Cemil Ekinci

Reduced enzymatic antioxidant defense mechanism in kidney tissues from gentamicin-treated guinea pigs : effects of vitamins E and C

In this study, the activities of major enzymes participating in free radical metabolism (xanthine oxidase, XO; Cu,Zn and Mn superoxide dismutases, SOD; glutathione peroxidase, GSH-Px; catalase, CAT) were measured in kidney tissues from guinea pigs treated with gentamicin alone (200 mg/kg/day), gentamicin plus vitamin C (600 mg/kg/day), gentamicin plus vitamin E (400 mg/kg/day), and gentamicin plus vitamins C and E together for 10 days, and from animals treated with physiological saline solution alone during this period. We found no significant differences between control and gentamicin groups with respect to XO and Cu,Zn-SOD activities. However, the activities of Mn-SOD, GSH-Px, and CAT were found to be significantly depressed in the gentamicin-treated group relative to controls. In the gentamicin plus vitamin C group, the renal tissue Mn-SOD activity was found to be higher as compared with control and gentamicin groups. In this group, XO, GSH-Px and CAT activities were also higher than in the gentamicin-treated group, but no statistically significant differences existed between the values of this group and controls. Similar results were also observed in the gentamicin plus vitamin E group for Mn-SOD, GSH-Px, CAT, and XO. In this group, the Cu,Zn-SOD activity was found to be decreased as compared with control and gentamicin groups. In the gentamicin plus vitamins C and E group, the Cu,Zn-SOD activity was found to be decreased, the XO activity to be unchanged, and Mn-SOD, GSH-Px, and CAT activities to be increased as compared with the gentamicin and control groups. The results suggest that the enzymatic antioxidant defense system was significantly disturbed because of the suppressed activities of Mn-SOD, GSH-Px, and CAT in the kidney tissues from animals treated with gentamicin. However, vitamins C and E given concurrently with gentamicin completely abrogated this enzymatic suppression.

The effects of long-term topical glaucoma medication on conjunctival impression cytology

Long-term use of topical drugs can induce changes in theconjunctiva and ocular surface. To determine theconjunctival changes resulting from topical glaucomamedication, patients with glaucoma were selected andclassified into seven groups, according to the medicationreceived: 24 eyes were treated with betaxolol, 20 eyes withlevobunolol, 32 eyes with timolol maleate, 22 eyes withpilocarpine, 52 eyes with beta-blocker and pilocarpine, 34eyes with beta-blocker and dipivefrin, and 32 eyes withmaximum therapy. Patients who were under 18 wereexcluded, as were those with any history of ocular surgeryand other interventions, long-term use of any topicallyadministered medication except glaucoma drugs, and anyhistory or slit-lamp examination evidence of ocular surfacedisorders. The changes in the conjunctiva of 216 eyes wereevaluated by means of ocular surface impression cytology.The medication group showed statistically significant degreesof conjunctival metaplasia when compared to the controlgroup (p < 0.01). The cytological grading was not correlatedwith age, sex, type of medication, duration of topicaltreatment or the number of drugs (p > 0.05). Duration oftreatment exceeding three months was not correlated withcytological grading. Thus, as far as surgical treatment wasconcerned, it was concluded that intervention within the firstthree months after the diagnosis would be most beneficial inthe management of glaucoma.The fact that the presence of the preservative benzalkoniumchloride was the same in all preparations suggests that itmay be the major factor in conjunctival metaplasia.

The best immunohistochemical panel for differentiating hepatocellular carcinoma from metastatic adenocarcinoma.

It can be difficult to differentiate hepatocellular carcinoma (HCC) from metastatic adenocarcinoma (MA). An appropriate immunohistochemical panel is required for the differential diagnosis. This study aimed at finding the best panel, including hepatocyte-specific antigen (Hepatocyte), pCEA, CD10, Villin, CD34, TTF-1, MOC-31, CK7, and CK20 antibodies. Sixty-eight cases of HCC and 107 cases of MA were investigated. Hepatocyte positivity was seen in 95.6% of HCCs and in 1.9% of MAs. pCEA was expressed in 47.8% of HCCs and in 86.8% of MAs. CD10 stained 73.13% of HCCs and 36.9% of MAs. Villin was positive in 23.5% of HCCs and in 81.0% of MAs. Canalicular staining with pCEA, CD10, and Villin was seen only in HCCs. Sinusoidal CD34 staining was seen only in 42.6% of HCCs. A small subset of HCCs demonstrated cytoplasmic TTF-1 and MOC-31. CK7 was expressed in 29.4% of HCCs and in 29.9% of MAs, whereas CK20 stained 14.7% of HCCs and 62.6% of MAs. In conclusion, Hepatocyte should be combined with pCEA, MOC-31, CD10, and CD34. Canalicular staining with pCEA, CD10, and Villin is specific for HCC. CK7 and CK20 expression may be seen in some HCCs. We suggest that the best panel for discriminating HCC from MA should contain Hepatocyte, MOC-31, pCEA, CD10, and CD34.

Chondrosarcoma Diagnosed by Fine Needle Aspiration Cytology

OBJECTIVE To define and discuss the cytologic findings in 6 conventional chondrosarcomas (CS), 1 chondroblastic osteosarcoma, 1 extraskeletal myxoid CS and 20 chondroma cases. STUDY DESIGN Study of fine needle aspiration cytology (FNAC) of cases air dried and May-Grünwald-Giemsa stained. RESULTS Tumor cells were embedded in a pink, amorphous, chondroid matrix in conventional CS. They were larger than chondroma cells and had vacuoles and small, pink, chondroid substance-like granules. Chondroblastic osteosarcoma was diagnosed as high grade CS by FNAC, but extremely pleomorphic chondrocytes, osteoid matrix, osteoblastic cells, and clinical and radiologic findings should have produced the proper diagnosis. Extraskeletal myxoid CS had a pinkish, granular, myxoid background. The tumor cells had granulated, dark blue cytoplasm and oval-round, lobulated, slightly indented, hyperchromatic nuclei. CONCLUSION FNAC is efficient for the diagnosis of CS and its variants as long as it is evaluated with radiologic and clinical findings by a pathologist familiar with bone pathology and cytology.

Diagnosis of Hepatocellular Carcinoma by Fine Needle Aspiration Cytology

OBJECTIVE To evaluate the importance of fine needle aspiration cytology (FNAC) in the diagnosis of hepatocellular carcinoma (HCC). STUDY DESIGN We analyzed 17 cytologic and 5 architectural features in a series of 320 FNACs from HCC and compared them with 73 FNACs from benign lesions and with 705 FNACs from metastatic carcinomas. One thousand ninety-eight patients who were diagnosed by liver FNAC between December 1988 and July 1998 and had adequate follow-up were included in the study. The specimens were evaluated according to the presence or absence of the cytologic features and cellular arrangement. A stepwise logistic regression analysis was performed on the data to determine the variables predictive of HCC. RESULTS Multinucleated tumor giant cells, cytoplasmic hyaline and central sinusoidal pattern were selected as the 3 most predictive parameters for differentiated reactive hepatocytes from HCC (P < .0001), while bile, centrally located nucleus in an atypical cell and intranuclear inclusion were selected as the 3 most predictive parameters for differentiated metastatic carcinoma from HCC (P < .0001-< .001) by stepwise logistic regression analysis. CONCLUSION In the 1,098 patients suspected of having hepatic malignancy, a correct diagnosis was made by a combination of the above features. The sensitivity of this procedure for hepatic malignancy was 99.5%, and the specificity was 100%.

Cytology of Clear Cell Carcinoma of the Female Genital Tract in Fine Needle Aspirates and Ascites

OBJECTIVE To define the cytomorphologic features of clear cell carcinoma (CCC) of the female genital tract. STUDY DESIGN The study consisted of four CCCs of the female genital tract in which clinical and histologic confirmation had been done. Cytologic findings were evaluated with May-Grünwald-Giemsa (MGG) stain of three cases of fine needle aspiration (FNA) material and peritoneal fluid cytology. All the FNA materials were obtained from metastatic supraclavicular lymph nodes. RESULTS We report here the cytomorphologic features of three FNA biopsies and peritoneal fluid cytology from four patients. Primary tumors from patients with aspiration material from supraclavicular lymph nodes were located in the ovary in two patients and vagina in one. The peritoneal fluid cytology was obtained from a patient with uterine cervical tumor. Cytologic findings were similar in all preparations. The cells had abundant, pale, finely vacuolated cytoplasm with indistinct cytoplasmic membranes. The nuclei were round to oval, with fine chromatin. The characteristic feature of CCC of the genital tract was basement membrane-like substance. This hyaline extracellular material stained pinkish to purple-red in MGG preparations and was frequently observed within the cancer cell clusters. In ascitic fluid, psammoma bodies were also observed. CONCLUSION The cytomorphologic characteristics of CCC of the genital tract are distinctive, and the entity may easily be diagnosed even at metastatic locations.

Myeloid sarcomas: a clinicopathologic study of 20 cases.

Objective: Myeloid sarcoma is a tumoral mass of mature or immature myeloid blasts in extramedullary anatomic locations. It can be seen de novo or in association with acute myeloid leukemia, myeloproliferative neoplasias, or myelodysplastic syndrome. Isolated myeloid sarcoma can be seen as a relapse in cases with allogenic bone marrow transplantation. Although it may involve any tissue in the body, the most common locations are skin, soft tissues, lymph nodes, and the gastrointestinal tract. Immunohistochemically, most cases show myelomonocytic or pure monoblastic differentiation. We reviewed the clinicopathological features of 20 cases of myeloid sarcoma diagnosed in our institute in view of the literature. Materials and Methods: The cases diagnosed between 2005 and 2012 at the Ankara University Faculty of Medicine, Department of Pathology, were selected. Clinicopathological findings including the age and sex of the patients; symptoms; anatomic location; accompanying hematological disease; and the morphological, immunohistochemical, and cytogenetic features of the cases were noted. Results: Sixteen of the patients were male and 4 were female. The median age at diagnosis was 47 years. The most commonly involved locations were the lymph nodes and skin. Immunohistochemically, eleven cases were of the myelomonocytic and 7 cases were of the myeloid phenotype, whereas 2 cases showed pure monoblastic differentiation. The median follow-up period for the 18 cases with known clinical data was 33 weeks. Five patients died of the disease in an average of 36 weeks. Conclusion: Myeloid sarcoma is a rare presentation of leukemias, myeloproliferative neoplasias, or myelodysplastic syndrome, composed of immature myelomonocytic cells in extramedullary tissues. It may present with variable morphological and phenotypic features, always creating a challenge in pathological diagnosis.

Suprarenal Symplastic Leiomyoma of the Inferior Vena Cava

We report on a case of a leiomyoma in the inferior vena cava that appeared in the image to be located in the adrenal gland. En bloc excision of the tumor with the right adrenal gland and the involved segment of the vena cava was carried out. Histopathological work-up of the tumor revealed smooth muscle fibers and marked nuclear pleomorphism consistent with symplastic leiomyoma. This case report presents a distinct histological variant of the rarely seen primary smooth muscle tumor of the inferior vena cava.

Encouraging Result of Tamoxifen in a Retinoblastoma Patient with Central Nervous System Metastasis

Extraocular retinoblastoma occurs more frequently in developing countries as a delayed diagnosis and prognosis of patients with conventional therapy is very poor. Metastatic retinoblastoma, especially in the central nervous system (CNS), is a highly lethal disease. Tamoxifen has been used in some previous studies with variety of responses to therapy in patients with unresectable recurrent brain tumors. A 7-year-old girl with recurrent metastatic retinoblastoma received 60 mg/m 2 tamoxifen in addition to chemotherapy and CNS radiotherapy. She was in remission until she has died in a traffic accident at week 114. The authors think that tamoxifen can be added to treatment protocols of metastatic retinoblastoma to provide longer and at least higher quality of life for these patients.

Chronic hepatitis in a patient with rigid spine myopathy: cause or just an association?

To the Editor,Rigid spine syndrome (RSS) is a congenital, axial, mus-cular dystrophy due to a mutation in the gene on chro -mosome 1p36 coding for selenoprotein N1 (SEPN1) (1,2). Up to date, no case of hepatic dysfunction has been reported in the literature. The following is a case report of a patient with rigid spine syndrome and coex -istent chronic hepatitis.An 18-year-old male patient was referred to the hepa-tology department due to persistent elevation in liv-er enzymes. His major complaint was fatigue. He was a child of consanguineous parents. The family history was otherwise insignificant. Physical examination re-vealed several facial and skeletal deformities as well as choreiform head and foot movements. Further neuro-logical examination revealed no deep tendon reflex-es except for the patella. Laboratory tests are shown in Table 1. Drug, alcohol, herbal, and toxic substance screening was insignificant. Initial investigation against liver dysfunction revealed that serological studies for hepatitis B (HBs-Ag, anti-HBc IgM/IgG, HBeAg, anti-Hbe) and hepatitis C antibody (anti-HCV) were all negative, with hepatitis B surface antibody positivity consistent with vaccine immunization. HCV-RNA PCR was nega-tive. Serum ceruloplasmin level was in the lower limit (0.19 g/L), with slightly low serum copper level (53 µg/dL) and elevated urinary copper excretion (210 µg/day), which was elevated insignificantly after D-penicillamine challenge (215.8 µg/day). In the ophthalmologic eval-uation, there was no Keiser-Fleicher ring, and a neuro-logical investigation excluded Wilson’s Disease. Serum iron, ferritin, and tumor marker levels were all within the normal range. Serological studies for anti-nuclear, anti-smooth muscle, anti-mitochondrial, liver/kidney microsomal-1, soluble liver antigen, and anti-SP100 an-tibodies were all negative. Serum immunoglobulin G, A, and M; alpha-1 anti-trypsin; and protein electrophoresis were also normal. In the ultrasonographic evaluation, there was no sign of steatosis, vascular pathology, or chronic parenchymal liver disease. Echocardiography was normal with no sign of respiratory or cardiac insuffi-ciency. Electromyography represented primary muscle involvement. The muscle biopsy was compatible with inflammatory myopathy (Figure 1-3). Genetic testing resulted in a characteristic mutation. Due to chronic elevation in liver enzymes, liver biopsy was performed. The lobullary architecture was protected and had mild inflammation in intralobullary spaces, consistent with chronic hepatitis. Neither fatty change nor any virolog-ical or autoimmune signs were defined in hepatocytes, and copper was all negative (Figure 4). As a result of 5 years of follow-up, 2-3-fold elevation of liver enzymes persisted, without any cirrhotic change.Congenital muscular dystrophy with early RSS is a rare disease characterized by several skeletal and muscular abnormalities and chronic respiratory failure (3-5). Our patient presented clinical, histological, and genetic al-terations consistent with RSS. For the evaluation of liver dysfunction, all the markers of viral, autoimmune, and metabolic liver diseases were