Vulvar Pyogenic Granuloma in a Postmenopausal Woman: Case Report and Review of the Literature

Introduction. Although pyogenic granulomas (PG) are common and benign vascular proliferations of the skin and mucous membranes, they are relatively rare on the vulva. Case Presentation. A 57-year-old G7P7 postmenopausal woman presented with a 3-year history of a foul smell and bleeding lesions in the genital region. A gynecologic examination revealed multiple large papillomatous, pedunculated, and lobulated lesions that were cherry-red and infective in appearance. There was a 2-cm lesion at the upper intersection of the labia majora, a 2-cm lesion on the right labium majus, and a 4-cm lesion on the clitoris. The patient complained of itching, and the lesions were asymptomatic, except for occasional bleeding. All lesions were excised and sent for histopathological examination, which revealed an ulcerated polypoidal structure with extensive proliferation of vascular channels lined by a single layer of endothelium. The histopathological features were consistent with PG. Conclusion. The present case is the first case of multiple pyogenic granulomas on the vulva in a postmenopausal woman

Lymphangiomatous Polyp of Tonsil: A Case Report

Lymphangiomatous polyps of the palatine tonsils are uncommon hamartomatous proliferations that could be clinically misdiagnosed as malignant neoplasms. These polyps consist of dilated lymphatic vessels located inside fibrous and/or adipose tissue. In this paper, a 27-year-old man who presented to the outpatient clinic with a complaint of dysphagia is presented. On physical examination, the patient had a smooth, polypoid mass extending from the posterior section of the right palatine tonsil into the oropharynx. The patient underwent right tonsillectomy. histopathological examination of the specimen showed typical features of a lymphangiomatous polyp of the tonsil. The case is reported with the accompanying literature to avoid the possibility of misdiagnosing it as a malignant lesion clinically.Lymphangiomatous polyps of the palatine tonsils are uncommon hamartomatous proliferations that could be clinically misdiagnosed as malignant neoplasms. These polyps consist of dilated lymphatic vessels located inside fibrous and/or adipose tissue. In this paper, a 27-year-old man who presented to the outpatient clinic with a complaint of dysphagia is presented. On physical examination, the patient had a smooth, polypoid mass extending from the posterior section of the right palatine tonsil into the oropharynx. The patient underwent right tonsillectomy. histopathological examination of the specimen showed typical features of a lymphangiomatous polyp of the tonsil. The case is reported with the accompanying literature to avoid the possibility of misdiagnosing it as a malignant lesion clinically

Secretory carcinoma: A case report

Onaltı yaşında bir kız çocuğun sağ memesinde bulunan 4,5x3,5x3 cm boyutlarda kitle eksizyonel olarak çıkarıldı. Kitlenin makroskopik incelemesinde; çevreden çok iyi sınırlı, fakat kapsülsüz tümöral doku izlendi. Tü- mörün mikroskopik görüntüsü belirleyici olup, eozinofilik sekresyonla dolu lümen oluşturan eozinofilik, granüler veya berrak sitoplazmalı hücrelerle döşeli tubuloalveolar ve fokal papiller yapılar vardı. Hücrelerin bazılarında nukleus belirgin nukleol içermekteydi, mitoz nadir olarak izlendi. S-100 protein, östrojen ve progesteron reseptörü, poliklonal karsinoembriyojenik antijen (CEA) antikorları ile yapılan immunhistokimyasal boyamalarda S-100 ile pozitif reaktivite görüldü. Östrojen ve progesteron reseptörü, CEA ile pozitif reaktivite saptanmadı. Bu bulgularla olguya sekretuar karsinom tanısı verildi. Meme tümörlerinin nadir görülen tipi olan sekretuar karsinom, meme kanserlerinin %1’inden azını oluşturur. Prognozu çok iyidir ve bir çok seride 5 yıllık yaşam %100’e yakın olarak bildirilmektedir.16 year-old girl with a mass measuring 4,5x3,5x3 cms, in the right breast was presented. The patient underwent surgical resection. Grossly, it was a noncapsulated, well circumscribed neoplasm. The microscopic apparence was distinctive. Tubuloalveolar and focally papilary formations, lined by cells with eosinophilic, granular or clear cytoplasm were seen forming lumina filled by an eosinophilic secretion. Some nucleus had prominent nucleoli, but mitoses were very scant. Immunohistochemistry was performed by using the following antibodies: S-100 protein, oestrogen and progesterone receptor and polyclonal carcinoembryonic antigen (CEA). The tumor cells were positive for S-100 protein and negative for, oestrogen and progesterone receptor and CEA. Clinical and morphological findings were consisted with a secretory carcinoma. Secretory carcinoma of the breast is a rare varyant of the breast carcinoma. It is accounting less than 1% of all breast neoplasms. The overall prognosis is excellent, most series quoting a 5-year survival rate close to 100%

An extraneural primary anaplastic ependymoma at the subcutaneous inguinal region: Report of a rare case

Ependymomas commonly arise in the central nervous system. Extraneural presentation is quite rare. Herein, we describe a primary extraneural ependymoma in a young female. The mass was located in the right inguinal area. The cut surface of the 7.5 mm × 6.5 mm × 4.5 mm sized tumor was brownish-yellow in color. Histologically, it was hypercellular exhibiting pseudorosette or rosette formations and some papillary structures. Mitosis was counted as high as 10 per 10 high power fields. Neither necrosis nor vascular endothelial proliferation within the tumor was observed. Tumor cells showed strong glial fibrillary acidic protein immunoreactivity. On epithelial membrane antigen, intracytoplasmic dot-like immunostaining was observed. This is the first report presenting a primary extraneural anaplastic ependymoma arising in the inguinal subcutaneous region

Secretory carcinoma: A case report

Onaltı yaşında bir kız çocuğun sağ memesinde bulunan 4,5x3,5x3 cm boyutlarda kitle eksizyonel olarak çıkarıldı. Kitlenin makroskopik incelemesinde; çevreden çok iyi sınırlı, fakat kapsülsüz tümöral doku izlendi. Tü- mörün mikroskopik görüntüsü belirleyici olup, eozinofilik sekresyonla dolu lümen oluşturan eozinofilik, granüler veya berrak sitoplazmalı hücrelerle döşeli tubuloalveolar ve fokal papiller yapılar vardı. Hücrelerin bazılarında nukleus belirgin nukleol içermekteydi, mitoz nadir olarak izlendi. S-100 protein, östrojen ve progesteron reseptörü, poliklonal karsinoembriyojenik antijen (CEA) antikorları ile yapılan immunhistokimyasal boyamalarda S-100 ile pozitif reaktivite görüldü. Östrojen ve progesteron reseptörü, CEA ile pozitif reaktivite saptanmadı. Bu bulgularla olguya sekretuar karsinom tanısı verildi. Meme tümörlerinin nadir görülen tipi olan sekretuar karsinom, meme kanserlerinin %1’inden azını oluşturur. Prognozu çok iyidir ve bir çok seride 5 yıllık yaşam %100’e yakın olarak bildirilmektedir.16 year-old girl with a mass measuring 4,5x3,5x3 cms, in the right breast was presented. The patient underwent surgical resection. Grossly, it was a noncapsulated, well circumscribed neoplasm. The microscopic apparence was distinctive. Tubuloalveolar and focally papilary formations, lined by cells with eosinophilic, granular or clear cytoplasm were seen forming lumina filled by an eosinophilic secretion. Some nucleus had prominent nucleoli, but mitoses were very scant. Immunohistochemistry was performed by using the following antibodies: S-100 protein, oestrogen and progesterone receptor and polyclonal carcinoembryonic antigen (CEA). The tumor cells were positive for S-100 protein and negative for, oestrogen and progesterone receptor and CEA. Clinical and morphological findings were consisted with a secretory carcinoma. Secretory carcinoma of the breast is a rare varyant of the breast carcinoma. It is accounting less than 1% of all breast neoplasms. The overall prognosis is excellent, most series quoting a 5-year survival rate close to 100%

Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn

Recent studies have demonstrated a role for calcium channel blocking agents in the treatment of persistent hyperinsulinemic hypoglycemia of newborns. We report a newborn infant with persistent hyperinsulinemic hypoglycemia whom we successfully treated with oral nifedipine alone after surgical therapies. A 4-day-old male infant was referred with intractable hypoglycemia and seziures. Normoglycaemia could be maintained only by the intravenous infusion of glucose at a rate of 20 mg/kg per minute. Persistent hyperinsulinemic hypoglycemia of newborn was diagnosed from an inappropriately raised plasma insulin concentration (44 mU/L) at the time of hypoglycemia. Medical treatments led to only a mild reduction in the intravenous glucose requirement; an 85-90% pancreatectomy was performed and histological "diffuse nesidioblastosis" was confirmed. However, despite all the medical treatments after the first pancreatectomy, the hyperinsulinemic hypoglycemia persisted and a second 95% pancreatectomy was performed. After the second pancreatectomy, persistent hyperinsulinemic hypoglycemia was treated with somatostatin and diazoxide, but led to no reduction in the intravenous glucose requirement. We report the case of an infant who had persistent hypoglycemia after two subtotal pancreatic resections but subsequently became normoglycemic on treatment with nifedipine (2 mg/kg per day). The patient was discharged home on oral nifedipine. Calcium channel blocking agents cuold be used with efficacy and safety in recurrent persistent hyperinsulinemic hypoglycemia

High-Grade Transformation of Adenoid Cystic Carcinoma Delineated with a Fibrous Rim: A Case Report

Background: High-grade transformation or dedifferentiation in carcinoma is progression of a low-grade malignant neoplasm to a high-grade carcinoma or poorly differentiated adenocarcinoma. This is rarely observed in adenoid cystic carcinoma of the salivary glands. Case Report: A 39 year-old woman presented with a painless mass at the left submandibulary region that had been growing slowly for 5 years. Submandibulary mass resection revealed a mass with peripheral adenoid cystic carcinoma and a central high-grade tumor delineated with a fibrous rim, raising the possibility of a hybrid or composite carcinoma, requiring differential diagnosis depending upon morphology and immunohistochemistry findings. The final histopathological diagnosis was high-grade transformation of adenoid cystic carcinoma. After surgical therapy, the patient was irradiated to the neck and submandibulary region. No sign of tumor recurrence has been evident for 36 months. Conclusion: This present case seems to be another rare case with high-grade transformation of adenoid cystic carcinoma and the fibrous rim may be a histopathological feature of such cases, which should be kept in mind

Multiple Intraosseous Lipoma: Report of Three Cases

WOS: 000298576600009Multiple intraosseous lipoma (MIOL) is extremely rare bone tumour, Its real incidence is estimated as much more because of most of these tumours is asymptomatic and undiagnosed. We reported 3 MIOL patients involving both upper and lower extremity. Two female patient with 30 and 26 age and one male with 52 years old represented by intraosseous lipomatous lesions involving bilateral wrist and hand bones, distal radius, proximal and distal femur, patella, proximal and distal tibia metaphyses, distal fibula, ankle and foot bones. Painful lesions were curetted and grafted by allograft. A distal radius fracture is treated by closed reduction and percutaneus pining. All the lesions healed that is managed by surgery. The asymptomatic lesions were not treated anyway. MIOL needs surgery in the case of pain, pathologic fracture, pathologic diagnosis confirmation and impending fracture. The malign transformation potential is present even rare. It must be followed in long period and carefully. CT is a good diagnostic imaging allowing negative density measurement in lesions between -60 and -110 HU

Postmenopozal Kadında Az Diferansiye Sertoli-Leydig Hücreli Tümör

Sertoli--Leydig hücreli tümör (SLHT)'lerin %70--75'i 40 yaşın altında, 0/010'dan azı menarştan önce veya postmenopozal dönemde görülmektedir. Bu çalışmada, postmenopozal lekelenme şek-- linde vajinal kanama ile hastanemize başvuran, sağ adneksiyal kitle saptanan 59 yaşındaki kadın olgu sunulmuştur. Olguya batın yıkama sıvısı örneklemesi, total abdominal histerektomi ve bilate-- ral salpingooferektomi yapıldı. İntraoperatif frozen kesitlerin değerlendirilmesinde seks kord stro-- mal tümör düşünüldü. Periton biyopsileri, omentektomi ve pelvik, paraaortik lenf nodu diseksiyonu ile evreleme cerrahisi yapıldı. Solid ve kistik alanlar içeren kitleden hazırlanan kesitlerin histopa-- tolojik incelemesinde; immatür görünümdeki sertoli hücrelerinin tübüller yanı sıra geniş sarko-- matöz dağılım paterni oluşturduğu görüldü. İmmünohistokimyasal çalışmada CD 56 ile kuvvetli, kalretinin, inhibin ile fokal pozitif boyanma görüldü. Histopatolojik ve immünohistokimyasal bul-- gular değerlendirilerek az diferansiye SLHT tanısı verildi. Az diferansiye SLHT nadir görülen, ayı-- rıcı tanısında iğsi hücre komponentli tümörlerin düşünülmesi gereken overin seks kord stromal tümörüdür.70—75% of Sertoli—Leydig cell tumors (SLCT) are diagnosed at before age of 40, and less than 10% takes place before menarche and following menapouse. We report case of right adnexal mass in 59 year—old postmenapousal woman who presented with vaginal bleeding. Sex—cord stro— mal tumor was diagnosed at peroperative frozen section assesment. Staging surgery consisting of peritoneal biopsies, omentectomy and pelvic paraaortic lymph node dissection was performed. ln histopathologic assesment of the slides which were prepared from solid—cyctic areas of the mass, revealed immature sertoli cells forming tubules and wide sarcomatoid differantiation. lmmunhis— tochemically, neoplastic cells stained strongly and diffusely positive with CD 56, focal positive with calretinin and inhibin. Poorly differentiated SLCT was diagnosed with the consideration of both histopathologic and immunhistochemical findings. Poorly differantiated SLCT are unusual sex cord stromal neoplasms of ovary of which differantial diagnosis should include spindle cell neoplasms