Immunohistochemical demonstration of CD31, HCG and receptors for estrogene on normal human placenta at term stage

Çalışmada; CD31, hCG ve Estrojene spesifik reseptörlerin normal gelişimini tamamlamış insan plasentasındaki lokalizasyonunun araştırılması amaçlandı. Materyal ve Metod: 10 adet insan plasentasından hazırlanan kesitler; Hematoksilen-Eozin, PAS ve Masson 'un trikrom boyaları ile boyandı. Ardından; HCG(Ab-5)(Lab Vision), CDS I (Diagnostic BioSystems), insan estrojen reseptörüne spesifik antikorlar (Diagnostic BioSystems) ile indirekt immunoperoksidaz yöntemi kullanılarak işaretlendi. Bulgular: CD31 ile; fetal kapillerleri döşeyen endotelyal hücre sitoplazmaları ile; koryon içerisindeki kapillerler ve diğer tüm damarsal yapıları çevreleyen endotel hücreleri işaretlendi. Sinsityotrofoblastlar hCG ile belirgin şekilde boyandı. Villuslar içerisinde; yer yer sitoplazmaları hCG ile işaretlenmiş mezenkimal hücreler gözlendi. Koryon içerisinde de sitoplazması boyanmış hücrelere rastlandı. Estrojene spesifik reseptörlerle; sinsityotrofoblast sitoplazmalannda, villuslar içindeki mezenkimal hücrelerin bir kısmında, koryon kesitlerinde bazı bağ dokusu içerisindeki hücrelerin sitoplazmalannda işaretlenme mevcuttu. Tartışma: CD31 ile villuslar içerisinde lokalize mezenkimal hücrelerde işaretlenme gözlemleyememiz; yeni damar oluşumunun artık son dönem plasentada stimüle edilmediğini düşündürmektedir. hCG ile boyanmış mezenkimal hücrelerin varlığı bu hücrelerin; sinsityotrofoblastlar gibi hCG sentezleyip salgılayan hücreler ya da sinsityotrofoblastlar a farklılaşma potansiyeline sahip öncül hücreler olabileceği kanısındayız.Estrojen reseptörüne spesifik antikorla; koryon kesitlerinde ve villus içi mezenkimal hücrelerde gözlemlenen boyanma; sinsityotrofoblastlara dönüşmek üzere programlanmış hücreler veya bu reseptörleri taşıyan diğer tipteki hücreler olabileceklerini düşündürmektedir.Introduction: The aim of the study was to investigate the localization of CD31, hCG and the receptors which are specific for estrogene in normal human placenta. Material and Methods: Sections from 10 normal human placenta were stained with Hematoksilen-Eozin, PAS ve Masson's trichrom stain and immunolabeled with the antibodies specific for HCG(Ab-5)(Lab Vision), CD31 (Diagnostic BioSystems) and human estrogene receptor s (Diagnostic BioSystems) . RESULTS: Antibodies specific for CD31 were localised in the fetal capillary endothelial cells's cytoplasm and the endothelial cells aroud the different types of vessels in Chorion. Syncythyotrophoblasts were immunostained with hCG. There were also immunolabeling in the cytoplasm of mesenchimal cells in villi, and in some cells in chorion. Labeling for the receptors specific for Estrogene were localised in the cytoplasm of syncythiotrophoblasts, in mesenchimal cells in villi and the cytoplasm of the connective tissue cells in chorion. Conclusions: We conclude that new vessel formation is not common in villi in term placenta since immunolabeling with CD31 in mesenchimal cells at this location were not seen. Mesenchimal cells which were stained with hCG might be the cells which synthesize and secrete HCG, like syncythyotrophoblasts, or they might be primitive cells which have potential for differentiation into the cyncythiotrophoblasts. Cells labeled with the estrogene receptor specific antibodies in mesenchimal cells in chorion and in villi would be the precursor cells of syncythiotrophoblasts or other cell types carrying these type receptors

Use of an aromatase inhibitor in patients with polycystic ovary syndrome: a prospective randomized trial

Objective: To compare the use of an aromatase inhibitor (letrozole) with the use of clomiphene citrate (CC). Design: Prospective randomized study. Setting: An infertility clinic in a university hospital. Patient(s): Seventy-four consecutive infertile patients with polycystic ovary syndrome were recruited. Thirty-eight patients were randomized to the letrozole group (99 cycles), and the remaining patients were recruited to the CC group (95 cycles). Intervention(s): The aromatase inhibitor letrozole (2.5 mg/d) and CC (100 mg/d) were administered orally on days 3–7 of menses. Main Outcome Measure(s): Number of follicles, endometrial thickness, E2 levels on hCG day, and pregnancy rates among both groups. Result(s): Ovulation occurred in 65.7% (65/99) of letrozole cycles and in 74.7% (71/95) of CC cycles. The median (minimum–maximum) number of follicles sized >15 mm in diameter on the day of hCG administration were 1 (0–4) and 1 (0–5) in the letrozole and CC groups, respectively. On the day of hCG administration, median serum E2 concentrations in the letrozole and CC groups were statistically significantly different: 189 pg/mL (18–1,581 pg/mL) and 386 pg/mL (27–6,190 pg/mL), respectively. The median serum E2 concentrations per follicle sized >15 mm in diameter on the day of hCG also statistically significantly differed between the letrozole and CC groups: 160 pg/mL (18–808 pg/mL) and 281 pg/mL (27–2,615 pg/mL), respectively. The median endometrial thickness on the day of hCG did not significantly differ between the CC and letrozole groups; it was 8 mm. Pregnancy was achieved in nine cycles (9.1%) of the letrozole group and in seven cycles (7.4%) of the CC group, which also was not a statistically significant difference. Conclusion(s): The aromatase inhibitor letrozole may be an acceptable alternative to CC as an ovulation-induction drug in patients with PCOS

Comparison of the “Twenty-Four Hour pH Monitoring Test” Results of the Pregnant and Non-Pregnant Reflux Patients

OBJECTIVE: Twenty-four hour pH monitoring test is an important and helpful tool in diagnosis of the gastro-esophageal reflux disease. In this study we aimed to compare test results of pregnant and nonpregnant patients with gastro-esophageal reflux disease. STUDY DESIGN: Twenty-four hour pH monitoring test performed in 10 pregnant and 10 non-pregnant control patients. Among 10 pregnant gastroesophageal reflux patients; 3 were in third trimester and 7 were in second trimester. All patients had clinical diagnosis of gastroesophageal reflux disease and have filled a detailed questionnaire about reflux symptoms. RESULTS: Except one patient in each group whole patients had reflux diagnosis confirmed. There was high seropositivity for helicobacter in both groups. We observed no significant difference in demeester scores of the groups. CONCLUSIONS: Although only significance detected in the longest reflux time in proximal test results, other proximal test results of the pregnant group were markedly worse also. In the larger study groups this difference can be elucidated more meaningfully

Gebe olan ve olmayan reflü hastalarının “24 saat pH monitorizasyon testi” ile karşılaştırılması

AMAÇ: 24 saat pH monitorizasyon testi gastroözofajiyal reflü tanısı için önemli ve yararlı bir araçtır. Bu çalışmada gebe olan ve olmayan gastroözofajiyal reflü hastalarında test sonuçlarını karşılaştırmayı amaçladık. GEREÇ VE YÖNTEM: 10 gebe ve 10 gebe olmayan control hastasına 24 saat pH monitorizasyon testi uygulandı. Gebe olan 10 reflü hastasının 3’ü üçüncü trimesterda ve 7’si ikinci tri mesterda idi. Bütün hastalar klinik olarak gastroözofajiyal reflü hastalığı tanısı almıştı. Hastalar reflü semptomları ile ilgili de taylı anket doldurdu. BULGULAR: Her iki grupta birer hasta hariç bu test ile reflü hastalığı doğrulandı. Her iki grupta da yüksek helikobakterse ropozitifliği vardı. Demeester skorlaması ile gruplar arasında anlamlı farklılık saptanmadı. SONUÇ: Sadece proksimal ölçümlerden en uzun reflü zamanı parametresinde anlamlı farklılık saptansa da, bütün ölçümler de gebe hastaların sonuçları daha fazla hastalık lehine idi. Daha büyük çalışma gruplarında daha anlamlı sonuçlar elde edilebilir.Objective: Twenty-four hour pH monitoring test is an important and helpful tool in diagnosis of the gastro-esophageal reflux disease. In this study we aimed to compare test results of pregnant and nonpregnant patients with gastro-esophageal reflux disease. Study Design: Twenty-four hour pH monitoring test performed in 10 pregnant and 10 non-pregnant control patients. Among 10 pregnant gastroesophageal reflux patients; 3 were in third trimester and 7 were in second trimester. All patients had clinical diagnosis of gastroesophageal reflux disease and have filled a detailed questionnaire about reflux symptoms. Results: Except one patient in each group whole patients had reflux diagnosis confirmed. There was high seropositivity for helicobacter in both groups. We observed no significant difference in demeester scores of the groups. Conclusions: Although only significance detected in the longest reflux time in proximal test results, other proximal test results of the pregnant group were markedly worse also. In the larger study groups this difference can be elucidated more meaningfully

Neonatal ovarian cyst: A case report

Amaç: Yenidoğan over kistlerinin tanı, takip ve tedavisinin belirlenmesi. Olgu Sunumu: Biz burada alt üriner sistem enfeksiyonu sonrası, postnatal birinci ayında yapılan batın ultrasonografisinde 31x23 mm boyutunda över kisti saptanan ve spontan regresyona uğrayan bir vakayı nadir görülmesi nedeniyle sunmaktayız. Sonuç: Over kisti yenidoğanlarda en sık görülen intraabdominal kitle olup, yenidoğanın maternal ve kendi gonadotropinlerine maruz kalması sonucu oluşmaktadır, Ultrasonografınin yaygın kullanımıyla birlikte neonatal over kisti tanısının insidansında artış olmuştur. Bu hastaların takip ve tedavisinde birçok farklı yaklaşım vardır. Hastanın kliniği, over kistinin büyüklüğü ve ultrasonografık olarak kistin ekojenitesi takip ve tedaviyi belirleyen en önemli etkenlerdir.Objective: The management of the ovarian cysyts in newborns. Case Report: Here we present a newborn who underwent an US examination because of urinary tract infection, which revealed a 31x23 mm ovarian cyst. Her cyst spontane-ously resolved within 5 months. Conclusion: Ovarian cysts are the most common intraabdominal masses of neonates resulting from neonatal ex-posure to maternal and self gonadotropines. Due to the widespread use of ultrasonography (US), the incidence of diagnosis of neonatal ovarian cysts have been increased. There is no consensus concerning the optimal follow-up and treatment. The most important criterias to determine the follow-up and treatment are patients' signs and symptoms, echogenicity of the cyst on ultrasound, and the diameter of the cyst

Prenatal Diagnosis and Management of Congenital Abnormalities of Central Nervous System

Among the congenital anomalies, central nervous system malformations are the most commonly seen ones whose antenatal sonographic diagnosis is very important. Sixteen cases, attempted to Karaelmas University Obstetrics Clinic, diagnosed as having central nervous system anomaly were presented. Ultrasonographic screening is a noninvasive method that should be recommended to all pregnant women. Second trimester ultrasonography is generally performed between 20-22 gestational weeks in order to detect fetal structural defects. In the early antenatal period the ultrasonographic diagnosis of major and minor anomalies will provide the chance of giving genetic counseling to families

Management of Fetal Bronchogenic Lung Cysts: A Case Report and Short Review of Literature

Congenital malformations of the lung (CML) are rare with similar embryological and clinical spectra and could result in mortality if left untreated. Bronchogenic cysts are formed during the budding of the tracheal diverticula and ventral foregut in the embryological period. In this paper we want to present a case of bronchogenic cyst with continuous intrauterine cyst aspiration follow-up. After the baby birth was operated and the postoperative period was uneventful. The pathological examination revealed a bronchogenic cyst

Endometrial polipden gelişen uterin seröz karsinom: Olgu sunumu

Seröz karsinom, tip II endometrial karsinomun tipik bir örneğidir. Sigara içme, diabetes mellitus ve hipertansiyon hikayesi olan 71 yaşındaki kadın hasta postmenapozal kanama şikayeti ile başvurmuştur. Küretaj materyalinde adenokarsinom tanısı almıştır. Histerektomi materyalinde uterusta polipoid kitlbelirlenmiştir. Histopatolojik olarak endometrial polipden gelişen seröz karsinom gözlenmiştir. İmmünhistokimyasal olarak tümör hücrelerinde p53 ve c-erbB-2 ile diffüz, östrojen ve progesteron reseptörü ile fokal reaksiyon saptanmıştır. Olgumuz, diabetes mellitus ve hipertansiyon hikayesine sahip olmasının yanı sıra östrojen ve progesteron reseptörleri ile fokal reaksiyon vermesi ile tip 1 endometrial karsinoma ilişkili klinik ve immünhistokimyasal bulguları paylaşmaktadır. Bu tümörde p53 ve c-erbB-2’nin aşırı ekspresyonu göz önünde bulundurulmalıdır.Serous carcinoma is the prototype of type II endometrial carcinoma. A 71-year-old woman who had history of smoking, diabetes mellitus and hypertension admitted to the hospital with postmenopausal uterine bleeding. Curettage material was diagnosed as adenocarcinoma. Hysterectomy specimen revealed a uterine polypoid mass which afterwards was histopathologically proven to be a serous carcinoma arising from an endometrial polyp. Immunohistochemically, tumor cells showed diffuse reaction for p53 and c-erbB-2, and focal reaction for estrogen and progesterone receptors. In addition to history of diabetes mellitus and hypertension, our case shared some clinical and immunohistochemical characteristics of type I endometrial carcinoma, such as focal expression of estrogen and progesterone receptors. Overexpressions of p53 and c-erbB-2 in this tumor type should be considered

Uterine Serous Carcinoma Arising From Endometrial Polyp: A Case Report

Serous carcinoma is the prototype of type II endometrial carcinoma. A 71-year-old woman who had history of smoking, diabetes mellitus and hypertension admitted to the hospital with postmenopausal uterine bleeding. Curettage material was diagnosed as adenocarcinoma. Hysterectomy specimen revealed a uterine polypoid mass which afterwards was histopathologically proven to be a serous carcinoma arising from an endometrial polyp. Immunohistochemically, tumor cells showed diffuse reaction for p53 and c-erbB-2, and focal reaction for estrogen and progesterone receptors. In addition to history of diabetes mellitus and hypertension, our case shared some clinical and immunohistochemical characteristics of type I endometrial carcinoma, such as focal expression of estrogen and progesterone receptors. Overexpressions of p53 and c-erbB-2 in this tumor type should be considered

Clinical and ultrasonographic evaluation of pelvic masses

AMAÇ: Bu çalışmada pelvik kitle tanısı almış hastaların ultrasonografik bulguları, Ca125 değerleri, malignite indeks riski (RMI), rezistans indeksi ve patoloji sonuçlarının malign ve benign ayrımını sağlamadaki etkinlikleri incelenmiştir. Materyal ve Metot: İki bin iki ile 2004 yılları arasında pelvik kitle tanısı alan 114 hasta değerlendirildi. Pelvik kitlelerin ultrasonografik malignite kriterleri (4 cm’den büyük kitle, solid, kistik, multiloküle, septalı, komplike kist, asit varlığı, düzensiz kist cidarı ve papiller yapı), Ca125 değerleri (?35U/ml), Doppler sonografik rezistans indeksi (RI?0.42) ve malignite risk endeksi (RMI?200) değerleri incelendi. Postoperatif patolojik tanılarına göre ovaryen karsinom ve borderline tümörler “malign” grubuna alınırken, fonksiyonel kistler benign pelvik kitleler grubunda değerlendirildi. Bahsi geçen parametrelerin preoperatif dönemde benign/malign kitlelerin ayrımını sağlayıcı etkinlikleri ile ilgili tanımlayıcı istatistikleri yapıldı. BULGULAR: Hastaların ortalama yaşı 39 (sınırlar 12-75) idi. On altı hasta postmenopozal idi. Yüz on dört hastanın 91’i ( %79) opere edildi. Hastaların 54’ü ( %59) operatif laparoskopi ile (malign tanı yok), 37’si ( %41) eksploratif laparotomi (13’ü malign) ile opere edildi. Cerrahi tedavi gerekli görülmeyen hastaların 18’i ultrasonografi ve Ca125 ile 5’i de ultrasonografik kist aspirasyonu sonrasında takip edildi. Opere edilmeyip takip edilen hastaların hiçbirinde 1 yıllık takip sonrası ovaryen malignite düşündüren bir bulgu saptanmadı. On üç hastanın postoperatif histopatolojisi malign idi (1 clear cell karsinom, 1 undiferensiye karsinom, 1 adenokarsinom, 1 malign Brenner tümörü, 1 karsinom metastazı, 4 borderline ovaryen tümör). Yetmiş sekiz hastanın histopatolojisi benign (13 endometrioma, 3 matür kistik teratom, 3 torsiyon, 2 tuboovaryen abse, 1 dejenere myom, 56 benign kist) idi. Malign/benign ayrımında RMI, Ca125 ve RI değerlerinin sensitivitelerinin %38 ile %69 arasında, spesifitelerinin %71 ile %99 arasında, pozitif prediktif değerlerinin %23 ile %83 arasında, negatif prediktif değerlerinin de %92 ile %94 arasında bulunduğunu göstermektedir. TARTIŞMA: Doppler ultrasonografinin malign/benign ayrımında sadece ultrasonografi ve Ca125 değerinin kombine edilmesi, ya da sadece malignite risk endeksine göre daha etkin olduğu saptandı. Malignite risk endeksinin literatürdeki bazı verilerden farklı olarak düşük sensitivitesinin sunulan çalışmadaki vaka sayısının az olmasıyla bağlantılı olabileceği düşünülmüştür. Ca125, Malignite risk endeksi ve Doppler sonografinin kombine kullanımı pelvik kitlelerin değerlendirmesinde tanısal etkinliği artırmaktadır.OBJECTIVES: Ultrasonographic findings, Ca125 levels, risk of malignity index, resistance index and pathologic results of pelvic masses were examined to determine their efficiency in malignant and benign differentiation. MATERIALS-METHODS: Onehundredfourteen patients with a diagnosis of pelvic mass between the years 2002-2004 were evaluated. The menopausal status, ultrasonographic appearance (mass lesion greater than 4 cm, solid, cystic, multiloculated, uniloculated, septated, complicated and existence of papillary structures), serum Ca125 levels (cut-of≥ 35U/ml), Doppler sonographic resistance index (cut-off≤ 0.42) and RMI (risk of malignancy index, cut-off≥200) were recorded. Ovarian carcinomas and borderline tumours were classified in the malignant group in the evaluation of the efficiency of these paramaters in malignant/benign differentiation. RESULTS: Patients mean age was 39 (Range 12-75). Sixteen patients were postmenopausal. Ninety one (79 %) of 114 patients were operated. Fifytfour patients (59 %) were laparoscopically operated (none of them was malignant), whereas explorative laparotomy was performed for 37 (41 %) patients (13 of them were malignant). Eighteen (15.8 %) of the remaing patients were followed-up by ultrasonography and serum Ca-125 determinations, and ultrasonographic cyst aspiration was performed in 5 patients (4.4 %). Postoperative histopathology of 13 patients showed malignant characteristics (1 clear-cell carcinoma, 1 undifferentiated carcinoma, 1 adenocarcinoma, 1 Brenner tumor, 1 carcinoma metastasis, and 4 borderline tumors) and 78 patients showed benign characteristics (13 endometriomas, 3 mature cystic teratomas, 3 ovarian torsions, 2 tuboovarian abcesses, 1 degenerated myoma, 56 benign cysts). The sensitivity of RMI, CA125 and RI in the differentiation of malignant/benign tumors ranged between 38-69 %, the specifity between 71-99 %, the positive predictive value between 23-83 % and the negative predictive value between 92-94 %. DISCUSSION: In the differentiation of malignant/benign lesions Doppler ultrasonography was found to be more effective than only ultrasonography and Ca125 or RMI. The low sensitivity of RMI was attributed to the insufficient number of cases in our study. The combination of these 3 parameters will increase the effectivity of clinical judgement of pelvic masses