Deniz Arik

Peritoneal tuberculosis mimicking ovarian cancer.

OBJECTIVE To evaluate the characteristics of 20 patients diagnosed as tuberculous peritonitis (TBP) mimicking ovarian cancer during a 10-year period at a single center. STUDY DESIGN Among 612 operations for ovarian malignancy we retrospectively reviewed the surgical and pathological reports of 20 patients suspected preoperatively as having ovarian malignancy but whose pathological results revealed TBP, between 2000 and 2011 in a university clinic. Demographic characteristics, physical and pelvic examination, laboratory investigations and radiological imaging of the patients were evaluated retrospectively. RESULTS Diagnostic laparotomy, laparoscopy and ultrasound guided tru-cut biopsy were performed in 11, 2 and 7 of the 20 patients, respectively. The mean age of the patients was 37.5 ± 17.3 years (range 16-70 years). The most common symptoms were abdominal pain (n=14%, 70%) and abdominal distension (n=13%, 65%). Serum CA 125 was elevated in 16 (80%) cases and the average CA 125 level was 289 ± 186.2 IU/ml. During ultrasonographic imaging and CT scans, ascites and a pelvic mass were detected in 19 (85%) and 12 (60%) patients respectively. TBP was suspected in 7 (35%) patients and ultrasound guided tru-cut biopsy was preferred as a first-line approach. Surgery was performed in 11 patients (55%) and during exploration widespread miliary nodules (n=9%, 81%), widespread adhesion (n=5%, 45%), adnexal mass (n=8%, 72%) and caseous necrotic substance (n=4%, 36%) were observed. Patients underwent unilateral (n=3% 27%) or bilateral (n=4%, 36%) salpingo-oophorectomy in seven (63%) cases. CONCLUSION Since ovarian cancer is a serious condition and preoperative diagnosis of TBP is difficult, laparotomy is usually mandatory to distinguish these two entities. Ultrasound guided tru-cut biopsy is useful in selected patients and frozen section analysis avoids hazardous radical surgery at operation.

Perianal Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer. Exposure to ultraviolet light is an important risk factor for BCC development and the disorder therefore develops commonly on body areas that are more exposed to sunlight, such as the face and neck. It is uncommon in the closed area of the body and quite rare in the perianal and genital regions. Herein, we report a 34-year-old patient with perianal BCC who had no additional risk factors.

Prognostic Significance of CD24 in Clear Cell Renal Cell Carcinoma

The role of cancer stem cells in the initiation and progression of cancer has become a well-studied area of emerging research, and stem cells with different surface markers have been identified in various types of cancer. CD24 is a membrane protein that acts as the ligand for P-selectin and has been defined as a stem cell marker of colonic cancer. The immunohistochemical expression of CD24 is associated with worse patient outcomes in small cell lung cancer, hepatocellular carcinoma, breast cancer, and colon cancer. In this study, we used immunohistochemistry to determine CD24 expression in clear cell, papillary and chromophobe renal cell carcinoma and investigated its relationship with other clinicopathological parameters and prognosis. A total of 108 cases of clear cell, 12 papillary and 13 choromophobe renal cell carcinoma were examined. Clinicopathological features including age, gender, vascular invasion, tumor necrosis, and T stage were recorded. Clinical stage and overall survival and disease-free survival times were recorded. The immunohistochemical expression of CD24 was classified as low or high based on the percentage and intensity of positive staining. CD24 expression was associated with both tumor grade and recurrence rates. The survival analysis revealed that patients with high CD24 expression exhibited significantly lower overall and disease-free survival. Increased expression of CD24 is related to the prognosis of clear cell renal cell carcinoma. This is the first study identifying a strong association between CD24 expression levels and survival. Thus, CD24 expression may aid in predicting prognosis in clear cell renal cell carcinoma.

Imaging findings of an extradigital fibro-osseous pseudotumor.

Fibro-osseous pseudotumor (FOPT) is a rare and benign ossifying lesion. Described as the superficial variant of myositis ossificans (MO), this rare entity mostly occurs in the subcutaneous tissues of the digits. The FOPT clinicopathological features may mimic a variety of benign and malignant soft tissue lesions, and the diagnosis can be difficult when it arises in an unusual anatomic location. In this report we describe the clinical and radiological features of a case of an FOPT that involved the hypothenar region of the hand.

Larinksin az görülen skuamöz hücreli karsinom varyantları: tek merkeze ait 7 yıllık deneyim

Larinksin malign epitelyal tum o rleri arasinda skuam o z hucreli karsinom en sik g o rulendir. Daha c ok erkeklerde, 6. ve 7. dekadlarda g o rulur. Son yillarda tutun ve alkol kullaniminin artmasi nedeniyle kadinlarda da insidansinin yukseldigi bildirilmektedir. Skuam o z hucreli karsinom supraglottik ve glottik b o lgede daha sik g o rulur. Dunya Saglik Orgutu, skuam o z hucreli karsinomun farkli alt tiplerini tanimlamistir. Bu varyantlardan bazilari konvansiyonel skuam o z hucreli karsinoma g o re daha iyi, bazilari ise daha k o tu prognozludur. Calismamizda skuam o z hucreli karsinomun az g o rulen varyantlari sunulmaktadir. Gerec ve Yontem: … Tip Fakultesi Patoloji Anabilim Dali’nda son 7 yillik d o nemde tum larinks biyopsileri taranmistir. Skuam o z hucreli karsinom varyantlari seklinde tani alan hastalar belirlenmis, olgularin histopatolojik ve klinik o zellikleri derlenmistir. Bulgular: Yedi yillik d o nemde larinks biyopsisi yapilan 1148 olgu bulunmaktadir. Bu olgulardan 460’i skuam o z hucreli karsinom tanisi almistir. Bunlardan 31’i nadir g o rulen skuam o z hucreli karsinom varyantidir. Bunlar arasinda 3 verruk o z karsinom, 6 bazaloid, 11 papiller, 4 ig si h ucreli, 6 akantolitik varyant skuam o z hucreli karsinom olgusu mevcuttur. Bir olgu ise adenoskuam o z karsinom tanilidir. Verruk o z karsinom olgularinda tum o r vokal kord yerlesimlidir. Bazaloid varyant ise olgularin tumunde supraglottik b o lgede saptanmistir. Diger varyantlarda glottik ve supraglottik b o lge degisen oranlarda tutulmaktadir. Olgularin sadece birinde infraglottik tum o r mevcuttur. Bu olgu akantolitik varyant skuam o z hucreli karsinom olarak degerlendirilmistir. Sonu c : Larinksin skuam o z hucreli karsinomunun az g o rulen varyantlarinin biyolojik davranislari farkliliklar g o stermektedir. Bu tum o rler multidisipliner yaklasim ile efektif sekilde tedavi edilebilir. Alt tiplerin taninmasi ve tariflenmesi uygun tedavi yaklasiminin belirlenebilmesi i c in gereklidir.

Adrenal crisis while on high-dose steroid treatment: what rheumatologist should consider?

Steroid treatment is commonly recommended for autoimmune disorders in rheumatology practice. While adrenal crisis may occur upon existence of an inducing factor in patients with known or unknown adrenal insufficiency as well as in those with a suppressed hypothalamic–pituitary–adrenal (HPA) axis due to chronic steroid use, addisonian crisis rarely develops in patients on supraphysiological doses of steroid and, when emerged, it might be very difficult to recognize. Here, we present a patient who developed adrenal crisis while receiving high-dose methylprednisolone treatment due to retroperitoneal fibrosis and we also discuss possible mechanisms with a brief literature review.

Nephrogenic adenoma of the urinary tract: A 6-year single center experience

BACKGROUND Nephrogenic adenoma is an uncommon benign lesion that occurs at several sites in urinary tract, from the renal pelvis to urethra, with the highest frequency in urinary bladder. Nephrogenic adenoma displays a broad spectrum of architectural and cytological features. Hence, recognition of its characteristic histopathological features is needed to distinguish this lesion from its mimickers. MATERIALS AND METHODS A retrospective series of 21 cases of nephrogenic adenoma in 18 patients, which were diagnosed in our department between 2010 and 2016, were analyzed. All histological slides were reviewed by two pathologists and the diagnosis of each case was confirmed. Immunohistochemistry was performed for PAX-8 in all cases. CK7, PAX-2, PSA, p53, p63, GATA-3 and α-methylacyl-CoA racemase (AMACR) were applied in problematic cases. RESULTS The most common location of the lesion was urinary bladder (14 patients) followed by renal pelvis (2 patients), ureter (1 patient) and urethra (1 patient). A history of urothelial carcinoma and repeated TUR procedures were observed in 12 patients. There were 2 pediatric patients aged 3 years. Both of them had undergone previous urosurgery because of megaureter in one and bladder exstrophy in the other. Other clinical antecedents included bladder diverticulum (1 patient), cystitis (1 patient) and nephrolithiasis (1 patient). Recurrence of lesion was seen in two patients (once in one case and twice in the other one). The median time to disease recurrence in these patients was 11 months (range, 2-20 months). Histologically, the lesions exhibited various morphological findings, with mixed (15 cases, 71.4%), pure tubular (3 cases, 14.3%), pure papillary (2 cases, 9.5%) and pure flat (1 case, 4.8%) growth patterns. Of the 15 cases with mixed patterns, 8 cases were tubulocystic and flat, 3 cases were tubular and flat, 2 cases were tubular, papillary and flat, 1 case was tubulocystic, papillary and flat, and 1 case was tubular and papillary. Flat pattern was observed in 15 cases (71.4%). It was seen in association with other patterns in 14 cases (mixed morphology) and purely in 1 case. Our findings suggested that the flat pattern is a frequent finding in nephrogenic adenomas. Notably one case in this series showed superficial extension into bladder muscularis propria. CONCLUSIONS Histologically nephrogenic adenoma may simulate a variety of malignancies. Awareness of characteristic morphologic features of nephrogenic adenoma is needed to diagnose this lesion correctly.

Is there a relation between the changes in circulating lymphocyte counts due to neoadjuvant chemoradiotherapy and intratumoral lymphocytic response and tumor regression grade in locally advanced rectal cancers

There are controversies about the relation between the peripheral lymphocyte levels and response to neoadjuvant therapy. While some authors have reported that a positive correlation between peripheral lymphocyte levels and tumor response, others have suggested the opposite. In the present study, we aimed to investigate the possible relations between the changes in circulating lymphocyte counts due to neoadjuvant chemoradiotherapy (CRT) and intratumoral lymphocytic response (ILR) and tumor regression grade (TRG) in locally advanced rectal cancers. Lymphocyte levels before, during and after CRT as well as before surgery and pathologic findings including ILRs and TRGs were recorded. Lymphocyte levels before CRT were accepted as absolute values. After the changes in the lymphocyte levels during and after CRT and before the surgery were recorded as ratios to the absolute values, the relation between the changes in lymphocyte levels, ILR and TRG were studied by using Pearson and Spearman correlation tests. There was a positive correlation between changes in peripheral lymphocytic levels after neoadjuvant CRT and ILRs. However, there were no other correlations between changes in lymphocytic levels and TRGs and ILRs. The changes in the peripheral lymphocyte counts after CRT may be predictive for ILR. Further studies may provide more information about the relation between peripheral lymphocytes and TILs and tumor response to neoadjuvant CRT.

CD105 (endoglin) expression as a prognostic marker of angiogenesis in squamous cell cervical cancer treated with radical radiotherapy

Introduction: Increased levels of endoglin may represent a new reagent of active neovascularization and angiogenesis process in various cancer types. The prognostic value of tumor CD105 (endoglin) expression in cervical squamous cell cancer (CSCC) patients treated with radical radiotherapy (RT) ± chemotherapy was investigated. Materials and Methods: CD105 (endoglin) expression was assessed by immunohistochemical methods in seventy patients, who were treated with radical RT ± chemotherapy for CSCC. The prognostic effects of CD105 on patient and treatment characteristics, local-regional control, and survival were assessed. Results: The median follow-up was 24 (5–99) months for the whole cohort. The median CD105 microvessel density was 55.5 (range; 12–136). Age (≤61 vs. >:61 years; P = 0.015), lymph node metastasis status (absent vs. present; P = 0.028), International Federation of Gynecology and Obstetrics stage (Ib–IIa vs. IIb–IVa; P = 0.036), cycles of concurrent chemotherapy (1–3 vs. 4–6 cycles; P = 0.001), and hemoglobin levels (≤10 g/dL vs. >:10 g/dL; P = 0.006) appeared to associate significantly with overall survival on univariate analysis. Discussion: No correlation was identified between the tumor CD105 (endoglin) expression and survival in CSCC patients treated with radical RT ± chemotherapy.

Calvarial-orbital metastasis of prostate carcinoma which was diagnosed with sixth cranial nerve palsy

Sixth nerve palsy is frequently due to infectious orbital lesions, trauma, elevated intracranial pressure, brainstem lesions, and vasculopathies. Here, we describe a rare cause of sixth cranial nerve (CN) palsy secondary to calvarial and orbital metastasis of prostate carcinoma. The diagnosis of the prostate carcinoma with sixth CN palsy is a very rare condition. A 66-year-old male patient presented with complaints of blurred vision, double vision, and inability to move outward in the right eye for 3 weeks. Magnetic resonance imaging revealed a right orbitocalvarial mass and the mass surgically removed completely. Pathologic findings were compatible with prostate adenocarcinoma metastasis. After surgical removal, significant improvement in sixth CN palsy was observed.