Arbil Acikalin

Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis: A Case Study and Review of the Literature

Well-differentiated papillary mesothelioma is an uncommon tumor of the testes that usually presents as a hydrocele. Here, we present the case of one patient who did not have a history of asbestos exposure. The tumor was localized in the tunica vaginalis and was composed of three pedunculated masses macroscopically. Microscopically, branching papillary structures with focal coagulative necrosis were present. In addition to immunohistochemistry, simian virus 40 DNA was also tested by polymerase chain reaction. This report presents one case of this rare entity, its clinical and macroscopic features, and follow-up results.

Mesenchymal Stem Cell: Does it Work in an Experimental Model with Acute Respiratory Distress Syndrome?

We hypothesized that bone marrow-derived mesenchymal stem cells (BM-MSCs) would have a possible role in the treatment of acute respiratory distress syndrome (ARDS). ARDS disease model was developed in Wistar albino male rats by intratracheal instillation of physiological saline solution. Anesthezied and tracheotomized rats (n = 8) with ARDS were pressure-controlled ventilated. Isolated and characterized rat (r-) BM-MSCs were labeled with GFP gene, and introduced in the lungs of the ARDS rat-model. After applying of MSCs, the life span of each rat was recorded. When rats died, their lung tissues were removed for histopathological examination. Also the tissue sections were analyzed for GFP labeled rBM-MSCs and stained for vimentin, CK19, proinflammatory (MPO, IL-1β, IL-6 and MIP-2) and anti-inflammatory [IL-1ra and prostaglandin E2 receptor (EP3)] cytokines. The histopathological signs of rat-model ARDS were similar to the acute phase of ARDS in humans. rBM-MSCs were observed to home in lung paranchyma. Although the infiltration of neutrophils slightly decreased in the interalveolar, peribronchial and perivascular area, a notable improvement was determined in the degree of hemorrhage, edema and hyaline membrane formation in rats treated with rBM-MSCs. Also decreased proinflammatory cytokines levels and increased the intensity of anti-inflammatory cytokines were established. Therefore MSCs could promote alveoar epithelial repair by mediating of cytokines from a proinflammatory to an anti-inflammatory response. As a novel therapeutic approach, mesenchymal stem cell treatment with intratracheal injection could be helpful in the management of critically ill patients with ARDS.

Protective Effects of Phosphodiesterase-4-specific Inhibitor Rolipram on Acute Ischemia-reperfusion Injury in Rat Kidney

OBJECTIVE To investigate the effect of Rolipram, a phosphodiesterase-4-inhibitor, on renal ischemia-reperfusion injury (IRI) in rats. METHODS Thirty rats were divided into 5 different groups of 6 rats. Nothing was done to the control group. In the second group, the renal pedicle was clamped for 30 minutes. In the third group, 1 mg/kg of Rolipram was given by intraperitoneal injection 30 minutes before clamping. The fourth group received the same injection when the clamp was placed, as did the fifth group 30 minutes after the clamp was opened. Clamping time was set at 30 minutes. Twenty-four hours later, nephrectomy was performed in all the groups. Half of each kidney was examined histopathologically. Levels of biochemical agents, such as malondialdehyde, superoxide dismutase, and catalase, were measured in the other half. RESULTS The malondialdehyde (MDA) levels significantly decreased and reached control levels in the group in which Rolipram was administered 30 minutes after reperfusion (P = .07). The catalase and superoxide dismutase activities obtained from renal homogentisates of the ischemia groups were evaluated; there were striking increases in tissue levels of these 2 enzymes in the groups in which Rolipram was administered during ischemia and 30 minutes after ischemia (P < .001). Histopathologically, there was no significant difference in inflammation between the Rolipram-administrated groups compared with group 1 (control) and group 2 (IRI). Tubular necrosis and apoptosis was significantly lower in group 5 than the other groups, except group 1 (P < .001). CONCLUSION We suggest that in surgical procedures that can lead to renal IRI, the administration of Rolipram can decrease oxidative renal tissue damage and the severe deterioration of renal function.

An unusual cause of hematospermia: Primary adenocarcinoma of the seminal vesicle.

Adenocarcinoma of the seminal vesicles is one of the rare causes of hematospermia. Primary seminal vesicle adenocarcinoma is extremely rare and difficult to diagnose due to frequent invasion of adenocarcinomas of the surrounding organs, especially the prostate. In the present study, a case of a primary seminal vesicle adenocarcinoma will be discussed in the light of the current literature.

Effect of silymarin on bladder overactivity in cyclophosphamide-induced cystitis rat model.

The purpose of this study was to investigate the effects of silymarin, a phytotherapeutic agent, on bladder overactivity in a cyclophosphamide (CYP)-induced cystitis rat model. Female Wistar Albino rats received a single intraperitoneal injection of CYP (150 mg/kg) or saline and after 72 h, bladder function was evaluated by in vitro preparations of whole bladders and cystometry with continuous saline infusion under urethane anesthesia. Silymarin or a vehicle was orally given for 7 days in rats. CYP was injected on the 5th day of silymarin or vehicle treatment and then the animals were killed on the 8th day. CYP-treatment dramatically potentiated the basal spontaneous contractions of isolated whole bladders compared to control rats. In anesthetized rats, during continuous infusion cystometry, intercontraction interval (ICI) was significantly shorter, but bladder voiding pressure was not significantly changed in CYP-injected rats compared to control rats. In the CYP-injected group, silymarin treatment significantly decreased the amplitude, frequency (contractions/min) and area under the curve of spontaneous contractions, but failed to change carbachol-induced contraction in isolated whole bladder. Also, silymarin treatment significantly increased the ICI in comparison to the vehicle treatment. In the saline-injected group, no significant changes in the bladder function were observed between the silymarin and vehicle-treated groups. Histopathological examination showed that CYP-induced bladder inflammation tended to be lower in the silymarin+CYP-treated group. In conclusion, the oral administration of silymarin suppressed CYP-induced bladder overactivity. Silymarin may be considered as an attractive treatment for CYP-induced bladder overactivity.

Intraoperative frozen section in ovarian neoplasms; a tertiary center experience.

Abstract Objective: Frozen section is an accurate diagnostic tool with some unavoidable pitfalls in gynecologic tumors. We aimed to evaluate the diagnostic value of frozen section, and to detect the factors causing erroneous diagnosis in ovarian tumors. Material and Method: Frozen section and paraffin section reports of 282 patients with ovarian neoplasms diagnosed between July 2006 and January 2013 in our institute were re-analyzed. Results were grouped into benign, borderline (for epithelial tumors) and malignant categories and compared between frozen section and paraffin section diagnosis, statistically. Results: Overall diagnostic accuracy of frozen section was 96.5%. Sensitivity of frozen section for benign, borderline and malignant tumors were 97.5%, 95.8%, and 95.6% and the related specificities were 97.5%, 97.6%, and 100%, respectively. We found the lowest positive predictive value in borderline group (79.3%), all of them with mucinous type epithelium. Second frequent discordant tumor type was immature teratoma. Conclusion: Apart from the limitations of frozen section, pathologists should be aware of the pitfalls of technique and tumor types and tend to sample from the solid areas particularly in mucinous tumors and teratomas to avoid inappropriate surgery. Öz Amaç: Jinekolojik tümörler için frozen kesit inceleme bazı tanısal tuzaklara karşın yeterli bir tanısal yöntemdir. Bu çalışmada, over tümörlerinde frozen incelemenin tanısal değerini ve tanısal yanlışlıkların nedenlerini tespit etmeyi amaçladık. Gereç ve Yöntem: Kurumumuzda Haziran 2006 ve Ocak 2013 yılları arasında over tümörü nedeni ile frozen inceleme yapılmış olan toplam 282 hastaya ait sonuçlar yeniden değerlendirildi. Tanılar benign, borderline (epitelyal tümörler için) ve malign olmak üzere üç alt gruba ayrıldı. Frozen ve parafin kesit sonuçları istatistiksel olarak karşılaştırıldı. Bulgular: Frozen incelemenin genel tanısal doğruluk oranı %96,5 idi. Benign, borderline ve malign tümörler için frozen incelemenin duyarlığı sırasıyla %97,5, %95,8 ve %95,6 idi. Özgüllük ise aynı sırayla, %97,5, %97,6 ve %100 idi. En düşük pozitif prediktif değer borderline grubunda saptandı (%79,3) ve hataya neden olan tüm olgular müsinöz tip epitelyal tümörler idi. Tanı uyumsuzluğu bulunan ikinci tümör grubu ise immatür teratom idi. Sonuç: Frozen incelemenin kısıtlılıkları yanısıra, patoloğun frozen incelemenin teknik veya tümör tipi ile ilgili tuzaklarını bilmesi, özellikle müsinöz tümörler ve teratom olgularında solid görünen alanlardan örneklenmesi yetersiz veya gereksiz operasyon yapılmasını önlemek adına yararlı olacaktır.

Perinatal autopsy evaluation of 2150 autopsies in the Çukurova region of Turkey.

Abstract Objective: We aimed to document the reasons of perinatal deaths in a large autopsy series performed in our institute, which is a reference center in the Çukurova region of Turkey. Material and Method: The study included 2150 autopsies performed between January 2000 and December 2012at our institute. Diagnoses were categorized according to the detected pathologies; congenital malformations were detailed based on systems. Results: A pathology was detected in 1619 of 2150 (73.3%) autopsies. Congenital malformations were the most common diagnosis with 68.2%. Neural tube defects and central nervous system malformations were the most frequent system malformation in 28.8% of cases, followed by the urogenital system (11.4%) and musculoskeletal system (8.3%), respectively. Malformation syndromes including multisystem anomalies were defined in 109 cases (9.3%). Conclusion: Congenital malformations are the most common reason for perinatal deaths, with autopsy having an additive role to prenatal and genetic evaluations and providing foresight for planning a subsequent pregnancy. Öz Amaç: Türkiye’nin Çukurova bölgesi için referans merkez konumunda olan ve oldukça geniş otopsi serisi içeren kurumumuzda yapılan fetal otopsi olgularını, değerlendirerek perinal ölüm nedenlerini tespit etmeyi amaçladık. Gereç ve Yöntem: Ocak 2000 ve Aralık 2012 yılları arasında kurumumuza gelen 2150 adet otopsi raporu yeniden değerlendirildi. Olgular tanılarına göre gruplandırıldı. Ayrıca konjenital malformasyonlar yer aldıkları sistemlere göre alt gruplara ayrıldı. Bulgular: Toplam 2150 olgunun 1619’unda (%73,3) patolojik bulgu saptandı. En sık patoloji %68,2 oranında konjenital malformasyonlar idi. Nöral tüp defektleri ve santral sinir sistemi anomalileri en sık malformasyon idi (%28,8). Bunu sırasıyla ürogenital sistem (%11,4) ve kas-iskelet sistemi (%8,3) takip etmekteydi. Bunun yanısıra, 109 olguda (%9,3) çoklu sistem tutulumu gösteren malformasyon sendromları tanımlandı. Sonuç: Fetal otopsi prosedürü, son yıllarda sayısal düşüş göstermekle birlikte, özellikle gebelik beklentisi olan kişiler için, prenatal tarama yöntemlerine tanısal katkısı olmakta ve malformasyonun yineleme olasılığı hakkında öngörü sağlamaktadır.

Rotator cuff metastases: A report of two cases with literature review

Context: Distant metastases of primary malignancies to the skeletal muscle tissue are a very rare event. Distant metastases that affect the rotator cuff are even rarer, and only a few of cases have been reported so far. Case Report: The present article reports two cases that presented to our hospital with the complaint of shoulder pain and had a soft tissue mass affecting the muscles of the rotator cuff and invading the neighboring bone compartments. One of the patients developed mucoepidermoid cancer metastasis of the submandibular gland, and the other was found to have a malignant epithelial tumor metastasized from the lower lobe of the right lung, whose primary origin could not be diagnosed until the imaging examinations were employed. Ultrasound and magnetic resonance imaging findings are presented in this paper. Conclusion: Metastases to the muscle tissues could be misdiagnosed as primary sarcomas. Because the therapy regiments and prognoses are fairly different for these two entities, the possibility of a metastasis to the muscle tissue must be considered as a differential diagnosis for case of painful soft tissue mass. Ultrasound is very useful in detection of the lesion and acts as a very important tool during guidance for biopsy. Magnetic resonance imaging, however, is a very valuable asset in the evaluation of the borders of the soft tissue mass and its invasive effect on the bony tissues. Particularly when the features such as lobulated contours, peripheral edema, and intratumoral necrosis exist, the possibility of metastases must be considered.

Sweet syndrome in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma: curious lymphocyte/neutrophil fluctuations.

Sweet syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by tender, red inflammatory nodules or papules that occur in association with infection, malignancy, connective tissue disease, or following exposure to certain drugs. Here, we present Sweet syndrome in a case with small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) which is a relatively rare co-occurrence. Conflict of interest:None declared.

Congenital peribronchial myofibroblastic tumor: a case report and review of the literature.

BACKGROUND Congenital peribronchial myofibroblastic tumor is a rare, solid mesenchymal tumor of the neonate, usually associated with non-immune hydrops fetalis. CASE REPORT We present a case of congenital peribronchial myofibroblastic tumor, in whom a right lung mass was detected in intrauterine life. 12 days after delivery by caesarean section, right lobectomy was performed. The tumor was limited to the lung, and was composed of spindle cells, proliferating around a bronchial unit. Central necrosis and 4-5 mitoses per 10 high power fields were present. The patient is well 26 months after surgery. CONCLUSION We report this rare tumor with clinical, radiological and pathologic findings and a review of the literature.