The turkish journal of ear nose and throat, May 2, 2019
Objectives: This study aims to characterize the cellular components of major salivary gland tumor... more Objectives: This study aims to characterize the cellular components of major salivary gland tumors and to identify the differentiating markers between tumor subtypes. Patients and Methods: Between January 2006 and December 2010, a total of 83 patients (42 males, 41 females; mean age 50.2±15.8 years; range, 21 to 82 years) with major salivary gland tumors (n=12 mucoepidermoid carcinomas, n=8 adenoid cystic carcinomas, n=3 acinic cell carcinomas, n=4 salivary duct carcinomas, n=2 myoepitheliomas, n=5 basal cell adenomas, n=31 pleomorphic adenomas, and n=18 Warthin tumors) with myoepithelial and epithelial immunohistochemical markers (smooth muscle actin [SMA], calponin, S100, CD10, GFAP, p63, GCDFP15, GLUT1, 34ßE12, CK14, CK19, CD117, and galectin-3) were evaluated using tissue microarray method. Results: The GFAP, S100, CK14, p63, and CK5/6 expressions were significantly lower in the malignant tumors (p<0.05), whereas the expression of neither SMA, nor calponin was significantly different between benign and malignant tumors. The CK19 expression was significantly higher in malignant tumors (p=0.004). Diffuse CD117 expression favored an adenoid cystic carcinoma; GFAP expression favored a pleomorphic adenoma; 34ßE12, p63, and CK5/6 expression favored a mucoepidermoid carcinoma; and GCDFP15 favored a salivary duct carcinoma and acinic cell carcinoma. Conclusion: Our study results showed that distinct tumor types exhibited different preferences for various markers. We, therefore, suggest that immunohistochemical characteristics of myoepithelial cells, rather than the quantity per se, show a significant difference between malignant and benign salivary gland tumors and CK19 expression may indicate the malignant nature of a salivary gland tumor in difficult-to-diagnose tumors.
A telephone survey investigating the impact of COVID-19 on patients with biopsy-proven LN was adm... more A telephone survey investigating the impact of COVID-19 on patients with biopsy-proven LN was administered. Data extraction included diagnosis, disease activity status, demographics, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. Covid-19 was classified as definite diagnosis of Covid-19 disease (presence of symptomatic Covid-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test). Comparisons between patients with or without hospitalization were performed. RESULTS: 114 patients (median age 34,9 6 12,4 years) with LN were included in the study. All were on different doses glucocorticoids, 82 were taking hydroxychloroquine and 30 took immunosuppressants. 31 patients (26 women, 5 men) developed symptomatic COVID-19 infection-they have at least one symptom (chest pain, fever, asthenia, chills, cough, sore throat, dyspnea, headache, arthralgia, myalgia, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. These 31 patients prior to their COVID-19 illness were treated with methylprednisolone, 16-with cyclophosphamide, 8-with azathioprine, 3-with hydroxychloroquine. Six patients (4 men, 2 women) required hospitalizationthese were more frequently older and with comorbidities (cardio-respiratory illness, hypertension and other) and active LN (3-class IV LN, 2-class V LN, 1 class III LN and 1 Class II LN, according the 2003 ISN/RPS classification). Adherence to therapy and to social distancing advise was high. The median time from onset of symptoms to hospital admission was 6 (3-11) days. The median length of stay was 12 days (8-20) days. No deaths occurred. CONCLUSION: Covid-19 is more frequent in the subgroup of LN patients without therapy with hydroxychloroquine, which might play some protective role against the most harmful manifestations of Covid-19. Male sex, previous lung disease, serum creatinine level, proteinuria, glucocorticoids use > 5 mg/day, were associated to hospitalization of patients with LN.
Coeliac disease (CD) is an autoimmune enteropathy which can present with patchy mucosal lesions. ... more Coeliac disease (CD) is an autoimmune enteropathy which can present with patchy mucosal lesions. The aim of the present study is to investigate the significance of duodenal bulb biopsy in the diagnostic work-up of CD in both pediatric and adult patients, and to highlight the key points for pathologists. D1 (duodenal bulb) and D2 (distal duodenum) biopsies of 153 newly diagnosed serology-positive CD patients were evaluated for villous/crypt ratio and intraepithelial lymphocyte (IEL) counts on CD3-stained slides and were classified according to Marsh. Mucosal pathology was patchy in 15% (13% only D1 and 2% only D2) of patients, and 85% of patients had diffuse mucosal pathology involving both D1 and D2 biopsies which showed concordant histology in 60% and discordant in 25% of the cases. Though majority of the patients (75%) with only D1 involvement were pediatric cases, no significant difference was found between pediatric and adult patients when all cases were considered (17 vs 14%). Our results clearly indicate that without D1 sampling, diagnosis of CD would have been missed in a significant number of cases (13%), thereby highlighting the importance of taking duodenal biopsies from multiple sites in the diagnostic work-up of CD. We, therefore, conclude that every biopsy piece from both D1 and D2 should be carefully evaluated for the whole spectrum of mucosal changes caused by gluten ingestion and classified using a scheme based on Marsh to allow recognition of mild lesions.
A 43-year-old male patient was admitted to the outpatient clinic for nausea, jaundice, and dark-c... more A 43-year-old male patient was admitted to the outpatient clinic for nausea, jaundice, and dark-colored urine in July 2019. He has been taking dexketoprofen/diclofenac sodium twice a week for headaches. He consumed 25 packs of cigarettes per year and 60-70 g of alcohol per week for 2 years. On his physical examination, he was icteric and had mild epigastric tenderness. At that time, his serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were 897 U/L (0-50) and 1799 U/L (0-50), respectively. His serum alkaline phosphatase (ALP) level was 141 U/L (40-130), gammaglutamyl transferase (GGT) 158 U/L (10-71), total bilirubin 7.4 mg/dL (0.1-1.2), direct bilirubin 4.3 mg/dL, and albumin 2.7 g/dL (3.5-5.2). INR was 1.32. Serological studies for viral hepatitis, autoimmune panel, and metabolic panel were all normal. We diagnosed NSAID-induced toxic hepatitis. After the drug was discontinued, his laboratory values returned to the normal range. He was discharged with normal liver tests.
Aim: Traditional serrated adenomas are the rarest member of the serrated polyps, that have endosc... more Aim: Traditional serrated adenomas are the rarest member of the serrated polyps, that have endoscopic and morphologic similarities with conventional adenomas, tubulovillous adenomas, in particular. We aimed to compare the histopathologic and immunohistochemical features of TSAs showing overt dysplasia with conventional TVAs in a compartmental manner using digitalized images. Patients and methods: For 25 TSAs and 25 TVAs, extent of the morphologic features including cytoplasmic eosinophilia, mid-zonal nuclei, ECFs, slit-like serration, brush border, gastric foveolar-like epithelium and goblet cells were evaluated. Immunohistochemistry was perfomed using primary antibodies including CK7, CK20, MUC2, MUC5AC, MUC6, B-catenin, Ki67, p53, p16, MLH1, MSH2, MSH6 and PMS2. Results: Eosinophilic cells, mid-zonal nuclei, slit-like serration and ECF were significantly more extensive in TSAs compared to TVAs (p<0,001) while gastric epithelium was also more extensive in TSA cohort with a lower significance (p<0,01). Cut-offs for these features yielding the highest sensitivity and specificity in discriminating TSAs from TVAs were determined ; mid-zonal nucleus resulted as the best discriminating histopathologic feature (100%, 92%) followed by eosinophilia (88%, 92%),and slit-like serration (84%, 92%) with highest sensitivity and specificities, respectively. Compartmental immunohistochemical evaluation revealed that CK20 and CK7 were mainly expressed in ECF while MUC5AC together with CK7 were found in epithelial compartment more frequently in TSAs compared to TVAs. P16 was more common in TSAs in all compartments whereas Ki67 and p53 were restricted to dysplastic compartments in both polyp groups. Conclusions: The present study demonstrated that mid-zonal nuclei, eosinophilic cells and slit-like serration followed by ECF proved to be the most discriminatory features for TSAs.The correct diagnosis of TSAs will allow to develop appropriate treatment and follow up modalities which seem to be crucial as their progression rate may be different from TVAs.
Renal involvement is most often seen in conjunction with multisystemic, disseminated lymphoma eit... more Renal involvement is most often seen in conjunction with multisystemic, disseminated lymphoma either by direct extension from a retroperitoneal mass or via hematogenous spread. Primary lymphoma of the kidney is not a common entity and it is a controversial issue on account of the absence of lymphatic tissues in the normal kidney. In this case report, we describe a 19-year-old male with hematuria, acute kidney injury, and bilateral renal masses due to massive lymphomatous infiltration of the kidneys, which was diagnosed as diffuse large B-cell non-Hodgkin lymphoma by Tru-Cut biopsy.
This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 I... more This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.
The Turkish journal of gastroenterology, Jul 17, 2020
Background/AimsTraditional serrated adenomas (TSAs), despite their low incidence in colorectum, m... more Background/AimsTraditional serrated adenomas (TSAs), despite their low incidence in colorectum, may originate in other parts of the gastrointestinal (GI) tract, including stomach and small intestine. Malignant transformation for upper GI TSAs has recently been reported in the literature. Here, we present a series of gastric and small intestinal TSAs with the aim to characterize their morphologic and immunophenotypic features as well as their neoplastic potential in a compartmental manner using digitalized images.Materials and MethodsThe study comprised 12 GI polyps with TSA features—5 gastric and 7 small intestinal. The extent of the characteristic features of TSA, including eosinophilic cells, ectopic crypt foci (ECF), slit-like serration, foveolar epithelium, goblet cells, together with dysplastic/carcinomatous foci were assessed on digitalized H&E images and were used as reference for immunohistochemical analysis.ResultsAll polyps in the cohort contained eosinophilic cells as the most extensive morphologic feature followed by ECF and slit-like serration in decreasing order. Serrated dysplasia was more common in gastric polyps, which more frequently showed neoplastic progression compared with the intestinal ones. CK20 was the most widely expressed marker with a preference to eosinophilic cells while ECFs were mostly negative. Ki67 showed the opposite pattern of CK20. MUC6 and MUC2 were selectively expressed in the basal zone and goblet cells, respectively.ConclusionOur results showed that the presence of eosinophilic cells with pencillate nuclei commonly accompanied by ECF and slitlike serration are the defining features of gastric and small intestinal TSAs. They frequently harbor neoplastic foci, particularly in gastric location where serrated dysplasia seems to be more common.
The fourth edition of the World Health Organization (WHO) classification of pituitary tumors reco... more The fourth edition of the World Health Organization (WHO) classification of pituitary tumors recommended evaluation of tumor proliferation and invasion to identify aggressiveness. We aimed to assess the prognostic roles of the Ki-67 proliferation index, mitotic index, P53 expression, and cavernous sinus invasion in pituitary adenomas (PAs). Among the 601 patients who underwent transnasal/transsphenoidal adenomectomy from 2001 to 2016, 101 patients (16.8%) who had tumors with a high (≥ 3%) Ki-67 index (group A) and a control group consisting of 43 patients with a low (< 3%) Ki 67 index who were matched for age, gender, and tumor type were included. Mitotic index and P53 expressions were evaluated. Patient characteristics, histopathology reports, pre/postoperative magnetic resonance imaging (MRI), and follow-up data were assessed retrospectively. The frequency of macroadenomas and mean tumor size were greater in group A when compared to group B (67.4 vs. 94.1%, p< 0.01 and 25 ± 10.6 vs. 18 ± 11 mm, p< 0.01, respectively). Invasion to cavernous sinus was found in 53 (36.8%) patients and was more frequent in group A (p<0.01). The mean number of surgery was higher in group A than group B (p< 0.05). The mean follow-up period was 46.6 ± 34 months. The postoperative MRIs and follow-up data for at least 24 months were available in 117 patients. Recurrence risk was higher in group A than group B (p = 0.03). Tumors with high Ki-67 proliferation index were grouped as 3-5, 6-10, 11-15, and > 15%. The risk of recurrence was not different between groups of high Ki-67 index. The optimal cutoff point of the Ki-67 proliferation index that predicted recurrence was 2.5% with 84.6% sensitivity and 47.4% specificity. The cavernous sinus invasion on MRI was associated with recurrence (p = 0.03). Tumor size and recurrence risk were not associated with P53 expression. High P53 expression was related with cavernous sinus invasion (p = 0.03). The mitotic index was not associated with recurrence risk and tumor invasion. Recurrence risk was higher in tumors with ≥ 2 histopathological atypia criteria (p = 0.01). High Ki-67 index with a 2.5% cutoff point and cavernous sinus invasion on MRI are reliable markers for predicting recurrence in PAs. Recurrence risk is also higher in tumors with two histopathological aggressiveness criteria. Strict follow-up and more aggressive treatment approaches may be necessary for invasive-proliferative PAs.
Özet Amaç. Gastrointestinal stromal tümörlerde (GİST) spesifik olarak ekspresyon gösteren ve kals... more Özet Amaç. Gastrointestinal stromal tümörlerde (GİST) spesifik olarak ekspresyon gösteren ve kalsiyum bağımlı klorid kanalı olarak bilinen DOG1, gastrointestinal stromal tümörlerin diğer sarkomlardan ayrımında kullanılan tanısal bir belirteçtir. Çeşitli araştırmalarda Gastrointestinal stromal tümor dışı mezenşimal tümörlerde değişen oranda DOG1 ekspresyonu bildirilmiştir. Bu çalışmada Nodüler fasiit, Nörofibroma, Desmoid tümör ve Dermatofibrosarkoma Protuberans olgularından oluşan bir vaka serisinde DOG1 ekspresyonu araştırılmıştır. Yöntem. Bu çalışmaya, Ankara Üniversitesi Tıp Fakültesi Tıbbi Patoloji Anabilim Dalı'nda 2005-2012 yılları arasında tanı almış Nodüler Fasiit (n=8), Desmoid tümör (n=8), Dermatofibrosarkoma Protuberans (n=8) ve Nörofibroma (n=8) vakaları dahil edilmiştir. Parafin bloklardan elde edilen kesitlerde otomatik immün boyama cihazı ile DOG1 çalışılmıştır. Bulgular. Yalnızca bir Nodüler fasiit olgusunda (1/8) fokal soluk sitoplazmik boyanma izlenirken, diğer olgularda DOG1 ekspresyonu saptanmamıştır. Sonuç. Fibroblastik /myofibroblastik benign ve lokal agresif neoplaziler ve nörofibromalarda DOG1'in tanısal değeri yoktur.
Introduction: The aim of this study was to assess whether epidermal growth factor receptor (EGFR)... more Introduction: The aim of this study was to assess whether epidermal growth factor receptor (EGFR) overexpression was a significant prognostic factor in clear cell renal cell carcinoma (CRCC) and whether its prognostic significance was affected by immunohistochemical expression patterns. Materials and methods: Immunohistochemistry was performed on 100 cases of CRCC using an antibody against EGFR. Tumors were grouped by nuclear grade (NG) as low-NG (NG1, 2) or high NG (NG3, 4), and by pathological stage as localized (pT1, 2), or locally invasive (pT3, 4). Clinical disease was grouped by clinical stage as early stage (stage I, II), or late stage (stage III, IV). Evaluation of the EGFR overexpression was based on cytoplasmic (EGFR Cyt), and membranous (EGFR Mem) staining. Results: EGFR Cyt correlated with high NG (P = 0.001), lymphovascular invasion (P = 0.028), regional lymph node involvement (P = 0.027), metastasis (P = 0.001), late stage (P = 0.003), cancer-specific death (P = 0.036), and was a predictor for disease-specific survival (P = 0.012) whereas EGFR Mem correlated with only local invasion (P = 0.021) and perirenal invasion (P = 0.009) and did not show any correlation with cancer-specific death or disease specific survival. Conclusion: Our findings suggest that EGFR overexpression is an important prognostic factor in CRCC, and its prognostic value differs significantly with respect to the location of EGFR immunostaining. This prognostic difference may give direction on the management and treatment of CRCC patients.
Applied Immunohistochemistry & Molecular Morphology, 2016
Small cell carcinoma (SmCC) is a rare and aggressive neuroendocrine carcinoma of the bladder. Neu... more Small cell carcinoma (SmCC) is a rare and aggressive neuroendocrine carcinoma of the bladder. Neuroendocrine carcinomas expressing somatostatin receptors (SSTR) in other viscera such as lung, pancreas, and gastrointestinal system respond to therapy with somatostatin analogs. In the present study, expressions of SSTRs 1 to 5 including type 2A are investigated by immunohistochemistry (IHC) and their relationship with clinicopathologic factors was evaluated. Hundred primary bladder SmCC cases were collected from 12 centers in Turkey. Forty-three cases were pure SmCC. Other cases had mostly papillary urothelial carcinoma as a second component. The percentage of the SmCC component ranged from 5% to 100%. SSTR-2A expression was membranous, whereas the other receptors showed cytoplasmic staining. The percentages of positive cases for SSTR-1, SSTR-2A, SSTR-3, SSTR-4, and SSTR-5 were 4% (3/75), 61.4% (54/88), 2.4% (2/84), 24.4% (20/ 82), and 6.25% (5/80), respectively. The percentage of SmCC component was positively correlated with the percentage of SSTR-2A expression (P = 0.003) while negatively correlated with patient age (P = 0.032). SSTR-2A expression was correlated with survival as a bad prognostic factor (P = 0.018). SSTR-1, SSTR-3, SSTR-4, and SSTR-5 expressions did not show any statistical significance with any parameter. In conclusion, although the limited number of cases with adequate term follow-up, SSTR-2A expression could be a prognostic factor and somatostatin analogs therapeutic candidate for SmCCs of the bladder as these tumors show high percentage of SSTR-2A expression.
1.7 mg/dL (normal range: 0.3-1 mg/dL), and albumin level of 2.7 g/ dL (normal range: 3.5-5.5 g/dL... more 1.7 mg/dL (normal range: 0.3-1 mg/dL), and albumin level of 2.7 g/ dL (normal range: 3.5-5.5 g/dL) were noted. The results of serological studies for viral hepatitis, an autoimmune panel, and a metabolic panel were all normal. Her D-dimer level was high: 5321 ng/mL (normal range: <250 ng/mL). The antithrombin-III and protein C activity level was 43% (normal range: 70-125%) and 51% (normal range: 70-140%), respectively. Abdominal ultrasonography (US) revealed hepatomegaly and a diffuse increase in parenchyma heterogenicity. Doppler US suggested no flow in the right hepatic vein. Magnetic resonance imaging (MRI) also showed hepatomegaly, a heterogenic liver parenchyma, and no contrast filling in the right hepatic vein, consistent with right hepatic vein occlusion. Anticoagulant therapy with low-molecular-weight heparin was initiated. She was followed-up in the outpatient clinic.
The turkish journal of ear nose and throat, May 2, 2019
Objectives: This study aims to characterize the cellular components of major salivary gland tumor... more Objectives: This study aims to characterize the cellular components of major salivary gland tumors and to identify the differentiating markers between tumor subtypes. Patients and Methods: Between January 2006 and December 2010, a total of 83 patients (42 males, 41 females; mean age 50.2±15.8 years; range, 21 to 82 years) with major salivary gland tumors (n=12 mucoepidermoid carcinomas, n=8 adenoid cystic carcinomas, n=3 acinic cell carcinomas, n=4 salivary duct carcinomas, n=2 myoepitheliomas, n=5 basal cell adenomas, n=31 pleomorphic adenomas, and n=18 Warthin tumors) with myoepithelial and epithelial immunohistochemical markers (smooth muscle actin [SMA], calponin, S100, CD10, GFAP, p63, GCDFP15, GLUT1, 34ßE12, CK14, CK19, CD117, and galectin-3) were evaluated using tissue microarray method. Results: The GFAP, S100, CK14, p63, and CK5/6 expressions were significantly lower in the malignant tumors (p<0.05), whereas the expression of neither SMA, nor calponin was significantly different between benign and malignant tumors. The CK19 expression was significantly higher in malignant tumors (p=0.004). Diffuse CD117 expression favored an adenoid cystic carcinoma; GFAP expression favored a pleomorphic adenoma; 34ßE12, p63, and CK5/6 expression favored a mucoepidermoid carcinoma; and GCDFP15 favored a salivary duct carcinoma and acinic cell carcinoma. Conclusion: Our study results showed that distinct tumor types exhibited different preferences for various markers. We, therefore, suggest that immunohistochemical characteristics of myoepithelial cells, rather than the quantity per se, show a significant difference between malignant and benign salivary gland tumors and CK19 expression may indicate the malignant nature of a salivary gland tumor in difficult-to-diagnose tumors.
A telephone survey investigating the impact of COVID-19 on patients with biopsy-proven LN was adm... more A telephone survey investigating the impact of COVID-19 on patients with biopsy-proven LN was administered. Data extraction included diagnosis, disease activity status, demographics, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. Covid-19 was classified as definite diagnosis of Covid-19 disease (presence of symptomatic Covid-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test). Comparisons between patients with or without hospitalization were performed. RESULTS: 114 patients (median age 34,9 6 12,4 years) with LN were included in the study. All were on different doses glucocorticoids, 82 were taking hydroxychloroquine and 30 took immunosuppressants. 31 patients (26 women, 5 men) developed symptomatic COVID-19 infection-they have at least one symptom (chest pain, fever, asthenia, chills, cough, sore throat, dyspnea, headache, arthralgia, myalgia, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. These 31 patients prior to their COVID-19 illness were treated with methylprednisolone, 16-with cyclophosphamide, 8-with azathioprine, 3-with hydroxychloroquine. Six patients (4 men, 2 women) required hospitalizationthese were more frequently older and with comorbidities (cardio-respiratory illness, hypertension and other) and active LN (3-class IV LN, 2-class V LN, 1 class III LN and 1 Class II LN, according the 2003 ISN/RPS classification). Adherence to therapy and to social distancing advise was high. The median time from onset of symptoms to hospital admission was 6 (3-11) days. The median length of stay was 12 days (8-20) days. No deaths occurred. CONCLUSION: Covid-19 is more frequent in the subgroup of LN patients without therapy with hydroxychloroquine, which might play some protective role against the most harmful manifestations of Covid-19. Male sex, previous lung disease, serum creatinine level, proteinuria, glucocorticoids use > 5 mg/day, were associated to hospitalization of patients with LN.
Coeliac disease (CD) is an autoimmune enteropathy which can present with patchy mucosal lesions. ... more Coeliac disease (CD) is an autoimmune enteropathy which can present with patchy mucosal lesions. The aim of the present study is to investigate the significance of duodenal bulb biopsy in the diagnostic work-up of CD in both pediatric and adult patients, and to highlight the key points for pathologists. D1 (duodenal bulb) and D2 (distal duodenum) biopsies of 153 newly diagnosed serology-positive CD patients were evaluated for villous/crypt ratio and intraepithelial lymphocyte (IEL) counts on CD3-stained slides and were classified according to Marsh. Mucosal pathology was patchy in 15% (13% only D1 and 2% only D2) of patients, and 85% of patients had diffuse mucosal pathology involving both D1 and D2 biopsies which showed concordant histology in 60% and discordant in 25% of the cases. Though majority of the patients (75%) with only D1 involvement were pediatric cases, no significant difference was found between pediatric and adult patients when all cases were considered (17 vs 14%). Our results clearly indicate that without D1 sampling, diagnosis of CD would have been missed in a significant number of cases (13%), thereby highlighting the importance of taking duodenal biopsies from multiple sites in the diagnostic work-up of CD. We, therefore, conclude that every biopsy piece from both D1 and D2 should be carefully evaluated for the whole spectrum of mucosal changes caused by gluten ingestion and classified using a scheme based on Marsh to allow recognition of mild lesions.
A 43-year-old male patient was admitted to the outpatient clinic for nausea, jaundice, and dark-c... more A 43-year-old male patient was admitted to the outpatient clinic for nausea, jaundice, and dark-colored urine in July 2019. He has been taking dexketoprofen/diclofenac sodium twice a week for headaches. He consumed 25 packs of cigarettes per year and 60-70 g of alcohol per week for 2 years. On his physical examination, he was icteric and had mild epigastric tenderness. At that time, his serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were 897 U/L (0-50) and 1799 U/L (0-50), respectively. His serum alkaline phosphatase (ALP) level was 141 U/L (40-130), gammaglutamyl transferase (GGT) 158 U/L (10-71), total bilirubin 7.4 mg/dL (0.1-1.2), direct bilirubin 4.3 mg/dL, and albumin 2.7 g/dL (3.5-5.2). INR was 1.32. Serological studies for viral hepatitis, autoimmune panel, and metabolic panel were all normal. We diagnosed NSAID-induced toxic hepatitis. After the drug was discontinued, his laboratory values returned to the normal range. He was discharged with normal liver tests.
Aim: Traditional serrated adenomas are the rarest member of the serrated polyps, that have endosc... more Aim: Traditional serrated adenomas are the rarest member of the serrated polyps, that have endoscopic and morphologic similarities with conventional adenomas, tubulovillous adenomas, in particular. We aimed to compare the histopathologic and immunohistochemical features of TSAs showing overt dysplasia with conventional TVAs in a compartmental manner using digitalized images. Patients and methods: For 25 TSAs and 25 TVAs, extent of the morphologic features including cytoplasmic eosinophilia, mid-zonal nuclei, ECFs, slit-like serration, brush border, gastric foveolar-like epithelium and goblet cells were evaluated. Immunohistochemistry was perfomed using primary antibodies including CK7, CK20, MUC2, MUC5AC, MUC6, B-catenin, Ki67, p53, p16, MLH1, MSH2, MSH6 and PMS2. Results: Eosinophilic cells, mid-zonal nuclei, slit-like serration and ECF were significantly more extensive in TSAs compared to TVAs (p<0,001) while gastric epithelium was also more extensive in TSA cohort with a lower significance (p<0,01). Cut-offs for these features yielding the highest sensitivity and specificity in discriminating TSAs from TVAs were determined ; mid-zonal nucleus resulted as the best discriminating histopathologic feature (100%, 92%) followed by eosinophilia (88%, 92%),and slit-like serration (84%, 92%) with highest sensitivity and specificities, respectively. Compartmental immunohistochemical evaluation revealed that CK20 and CK7 were mainly expressed in ECF while MUC5AC together with CK7 were found in epithelial compartment more frequently in TSAs compared to TVAs. P16 was more common in TSAs in all compartments whereas Ki67 and p53 were restricted to dysplastic compartments in both polyp groups. Conclusions: The present study demonstrated that mid-zonal nuclei, eosinophilic cells and slit-like serration followed by ECF proved to be the most discriminatory features for TSAs.The correct diagnosis of TSAs will allow to develop appropriate treatment and follow up modalities which seem to be crucial as their progression rate may be different from TVAs.
Renal involvement is most often seen in conjunction with multisystemic, disseminated lymphoma eit... more Renal involvement is most often seen in conjunction with multisystemic, disseminated lymphoma either by direct extension from a retroperitoneal mass or via hematogenous spread. Primary lymphoma of the kidney is not a common entity and it is a controversial issue on account of the absence of lymphatic tissues in the normal kidney. In this case report, we describe a 19-year-old male with hematuria, acute kidney injury, and bilateral renal masses due to massive lymphomatous infiltration of the kidneys, which was diagnosed as diffuse large B-cell non-Hodgkin lymphoma by Tru-Cut biopsy.
This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 I... more This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.
The Turkish journal of gastroenterology, Jul 17, 2020
Background/AimsTraditional serrated adenomas (TSAs), despite their low incidence in colorectum, m... more Background/AimsTraditional serrated adenomas (TSAs), despite their low incidence in colorectum, may originate in other parts of the gastrointestinal (GI) tract, including stomach and small intestine. Malignant transformation for upper GI TSAs has recently been reported in the literature. Here, we present a series of gastric and small intestinal TSAs with the aim to characterize their morphologic and immunophenotypic features as well as their neoplastic potential in a compartmental manner using digitalized images.Materials and MethodsThe study comprised 12 GI polyps with TSA features—5 gastric and 7 small intestinal. The extent of the characteristic features of TSA, including eosinophilic cells, ectopic crypt foci (ECF), slit-like serration, foveolar epithelium, goblet cells, together with dysplastic/carcinomatous foci were assessed on digitalized H&E images and were used as reference for immunohistochemical analysis.ResultsAll polyps in the cohort contained eosinophilic cells as the most extensive morphologic feature followed by ECF and slit-like serration in decreasing order. Serrated dysplasia was more common in gastric polyps, which more frequently showed neoplastic progression compared with the intestinal ones. CK20 was the most widely expressed marker with a preference to eosinophilic cells while ECFs were mostly negative. Ki67 showed the opposite pattern of CK20. MUC6 and MUC2 were selectively expressed in the basal zone and goblet cells, respectively.ConclusionOur results showed that the presence of eosinophilic cells with pencillate nuclei commonly accompanied by ECF and slitlike serration are the defining features of gastric and small intestinal TSAs. They frequently harbor neoplastic foci, particularly in gastric location where serrated dysplasia seems to be more common.
The fourth edition of the World Health Organization (WHO) classification of pituitary tumors reco... more The fourth edition of the World Health Organization (WHO) classification of pituitary tumors recommended evaluation of tumor proliferation and invasion to identify aggressiveness. We aimed to assess the prognostic roles of the Ki-67 proliferation index, mitotic index, P53 expression, and cavernous sinus invasion in pituitary adenomas (PAs). Among the 601 patients who underwent transnasal/transsphenoidal adenomectomy from 2001 to 2016, 101 patients (16.8%) who had tumors with a high (≥ 3%) Ki-67 index (group A) and a control group consisting of 43 patients with a low (< 3%) Ki 67 index who were matched for age, gender, and tumor type were included. Mitotic index and P53 expressions were evaluated. Patient characteristics, histopathology reports, pre/postoperative magnetic resonance imaging (MRI), and follow-up data were assessed retrospectively. The frequency of macroadenomas and mean tumor size were greater in group A when compared to group B (67.4 vs. 94.1%, p< 0.01 and 25 ± 10.6 vs. 18 ± 11 mm, p< 0.01, respectively). Invasion to cavernous sinus was found in 53 (36.8%) patients and was more frequent in group A (p<0.01). The mean number of surgery was higher in group A than group B (p< 0.05). The mean follow-up period was 46.6 ± 34 months. The postoperative MRIs and follow-up data for at least 24 months were available in 117 patients. Recurrence risk was higher in group A than group B (p = 0.03). Tumors with high Ki-67 proliferation index were grouped as 3-5, 6-10, 11-15, and > 15%. The risk of recurrence was not different between groups of high Ki-67 index. The optimal cutoff point of the Ki-67 proliferation index that predicted recurrence was 2.5% with 84.6% sensitivity and 47.4% specificity. The cavernous sinus invasion on MRI was associated with recurrence (p = 0.03). Tumor size and recurrence risk were not associated with P53 expression. High P53 expression was related with cavernous sinus invasion (p = 0.03). The mitotic index was not associated with recurrence risk and tumor invasion. Recurrence risk was higher in tumors with ≥ 2 histopathological atypia criteria (p = 0.01). High Ki-67 index with a 2.5% cutoff point and cavernous sinus invasion on MRI are reliable markers for predicting recurrence in PAs. Recurrence risk is also higher in tumors with two histopathological aggressiveness criteria. Strict follow-up and more aggressive treatment approaches may be necessary for invasive-proliferative PAs.
Özet Amaç. Gastrointestinal stromal tümörlerde (GİST) spesifik olarak ekspresyon gösteren ve kals... more Özet Amaç. Gastrointestinal stromal tümörlerde (GİST) spesifik olarak ekspresyon gösteren ve kalsiyum bağımlı klorid kanalı olarak bilinen DOG1, gastrointestinal stromal tümörlerin diğer sarkomlardan ayrımında kullanılan tanısal bir belirteçtir. Çeşitli araştırmalarda Gastrointestinal stromal tümor dışı mezenşimal tümörlerde değişen oranda DOG1 ekspresyonu bildirilmiştir. Bu çalışmada Nodüler fasiit, Nörofibroma, Desmoid tümör ve Dermatofibrosarkoma Protuberans olgularından oluşan bir vaka serisinde DOG1 ekspresyonu araştırılmıştır. Yöntem. Bu çalışmaya, Ankara Üniversitesi Tıp Fakültesi Tıbbi Patoloji Anabilim Dalı'nda 2005-2012 yılları arasında tanı almış Nodüler Fasiit (n=8), Desmoid tümör (n=8), Dermatofibrosarkoma Protuberans (n=8) ve Nörofibroma (n=8) vakaları dahil edilmiştir. Parafin bloklardan elde edilen kesitlerde otomatik immün boyama cihazı ile DOG1 çalışılmıştır. Bulgular. Yalnızca bir Nodüler fasiit olgusunda (1/8) fokal soluk sitoplazmik boyanma izlenirken, diğer olgularda DOG1 ekspresyonu saptanmamıştır. Sonuç. Fibroblastik /myofibroblastik benign ve lokal agresif neoplaziler ve nörofibromalarda DOG1'in tanısal değeri yoktur.
Introduction: The aim of this study was to assess whether epidermal growth factor receptor (EGFR)... more Introduction: The aim of this study was to assess whether epidermal growth factor receptor (EGFR) overexpression was a significant prognostic factor in clear cell renal cell carcinoma (CRCC) and whether its prognostic significance was affected by immunohistochemical expression patterns. Materials and methods: Immunohistochemistry was performed on 100 cases of CRCC using an antibody against EGFR. Tumors were grouped by nuclear grade (NG) as low-NG (NG1, 2) or high NG (NG3, 4), and by pathological stage as localized (pT1, 2), or locally invasive (pT3, 4). Clinical disease was grouped by clinical stage as early stage (stage I, II), or late stage (stage III, IV). Evaluation of the EGFR overexpression was based on cytoplasmic (EGFR Cyt), and membranous (EGFR Mem) staining. Results: EGFR Cyt correlated with high NG (P = 0.001), lymphovascular invasion (P = 0.028), regional lymph node involvement (P = 0.027), metastasis (P = 0.001), late stage (P = 0.003), cancer-specific death (P = 0.036), and was a predictor for disease-specific survival (P = 0.012) whereas EGFR Mem correlated with only local invasion (P = 0.021) and perirenal invasion (P = 0.009) and did not show any correlation with cancer-specific death or disease specific survival. Conclusion: Our findings suggest that EGFR overexpression is an important prognostic factor in CRCC, and its prognostic value differs significantly with respect to the location of EGFR immunostaining. This prognostic difference may give direction on the management and treatment of CRCC patients.
Applied Immunohistochemistry & Molecular Morphology, 2016
Small cell carcinoma (SmCC) is a rare and aggressive neuroendocrine carcinoma of the bladder. Neu... more Small cell carcinoma (SmCC) is a rare and aggressive neuroendocrine carcinoma of the bladder. Neuroendocrine carcinomas expressing somatostatin receptors (SSTR) in other viscera such as lung, pancreas, and gastrointestinal system respond to therapy with somatostatin analogs. In the present study, expressions of SSTRs 1 to 5 including type 2A are investigated by immunohistochemistry (IHC) and their relationship with clinicopathologic factors was evaluated. Hundred primary bladder SmCC cases were collected from 12 centers in Turkey. Forty-three cases were pure SmCC. Other cases had mostly papillary urothelial carcinoma as a second component. The percentage of the SmCC component ranged from 5% to 100%. SSTR-2A expression was membranous, whereas the other receptors showed cytoplasmic staining. The percentages of positive cases for SSTR-1, SSTR-2A, SSTR-3, SSTR-4, and SSTR-5 were 4% (3/75), 61.4% (54/88), 2.4% (2/84), 24.4% (20/ 82), and 6.25% (5/80), respectively. The percentage of SmCC component was positively correlated with the percentage of SSTR-2A expression (P = 0.003) while negatively correlated with patient age (P = 0.032). SSTR-2A expression was correlated with survival as a bad prognostic factor (P = 0.018). SSTR-1, SSTR-3, SSTR-4, and SSTR-5 expressions did not show any statistical significance with any parameter. In conclusion, although the limited number of cases with adequate term follow-up, SSTR-2A expression could be a prognostic factor and somatostatin analogs therapeutic candidate for SmCCs of the bladder as these tumors show high percentage of SSTR-2A expression.
1.7 mg/dL (normal range: 0.3-1 mg/dL), and albumin level of 2.7 g/ dL (normal range: 3.5-5.5 g/dL... more 1.7 mg/dL (normal range: 0.3-1 mg/dL), and albumin level of 2.7 g/ dL (normal range: 3.5-5.5 g/dL) were noted. The results of serological studies for viral hepatitis, an autoimmune panel, and a metabolic panel were all normal. Her D-dimer level was high: 5321 ng/mL (normal range: <250 ng/mL). The antithrombin-III and protein C activity level was 43% (normal range: 70-125%) and 51% (normal range: 70-140%), respectively. Abdominal ultrasonography (US) revealed hepatomegaly and a diffuse increase in parenchyma heterogenicity. Doppler US suggested no flow in the right hepatic vein. Magnetic resonance imaging (MRI) also showed hepatomegaly, a heterogenic liver parenchyma, and no contrast filling in the right hepatic vein, consistent with right hepatic vein occlusion. Anticoagulant therapy with low-molecular-weight heparin was initiated. She was followed-up in the outpatient clinic.
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