Asuman Nihan Haberal

VEGF, COX-2, and PCNA expression in renal cell carcinoma subtypes and their prognostic value

ObjectiveTo evaluate the prognostic value of new markers such as VEGF (vascular endothelial growth factor), COX-2 (cyclooxygenase-2), and PCNA (proliferating cell nuclear antigen) and review their differences in expression by histological subtype in patients with renal cell carcinoma (RCC).MethodsAbout 99 patients who underwent radical (nxa0=xa079) or partial nephrectomy (nxa0=xa020) were included in this study. Histopathological specimens from the subjects were retrospectively analyzed immunohistochemically for the presence of VEGF, COX-2, or PCNA.ResultsMean staining ratios for VEGF, COX-2, and PCNA were 16.5, 16.8, and 31%, respectively. Correlations were evaluated among these three prognostic factors. There was no correlation between PCNA and VEGF (Pxa0=xa0.068), but there were significant correlations between COX-2 and both PCNA and VEGF (Pxa0=xa0.005 and Pxa0=xa0.000, respectively). A significant correlation was found between the expression of VEGF and both pathologic stage and vascular invasion (Pxa0=xa0.018 and Pxa0=xa0.025, respectively). In addition, patients with conventional RCC had significantly lower VEGF and COX-2 levels than those with papillary RCC (Pxa0<xa0.012).ConclusionsIt is obvious that prognostic factors such as VEGF, COX-2, and PCNA may vary depending on histological subtype. The level of expression of these factors together with histological subtype may provide valuable predictive information about the outcome of treatment.

Hepatocyte Growth Factor in Patients with Three Different Stages of Chronic Liver Disease including Hepatocellular Carcinoma, Cirrhosis and Chronic Hepatitis: An Immunohistochemical Study

BACKGROUND AND AIMSnThe specific role of hepatocyte growth factor in liver disease is unknown. The presence and density of this factor in patients with three different stages of liver disease were investigated, with the aim of assessing its prognostic significance.nnnPATIENTS AND METHODSnLiver specimens from patients with chronic hepatitis (n=20), cirrhosis (n=20), hepatocellular carcinoma (n=30) and normal livers (n=20) were immunohistochemically stained to determine the presence and density of hepatocyte growth factor.nnnRESULTSnThere were significantly more hepatocyte growth factor-positive Kupffer and Ito cells in all three diseased groups than in the control group. Also, there was significantly more positive staining in chronic hepatitis specimens than in specimens from the cirrhosis, hepatocellular carcinoma and control groups (P<0.05). The hepatoma cells in 10 of the hepatocellular carcinoma cases stained positive, but none of the hepatocytes in the chronic hepatitis, cirrhosis and normal liver specimens stained. It was only possible to assess nonmalignant hepatocytes adjacent to the hepatocellular carcinoma in the four resection specimens, and no staining for hepatocyte growth factor was observed in these areas. There was no statistical association between density of hepatocyte growth factor and histological activity index in chronic hepatitis, or between density of hepatocyte growth factor and grade of hepatocellular carcinoma.nnnCONCLUSIONSnSimilar to some previous reports, this study revealed that hepatoma cells can also express this growth factor. Immunohistochemical detection of hepatocyte growth factor may prove to be a useful method of diagnosing hepatocellular carcinoma in challenging cases.

The analysis of gastrointestinal amyloidosis in 78 patients with chronic renal failure

Systemic amyloidosis is not a single disease, but the product of a variety of diseases. Amyloid proteins are insoluble fibrils that are deposited extracellularly in many organ tissues. They stain with Congo red and appear apple green under polarized light. Definitive diagnosis and classification of amyloidosis requires histologic examination of tissue samples. Gastrointestinal tract involvement is common, and all parts of the system can be affected. Immuno–histochemical studies have shown that amyloid deposited in the gastrointestinal system is most often of the AA, A kappa, or A lambda types. Another type of amyloid protein, beta–2 microglobulin (β2M), predominantly affects the musculoskeletal system, and is usually seen in patients who have been on long–term hemodialysis. Mixed systemic amyloidosis (β2M and AA) is seen only rarely in these patients. In this study, we attempted to answer why this is so, and examined whether or not mixed amyloidosis is related to amyloidogenesis. We studied gastrointestinal tissues from 78 chronic renal failure patients who had systemic amyloidosis with gastrointestinal involvement. A total of 115 endoscopic samples and 1 jejunal resection specimen were analysed immunohistochemically. Immunohistochemical testing using a panel of antisera directed against two major amyloid fibril proteins (AA–Monoclonal, Dako–, and β2 MPolyclonal, Dako–) showed that all samples contained AA amyloid, but not β2M type protein. These findings can be explained by the patients relatively short average duration of hemodialysis and the predominance of endoscopic biopsy samples in our study.

Does Aquaporin-1 expression have clinical significance in serous epithelial ovarian cancer?

OBJECTIVEnTo assess the relationship between Aquaporin-1 (AQP1) expression and clinicopathological variables in serous epithelial ovarian cancer (EOC).nnnMATERIAL AND METHODSnSerous EOC cases treated in our institution between January 2007 and December 2009 were included in the study. A semi-quantitative immunohistochemical method was used to determine AQP1 expression levels, intratumoral microvessel density (IMD) and AQP1/IMD ratios. The relationship between these parameters and clinicopathological variables were assessed. P values less than 0.05 was considered statistically significant.nnnRESULTSnA total of 55 cases of serous EOC were included in the study. AQP1 was strongly expressed in the membranes of microvessels and small vessels within all tumor tissues. In a few cases, AQP1 expression was also observed in the membrane of interstitial cells and in individual tumor cells. A positive correlation was detected between preoperative CA125 levels and the expression of AQP1 (R: 0.277, p<0.05). AQP1 expression was similar between FIGO stage I-II and FIGO stage III-IV cases (p > 0.05). A significant relationship did not exist between AQP1 expression and FIGO stage, lymph node metastasis or ascites volume (p>0.05).nnnCONCLUSIONnIn this study, AQP1 expression did not have a significant association with important clinicopathological variables in serous EOC. Future studies are needed to determine AQP1 expression in other histological types of EOC.

Primary Ovarian Malignant Melanoma Arising in Teratomatous Component of Mixed- Germ Cell Tumor in a Child: Case report

Primary ovarian malignant melanoma arising in teratomatous component of germ cell tumors is seen extremely rare with most reports being only of single cases and small series in reproductive aged woman and mostly from cystic teratoma, whereas information on pediatric presentation is sparse. This case is reported for being extremely rare tumor.

Bilateral synchronous ovarian tumours: an uncommon case and review of the literature

Synchronous ovarian tumours are rare. Management of these patients can differ from that of patients with uniform tumours. We present a case of synchronous epithelial ovarian cancer and malignant mixed Müllerian tumour in different ovaries, its follow-up and management until death. To our knowledge this is the second case in the English literature to date. A 61-year-old woman with bilateral adnexal masses underwent complete debulking surgery for ovarian cancer. The final pathology was reported as malignant mixed Müllerian tumour in the right ovary with intact borders and stage 2 grade 3 serous carcinoma in the left ovary. She had a 17-month disease-free interval after 6 cycles of paclitaxel and carboplatin. Recurrence of malignant mixed Müllerian tumour was reported in the pathology after secondary debulking including a partial ileal resection. After 6 cycles of gemcitabine and cisplatin she had a widespread recurrence in the thorax and abdomen. The patient died of disease recurrence at the 25th month after diagnosis. Coexistence of serous and malignant mixed Müllerian tumour in different ovaries is very rare. The main treatment is complete cytoreduction followed with chemotherapy. Platinum-taxane based chemotherapy resulted in an acceptable disease-free interval in our case, but it is not standard yet. A management protocol may be developed with the increasing number of similar cases in the literature.

Oncological and obstetric outcomes after fertility-sparing radical abdominal trachelectomy for early stage cervical cancer: a tertiary centre’s 10 years’ experience

Abstract The aim of this study is to present our clinical experience about fertility-sparing procedures in early stage cervical cancer and its obstetrical and oncological outcomes. Between the years 2006 and 2016, a total of 22 early stage cervical cancer patients who underwent a fertility-sparing radical abdominal trachelectomy in our clinic were retrospectively analysed. The median age was 33 (range: 28–39) years. The median follow-up was 47 (range: 22–125) months. Five patients (22.7%) had Stage IA1, three patients had (13.6%) Stage IA2, and 14 patients (63.6%) had Stage IB1 disease. Only one patient had a recurrence. A pregnancy was obtained in five patients (22.7%) and one of them (20%) had a live birth. A pregnancy was obtained spontaneously in two patients (40%), whereas assisted reproductive techniques were used in three of the patients (60%). A miscarriage occurred in two patients (40%), and one of them was within the first trimester and the other was within the second trimester. Impact statement What is already known on the subject? Currently, the first-line treatment of early stage cervical cancer is surgery. However, a fertility-sparing trachelectomy is the most widely adopted approach in the reproductive aged patients who have a desire to be pregnant later. What does this study add? In the literature, there is a growing number of studies on this subject. However, it would take time to obtain adequate knowledge. We believe that our study would contribute to the existing data. What are the implication of these findings for clinical practice? This study is important as it indicates that a multidisciplinary approach is required to preserve fertility among gynaecologic oncologists and the outcomes would be reflected into the clinical practice. In addition, we believe that our study would pave the way for further studies regarding this subject among oncologists.

Possible impact of immunosuppressive therapy regimens on histopathologic outcomes of abnormal uterine bleeding in solid-organ transplant recipients

In this study, we aimed to determine the frequency of histopathologic outcomes of solid‐organ transplantation in women with abnormal uterine bleeding (AUB) receiving immunosuppressive therapies.

Is the presence of endometriosis associated with a survival benefit in pure ovarian clear cell carcinoma

BackgroundThe purpose of this study was to compare the prognoses of women with pure ovarian clear cell carcinoma (OCCC) arising from endometriosis to those of women with pure OCCC not arising from endometriosis treated in the same manner.MethodsA dual-institutional, retrospective database review was performed to identify patients with pure OCCC who were treated with maximal or optimal cytoreductive surgery (CRS) followed by paclitaxel/carboplatin chemotherapy between January 2006 and December 2016. Patients were divided into two groups according to the detection of cancer arising in endometriosis or not, on the basis of pathological findings. Demographic, clinicopathological, and survival data were collected, and prognosis was compared between the two groups.ResultsNinety-three women who met the inclusion criteria were included. Of these patients, 48 (51.6%) were diagnosed with OCCC arising in endometriosis, while 45 (48.4%) had no concomitant endometriosis. OCCC arising in endometriosis was found more frequently in younger women and had a higher incidence of early stage disease when compared to OCCC patients without endometriosis. The 5-year overall survival (OS) rate of the patients with OCCC arising in endometriosis was found to be significantly longer than that of women who had OCCC without endometriosis (74.1 vs. 46.4%; pxa0=xa00.003). Although univariate analysis revealed the absence of endometriosis (pxa0=xa00.003) as a prognostic factor for decreased OS, the extent of CRS was identified as an independent prognostic factor for both recurrence-free survival (hazard ratio (HR) 8.7, 95% confidence interval (CI) 3.15–24.38; pxa0<xa00.001) and OS (HR 11.7, 95% CI 3.68–33.71; pxa0<xa00.001) on multivariate analysis.ConclusionOur results suggest that endometriosis per se does not seem to affect the prognosis of pure OCCC.

Prevalence of endometrial cancer or atypical hyperplasia diagnosed incidentally in infertility clinic

OBJECTIVE: Infertile patients may have a higher incidence of endometrial cancer (EC) compared with the general population. However, the prevalence of EC in infertile patients is still not clear, and, in the literature, there are only a few studies on the aforementioned topic. In this study, we aimed to investigate the prevalence of endometrial atypical hyperplasia (AH)/endometrial intraepithelial neoplasia (EIN) and EC in women who were seen for evaluation of infertility.