Ebru Demiralay

Morphological evaluation of parathyroid adenomas and immunohistochemical analysis of PCNA and Ki-67 proliferation markers.

OBJECTIVE Parathyroid adenomas are the most common cause of primary hyperparathyroidism. Biological studies have shown that parathyroid adenomas are monoclonal proliferations. Up to date, five cell types have been identified in normal parathyroid tissues; chief cells, vacuolated chief cells, dark chief cells, oxyphil cells and transitional oxyphil cells. Most parathyroid adenomas are predominantly composed of chief cells. In this study, we aimed to indicate the relationship between the predominant cell type in parathyroid adenomas and proliferating cell nuclear antigen, Ki-67 antigen, and serum parathormone levels and the gland weight. MATERIAL AND METHOD 15 cases who had a diagnosis of parathyroid adenomas were included in the study. Histopathologically, the predominant cell type was determined in all the cases. Paraffin blocks were immunohistochemically stained with proliferating cell nuclear antigen and Ki-67. RESULTS The average parathormone level of the cases was 239.52 ± 36.61 pg/ml before surgery. Mean gland weight was 1.69 ± 0.49 g. Two of the cases showed atypical adenoma characteristics. The predominant cell type was vacuolated chief cell. Immunohistochemical investigation showed that the mean average Ki-67 index value was 4.26 ± 0.86%. The mean proliferating cell nuclear antigen index was 93.20± 45.72/10³. There was a meaningful relationship between gland weights and serum parathormone levels. There was no meaningful relationship between predominant cell types and serum parathormone levels, proliferating cell nuclear antigen index, and Ki-67 index. The chief cell was identified as the predominant cell type. CONCLUSION It can be concluded that parathyroid adenomas come into existence as a result of neoplastic proliferation of chief cells, especially vacuolated chief cells.

Carnitine or dimethyl sulfoxide, or both, for the treatment of anthracycline extravasation in rats

Abstract This study aimed to compare the efficacy of topical dimethyl sulfoxide (DMSO), intralesional and systemic carnitine as monotherapy and in combination against ulceration in rats induced by intradermal doxorubicin extravasation. Sixty-nine 3-month-old male Wistar albino rats, weighing between 200–225 g, were used in this study. Rats were applied monotherapy or a combination of topical DMSO, intraperitoneal or intralesional carnitine. Control groups received saline or no drug. The necrotic area was measured and extravasated neutrophil leukocytes were counted in healthy tissue adjacent to necrotic areas. Monotherapy with topical and systemic carnitine did not significantly reduce the size of necrotic areas. However, topical DMSO had reduced necrotic areas and inflammatory cells significantly and the addition of systemic carnitine to topical DMSO had increased the efficacy. DMSO is an effective, safe, and easy-to-apply treatment for doxorubicin-induced extravasation. Further clinical studies are needed to evaluate the use of carnitine in combination with DMSO.

Thrombocytosis and small bowel perforation: unusual presentation of abdominopelvic actinomycosis.

Intrauterine devices (IUD) are frequently used as a family planning procedure in developing countries because they are easy to administer and governmental policies support their use in many countries. It is recommended that IUDs be removed or replaced after 10 years, but longer use is common, especially in developing countries. In some cases, rare infections such as pelvic inflammatory diseases, pelvic tuberculosis, or abdominopelvic actinomycosis related to IUD can develop. Pelvic actinomycosis is a rare disease and is often diagnosed incidentally during surgery. In recent years, there has been an increase in actinomycotic infections mostly due to long-term usage of IUD and forgotten intravaginal pessaries. It usually develops as an ascending infection. It is usually associated with non-specific symptoms such as lower abdominal pain, menstrual disturbances, fever, and vaginal discharge. The disease is sometimes asymptomatic. The rate of accurate preoperative diagnosis for pelvic actinomycosis is less than 10%, and symptoms and imaging studies sometimes mimic pelvic malignancy. This report details a case with abdominopelvic actinomycosis associated with an IUD presenting with highly elevated thromboctye count and small bowel perforation with abscess formation.

nNOS expression in the brain of rats after burn and the effect of the ACE inhibitor captopril

OBJECTIVE To investigate the role of endogenous neuronal nitric oxide synthase (nNOS) on brain injury after burn and the effects of the captopril. METHODS Wistar albino rats (200-250 g) were exposed on the dorsal surface to 90°C (burn) or 25°C (sham) water for 10 s. The ACE group was treated with intraperitoneal 10 mg/kg captopril immediately after burn and this treatment was repeated twice daily. At the end of the 24 h brain samples were taken. nNOS was studied in brain areas by immunohistochemistry. RESULTS There was no difference between the cerebellar and hypothalamic areas the nNOS expression of all groups. nNOS expression increased in the frontal cortex, striatum and midbrain in the burn group compared to the control group. In the frontal cortex, nNOS expression significantly decreased after ACE inhibitor treatment (p<0.05). The striatal nNOS of the ACE group significantly increased when compared to the control group (p=0.001). In the midbrain of the animals, nNOS decreased in the ACE group. Hippocampal nNOS expression did not change after burn and significantly increased after ACE inhibitor therapy (p<0.05). CONCLUSIONS Our data showed that the pathophysiological events following burn appear to be related to an acute inflammatory reaction which is associated with nNOS in the frontal cortex, striatum and midbrain, and captopril treatment abrogates the nNOS response in the frontal cortex and midbrain.

Sirolimus induced diffuse alveolar hemorrhage: A case report

Sirolimus, mammalian targets of the Rapamycin, is responsible for inhibition of T and B cell proliferation, and usually. Recently we treated a 33 year old renal transplant reciepent with sirolimus induced diffuse alveolar hemorrhage. She was first diagnosed with pneumonia and underwent antibiotic therapy. In her radiological images there was bilateral diffuse patchy infiltration. In the 48th hour of antibiotic treatment her fever and inflammatory markers were still high, and afterwards, bronchoscopy was performed. Pathology result of the patient was reported as hemosiderin-loaded macrophages, eosinophil predominancy and few lymphocytes . Our final diagnosis was diffuse alveolar hemorrhage due to sirolimus. We discontinued sirolimus and started pulse steroid (1 gr/day methylprednisolon) for three days. In the following period her oxygen supply declined immediately and clinical condition of the patient got better. After two weeks we disharged the patient, continued methylprednisolon treatment in 1mg/kg/day dosage. By tapering the dose slowly we planned 6 months of steroid treatment. During her follow ups, pulmonary symptoms and radiological images got better.

Sirolimus-Induced Diffuse Alveolar Hemorrhage: A Case Report.

Sirolimus is a mammalian target of the rapamycin, a protein kinase, which is responsible for inhibition of T cell and B cell proliferation. Sirolimus has side effects on lugs, and may cause cryptogenic organizing pneumonia, diffuse alveolar hemorrhage, lymphocytic pneumonitis, hypersensitivity pneumonitis, desquamative interstitial pneumonia, and pulmonary alveolar proteinosis. Diagnosis is based on the combination of clinical, radiological, histological, and pathological investigation. We report a case of diffuse alveolar hemorrhage in a 33-year-old, female renal transplant recipient. After discontinuation of sirolimus, radiological images and clinical condition of the patient got better. We also planned steroid therapy for 6 months by tapering the dosage slowly. After steroid therapy, full recovery of pulmonary functions achieved, and the patient is observed in our outpatient clinic with lack of any pulmonary symptoms.

Rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction: case report.

Although diverticular disease of the colon is common, the occurrence of rectal diverticula is extremely rare with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are seen even less frequently, and surgical intervention is needed for only complicated cases. Here we report the case of a 63-year-old woman presenting with rectal diverticulitis mimicking rectal carcinoma with intestinal obstruction.

Detection of HPV positivity by immunohistochemistry in colposcopic cervical biopsies with a cytological diagnosis of ASCUS.

Abstract Objective: Many epidemiological studies have shown that human papillomavirus related infections play a major role in cervical preinvasive and invasive lesions. ASCUS (atypical cells of undetermined significance) observed in about 4-5% of all cervical cytology specimens. We searched for the presence of HPV with immunohistochemical methods in the biopsy material of patients diagnosed with ASCUS using cytology. Material and Method: The colposcopic biopsy or Loop Electro Excisional Procedure (LEEP) material of 115 patients with a diagnosis of ASCUS were evaluated. HPV (type 6,11,16,18,31,33,42,51,52,56 and 58) immunohistochemistry was applied to all materials. The relationship between the biopsy results and HPV positivity was investigated. Results: Cervical intraepithelial neoplasia (CIN) I was found in 34.8%, CIN II in 13% and CIN III in 9.6% of the patients and cervicitis was present in 42.6% of the patients. HPV immunohistochemistry was positive in 11 cases (9.6%) and no staining was seen in 104 cases (90.4%). No positive staining was seen in the chronic cervicitis cases. The rate of positive staining was 15% (6/34) in the CIN I diagnosed group, 20% (3/12) in the CIN II diagnosed group and 18.2% (2/9) in the CIN III diagnosed group. Conclusion: HPV positivity was found to be lower compared to the literature both in total and in cases diagnosed by biopsy. No staining occurred in any patient with cervicitis. In conclusion, we believe that immunohistochemical examination is not an appropriate method for the determination of HPV. Öz Amaç: Yapılan birçok epidemiyolojik çalışmada human papilloma virüse bağlı enfeksiyonların servikal preinvaziv ve invaziv lezyonlarda başlıca rolü oynadığı ispatlanmıştır. ASCUS (atypical cells of undetermined significance) tüm servikal sitolojilerin yaklaşık %4-5’inde saptanır. Bu çalışmada sitolojide ASCUS tanısı almış ve kolposkopik biyopsi uygulanmış hastaların biyopsi materyallerinde immünohistokimyasal olarak HPV varlığı araştırıldı. Gereç ve Yöntem: 115 ASCUS tanısı alan hastanın kolposkopik biyopsi ve/veya Loop Electro Excisional Procedure (LEEP) materyalleri değerlendirildi. Tüm materyallere immünohistokimyasal olarak HPV (tip 6,11,16,18,31,33,42,51,52,56 ve 58) uygulandı. Biyopsi sonuçları ile HPV pozitifliği arasındaki ilişki araştırıldı. Bulgular: Çalışma grubundaki hastaların %34,8’inde CIN (Servikal intraepitelyal neoplazi) I, %13’ünde CIN II, % 9,6’sında CIN III, % 42,6’sında servisit saptandı. Olguların 11’inde (% 9,6) HPV immünohistokimyası pozitif olup, 104’ünde (% 90,4) boyanma görülmedi. Kronik servisitlerde pozitif boyanma görülmedi. CIN I tanılı grupta pozitif boyanma oranı %15 (6/34), CIN II tanılı grupta %20 (3/12) ve CIN III tanılı grupta %18,2 (2/9) idi. Sonuç: Çalışmamızda, HPV pozitifliği hem toplamda, hem de biyopsi ile tanımlanmış CIN olgularında literatürde verilen rakamlara göre oldukça düşüktür. Ancak servisit olgularının hiçbirinde boyanma olmamıştır. Sonuç olarak immünohistokimyasal incelemenin HPV tespitinde kullanılmasının uygun bir teknik olmadığı düşünülmüştür.

Vulvar intraepithelial neoplasia and vulvar squamous cell carcinoma: a clinicopathologic study of 18 cases

Background: The vulvar intraepithelial neoplasia is divided into two groups: usual type and differentiated type. The differentiated vulvar intraepithelial neoplasia which is frequently seen together with the invasive squamous cell carcinoma can be confused with some benign lesions. To analyse p16, p53, and Ki-67 expression characteristics of different histological types of invasive squamous cell carcinoma of the vulva and vulvar intraepithelial neoplasia is aimed in this study. Methods: In this study, immunohistochemical analysis of 18 vulvectomy cases with p16, p53, and Ki-67 was performed. Results: Of 18 patient who underwent vulvectomy, 9 had invasive squamous cell carcinoma and 9 vulvar intraepithelial neoplasia. 3 additional vulvar intraepithelial neoplasia lesions were found accompanying the invasive squamous cell carcinomas. Mean Ki-67 PI was 32,3% in usual type (human papilloma virus-related) vulvar intraepithelial neoplasia cases (n:9), and 26,4% in differentiated vulvar intraepithelial neoplasia cases (n:3)(p>0,05). Mean p16 staining degree was 2,6 for usual type vulvar intraepithelial neoplasias. No p53 expression was present in squamous cell hyperplasia or lichen sclerosis lesions. Conclusions: Ki-67 PI does not have significant value in recognizing vulvar intraepithelial neoplasia usual type and differentiated vulvar intraepithelial neoplasia. p53 positivity can be of value in distinguishing especially differentiated type vulvar intraepithelial neoplasia from benign lesions.

The effect of captopril on brain apoptosis after burn injury in rats.

AIM The purpose of this study was to determine the possible protective effects of captopril treatment against apoptosis in the brain induced by burn injury. MATERIAL AND METHODS Under ether anaesthesia, Wistar albino rats (200-250 g) were exposed to a 900C (burn) or 250C (sham) water bath for 10 s. The ACE group was treated with i.p. 10 mg/kg captopril immediately after burn injury and this treatment was repeated twice daily. At the end of the 24 hours, brain samples were taken. Apoptotic brain cells marked by terminal deoxynucleotidyl transferase-mediated d-UTPnick end labeling (TUNEL) were evaluated in the cerebellum and midbrain of rats. RESULTS Apoptotic cells in the cerebellum were significantly decreased after captopril treatment and found to be lower when compared to the burn group (p < 0.001). In the midbrain of rats, the numbers of TUNEL-positive cells and apoptotic bodies were significantly increased in the burn group when compared to the control group (p < 0.001). The burn-induced changes were reduced in the captopril-treated burn group (p < 0.01). CONCLUSION Captopril has beneficial effects in burn injury and should be assessed as a therapeutic agent in the management of this condition.