Postpartum Cystic Juvenile Granulosa Cell Tumor: A Case Report

Introduction: Juvenile granulosa cell tumor (JGCT) is a subtype of granulosa cell tumors of the ovary. 80% of JGCT occurs at prepubertal period. And, it is considered to be a slow growing tumor. In addition, gross appearence of it is mostly solid. Herein, we report a pure cystic JGCT case that was detected soon after childbirth with huge dimension.Presentation of Case: We report a 21 year-old woman who presented with abdominal mass during 6th month after childbirth. Ultrasound revealed a cystic mass of approximately 20 cm in diameter originated from left ovary. The patient underwent laparotomy and unruptured left ovarian cystic mass resection was performed. Uterus and right ovary were totally normal and extraovarian spread was not found. Macroscopic examination revealed totally cystic tumor of 25,5x22x10,2 cm with smooth outlines, containing serous fluid. There were papillary projections and small polypoid structures around 1 cm in diameter into the cavity. Histopathologic and immunohistochemical findings were compatible with JGCT. Relaparotomy was performed for staging and the patient was evaluated as stage IA. She is currently under clinical follow up without any further treatment.Conclusion: It should be noted that JGCT may rapidly grow and reach a higher dimension, occur during pregnancy and at postpartum period, and may present as cystic rather than a solid mass as in our case presented here

Clear Cell Meningioma: A Rare Great Mimicker

Introduction: Clear cell meningioma is an infrequent, agressive variant of meningioma that shows proclivity to the spine. This study aimed to report a case of clear cell meningioma of the lumbar spine and discuss the differential diagnosis, and emphasize the necessity and usefulness of immunohistochemistry for definite diagnosis.Case report: A 23-year-old man admitted to the Department of Neurosurgery with backache existed for about 4 years. Magnetic Resonance Imaging revealed a well-circumscribed intradural and extramedullary mass in the spinal canal at the 5th lumbar vertebra extending to the right neural foramen. The lesion was excised gross totally and diagnosed as “clear cell meningioma”. The patient has been doing well for a year without any sign of recurrence.Discussion: Clear cell meningioma should be considered in the differential diagnosis of the masses located in the spine radiologically. In addition, the histopathological mimickers of it that are composed of clear cells, particularly renal cell carcinoma, should be ruled out by the aid of immunohistochemistry

Adenoid Cystic Carcinoma of the Scalp as a Cause of Recurrent Operations

Introduction: Primary cutaneous adenoid cystic carcinoma (PACC) is a rare slow-growing tumor. Presentation of the case: We report a 62 year-old woman presented with a nodular lesion on the scalp who had three operations before for recurring lesion at the same localization. In the operation, we detected a lesion which was adherent to thesubcutaneous tissue. The lesion was firm and gray-white colored, and invading the surrounding soft tissues. According to histopathological findings, the patient diagnosed with adenoid cystic carcinoma.  Conclusions: Primary cutaneous adenoid cystic carcinoma is a rare tumor that the etiology, origin, and treatment are still controversial. The metastases must be ruled out from other sites, especially from the salivary glands after the its pathological diagnosis

Triple Synchronous Tumors in a Patient: Gastric Adenocarcinoma, Omental Gastrointestinal Stromal Tumor and Renal Angiomyolipoma

Introduction: The presence of synchronous distinct tumors is uncommon in the literature, and the etiology of it is still unknown.Presentation of Case: Herein, we report a 42 year-old-woman with synchronous triple tumors of gastric adenocarcinoma, renal angiomyolipoma (AML), and omental gastrointestinal stromal tumor (GIST). She underwent total gastrectomy after the diagnosis of adenocarcinoma by endoscopic biopsy. During macroscopic examination of gastrectomy specimen, an ulcerated tumor about 4.5 cm in diameter was observed in the fundus. Histopathologically, it was diagnosed as adenocarcinoma harboring some signet-ring features. While dissecting lymph nodes of the omentum of the lesser curvature, a nodular mass about 4.2 cm in diameter seemed to be a lymph node was detected macroscopically. However, it was diagnosed as GIST by histopathological and immunohistochemical features. Also, partial nephrectomy was performed during the same session due to a mass detected radiologically in the left kidney about 2.2 cm in diameter. It was indicated to be metastatic gastric adenocarcinoma clinically but AML was determined by histopathological and immunohistochemical findings.Conclusion: To the best of our knowledge, our patient is the first case in the literature that has synchronous tumors of gastric adenocarcinoma, omental GIST and renal AML

Metastatic Serous Carcinoma Initially Presented As An Incarcerated And Strangulated Umbilical Hernia: A Rare Case Report

Introduction: We report a rare case of a metastatic serous ovarian carcinoma presented as an incarcerated and strangulated umbilical hernia.Presentation of case: A 54 year-old female was admitted to the hospital with a painful mass around the umblical region. It was elucidated during clinical history that the mass had been present for 3 to 4 years without pain. An incarcerated and strangulated umbilical hernia including a solid mass and mesenteric fat was detected on physical examination. She underwent an urgent operation for strangulated umbilical hernia. The pathological diagnosis of the hernia material was reported as carcinoma compatible with serous ovarian carcinoma metastasis. Concurrently, total abdominal histerectomy and bilateral salphingo-oopherectomy, pelvic and paraaortic lymph node dissection, omentectomy and sigmoid colon resection were performed. Histopathological evaluation confirmed the serous carcinoma originated from the left ovary.Conclusion: In the literature, some metastatic tumors have been reported to be presented as umbilical metastasis rarely. However, the present case is the first metastatic ovarian cancer that initially presented as an incarcerated and strangulated umbilical hernia in the literature, to the best of our knowledge. 

Adequacy And Quality of Cervico-Vaginal Smear Sampling in the Different Age Groups

Aim: The aim of this study is to detect the adequacy and quality of cervico-vaginal sampling in different age groups. Method: As a screening test, cervico-vaginal smears were obtained from 1179 women was admitted to Obstetrics and Gynecology Clinic of Bozok University Hospital between September 2012 and April 2013. Patients were grouped according to their ages. Patients under 20 years were designated as adolescents, patients between 20 and 44 years represented fertile period and patients 45 years and over were defined as menopausal patients. All the smears were evaluated by the same pathologist. Transformation Zone detection is required for sufficient and appropiate smear sampling. Kruskal Wallis H Tests were used for statistical analysis. Values under 0.05 were accepted as significant. Mann Whitney U test was performed for detecting the origin of significance. Results: Among 1179 patients, 14 of them were adolescents (1.18%), 752 of them belonged to fertile period group (63.78%) and 413 of them were menopausal patients (35.02%). In these groups smear sampling sufficiency and quality detected as; 64.20% in adolescents, 72.90% in fertile period and 59.95% in menopausal patients. Among smears with inflammation, 7 of them were adolescents (50%), 470 of them were in fertile period group (62,50%) and 158 cases were in menopause group (38,25%). Only 1 patient diagnosed as ASC-US (0,08%) and no other premalignant lesion was detected. There was a statistical difference between groups (p<0,05) and in the fertile group cervicovaginal samplings were more efficient. Conclusion: As the transformation zone presents in the easily screened outer portion, the more efficient sampling has been achieved in the fertile group compared to other groups

Clinicopathological significance of the proliferation markers Ki67, RacGAP1, and topoisomerase 2 alpha in breast cancer

WOS: 000382974300005PubMed ID: 27284123Objectives. The aims of this study are to evaluate expressions of Ki67, RacGAP1 (MgcRacGAP) and topoisomerase 2 alpha (TOP2a), the markers related with cell proliferation that have been proposed to affect the prognosis in the literature and correlate the results with clinicopathological parameters of breast cancer patients. Methods. Ki67, RacGAP1, and TOP2a antibodies were applied immunohistochemically to the tissue micrarray blocks of 457 female breast cancer patients. The results were correlated with clinical, prognostic, histopathological features, and other immunohistochemical findings (estrogen receptor [ER], progesterone receptor [PR], HER2, cytokeratin [CK]5/6, CK14, epidermal growth factor receptor [EGFR] and vimentin), statistically. Results. Ki67 expression demonstrated direct correlation with TOP2a expression, mitotic count, tumor grade, geographic necrosis, basal-like phenotype. RacGAP1 expression was directly correlated with TOP2a expression, nipple invasion, and number of metastatic lymph nodes, and it was inversely correlated with PR expression. TOP2a expression was directly correlated with vimentin and Ki67 expressions, mitotic count, tumor grade, and geographic necrosis, and nipple invasion, and negatively correlated with ER and PR expressions. Higher TOP2a and Ki67 expressions were correlated with shorter overall survival. Higher TOP2a expression and RacGAP1 positivity were directly correlated with shorter disease-free survival. Conclusion. This study showed that the overexpressions of Ki67, RacGAP1, and TOP2a affect the prognosis adversely, thus to develop target therapies against RacGAP1 and TOP2a as well as using Ki67 as a part of routine pathology practice might be beneficial in breast cancer therapy and prediction of prognosis.Bozok University Scientific Research Projects Unit [2014TF/A92]The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported financially by Bozok University Scientific Research Projects Unit (Project No. 2014TF/A92)

Clinicopathological significance of insulin-like growth factor-1 receptor expression in breast cancer

OBJECTIVE: Insulin-like growth factor 1 receptor (IGF1R) is a receptor protein tyrosine kinase that is claimed to be related with tumor development and progression of breast cancer with some conflicting results in the literature. The aims of the study are to investigate expression of IGF1R, and correlate with clinicopathological parameters to clarify the significance of IGF1R on breast cancer.MATERIAL AND METHODS: IGF1R and Ki67 were applied immunohistochemically to the tissue microarray sections of 370 female breast cancer patients. The results were correlated with clinical, prognostic, histopathological features, and other immunohistochemical findings [ER, PR, HER2, CK5/6, and CK14] statistically.RESULTS: IGF1R overexpression showed direct correlation with Ki67 index (P=0.028), HER2 positivity (P=0.001), mitotic count (P=0.004), tumor grade (P=0.015), and geographic necrosis (P=0.023); and negative correlation with ER positivity (P=0.003). There was statistically significant difference between IGF1R expression and the molecular subtypes (P<0.001), mostly HER2+ phenotype. IGF1R expression was found to be higher in invasive ductal carcinoma (IDC) than invasive lobular carcinoma (ILC) (P=0.036). Both IGF1R and Ki67 expression were negatively correlated with disease-free survival (DFS) (P=0.020, P=0.023, respectively) and overall survival (OS) [P<0.001, each] rates. The inverse association between IGF1R overexpression and OS rate was also supported by multivariate analyses (P=0.025).CONCLUSIONS: Overexpression of IGF1R was found to be directly correlated with shorter DFS and OS as well as some clinicopathological features associated with adverse prognosis such as higher Ki67 index, mitotic count, tumor grade, presence of geographic necrosis, HER2 positivity, ER negativity, HER2+ molecular subtype, histological tumor type of IDC rather than ILC. Thus, IGF1R might be considered as an useful target for comprehensive future anti-tumor therapy investigations. Additionally, using IGF1R as well as Ki67 as a part of routine pathology practice might be fruitful in breast cancer therapy and prediction of prognosis

Detection of insulin-like growth factor receptor-1 in the human cremaster muscle and its role in the etiology of the undescended testis

Summary: Purpose: Previous studies of undescended testis (UT) has focused on insulin-like hormone 3 (INSL3), the genitofemoral nerve, and androgens in the testicular descent. Leydig cells, which are under the control of insulin-like growth factor-1 (IGF1), produce both androgens and INSL3. We aimed to investigate whether insulin-like growth factor receptor-1(IGFR1) exists in the cremaster muscle (CM) complex and is associated with normally descended testis as well as UT cases in humans. Methods: We studied 30 CM from 15 patients who comprised the UT group (UTG), and 15 patients with unilateral testicular torsion (Control group; CG). Muscles, nerves, and vessels within the CM specimen were examined to determine the presence of IGFR1. Results: The mean staining score (MSS) of IGFR1 in CM and its nerves were higher in the CG than in the UTG. These results were statistically significant (p = 0.01 and p = 0.02). Although the MSS of IGF1R was higher in the vessels of CM in the CG than the UTG, this was not statistically significant (p = 0.48). Conclusions: IGFR1 with heterotetrameric receptor via IGF1, IGF2, insulin, and probably androgen, contribute to the remodeling and development of CM as well as the testis descent. In the current study, the presence of the IGFR1 in the CM was shown. Additionally, the IGFR1 density of the CM was lower in the UT cases than in the CG cases. Further evaluation of IGFR1 and other etiological factors can elucidate how they interact. Keywords: Undescended testis, Cremaster muscle, Insulin-like-growth factor receptor