Berna Aytac

Clinicopathologic features of incidental prostatic adenocarcinoma in radical cystoprostatectomy specimens

BackgroundThe aim of this study is to review all features of incidentally discovered prostate adenocarcinoma in patients undergoing radical cystoprostatectomy for bladder cancer.MethodsThe medical charts of 300 male patients who underwent radical cystoprostatectomy for bladder cancer between 1997 and 2005 were retrospectively reviewed. The mean age of the patients was 62 (range 51-75) years.ResultsProstate adenocarcinoma was present in 60 (20%) of 300 specimens. All were acinar adenocarcinoma. Of these, 40 (66.7%) were located in peripheral zone, 20 (33.3%) had pT2a tumor, 12 (20%) had pT2b tumor, 22(36.7%) had pT2c and, 6 (10%) had pT3a tumor. Gleason score was 6 or less in 48 (80%) patients. Surgical margins were negative in 54 (90%) patients, and tumor volume was less than 0.5 cc in 23 (38.3%) patients. Of the 60 incidentally detected cases of prostate adenocarcinoma 40 (66.7%) were considered clinically significant.ConclusionIncidentally detected prostate adenocarcinoma is frequently observed in radical cystoprostatectomy specimens. The majority are clinically significant.

Anorectal Malignant Melanomas: Experience of Uludag University

Anorectal melanomas represent a group of mucosal melanomas with unknown etiology and poor prognosis. The lesions can be misdiagnosed as hemorrhoids during clinical examination. We reviewed the morphological and clinical features of 14 anorectal melanomas, and discuss the treatment modalities of this entity. Fourteen patients who were diagnosed with anorectal malignant melanoma between 1997 and 2004 were evaluated with regard to age, sex, size, morphology, lymph node or distant metastasis, treatment modality and survival. Eight patients were female and six were male, and their mean age was 58 years. The size of melanoma ranged from 3 cm to 8 cm. Pathological evaluation revealed epithelioid and spindle cell type tumor in seven and two patients, respectively, whereas, in the remaining seven patients, the tumor was composed of both types. Pigmentation was apparent in all tumors. There was lymph node metastasis in 11 patients and distant metastasis in all patients. Eleven patients underwent abdominoperineal resection and three were treated by local excision. Mean survival was 8.7 months. Prognosis of anorectal melanoma remains poor. Awareness of the diverse clinicopathological features of these lesions, both on the part of the clinicians and pathologists, is crucial for their early detection and proper treatment.

Touch imprint cytology of prostate core needle biopsy specimens: A useful method for immediate reporting of prostate cancer

Background: Cytology plays an important role in the preoperative assessment of many cancers. It is used as a first-line pathological investigation in both screening and diagnostic purposes. Aims: To determine the diagnostic value and accuracy of touch imprint cytology (TIC) smear of prostate core needle biopsy (CNB) specimens in the diagnosis of prostate carcinoma. Materials and Methods: One hundred and twenty-one patients had ultrasound-guided transrectal prostate CNB. A total of 1210 TIC smears were prepared from all CNB specimens. Results: Diagnoses of 1210 TIC smears were compared with the histopathological findings of the CNB specimens. One hundred and seventy (14%) TIC smears were found positive for malignancy, 35 (2.9%) were diagnosed as suspicious for malignancy and 1005 (83.1%) were found negative for malignancy. Twenty-five of 35 suspicious imprints and 150 of 170 malignant smears were confirmed to be malignant on histopathological evaluation. Although 20 malignant TIC smears were defined as benign in standard histological preparations, 10 of them had definitive diagnosis of malignancy following extensive serial sectioning. Last of all, there were 10 false-positive cytology results. Moreover, 10 of the 35 suspected TIC smears were false negative when compared with the histopathological diagnosis. The sensitivity, specificity, positive predictive value and negative predictive value of touch imprint smear results were 100%, 98%, 90.2% and 100%, respectively. Conclusions: TIC smears can provide an immediate and reliable cytological diagnosis of prostate carcinoma. It may clearly help the rapid detection of carcinoma, particularly in highly suspected cases that had negative routine biopsy results for malignancy with abnormal serum prostate specific antigen (PSA) levels and atypical digital rectal examination.

A rare parasitic infection in Turkey: schistosomiasis. Case report.

Schistosomiasis is a water-borne parasitic disease. It is endemic in tropical and subtropical countries mainly in Africa and the eastern Mediterranean region. We report a case of a 37-year-old male who attended our hospital for terminal hematuria and irritative voiding symptoms. Schistosoma haematobium eggs were found in his urine sediment. He underwent transurethral resection of the bladder. Pathological study confirmed the existence of vesical schistosomiasis. S. haematobium cases are rarely seen in Turkey. Epidemiological and clinical significance of S. haematobium has been discussed.

Angiomyofibroblastoma-like tumor of the scrotum: a case report and review of literature.

Angiomyofibroblastoma-like tumor is a rare mesenchymal tumor of men. It commonly occurs during the fifth to eighth decades of life and mainly involves the inguinoscrotal region. It is derived from perivascular stem cells and has capacity of lipoid and myofibroblastic differentiation. Histopathologically this tumor in the male genitalia mimics female angiomyofibroblastoma but there are morphological and immunohistochemical differences between these lesions. We report a case of an angiomyofibroblastoma-like tumor that arose in the scrotal region in a 40-year-old man.

What is the adequacy of biopsies for prostate sampling

OBJECTIVE To investigate the adequacy of the samples obtained by prostate biopsies and the factors those could affect this adequacy. MATERIALS AND METHODS Three hundred seventy-eight patients who underwent transrectal ultrasound guided biopsy have been included into the study. The biopsy samples have been retrospectively reviewed in terms of presence of prostatic glandular elements and prostatic tissue. Factors which may affect the presence of glandular elements have been investigated. RESULTS The mean age, PSA level, and prostate volume were 65 ± 8.1 years, 13.6 ± 17.8 ng/ml, and 52.5 ± 29.8 ml, respectively. Overall cancer detection rate was 25.3%. The highest incidence of absence of prostatic glandular elements was detected at apical (21.8%) and far lateral (21.5%) biopsy samples. The overall rate of absence of glandular elements was 0.16. Absence of glandular elements in at least 1 sample of the biopsy set was detected in 50% of patients. This figure was 27.8% and 16.1% for the absence of glands in at least 3 and 5 samples of the biopsy set, respectively. These results have also been found to be operator-dependent. For patients with PSA between 4 and 10 ng/ml, we found that cancer detection rate was lower in patients with absence of glandular elements. When the possible factors were analyzed, age, PSA, prostate volume, findings of prostate examination, and presence of cancer were not found to be effective on these parameters, whereas the most important factor was the biopsy localization. CONCLUSION Our study showed that prostatic glandular elements, which are keys for histological diagnosis, were absent in a significant number of prostatic biopsy samples and patients. This inadequacy was most prominent in apical and far lateral biopsy specimens and found to be operator-dependent.

Multicystic dysplastic kidney: four-year evaluation.

OBJECTIVE Multicystic dysplastic kidney is a relatively common developmental abnormality in infants and children. Additional abnormalities like vesicoureteral reflux, ureteropelvic junction obstruction, and ureterovesical junction obstruction may accompany multicystic dysplastic kidney. In this article, we reviewed the pathogenesis, diagnosis, associated urinary tract anomalies and results of management of multicystic dysplastic kidney in the light of the literature. MATERIAL AND METHOD We retrospectively assessed 20 children with unilateral multicystic dysplastic kidney between January 2005 and December 2009. Mean duration of follow-up was 35 ± 8.7 months. All children with multicystic dysplastic kidney underwent nephrectomy. Patient characteristics, the pathology findings, associated urinary tract anomalies and results of management were reviewed. RESULTS Abdominal ultrasound, voiding cystourethrography and renal scintigraphy revealed vesicoureteral reflux in 3 (15%) children, ureteropelvic junction obstruction in 3 (15%) children, and a duplex system in the contralateral kidney in 1 (5%) child. Blood pressure values, serum urea, creatinine and urinalysis were within normal range in all children during follow-up. CONCLUSION A conservative approach to children with multicystic dysplastic kidney has been advocated, but surgical removal is also another management modality on the basis of risk of hypertension, mass effect, potential for malignant change, and cost of repeated ultrasound examination.

Maspin expression in gastrointestinal stromal tumors

BackgroundTo investigate the role of maspin expression in the progression of gastrointestinal stromal tumors, and its value as a prognostic indicator.MethodsIn the study 54 patients with GIST diagnosis were included in Uludag University of Faculty of Medicine, Department of Pathology between 1997-2007. The expression of maspin in 54 cases of gastrointestinal stromal tumor was detected by immunohistochemistry and compared with the clinicopathologic tumor parameters.ResultsThe positive expression rates for maspin in the GISTs were 66,6% (36 of 54 cases). Maspin overexpression was detected in 9 of 29 high risk tumors (31%) and was significantly higher in very low/low (78.6%) and intermediate-risk tumors (63.6%) than high-risk tumors.ConclusionsMaspin expression might be an important factor in tumor progression and patient prognosis in GIST. In the future, larger series may be studied to examine the prognostic significance of maspin in GISTs and, of course, maspin expression may be studied in different mesenchymal tumors.

Significance of nm23 Immunoexpression in the Prognosis of Renal Cell Carcinoma

Non-metastatic gene 23 (nm23) is a metastasis suppressor gene that is expressed in all tissues and decreased nm23 expression may be linked to poor prognosis. By immunohistochemical staining of nm23 protein antibodies this study examined the prognostic value of nm23 protein expression in 54 renal cell carcinoma (RCC) patients and analysed its relationship with tumour, node, metastases (TNM) surgical stage, Fuhrman nuclear grade, lymph node involvement and survival. Of the 54 RCC cases studied, 11 (20.4%) showed positive lymph node involvement while 43 (79.6%) were lymph node negative. There was no difference in nm23 protein expression between cases with and without lymph node involvement. In addition, nm23 protein expression was not related to TNM stage, Fuhrman nuclear grade or survival. More extensive studies are required to understand the effect of nm23 protein expression on the biological behaviour of RCC.