Aylar Poyraz

Comparison of 1998 WHO/ISUP and 1973 WHO Classifications for Interobserver Variability in Grading of Papillary Urothelial Neoplasms of the Bladder

Aim: Our aim was to compare the interobserver variability between the 1998 WHO/ISUP and 1973 WHO classifications. Methods: 258 consecutive papillary urothelial carcinomas were reviewed by two pathologists and assigned a tumor grade according to the 1973 WHO and 1998 WHO/ISUP without the knowledge of primary diagnosis and clinical follow-up. All cases were also histologically staged by the two pathologists separately as follows: pTa (noninvasive), pT1 (lamina propria invasion only), pT2 (muscularis propria invasion). Findings of both pathologists and degree of agreement were compared statistically by using Pearson’s χ2 test and ĸ statistics respectively. A ĸ value of 0.21–0.40 is accepted as fair, 0.41–0.60 moderate and 0.61–0.80 substantial agreement. Results: Regardless of the pathologist, tumor grades of two classifications correlated to each other and the pathological stage (p < 0.05). Overall degree of agreement between pathologists was higher in the 1998 WHO/ISUP (ĸ 0.59) than the 1973 WHO (ĸ 0.41), but both were still moderate. Papillary urothelial neoplasia with low malignant potential was the group of 1998 WHO/ISUP that showed the lowest degree of agreement and if excluded, interobserver variability of the 1998 WHO/ISUP decreased significantly (ĸ 0.84). Conclusion: The diagnosis of papillary urothelial neoplasia with low malignant potential and the criteria that differentiates it from low-grade carcinomas needs improvement in order to compare the different studies and therapies and to provide more accurate information for management.

Mitomycin C decreases the rate of stricture formation in caustic esophageal burns in rats

BACKGROUND Although the incidence of caustic ingestion is declining, the management of caustic esophageal strictures remains a challenge. Although many agents have been tried experimentally to treat strictures, few have gained clinical application. The aim of this study was to investigate the influence of mitomycin C (MMC), which inhibits fibroblastic proliferation in treating delayed caustic esophageal strictures. METHODS Forty-two rats were allocated into 3 groups. Caustic esophageal burns were created as described by Gehanno. Group A was instilled only with saline. Group B was injured with 10% NaOH and left untreated. Group C was injured and received topical MMC at 0.04% concentration in the fourth week. At 56 days, stenosis index (SI), collagen deposition, and hydroxyproline content (HP) were determined in distal esophageal segments. Statistical analyses were performed. RESULTS The mean SI in group B was significantly higher than others (SI: 1.15 +/- 0.37 d/lum, P < .05). Collagen accumulation was highest in group B, followed by groups C and A, respectively. Collagen deposition in group C was statistically lower than group B (P < .018). The mean HP in group B was statistically higher than others (5.07 +/- 1.30 microg/mg tissue, P < .05), and similar between groups A and C (1.20 +/- 0.20, 1.91+/- 0.79, respectively, P = .73). CONCLUSION In the current study, MMC treatment ameliorated caustic esophageal stricture as reflected in the significantly lower SI. We conclude that MMC application is effective in the treatment of caustic esophageal strictures.

Micropapillary Pattern in Urothelial Carcinoma: A Clinicopathological Analysis

Objectives: Our aim was to review our pathological archive to find out the actual incidence of micropapillary pattern (MPP) in our urothelial carcinoma patient population and determine its correlation with clinical outcome. Patients and Methods: 14 out of 170 cases with complete clinical follow-up were clinicopathologically analyzed. The extent of MPP was determined as tumor percentage. Results: 12 further cases with MPP were defined in the review. The percentage of patients with positive MPP increased in parallel to the tumor stage. There was no considerable difference between MPP-positive and MPP-negative groups according to the progression rates in non-muscle-invasive and muscle-invasive groups. Progression-free survival was much shorter in MPP cases, but again without statistical significance. Also, there was no significant relation between percentage of MPP and progression-free survival. Conclusions: Awareness of pathologists about MPP and its highly possible relation with aggressive behavior must be raised, as it may be more common than reported. A multicentric review of a large number of cases with MPP is needed for a better definition of its biological behavior. Focal MPP cases may have a better prognosis but this needs to be confirmed.

The rare presentations of a large polyp and an esophageal carcinoma in heterotropic gastric mucosa: a case series

BackgroundHeterotopic gastric mucosa (HGM) is commonly seen in the upper esophagus during endoscopyand is generally considered a benign disease. A hyperplastic polyp and an adenocarcinoma arising in heterotopic gastric mucosa are quite rare occurences.Case presentationsWe present two cases: The first is a patient who suffered from dysphagia because of a large hyperplastic polyp that arose from HGM; the polyp was excised endoscopically. Secondly, we report a rare case of adenocarcinoma arising in HGM of the cervical esophagus.ConclusionMorphologic changes or malignant transformation can develop in the inlet patch. Therefore, gastroenterologists should be aware of the possibility of HGM just distal to the upper esophageal sphincter.

Expression of c-erbB-2 Oncoprotein in Gastric Carcinoma: Correlation with Histopathologic Characteristics and Analysis of Ki-67

Amplification and overexpression of the c-erbB-2 gene has been demonstrated in several tumors and thought to be important determinants of biologic behaviors of carcinomas. In this study, correlation between c-erbB-2 expression und histopathologic parameters, including proliferative activity of gastric carcinomas was evaluated. Paraffin-embedded tissue sections from 62 patients who underwent curative resection of gastric carcinoma were analyzed immunohistochemically for the expression of c-erbB-2 and Ki-67. Strong membrane staining for c-erbB-2 was detected in 11 of 62 gastric carcinomas (17,7%) and no positive reaction was evident in noncancerous tissue. The incidence of c-erbB-2 positivity in intestinal type carcinomas (24,3%) was higher than that of diffuse type carcinomas (4,76%). Positive staining for c-erbB-2 was present in one of the 9 (11,1%) early gastric carcinomas and 10 of 53 (18,8%) advanced gastric carcinomas. However, no statistically significant relationships were found between c-erbB-2 expression and histopathologic type, depth on invasion, the tumor size or lymph node metastases. Among the metastatic lymph nodes, 3 were positively stained with c-erbB-2 whereas the primary tumors of two cases had been found to be negative. Additionally, no correlation was found between c-erbB-2 reactivity and proliferative activity of carcinoma cells. The results suggest that expression of c-erbB-2 protein may occur selectively in intestinal type of gastric carcinomas. However, c-erbB-2 expression is not a reliable marker of malignant potential in gastric carcinomas.

Expression of Bcl-2 and c-ErbB-2 in colorectal neoplasia.

Several studies have been demonstrated the value of c-ErbB-2 and Bcl-2 in predicting the biological behaviour of tumors. The aim of this study was to investigate Bcl-2 and c-ErbB-2 expression in colorectal carcinomas and the correlation between their presence and other clinicopathologic parameters. Eighty-six colorectal carcinomas and 17 adenomas were stained with Bcl-2 and c-ErbB-2 immunohistochemically. Staining patterns were assessed semiquantitatively and correlated with tumor size, Duke’s classification, tumor differentiation, mucinous characteristic and anatomic locations. We detected Bcl-2 expression in 10 of 17 adenomas (58.8 %) and 31 of 86 carcinomas (36.04 %). Positive staining in normal mucosa was observed only in the compartment of cryptic cells. However neither the difference in the rates of Bcl-2 positivity in adenoma and carcinoma groups, nor the correlation with other mentioned clinicopathological parameters, were found statistically significant. Bcl-2 expression was found to be significantly high in mucinous carcinomas. Expression of c-ErbB-2 was observed in 12 of 86 (13.95 %) carcinomas. It was not detected in adenomas and normal mucosa. Although the incidence of c-ErbB-2 in nonmucinous carcinoma was higher than that of mucinous carcinoma, this was not significant. In addition we were unable to show any significant relation between c-ErbB-2 expression and other clinicopathologic features. Our result suggest that c-ErbB-2 protein expression in colorectal carcinomas, is not very frequent event. There is no correlation between c-ErbB-2 expression and malignant potential of colorectal carcinomas. Higher expressions of Bcl-2 in adenomas than carcinomas suggest us a possible role of Bcl-2 in early carcinogenesis of colon. However since we were unable to find any significant correlation between Bcl-2 expression and other parameters the impact of this gene on biological behavior is still unclear for us.

Investigation of the Ototoxic Effects of Interferon α2A on the Mouse Cochlea

This prospective randomized study investigates the possible toxic effects of interferon (IFN) α2A on the mouse cochlea. Thirty-six albino Swiss mice that were randomly assigned to 3 groups underwent baseline auditory brain stem response testing bilaterally to objectively assess baseline hearing levels. The first group received a single dose of 50,000 units, and the second group received 100,000 units of IFN-α2A intraperitoneally, whereas the third group was given no medication. Repeat auditory brain stem response testing revealed a significant rise in mean baseline peak equivalent sound pressure level thresholds in the groups that received IFN (P < 0.001). Histologicallly, the cochleae of mice that received IFN had a decreased number of fibroblasts in the spiral limbus, as well as prominent cytoplasmic vacuolation of these cells, compared with control animals. Loss of hair cells was not observed. It is possible that reversible biochemical and metabolic changes in the cochlea, rather than morphologic abnormalities, manifest IFN ototoxicity. (Otolaryngol Head Neck Surg 2001;124:107-10.)

P53 and proliferating cell nuclear antigen (PCNA) expression in non-tumoral liver diseases.

The tumor suppressor gene p53 is known to be involved in the negative regulation of cell growth. Proliferating cell nuclear antigen (PCNA), which is a nuclear protein and a component of the DNA replication process, is also involved in growth regulation. Both have been studied as progression markers in various tumors including hepatocellular carcinoma. In the present study, the aberrant p53 protein and PCNA expressions in non‐tumoral liver diseases were investigated. Using monoclonal antibodies anti‐p53 (D07‐DAKO) and anti‐PCNA (PC10‐DAKO), 149 samples were stained, including 10 normal and 10 tumoral control liver tissues. p53 Overexpression was detected in 52 specimens (35%) whereas PCNA positivity was found in 96 (64%). There were 21 different pathological entities but most of the positive samples could be grouped into four types of diseases; namely, non‐specific reactive hepatitis, steatohepatitis, chronic hepatitis and cirrhosis. Statistical analyses performed on these groups revealed that p53 positivity was found to be significantly higher in steatohepatitis (P < 0.05), while PCNA positivity did not show any statistical significance. The number of samples showing both p53 and PCNA positivity was 42 but their coexistence was not found to be significant. Certain cytological alterations like nuclear pleomorphism, steatosis and cholestasis, in addition to necroinflammatory activity, were evaluated for their possible impact on p53 and/or PCNA positivity. Necroinflammatory activity in steatohepatitis and steatosis in chronic hepatitis was found to be significant for p53 positivity (P < 0.05). In contrast, nuclear pleomorphism in non‐specific reactive hepatitis was found to be significant for PCNA positivity (P < 0.05).

Nasal septal perforation in an adolescent girl with Crohn's disease: a rare extraintestinal manifestation.

Crohns Disease (CD) is a chronic granulomatous inflammatory bowel disease which may also involve the extraintestinal organs such as joints, liver, skin and perianal tissue. Involvement of the aerodigestive tract is quite rare in CD. We report a 16-year-old girl with CD and nasal perforation as an extraintestinal manifestation of the disease.

Submandibular accessory salivary gland causing Warthin's duct obstruction

Submandibular masses are mostly secondary to sialolithiasis. Salivary gland tumors should be considered in the differential diagnosis. In this case report, an unusual cause of Warthins duct obstruction caused by an accessory salivary gland tissue is presented.