Fatmagul Kusku Cabuk

Mechanoreceptors of the ligaments and tendons around the knee

Proprioceptive inputs from the joints and limbs arise from mechanoreceptors in the muscles, ligaments and tendons. The knee joint has a wide range of movements, and proper neuroanatomical organization is critical for knee stability. Four ligaments (the anterior (ACL) and posterior (PCL) cruciate ligaments and the medial (MCL) and lateral (LCL) collateral ligaments) and four tendons (the semitendinosus (STT), gracilis (GT), popliteal (PoT), and patellar (PaT) tendons) from eight fresh frozen cadavers were harvested. Each harvested tissue was divided into its bone insertion side and its tendinous part for immunohistochemical examination using S100 staining. Freeman–Wykes classification was used to identify the mechanoreceptors. The mechanoreceptors were usually located close to the bone insertion. Free nerve endings followed by Ruffini endings were the most common mechanoreceptors overall. No Pacini corpuscles were observed; free nerve endings and Golgi‐like endings were most frequent in the PCL (PCL‐PaT: P = 0.0.1, PCL‐STT: P = 0.00), and Ruffini endings in the popliteal tendon (PoT‐PaT: P = 0.00, Pot‐STT: P = 0.00, PoT‐LCL: P = 0.00, PoT‐GT: P = 0.00, PoT‐ACL: P = 0.09). The cruciate ligaments had more mechanoreceptors than the medial structures (MS) or the patellar tendon (CR‐Pat: P = 0.000, CR‐MS: P = 0.01). The differences in mechanoreceptor distributions between the ligaments and tendons could reflect the different roles of these structures in the dynamic coordination of knee motion. Clin. Anat. 29:789–795, 2016.

Schwannoma of the submandibular gland: a case report

IntroductionSchwannoma is a benign, solitary, and slowly progressive encapsulated tumor originating from the sheath of myelinated nerve fibers. Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor. Here, we present an unusual case of a schwannoma of the submandibular gland in a 19-year-old man. Total excision of the submandibular gland resulted in complete resolution of symptoms with no cranial nerve deficits. The details of the histopathologic and immunohistochemical features are presented.Case presentationA 19-year-old Caucasian man was admitted to our clinic with a painless mass on the right side of his neck that he had had for the past four months. A neck examination revealed a smooth-surfaced, mobile, firm, and painless mass, 6cm in its greatest diameter, on the right side of the submandibular region. Fine-needle aspiration cytology was suggestive of a submandibular gland schwannoma. After the initial evaluation, our patient was prepared for surgical evaluation and resection with a presumptive diagnosis of a neurogenic tumor of the submandibular gland. The final diagnosis of schwannoma was verified by microscopic and immunohistochemical studies. At one-year follow-up of the case, there was no evidence of recurrence.ConclusionsSchwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor. Our findings indicate good prognosis in an unusual case of a submandibular gland schwannoma in a 19-year-old man treated by surgical excision with no recurrence within 12 months of follow-up.

Histological features in abdominal wall endometriosis

Endometriosis is localization of endometrial tissue out of endometrium and myometrium. Location on peritoneum and scar tissue associated with abdominal incision called as abdominal wall endometriosis (AWE). Abdominal wall endometriosis is a rare lesion affection under 1% of effected patients. However, due to increase in laparoscopy, hysterectomy and cesarean section procedurs, the AWE cases are increasing. In this study we aim to analyse AWE rates and evaluate their histologic properties. Endometriosis cases between 2010-2015 were included in study. These cases were evaluated according to localization and out of these 23 cases were revealed as AWE, and in 15 of 23 cases histologic specimens can reach. 317 cases with endometriosis were revealed and 23 (7.2%) were identified as AWE. The mean age was 35±5 (29-45). In 11 (47.8%) cases AWE was developed on scar tissue which have a history of cesarean section procedurs in a mean 3.4 year before. In 10 (66%) cases tubal (ciliary) metaplasia, in 3 (20%) cases hobnail metaplasia and in one case (7%) atypia and mitosis were observed as glandular changes. In 11 (73%) cases myxoid changes, 3 (20%) signet ring-like cells-like changes, 2 (13%) atypical myocytes with giant cells, in one (7%) case thick walled vessels resemble spiral arteries of endometrium and in one case (7%) decidual changes were observed as stromal changes. In this study we highlight the high prevalence of AWE compare to literature. Besides, the wide spectrum of stromal and glandular metaplastic changes could be challenging in proper diagnosis. AWE should keep in mind in the differential diagnosis of lesions in this localization.

The Relationship between Bone Mineral Density and Estrogen Receptor Positivity in Patients with Breast Cancer

OBJECTIVE The effect of estrogen on bone mineral density (BMD) and breast cancer has been known for a long time. The aim of this study was to compare of the BMD of patients with breast cancer and healthy individuals, and to investigate the degree of correlation of estrogen receptor (ER) with BMD. MATERIALS AND METHODS Seventy-one patients with postmenopausal breast cancer and 79 healthy dividuals were included in the study. The patient demographics (age, menopause age, body mass index, number of children, BMD, Z scores, and estrogen status for breast cancer patients) were taken from hospital records. RESULTS No significant difference was detected between the case and control groups in lumbar region Z scores (p=0.074). At the femur neck, the control group Z scores was higher than patient group (p=0.002). BMI was higher in the patients with breast cancer (p=0.001). There was no statistically significant correlation between ER positivity, BMD, and BMI in ER-positive patients (p=0.495, p=0.8, p=0.846, respectively). There was no difference between the Z scores when the patients were divided into two groups as ER positive and negative (p=0.156, p=0.335, respectively). CONCLUSION This study revealed that there is no difference in lumbar region Z scores between patients with breast cancer and heathy controls; however, the Z scores were higher in the femur neck in the control group, and the BMI was lower in the patient group. Tumor ER positivity does not positively affect BMD.

PET-MRI Findings of Two Patients with Breast Carcinoma before Treatment

Integrated positron-emission tomography-magnetic resonance imaging (PET-MRI) is a new hybrid simultaneous imaging modality with higher soft tissue contrast and lower radiation doses compared with PET-CT. Two patients who were referred to our hospital with left breast masses that were pathologically diagnosed as invasive ductal carcinoma. The women were then scanned using the first PET-MRI system in Turkey, which was established in our department. In this case report, we aimed to determine the advantages of PET-MRI in staging, follow-up, neoadjuvant chemotherapy response, and to compare the usefulness of this modality with PET-CT and dynamic contrast-enhanced breast MRI.

A Rare Tumor that Mimicked Metastasis in a Patient with Breast Cancer: Epithelioid Hemangioendothelioma

A woman aged 50 years was diagnosed as having an invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast and underwent bilateral mastectomy eight years ago. A mass was identified during follow-up in positron-emission tomography (PET) image in the left infraclavicular region, indicating metastasis. Histopathologic examination showed a mass of 1.9 × 1 × 0.7 cm in dimensions characterized by spindle or round nuclei cells that formed island or cords in hyaline and myxoid ground and intracytoplasmic vacuoles containing erythrocytes. In the immunohistochemical analysis, tumor cells were widespread with diffuse positivity with CD34 and vimentin. These findings redirected us from a diagnosis of metastatic carcinoma to epithelioid hemangioendothelioma, a rare tumor of intermediate vascular tumor groups. In this respect, confirmation through biopsy from considered cases of metastasis is important in making a definite pathologic differential diagnosis.