Basak Doganavsargil

A comparison of p21 and p27 immunoexpression in benign glands, prostatic intraepithelial neoplasia and prostate adenocarcinoma

To assess the immunoexpression of p21 and p27 proteins in consecutive areas of benign glands, prostatic intraepithelial neoplasia (PIN) and prostate adenocarcinoma.

Clinical and morphological characteristics of osteoid osteoma and osteoblastoma: a retrospective single-center analysis of 204 patients.

Osteoid osteoma and osteoblastoma are histologically similar, benign bone-forming tumors. In this retrospective study, we aimed to evaluate the natural history; clinical, pathologic, and radiologic findings; and treatment results in 204 patients between 1959 and 2006 in a single institution. According to the World Health Organizations definition, tumors ≤1 cm in diameter were classified as osteoid osteoma, and those ≥2 cm, as osteoblastoma. For tumors between 1 cm and 2 cm, other criteria, such as the bone involved, the site, the presence of a nidus, and presence of peripheral sclerosis, were used for diagnosis. There were 131 patients with osteoid osteoma (93 male, 38 female) and 73 patients with osteoblastoma (40 male, 33 female). The mean age in the osteoid osteoma and osteoblastoma groups was 16.4 ± 7 and 19.6 ± 9.9 years, respectively. The osteoid osteoma cases were mostly localized in the extremities, whereas the osteoblastoma cases involved the vertebral column and sacrum. The nidus size varied between 0.2 and 1.5 cm in osteoid osteoma cases, and the tumor size range was 1.3-10 cm in the osteoblastoma cases. The pain was encountered in 89% of osteoid osteoma and 45% of osteoblastoma patients. Histopathology was similar in both cases. The treatment of choice was conservative surgery for both diagnoses. In conclusion, osteoblastoma is clinically and radiologically more aggressive than osteoid osteoma.

Therapeutic efficacy of vasoactive intestinal peptide in escherichia coli lipopolysaccharide-induced experimental periodontitis in rats.

BACKGROUND The aim of the present study was to evaluate the therapeutic efficacy of vasoactive intestinal peptide (VIP), an immunoregulatory molecule, in experimental periodontitis. METHODS Sixty-three male Sprague-Dawley rats were divided into five groups: control; lipopolysaccharide (LPS); LPS + 0.1 nmol VIP; LPS + 1 nmol VIP; and LPS + 10 nmol VIP. Saline was injected into the gingiva of control rats on days 1, 3, and 5, whereas the other groups received injections of Escherichia coli LPS. VIP groups received intraperitoneal injections of relevant dosages on days 2, 4, 6, 8, and 10. The control and LPS groups were given saline instead of VIP in the same manner. On day 11, serum samples were obtained, and rats were sacrificed. Alveolar bone loss; serum levels of tumor necrosis factor-alpha, interleukin (IL)-1beta, -10, and -18, soluble receptor activator of nuclear factor-kappa B ligand (sRANKL), and osteoprotegerin (OPG); and the immune expression of RANKL and OPG were evaluated. RESULTS The application of VIP caused a dose-dependent decline in alveolar bone loss compared to the LPS group, but the differences were not significant (P >0.05). A reduction in the histologic findings of inflammation was observed in all VIP groups. The 1- and 10-nmol VIP groups showed significantly lower serum sRANKL and OPG levels compared to the LPS group (P <0.05). The number of positively stained vessels for endothelial OPG was greater in the 1-nmol VIP group than in the LPS group (P <0.05). CONCLUSION When periodontitis was induced by E. coli LPS, VIP downregulated the inflammatory response and inhibited alveolar bone loss, possibly by differentially regulating the tissue levels of RANKL and OPG.

Reabsorption of ascites and the factors that affect this process in cirrhosis.

Ascites is one of the main features of liver decompensation in cirrhosis, and it is considered to be a dynamic process. In this study, we aimed to (1) measure the reabsorption rate of ascites; (2) evaluate whether these findings were related to features of ascites, hemodynamics, and serum measurements; and (3) examine morphologic changes in the diaphragm of cirrhotic patients. In all, 42 cirrhotic patients with ascites were enrolled in the study to comprise our study group. Using the dextran 70 test, patient ascites volumes and reabsorption rates were measured. Biopsies from the peritoneal side of the diaphragm were also processed for scanning electron microscopy and lymphatic immunohistochemical studies from the cirrhotic patients and control cadavers. The mean ascites reabsorption rate was 4.5 +/- 4.5 (0.18-14.6) mL/min, which correlated significantly with the calculated ascites volume (r = 0.75, P < 0.001). The mean ascites viscosity was 1.07 +/- 0.07 (0.99-1.17) centipoise, which demonstrated a high degree of negative correlation with the ascites reabsorption rate (r = -0.77, P < 0.001). Patients with a history of spontaneous bacterial peritonitis had significantly lesser ascites reabsorption rates than patients without this particular history. The size of lymphatic stomata in scanning electron microscopy depictions was increased, and lymphatic lacunae were dilated in immunohistochemical studies in the cirrhotic patients with ascites. However, these findings were not uniform in every cirrhotic patient with ascites. The volume and viscosity of ascites seem to influence its reabsorption rate. Additionally, previous episodes of spontaneous bacterial peritonitis may be responsible for the decreased ascites reabsorption rates observed in certain patient populations.

Autopsy Findings of a Case with Oxalosis

Oxalosis, deposition of calcium oxalate in tissues, is the final stage of hyperoxaluric syndromes. Being a rare entity, it is often missed, or the diagnosis is delayed, since the definitive diagnosis requires special laboratory tests. Kidneys, the walls of blood vessels, and bones are the major sites for crystal deposition. We report the autopsy findings of a 4-year-old girl who presented with end-stage renal disease in which the clinical presentation was consistent with primary hyperoxaluria Type I. The case is unusual, as there was extensive crystal deposition throughout the body, including in tissues that are rarely involved, such as ovaries, fallopian tubes, uterus, thymus, salivary glands, pancreas, and bladder.

Is it possible to diagnose infectious oesophagitis without seeing the causative organism? A histopathological study

BACKGROUND/AIMS We investigated the utility of using histological changes to diagnose infectious oesophagitis when causative organisms cannot be seen. MATERIALS AND METHODS Sixty-seven endoscopic biopsy specimens (51 Candida, 9 herpes simplex virus, 4 tuberculosis, and 3 cytomegalovirus oesophagitis) collected from 2000-2010 that matched the investigative criteria were included in the study. Cases were re-evaluated for histological changes observed in oesophagitis, and the findings were statistically compared using nonparametric tests. RESULTS Thirty-nine cases occurred in male patients, and 28 occurred in female patients; the mean age of the patients was 51±20.1 years (range, 5-94 years). All cases showed lymphocytic and neutrophilic infiltration; while 27 (40.3%) showed eosinophilic infiltration. The density of lymphocytes and eosinophils were 8.43±6 and 1.07±1.62 per high power field, respectively, and these rates were higher in tuberculosis oesophagitis cases. Lamina propria infiltration was present in herpes simplex virus and Candida oesophagitis. Dense neutrophilic infiltration (>50/high power field) was noted in herpes simplex virus oesophagitis. Candida colonization was observed in 82% of cases with eosinophilic infiltration, and 80% of cases with erosion. Ulceration was present in all tuberculosis oesophagitis cases (p<0.001). Basal cell hyperplasia, papillary elongation, and dilated intercellular spaces were seen in all cases except for 2 Candida oesophagitis cases. Lamina propria fibrosis was especially noted in cytomegalovirus oesophagitis cases. CONCLUSION It is not possible to distinguish infectious oesophagitis from other subtypes, especially reflux oesophagitis, if the causative organism is not detected. Clinicopathological correlation and control with repeat targeted biopsies are essential for diagnosis.

Immunohistochemical detection of CD 95 (Fas) & Fas ligand (Fas-L) in plasma cells of multiple myeloma and its correlation with survival

Multiple myeloma (MM) is a malignant disease resulting from an uncontrolled proliferation of a neoplastic plasma cell clone in the bone marrow, which might also be induced by the loss of control on apoptosis. Fas ligand (Fas-L), a member of the tumor necrosis factor family, induces apoptosis mediated via its transmembrane death receptor Fas (Apo-1/CD95) antigen. In the present study, immunostaining was performed on the initial diagnostic bone marrow biopsies of 36 MM patients (1 stage I, 5 stage II, 30 stage III), to evaluate the distribution of Fas receptor and Fas-L on malignant plasma cells. Both Fas and Fas-L were positive in 13 cases and negative in 3, whereas 10 cases were Fas-negative, Fas-L-positive and 10 were Fas-positive, Fas-L-negative. Although no association was found between the expression of Fas receptor or Fas-L and overall survival, Fas-L positivity was significantly associated with a shorter event-free survival (p = 0.0335). In this study, it has been shown that the expression of Fas-L, in malignant plasma cells of myeloma patients significantly shortens the event-free survival, indicating that the defect in apoptosis might be associated with disease progression in MM.

Cystic bone lesions: histopathological spectrum and diagnostic challenges.

Abstract Objective: Bone cysts are benign lesions occurring in any bone, regardless of age. They are often asymptomatic but may cause pain, swelling, fractures, and local recurrence and may be confused with other bone lesions. Material and Method: We retrospectively re-evaluated 143 patients diagnosed with aneurysmal bone cyst (n=98, 68.5%), solitary bone cysts (n=17 11.9%), pseudocyst (n=10.7%), intraosseous ganglion (n=3, 2.1%), hydatid cyst (n=2; 1.4), epidermoid cyst (n=1, 0.7%) and cysts demonstrating “mixed” aneurysmal-solitary bone cyst histology (n=12, 8.4%), and compared them with nonparametric tests. Results: Aneurysmal bone cyst, solitary bone cysts and mixed cysts were frequently seen in the first two decades of life while the others occurred after the fourth decade. Aneurysmal bone cysts, intraosseous ganglion and pseudocysts were more common in women contrary to solitary bone cyst and mixed cysts (the female/male ratio was 1.22, 2 and 1.5 versus 0.7 and 0.5, respectively). Aneurysmal bone cyst, solitary bone cysts and “mixed” cysts were mostly seen in long bones, predominantly the femur, while epidermoid, hydatid and pseudocysts were all seen in flat bones like the vertebra, pelvis and mandible (p=0.001, chi-square). Repeat biopsies were performed in 19 cases (13.3%), 84.2% of which were aneurysmal bone cyst (5 conventional, 9 solid, 1 secondary and 1 subperiosteal) and three (15.8%) were mixed cysts (p=0.02, chi-square). Notably, some of them were located in inaccessible areas of pelvis (n=3), femur (n=3) and maxilla (n=2). Conclusion: The most common and challenging intraosseous cysts are aneurysmal bone cysts, particularly the “solid” variant. The “mixed” aneurysmal-solitary bone cyst “subgroup” requires further research with larger series to be defined more thoroughly. Öz Amaç: Kemik kistleri, her yaşta ve kemikte gorulebilen benign lezyonlardır. Sıklıkla asemptomatiktirler, ancak ağrı, şişlik, kırık ve lokal nuks yapabilir, diğer kemik lezyonlarıyla karıştırılabilirler. Gereç ve Yöntem: Calışmamızda 98’i (%68,5) anevrizmal kemik kisti; 17’si (%11,9) soliter kemik kisti; 12’si (%8,4) “mikst” anevrizmal kemik kisti-soliter kemik kisti histolojisi gosteren; 10’u (%7) psodokist, 3’u (%2,1) intraosseoz ganglion, 2’si (%1,4) kist hidatik, 1’i (%0,7) epidermoid kisti tanısı almış; toplam 143 olgu geriye donuk olarak değerlendirilmiş, klinikopatolojik veriler nonparametrik testlerle karşılaştırılmış, bulgular histopatolojik tanı guclukleri acısından tartışılmıştır. Bulgular: Anevrizmal kemik kisti, soliter kemik kisti ve mikst kistler ilk iki dekatta; diğerleri dorduncu dekaddan sonra gorulmektedir. Anevrizmal kemik kisti, intraosseoz ganglion ve psodokistler kadınlarda; soliter kemik kisti ve mikst kistler ise erkeklerde daha sık gorulmektedir (Kadın/erkek oranı sırasıyla 1,22; 2 ve 1,5’a karşı 0,7 ve 0,5’dir) Anevrizmal kemik kisti, soliter kemik kisti ve mikst kist; femur başta olmak uzere en sık uzun kemikleri tutarken (sırasıyla %24,5, %47, %33,4;epidermoid kist, kist hidatik ve psodokistler tum olgularda vertebra, pelvis, mandibula gibi yassı kemikleri secmektedir (p=0,001, ki-kare). Biyopsi tekrarı yapılan 19 olgunun (%13,3); %84,2’si anevrizmal kemik kisti (5 konvansiyonel, 9 solid, 1 sekonder, 1 subperiosteal); 3’u (%15,8) ”mikst kist” dir (p=0,02, ki-kare). Bu olguların bir kısmının pelvis (n=3), femur (n=3), maksillada (n=2) zor ulaşılan alanlarda yerleştiği dikkati cekmiştir. Sonuç: İntraosseoz kistler icerisinde en sık gorulen, aynı zamanda en cok ayırıcı tanı gucluğu yaratan lezyon solid varyantı başta olmak uzere anevrizmal kemik kistidir. Mikst anevrizmal kemik kisti-soliter kemik kisti olgu grubu iyi tanımlanmamış bir grup olup daha geniş serilerle araştırılmalıdır.

Osteosarcomas of jaw: Experience of a single centre

Abstract Although osteosarcoma is the most common primary malignant tumour of bone, osteosarcomas of jaw are rare. In osteosarcomas of jaw, evaluating the clinicopathological factors affecting the prognosis is not easy because of different approaches to diagnosis, treatment, and follow-up. This study reviewed 14 cases of JOS that were diagnosed between 1990–2010, in terms of age, gender, site, clinical history, histopathologic type and histopathologic grade, treatment, and prognosis. Median age was 35 years, while male:female ratio was 1.8:1. Eight tumours were located in the mandible. Osteoblastic differentiation was the predominant feature in seven cases followed by chondroid osteosarcoma (four cases), fibroblastic osteosarcoma, low-grade (parosteal) osteosarcoma associated with fibrous dysplasia, and postradiation osteosarcoma (one cases each). During follow-up, recurrence was seen in four patients at least once and they all died. In conclusion, early diagnosis and complete resection seems to be effective in prognosis. Therefore, clinicians and pathologists should be aware of its characteristics and main differential diagnosis to avoid late recognition.

An autoimmune disease refractory to immunosuppressive regimens: Celiac disease diagnosed long after liver transplantation

CD is defined as T‐lymphocyte‐mediated gluten sensitivity. Although CD is known to affect the small intestine, it is nonetheless a multisystem disorder. Liver involvement in CD may vary from isolated hypertransaminasemia to cirrhosis. Because CD is an inappropriate immune response to gluten proteins, strict gluten‐free diet is the principal therapy, along with management of liver dysfunction. In patients who fail to respond to a gluten‐free diet, immunosuppressive drugs may improve intestinal inflammatory activity in untreated CD. The present case report is of a 25‐yr‐old woman with diarrhea lasting several weeks. The patient had received a liver transplant 13 yr earlier, and presented with cryptogenic cirrhosis diagnosed as CD. This appears to be the first case of its kind in which a pediatric long‐term liver transplant patient presents with diarrhea eventually diagnosed as CD whose diet included gluten, and who was treated by an immunosuppressive drug regimen. Because of the normalization of CD‐related antibodies in the post‐transplantation period without gluten restriction, CD should be part of a list of diagnostic possibilities in liver transplant patients presenting with diarrhea of unknown etiology.