Aylin Okçu Heper

An unusual presentation of helicobacter pylori infection: so-called “Russell body gastritis”

Helicobacter pylori (H. pylori) is a “slow” bacterial pathogen, which induces several gastroduodenal diseases. Varying degrees of inflammation can be present in the gastric mucosa of patients infected with H. pylori. The case presented here is a male patient suffering from dyspepsia and nausea. His upper gastrointestinal endoscopy revealed pan gastritis. Histological examination of multiple gastric biopsies taken from the body and antrum showed a rare morphological expression of H. pylori gastritis characterized by diffuse plasma cell infiltration with extensive Russell body formation. Diffuse infiltration of plasma cells with Russell bodies in gastric mucosa can cause difficulties in differentiation from neoplastic processes. However, immunohistochemically, the infiltrating cells in the gastric mucosa stained negatively with cytokeratins while they expressed both kappa and lambda light chains showing their polyclonal nature. The presence of diffuse plasma cells with Russell bodies in the gastric mucosa may represent a different presentation of H. pylori gastritis. There are only two case reports of similar presentation and both have been called “Russell body gastritis”.

Extracellularly Signal-Regulated Kinase Activity in the Human Endometrium: Possible Roles in the Pathogenesis of Endometriosis

CONTEXT Endometriosis is an estrogen-dependent disease characterized by the presence of endometrial tissue outside of the uterine cavity, causing pelvic pain and infertility in 10% of reproductive-aged women. It is unclear why ectopic endometrium remains viable in only a subset of women. ERK1/2 plays key intracellular roles in activating cellular survival and differentiation processes. OBJECTIVE We sought to determine ERK1/2 activity in patients with endometriosis and its possible roles in regulating endometrial cell survival. DESIGN ERK1/2 phosphorylation and expression throughout the menstrual cycle were evaluated in vivo in normal and endometriotic human endometrium, and in vitro techniques assessed the steroidal regulation of ERK1/2 and its effect on endometrial cell survival. RESULTS Total ERK1/2 remained constant in normal and endometriotic endometrium throughout the menstrual cycle. Phospho-ERK1/2 was high in the late proliferative and secretory phases in normal endometrium (P < 0.05). In endometriotic glandular cells, there was no cyclical variation in phospho-ERK1/2. In endometriotic stromal cells, there was also a reduction in phospho-ERK1/2 variation, with higher levels in the early-mid secretory phase (P < 0.05). In cultured endometrial stromal cells (ESCs), estrogen plus progesterone increased ERK1/2 phosphorylation within 15 min (P < 0.05). Although estrogen alone did not induce ERK1/2 phosphorylation in normal ESCs, there was a significant response to estrogen in ESCs isolated from eutopic endometriotic endometrium (P < 0.05). ERK1/2 inhibition in ESCs reduced proliferation and increased apoptosis (P < 0.05). CONCLUSION Abnormally high levels of ERK1/2 activity may be involved in endometriosis, possibly by stimulating endometrial cell survival.

Behcet's disease-like presentation of bullous pyoderma gangrenosum associated with Crohn's disease

A 47‐year‐old woman presented with a 2‐month history of generalized arthralgia and a 10‐day history of oral aphthous ulcers. After hospitalization, papulopustular lesions and perianal ulcerations developed. Pathergy test was positive and ophthalmological examination was normal. The presence of oral aphthous ulcers, genital ulcerations, papulopustular lesions and arthralgia, and the positive pathergy test suggested the diagnosis of Behçets disease (BD). In a few days, positive pathergy reactions and papulopustular lesions evolved into bullous lesions, which were diagnosed dermatopathologically as pyoderma gangrenosum. Two days after the presentation of papulopustular lesions, the patient experienced diarrhoea accompanied by bloody stools and mucus. Histopathological examination of biopsy specimens showed no vasculitis but revealed findings suggestive of Crohns disease. The patient responded well to treatment with systemic steroids and 5‐aminosalicylic acid. Our case demonstrates that the differential diagnosis of BD and inflammatory bowel disease may be perplexing and that these two diseases may be closely related.

Postirradiation linear morphoea

Postirradiation morphoea is an uncommon side‐effect of radiotherapy. We report a 74‐year‐old woman who was treated with radiotherapy for endometrial carcinoma. About 3.5 years after the first dose of radiotherapy, the patient developed linear morphoea starting from the radiation port and affecting distant, nonirradiated skin. Lesions of radiation‐induced morphoea are generally described as well‐demarcated, indurated plaques with varying amounts of associated erythema; however, there is no previous publication of unilateral band‐like distribution of morphoea associated with radiotherapy, to our knowledge.

Effects of amniotic membrane on wound healing and adhesions in experimental strabismus surgery.

Purpose To evaluate the efficiency of amniotic membrane in prevention of adhesion formation after strabismus surgery. Methods A prospective, controlled study was conducted on 20 eyes of 10 pigmented rabbits. After disinsertion of the superior rectus muscle, under the muscle insertion area to induce adhesion formation, a partial-thickness 4 × 4 mm sclerectomy was performed in both eyes. In the right eyes, a piece of appropriate size human amniotic membrane was sutured on the sclerectomy site. As the control group, left eyes were operated with a similar procedure but without amniotic membrane transplantation. After 2 months, both eyes were enucleated to perform histopathologic examination. Results There was no adhesion between the sclera and muscle in the amniotic membrane group; however, there were various degrees of adhesions in the control group (p=0.004). Fibrosis in rectus muscle was present in 40% of the specimens in the amniotic membrane group and 90% in the control group with a higher grade (p=0.023). The mean number of inflammatory cells was significantly higher in the amniotic membrane group (p=0.005). Conclusions According to our results, amniotic membrane has antifibrotic effect but no anti-inflammatory effect in rabbit eyes due to possible xenograft reaction to human tissues. It is effective in prevention of adhesion formation with possible physical barrier action.

Retinoblastoma in Turkey: Results From a Tertiary Care Center in Ankara

PURPOSE To evaluate the presentation patterns and results of management of retinoblastoma at a tertiary care center in Ankara, Turkey, with special emphasis on globe conservation rate in unilateral and bilateral intraocular retinoblastoma. METHODS Patients were grouped according to the International Classification of Retinoblastoma. For intraocular retinoblastoma, group E and some group D eyes underwent primary enucleation. Secondary enucleation was performed after failure of chemoreduction, focal treatments, external beam radiotherapy (EBRT), and intra-arterial chemotherapy used in various combinations. For extraocular retinoblastoma cases, treatment consisted of enucleation/exenteration or orbital biopsy, high-dose chemotherapy, and EBRT to the orbit and metastatic sites. RESULTS During the study period from October 1998 to May 2010, 165 of 192 (85.9%) patients had intraocular disease and 27 (14.1%) patients had extraocular disease. In total, primary or secondary enucleation was performed in 70 of 94 eyes with unilateral retinoblastoma (74.5%) and in 34 of 142 eyes with bilateral retinoblastoma (23.9%). The overall globe conservation rate was 69.6%. Only one patient in the intraocular retinoblastoma group died of metastatic retinoblastoma to the central nervous system. Twenty of 27 patients (74.1%) with extraocular retinoblastoma were found to have metastasis to the central nervous system, bone, bone marrow, and/or lymph nodes. At a mean follow-up of 28.0 months (median: 12 months; range: 1 to 120 months), survival was 33.3% despite intensive treatment. CONCLUSIONS The overall risk of enucleation was 75% in eyes with unilateral retinoblastoma and 24% in eyes with bilateral retinoblastoma. Extraocular retinoblastoma carries a 75% risk of systemic metastasis and 67% risk of death.

Congenital pilar leiomyoma.

Piloleiomyomas are benign smooth muscle tumors arising from the arrectores pilorum muscles in the skin. They usually occur as multiple firm dermal nodules located on the extremities and trunk. Solitary lesions are rare. Leiomyomas usually develop during adolescence or early adult life. Congenital pilar leiomiyoma is an extremely rare entity. We present a case of congenital solitary pilar leiomyoma located on the face.

Keratosis Lichenoides Chronica: Marked Response to PUVA in Combination with Acitretin

Sir, Keratosis lichenoides chronica (KLC) is a rare, chronic and progressive dermatosis. The disease usually affects adults aged 20–50 years and is very resistant to therapy (1). Although KLC shares some clinical and dermatopathological features with lichen planus, it is considered to be a distinct entity (2). We report a patient with recalcitrant KLC, who had a marked response to PUVA in combination with acitretin.

Is it Possible to Prefabricate a Vascularized Peripheral Nerve Graft

The ideal technique to repair a damaged peripheral nerve is primary repair. Unfortunately, most damaged peripheral nerves have gaps making primary repair impossible. Autologous nerve grafts that are used to repair damaged nerves can either be conventional nonvascularized nerve grafts or vascularized nerve grafts. Vascularized nerve grafts are proposed to be superior to conventional nerve grafts especially in recipient beds that are scarred, with poor vascular supply. One of the disadvantages of vascularized nerve grafts is the limited donor site. It is possible to eliminate this problem by prefabricating vascularized nerve grafts. In this study, to prefabricate a vascularized nerve, segments harvested from left sciatic nerves of 10 Wistar albino rats were implanted on right femoral vessels, and intact right sciatic nerves were used as controls to evaluate the function, electrophysiologic studies, and histopathologic examination, were performed on these grafts 4 weeks after implantation. Prefabricated sciatic nerve grafts showed vascularization, but they did not show compound action potential activity to electrical stimulation and demonstrated diffuse and severe vacuolar degeneration and myelin loss. We were unable to prefabricate a functional vascularized nerve graft by this method.

Eye‐conserving treatment in massive congenital orbital teratoma

An 8‐month‐old healthy girl presented with a left orbital mass, which orbital magnetic resonance imaging revealed to be a well‐circumscribed, mostly cystic lesion. The patient underwent orbitotomy via inferior fornicial conjunctival approach. Tumour shrinkage was accomplished by aspiration of the intralesional fluid, and the remaining debulked mass was removed by total excisional biopsy. Pathological examination revealed a cystic tumour lined mainly with keratinized stratified squamous epithelium, in addition to small foci of mucinous ciliated epithelium resembling respiratory epithelium. Histopathological findings were consistent with the diagnosis of mature orbital teratoma (hair follicles, adipose tissue, mature glial elements, choroid plexus‐like papillary organizations and small foci of cartilage in the cyst wall). Derivatives of all three germ lines were present. At 56‐month follow up, uncorrected visual acuity in the affected eye was 6/9. This case demonstrates the importance of decompressing the tumour before dissecting it from the periorbital tissues in an eye‐conserving approach to orbital teratoma.