Goblet cell carcinoid: Case report

The mixt endocrine-exocrine carcinoma of the appendix,being a rare tumor, makes up a very little part of all gastrointestinalsystem tumors. These tumors are thought tobe the intermediary tumors taking place between adenocarcinomasand endocrine tumors. Generally they areseen in the 5th -6th decades equally in males and females.Being very characteristic, the histomorphological pictureof goblet cell carcinoid consists of atypical epithelial cellswith conspicuous nucleoli that make small abortive glandsdemonstrating scattered nests under surface epitheliumand containing Goblet cells. The tumor exhibits transmuralspread producing mucin pools designating positiveimmunoreaction histochemically with musicarmenstain. In addition to CEA and keratin expressions, thereis neuroendocrine differentiation that may be illustratedboth immunohistochemically and ultrastructurally. In ourcase, under the appendix epithelium we determined atumor that was formed by gland structures lined by mucinousepithelial cells with conspicuous nucleoli, growingforward to the muscle layer and seeming invasive. Weestablished that the tumor expressed PanCK, synaptophysin,chromogranin and CEA in immunohistochemicalstudy and stained positively with PAS, PAS-AB andmusicarmen in histochemical study. We considered thecase as goblet cell carcinoid when clinical, histopathological,histochemical and immunohistochemical data wereassessed together. In the time interval 2 years after theoperation, any recurrence and/or metastase was not determined.Key words: Goblet cell carcinoid, CEA, chromogranin A,PAS-AB, musicarme

Plasmacytoma: A Rare Case of Bone Malignancy

Solitary Plasmacytoma is a rare disease characterized by a localized proliferation of neoplastic monoclonal plasma cell, without evidence of systemic disease. It can be subdivided into solitary bone plasmacytoma if the lesion originates in bone, or solitary extramedullary plasmacytoma if the lesion involves a soft tissue. A 25-year-old male patient is admitted to our clinic with hip pain. In the biopsy performed from the left iliac bone, atypical cells with rounded nuclei, granular chromatin and eccentrically located, extensive cytoplasm, and plasma cell morphology were observed. Because of CD38 positivity and plasma cell morphology, kappa lambda examination performed by CISH showed kappa positive lambda negative. Plasmocytomas are easily recognizable on tissue sections if the plasma cells are not poorly differentiated (plasmoblastic or anaplastic). In poorly differentiated lesions, immunohistochemical staining or in situ hybridization studies of kappa and lambda light chains can be performed

A case of Choriocarcinoma primarily located in the urinary bladder

Choriocarcinoma is a tumor with poor prognosis which usually develops in the uterus and ovaries in females and testes in males. Choriocarcinomas primarily located in the urinary bladder occur extremely rare. In the radiological examination of the 28 year old male patient presented with cough, difficulty in breathing, dysuria and hematuria; lung lesions compatible with metastasis and a mass which was extending inside of the lumen in the anterior wall of the urinary bladder were determined. During the cystoscopic investigation, an incomplete transurethral resection was applied to the tumor. In the histopathological evaluation of the tumor tissue, cells compatible with syncytiotrophoblasts were observed among the polyhedral large mononuclear cells. While positive staining with pancytokeratin, cytokeratin 7, high molecular weight cytokeratin, human plasental lactogen, and human corionic gonadotrophin was observed in the tumor tissue, there was not any staining with epithelial membrane antigen, carcinoembryonic antigen, CD30, p63, and cytokeratin 20. Present histopathological and immunohistochemical findings were evaluated as compatible with coriocarcinoma. Because of being seen rarely, having poor prognosis, causing death due to metastasis, the necessity of holding in mind in the differential diagnosis of high grade urothelial carcinomas, it is purposed to present the case accompanied by literature information

Primary Sjögren’s Syndrome with Sensory Ganglionopathy and Painful Legs and Moving Toes Syndrome

Sjogren’s syndrome is characterized by the sicca syndrome, with dryness of the mouth (xerostomia) and the eyes (xerophthalmia). Sjogren's syndrome is the only connective tissue disease that has been associated with sensory neuronopathy. The syndrome of painful legs and moving toes consisting of pain in the lower limbs with spontaneous movements of the toes or feet. The association between Sjogren’s syndrome and painful legs and moving toes syndrome is a rare condition

A rare chest wall localized soft tissue sarcoma: Clear cell sarcoma

The clear cell sarcomas of soft tissue are rare tumorsoriginating from neural crest cells and presenting withpoor prognosis. By the reason of the resemblance ofhistological properties to malign melanoma (eg. the immunoreactivityto S100 and HMB45, the presence of melanosomesultrastructurally), these tumors are also definedas malign melanomas of soft tissue. But distinctivelyfrom cutaneous melanoma, clear cell sarcoma is almostalways deeply localized and the biological behaviour ofthe last one is also different. The differential diagnosisbetween clear cell sarcoma and desmoplastic or spindlecell malign melanoma may be more difficult because ofthe dermal localization of the last ones. In our case, itwas observed an infiltrative tumor composed of uniformseeming cells with vesicular nuclei, distinct nucleoli, paleeosinophilic and sometimes clear, scant cytoplasms, inaddition to necrotic areas. On immunohistochemical examination,the tumoral cells showed a positive immunoreactivityto vimentin, S100, HMB45, and SMA, while showingnegative immunoreactivity with CD34, PanCK, EMA,LCA, CD99 and desmin. Ki-67 proliferation index was determinedas approximately 50%. Because of deep localizationand different morphological-immunohistochemicalfindings of the tumor, the case was diagnosed as “clearcell sarcoma”. It was observed a tumor with similar morphologyin the biopsy sample taken from vertebra of thepatient one month later than the first material and this wascommented as the metastasis of the tumor to vertebra.Key words: Clear cell sarcoma, chest wall, metastasis,vertebral, HMB-45, S-10

Aquaporin 1, Aquaporin 3 and Aquaporin 5 expression and EGFR mutation in malignant pleural mesotheliomas: an imunohistochemical and molecular study

Malignant pleural mesothelioma is a rare and fatal malignancy. This disease is, unfortunately, at its advanced stage when it is diagnosed. Survival time is usually not more than a few months. The aim of this study was to analyse the expression of Aquaporin 1, Aquaporin 3 and Aquaporin 5 in malignant pleural mesotheliomas and to explore the relationship of these levels of expression with epidermal growth factor receptor (EGFR) gene mutation and prognostic parameters. In this study, 60 cases diagnosed as malignant pleural mesothelioma among the pleural biopsy materials in the archives of the Pathology Department of Medical Faculty of Dicle University in 2003–2013 were evaluated. The tissues were stained immunohistochemically with antibodies against Aquaporin 1, Aquaporin 3 and Aquaporin 5, and the existence of EGFR mutation was investigated in the tissues by real-time polymerase chain reaction (PCR). The obtained results showed expression of Aquaporin 1, Aquaporin 3 and Aquaporin 5 in varied amounts in malignant pleural mesotheliomas. However, no significant relation was obtained thus far between the expression levels of these aquaporins and the prognostic parameters. No mutations were detected in the EGFR gene exons 18–21 by using real-time PCR. It could be suggested that although Aquaporin 1, Aquaporin 3 and Aquaporin 5 are expressed in malignant pleural mesothelioma, they do not have any effect on the prognostic parameters. Mutations in different domains of EGFR gene, other than exons 18–21, should be sought to develop new targeted treatments

Can aquaporins be used as diagnostic and prognostic markers for uterine smooth muscle tumours?

Generally, uterine leiomyosarcoma is easily diagnosed. However, uterine smooth muscle tumours which show atypical histological features and unusual growth patterns may mimic malignancy and may not be easily diagnosed. In this study, our aim is to show the expressions of Aquaporin3, Aquaporin7 and Aquaporin9 in uterine smooth muscle tumours, and to investigate if aquaglyceroporins can be used as diagnostic and prognostic markers to start rapidly an appropriate treatment for patients with these tumours in order to extend the survival time. We determined that there had been 74 patients diagnosed with uterine smooth muscle tumours. We divided patients into four groups based on the diagnosis: bizarre leiomyoma, smooth muscle tumour of uncertain malignant potential, leiomyosarcoma and leiomyoma. Aquaporin3, Aquaporin7 and Aquaporin9 were detected by using monoclonal anti-Aquaporin3, anti-Aquaporin7 and anti-Aquaporin9 antibodies, respectively. In leiomyosarcoma group, we observed a statistically significant relation of Aquaporin3 expression with survival time, grade, stage, mitotic index and Ki-67 score. A significant relation of both Aquaporin7 and Aquaporin9 expressions with survival time, grade, stage was not statistically detected in leiomyosarcoma group. The decrease of Aquaporin3 expression can be used as important diagnostic and prognostic marker. Aquaporin7 and Aquaporin9 expressions cannot be used as diagnostic and prognostic markers

The evaluation of diagnostic and clinical findings in grand multiparous patients with endometrial cancer

Objective: The aim of the present study is to evaluate differences in diagnostic and clinical characteristics of the grand multiparous patients with endometrial cancer comparing with the other patients with endometrial cancer.Methods: A total of 34 patients that operated for endometrial cancer between January 2006 and August 2012 in our clinic were included. The patients were divided into three groups according to the number of births; group 1 (nulliparous patients, n=8), group 2 (the number of delivery from one to four, n=12), group 3 (grand multiparous patients, n=12). The diagnostic, clinical and histopathological data of the patients in the group 3 (grand multiparous patients) were compared with those of the other groups.Results: The mean age of the patients in group 3 (grand multipara) was found to be significantly higher than those of the other groups (p0.05). The percentages of patients with the tumor stage 1A in the groups 1, 2 and 3 were found to be 75%, 64.2% and 83.3%, respectively. All of the grand multiparous patients (group 3) were found to have stage 1 tumor.Conclusion: In conclusion, grand multiparous patients were diagnosed at advanced age but their diseases were endometrioid type endometrial cancer at an early stage. The protective effect of pregnancies against endometrial cancer decreases at advanced age. The period of time after last birth may be a factor on the risk of endometrial cancer. Key words: Endometrial cancer, grand multiparity, nulliparity, pregnanc