Atypia and differential diagnosis in cellular blue nevi: Clinicopathological study of 21 cases [Hücresel mavi nevuslarda atipi ve ayirici tani: 21 olgunun klinikopatolojik değerlendirilmesi]

PubMed ID: 25690862Objective: Cellular blue nevus differs from the classic blue nevus with characteristics such as large size, cellularity, intense pigmentation, and growing pattern with subcutaneous infiltration. It is a dermal melanocytic tumor that can be confused with melanoma due to the atypia it may contain. Material and Method: Hematoxylin-eosin and mIB-1 stained slides of 21 cases diagnosed between 2000-2014 were re-evaluated. In order to attract attention to this rare lesion, 21 cases are presented with the clinical and above-mentioned histopathological findings. Results: Thirteen (61.9%) cases were females and eight (38.1%) were male. The mean age was 25.4 (2-73). The most frequent localization was the sacral and gluteal region (11 cases). The mean diameter was 14.4 mm (4-60 mm). From the parameters defined to assess the atypia, ulceration was identified in four cases. Prominent cellularity and subcutaneous infiltration were seen in three and 16 cases, respectively. mitosis was seen in six tumors. Immunohistochemically, mIB-1 was present in two cases as 3% and 2% respectively, while in others it was 1% or less. Although there is no precise definition for the “a typical cellular blue nevus”, five patients were assessed as atypical cellular blue nevus (a case with infiltrative development of six cm tumor diameter, two cases with two mitosis and a mIB-1 index 3% and 2%, a case with one mitosis and confluent development and a case with one mitosis in addition to focal necrosis areas). No lymph node and/or distant metastasis was observed during follow-up. Conclusion: We think it is more important to rule out the possibility of conventional melanoma in cellular blue nevus with exaggerated morphological findings alongside low proliferative activity rather than to determine the atypia. © 2015, Federation of Turkish Pathology Societies. All Rights Reserved

Meme karsinomlarında sentinel lenf nodülü biyopsilerinin histopatolojik ve immunohistokimyasal özellikleriyle değerlendirilmesi

Aim: Breast cancer is the most common malignity and cancer-related cause of death for women. Sentinel lymph node biopsy (SLNB) is a minimally invasive method for the evaluation of lymph node involvement. We aimed to determine the success of SLNB in predicting axillary lymph node (ALN) metastasis, the efficacy of intraoperative diagnosis of SLNB, and investigate a correlation with the characteristics of the primary tumour. Materials and Methods: Eighty-six patients with breast cancer who had undergone SLNB were included. Cases were re-evaluated with intraoperative histopathological diagnosis, axillary lymph node dissection (ALND), and primary tumour excision materials. The correlation between immunohistochemical characteristics (ER, PR, Her2, p53, and Ki67) of the primary tumour, and status of axillary metastasis were also investigated retrospectively. Results: Nine of 16 patients who had received ALND following the diagnosis of macrometastasis in SLNB intraoperatively, had ALN metastasis. Sixteen cases were diagnosed as micrometastasis or submicrometastasis in SLNB, and among them, only one out of 9 patients with completion of ALND, had metastasis in ALN. All 15 metastatic cases diagnosed intraoperatively had macrometastasis in paraffin sections. Cases within the good prognostic tumour group had low rates of metastasis in SLNB. Among the immunohistochemical markers performed for primary tumours, only Ki67 was found to be higher in cases with metastasis in SLNB. Conclusion: Our findings are in agreement with previous studies. If SLNB is negative for metastasis, SLNB is the reliable, appropriate and adequate way of axillary management with reduced arm-morbidity. Larger studies with long follow-up periods are needed to find out if completion of ALND is necessary for all patients with metastasis in SLNB.Amaç: Meme karsinomu kadınlarda en sık görülen malignite olup, günümüzde kadınlarda kansere bağlı ölüm nedenlerinin başında yer alır. Sentinel lenf nodülü biopsisi (SLNB), meme karsinomlu hastanın lenf nodülü tutulumunun değerlendirilmesinde minimal invaziv bir uygulamadır. Çalışmamızda SLNB’nin aksiller metastazı öngörme gücü, sentinel lenf nodu (SLN) incelemesinde intraoperatif histopatolojik değerlendirmenin etkinliği ve primer tümöre bağlı histopatolojik ve immunhistokimyasal (İHK) özelliklerin metastazla ilişkisini araştırmayı hedefledik. Gereç ve Yöntem: Çalışmaya, bölümümüzde SLNB değerlendirilen 86 olgu dahil edildi. Olgular intraoperatif histopatolojik değerlendirme sonuçları, SLNB sonrasında aksiller lenf nodülü diseksiyonu (ALND) uygulanmış olgularda aksillaya ait materyalleri yanısıra primer tümör eksizyon materyalleriyle birlikte incelendi, tümörde uygulanan İHK inceleme (östrojen reseptörü, progesteron reseptörü, Her2, p53, Ki67) sonuçlarının metastazla ilişkisi retrospektif olarak araştırıldı. Bulgular: SLN’de makrometastaz saptanması nedeniyle ALND uygulanan 16 olgunun 9’unda aksillada metastatik lenf nodülleri saptandı. Mikrometastaz ve izole tümör hücreleri saptanan 16 hastadan ALND uygulanan dokuz olgunun sadece birinde aksiller metastaz gözlendi. İntraoperatif değerlendirme sonucunda malignite saptanan 15 hastanın tümünde parafin kesitlerinde de makrometastaz gözlendi. Tümörü iyi prognostik grupta yer alan hastalarda SLN metastaz oranı daha düşük bulundu. SLNB’de metastaz saptanan hastaların primer tümörlerinde uygulanan İHK belirleyicilerden sadece Ki67 ortalaması metastatik grupta daha yüksek bulundu. Sonuç: SLNB uygulanan olgu grubunu değerlendirdiğimiz çalışmamızda literatürle uyumlu sonuçlar elde ettik. SLNB, negatif saptanması durumunda, tek başına uygun, güvenilir ve ALND’ye göre kol morbiditesinde azalma ve daha iyi yaşam kalitesi sağlayan etkin bir yöntemdir. SLNB’de metastaz saptanan hastaların tümünde ALND uygulaması yapılmalı mıdır sorusunun yanıtı için geniş serilerde uzun süre takipli çalışmalara ihtiyaç bulunmaktadır

Primer ve metastatik akciğer tümörlerinin ayırıcı tanısında tiroid transkripsiyon faktör-1 ekspresyonunun önemi ve güvenilirliği

Introduction: Thyroid transcription factor-1 (TTF-1) has an important role in the morphogenesis and early differantiation of the fetal tyhroid, brain and lung. Tyhroid and lung carcinomas express TTF-1 in a high proportion. TTF-1 immunostaining is commonly used in the diagnosis of lung adenocarcinomas. In this study , TTF-1 immunreactivity has been examined in different types of primary lung carcinomas and lung metastases from different sites. The reliability of TTF-1 has been studied in the diagnosis of primary and metastatic lung carcinomas. Materials and Methods: One hundred eleven primary lung carcinomas and 23 metastatic lung carcinomas have been included. TTF-1 was positive in 78 of 111 primary lung carcinomas (%70). This ratio was very high especially in small cell carcinomas(%100) and adenocarcinomas(%83). In the metastatic group, diffuse TTF-1 immunoreactivity was seen in thyroid cancer metastasis, as expected and TTF-1 expression was not seen in other metastatic carcinomas. Results and Discussion: Our study shows that TTF-1 has a great value in differential diagnosis of primary and metastatic lung carcinomas, and it's a sensitive (%70) and spesific (%100) immunohistochemical method in routine studies.Giriş: Tiroid transkripsiyon faktör-1 (TTF-1), gelişmekte olan tiroid, akciğer ve beyinin erken diferansiyasyon ve morfogenezinde önemli rol oynar. TTF-1 ekspresyonu, akciğer ve tiroid kanserlerinde yüksek oranlarda görülmektedir. TTF-1'in immunohistokimyasal (İHK) uygulaması, akciğer kökenli adenokarsinomların identifikasyonunda oldukça yaygın olarak kullanılmaktadır. Bu çalışmada primer akciğer kanserlerinin farklı tiplerinde ve farklı organlardan akciğere metastaz yapmış kanserlerde TTF-1 immunoreaktivitesi incelenerek TTF-1'in primer- metastaz ayırıcı tanısındaki yeri ve güvenilirliği irdelendi. Gereç ve Yöntem: Primer akciğer tümörü tanısı alan 111 olgu ve metastatik akciğer tümörü tanısı alan 23 olgu çalışmamıza dahil edildi. Primer akciğer tümörlerine genel olarak bakıldığında toplam 111 olgunun 78'inde yani %70'inde TTF-1 ekspresyonu saptandı. Özellikle küçük hücreli karsinom (%100) ve adenokarsinomlarda (%89) bu oran oldukça yüksekti. Metastatik akciğer tümörlerinde ise tiroid karsinom metastazında beklendiği gibi diffüz bir pozitiflik izlenirken, diğer tümör metastazlarının hiçbirinde TTF-1 ekspresyonu izlenmedi. Sonuç ve Tartışma: Bizim sonuçlarımız da göstermektedir ki, TTF-1 ekspresyonu primer akciğer tümörlerinin metastatik tümörlerinden ayırıcı tanısında oldukça değerli bir belirleyicidir ve İHK olarak rutin işleyişte kullanabileceğimiz sensitif (%70) ve oldukça spesifik (%100) bir metoddur

Role of Systemic Inflammatory Markers in Pediatric Kidney Transplantation

Background: Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII = N × P/L), and neutrophil percentage-albumin ratio (NPAR) have become accepted markers of inflammation in recent years. These indices are used as indicators of disease activity, mortality, and morbidity in many diseases. This study evaluated the relationship between inflammatory indices and graft function in pediatric kidney transplant recipients. Methods: Medical records of pediatric patients who underwent kidney transplantation at Ege University between 1995 and 2020 were reviewed retrospectively. Demographic, clinical, and laboratory data were recorded during the third month, first year, and fifth year of transplantation and at the last visit. Results: The median age of the 119 patients (60 boys/59 girls) at the time of transplantation was 154 months, and the median follow-up period was 101 months. According to Spearman correlation analysis, patients' final creatinine levels were positively correlated with NLR (r = 0.319), PLR (r = 0.219), SII (r = 0.214), and NPAR (r = 0.347) of the last visit; final estimate glomerular filtration rate levels were negatively correlated with NLR (P = .010, r = −0.250) and NPAR (P = .004, r = −0.277). The median NPAR of the patients with chronic allograft dysfunction at the last visit was found to be statistically significantly higher than without (P = .032). Conclusion: NLR, PLR, SII, and NPAR values are correlated with creatinine levels after 5 years of kidney transplantation. The NPAR and final creatinine levels had the highest correlation coefficient among these inflammatory markers. These results suggest that inflammatory markers, especially NPAR, may be a candidate to be an indicator of ongoing inflammation in the graft. © 2023 Elsevier Inc