancer cases in daily practice