Ferhunde Dizdaroglu

Spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis.

Background: Autoimmune pancreatitis is an evolving entity. Methods: A patient who had spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis is presented. Results: A 58-year-old diabetic woman with jaundice was referred for pancreatic head carcinoma diagnosed by magnetic resonance imaging (MRI). At laparotomy, a pancreatic head mass (4 × 3 cm) that involved the transverse mesocolon and two other hard masses (1 cm) in the pancreatic body and tail were found. The gallbladder was palpated as a hard tumor mass. Frozen section examination of the gallbladder and pancreatic biopsies revealed cholecystitis and pancreatitis with lymphoplasmacytic infiltration. The common bile duct was brittle and unsuitable for anastomosis. Starting 1 month after the operation, drainage from the biliary catheter decreased gradually and stopped. There was no parenchymal lesion on MRI examination in the 2nd postoperative month. Cholangiography from the percutaneous catheter showed flow of contrast agent into the duodenum. Serum immunoglobulin G, G4 and E levels were increased. Conclusion: To the best of our knowledge, this is the first report of spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis.

Differing DNA methylation patterns and gene mutation frequencies in colorectal carcinomas from Middle Eastern countries

Purpose: The epidemiology of colorectal carcinoma is well known to differ among countries but the molecular characteristics are usually assumed to be similar. International differences in molecular pathology have not been studied extensively but have implications for the management of patients in different countries and of immigrant patients. Experimental Design: We evaluated the CpG island methylator phenotype pathway characterized by concordant methylation of gene promoters that often silences transcription of the genes, the microsatellite instability pathway, and K-ras and p53 gene status in 247 colorectal carcinomas from the three selected Middle Eastern countries of Egypt, Jordan, and Turkey. Results: Colorectal carcinoma from Egypt had the lowest frequencies of methylation. In multinomial logistic regression analysis, Jordanian colorectal carcinoma more frequently had methylation involving the p16 tumor suppressor gene (odds ratio, 3.5; 95% confidence interval, 1.2-10.6; P = 0.023) and MINT31 locus (odds ratio, 2.3; 95% confidence interval, 1.0-5.1; P = 0.041). The K-ras proto-oncogene was more frequently mutated in colorectal carcinoma from Turkey (odds ratio, 2.9; 95% confidence interval, 1.2-6.7; P = 0.016), but p53 overexpression was more common in both Jordanian and Turkish colorectal carcinoma than in Egyptian cases (odds ratio, 2.5; 95% confidence interval, 1.2-5.5; P = 0.019; and odds ratio, 3.6; 95% confidence interval, 1.8-7.1; P = 0.0003, respectively). The findings in Turkish colorectal carcinoma were most similar to those reported for Western cases. Conclusions: Colorectal carcinoma from Middle Eastern countries have differing gene methylation patterns and mutation frequencies that indicate dissimilar molecular pathogenesis, probably reflecting different environmental exposures. These molecular differences could affect prevention strategies, therapeutic efficacy, and transferability of clinical trial results.

Bombesin Ameliorates Colonic Damage in Experimental Colitis

In the present study we investigated thepossible therapeutic effects of bombesin on anexperimentally induced colitis model in rats.Inflammation of the colon was induced by a singleintracolonic administration of 30 mg of 2,4,6-trinitrobenzene sulfonic acid(TNBS) at 8 cm from the anus. Immediately after theinduction of colitis, some rats were given bombesin (10μg/kg; subcutaneously) three times a day for 14 days, while another group received vehicletreatment. On day 14, the rats were decapitated andplasma carbonyl content and tissue myeloperoxidaselevel, as an index of granulocyte infiltration intointestinal tissue, were determined in order to obtain anobjective evaluation of colonic injury. In the colitisgroup, increased macroscopic damage score, elevated MPOlevel and high plasma carbonyl content, together with the microscopic appearance revealed severeinflammatory changes resembling IBD. Bombesin treatmentattenuated the TNBS-induced colonic damage andstimulated histopathologically apparent mucosalproliferation, suggesting that bombesin may play a role inprotecting gut integrity.

Cystic lymphangioma of the right adrenal gland.

Lymphangiomas are benign malformations of the vessels. They are commonly located in the neck, axillary region and mediastinum. Lymphangioma of the adrenal gland is very rare. These lesions were first discovered as incidental autopsy findings. As the imaging techniques have improved, they now appear as incidental findings at abdominal ultrasonography and computed tomography scan examinations. They are usually asymptomatic. We present a 26-year-old woman admitted to the hospital, complaining of weakness, putting on weight, and lumbago. Her laboratory findings were within normal limits. Radiological examination revealed a 7 cm cystic lesion located in the right adrenal gland. Right adrenalectomy was performed. Histopathological examination and immunohistochemical analysis of the cystic lesion was consistent with a lymphangioma.

Immunohistochemical detection of E-cadherin, α- and β-catenins in papillary thyroid carcinoma

E-cadherin and catenins play a major role in neoplastic cell behavior as a suppressor of invasion and/or metastasis. The aim of this study was to determine E-cadherin, α-catenin and β-catenin expressions in papillary thyroid carcinoma (PTC) and to correlate the results of expression to initial clinicopathological parameters and clinical outcome. Forty-one cases (mean age 37.3±11.2 yr) with PTC were studied. Patients were followed-up with a mean period of 47.6±27.0 months. A retrospective immunohistochemical analysis of E-cadherin, α-catenin and β-catenin was performed on paraffin-embedded tissue sections. Tissues from ten patients with benign goiter were used as controls. E-cadherin, α- and β-catenin immunoreactivities were found in 80% (33/41), 76% (31/41) and 97% (40/41) of patients respectively. No correlation was found between E-cadherin, α- and β-catenin immunoreactivities and sex, local invasion or lymphatic spread at the time of initial examination. Distant metastases and/or local recurrences developed in 6 patients during follow-up. Recurrences/metastases developed both E-cadherin, α- and β-catenin positive and negative primary tumors. Disease-free survival curves according to Kaplan-Meier analysis and log-rank test did not show any significant differences between E-cadherin, α- and β-catenin positive and negative patients. According to our findings, E-cadherin, α- and β-catenin expressions may not add any valuable information to the follow-up in a subgroup of PTC patients with a relatively benign course.

Does HepPar-1 immunoexpression have a role in differential diagnosis of periampullary cancer?

Aims: Histological subtyping of periampullary carcinomas is considered as a criterion for prognosis and therapeutic implications of these tumours. We assessed the immunoexpression rates of HepPar‐1, CDX2 and MUC2 antibodies in different subtypes of periampullary adenocarcinomas (PAC), intestinal and pancreatobiliary, in order to assess their impact on differential diagnosis of this group of cancers. The expression of antibodies was also measured in ductal adenocarcinoma of the pancreatic head (DAPH). Methods: Sixty‐five patients with PAC and DAPH who underwent pancreatic Whipple resection constituted the study cohort. Of these, 46 (71%) had PAC, and 19 (29%) had DAPH. Among PACs, 20 (44%) were intestinal and 26 (56%) were pancreatobiliary type. Results: HepPar‐1 immunoreactivity was detected in 18 (39%) of all PACs. The rate of HepPar‐1 expression was significantly higher in intestinal type PAC (75%) than it was in pancreatobiliary type (12%). The sensitivity, specificity, and accuracy of HepPar‐1 immunoexpression for diagnosing intestinal type PAC were 75%, 89%, and 83%, respectively. Similarly, the rates of both CDX2 and MUC2 expressions were significantly higher in intestinal type PAC (80%) than they were in pancreatobiliary type (8%). The sensitivity, specificity, and accuracy of both CDX2 and MUC2 immunoexpressions for intestinal type PAC were 80%, 92%, and 87%, respectively. Conclusion: HepPar‐1 antibody was found to be a highly sensitive and specific marker for distinguishing intestinal type from pancreatobiliary type among PACs. In addition to CDX2 and MUC2 antibodies, HepPar‐1 immunoexpression seems to have a potential role in differential diagnosis of PACs.

Anti-CD10 (56C6) is expressed variably in adrenocortical tumors and cannot be used to discriminate clear cell renal cell carcinomas.

In the evaluation of retroperitoneal masses, the practicing pathologist faces a dilemma when making a diagnosis based on histology given the often overlapping morphologic appearances of the adrenocortical carcinoma, renal cell carcinoma (RCC), and hepatocellular carcinoma (HCC). CD10 is expressed in a membranous fashion in the vast majority of clear cell RCCs; therefore, it is widely used for distinction from its mimics. However, its expression is not well-investigated in adrenal cortical tumors. We examined CD10 expression in 47 surgically resected adrenocortical tumors (26 adenomas and 21 carcinomas) and compared with 20 clear cell RCCs and 25 HCCs. Twenty HCCs (80%), 18 RCCs (90%), 11 adrenocortical carcinomas (52%), and 18 adrenocortical adenomas (69%) were positive for CD10. HCCs were characterized by a canalicular staining, and clear cell RCCs exhibited membranous or mixed membranous-cytoplasmic staining. Adrenocortical tumors displayed mainly cytoplasmic staining. Four adrenocortical carcinomas and one adenoma also displayed the membranous staining pattern. Despite the relatively small number of samples, our preliminary results revealed that adrenocortical tumors may express CD10 (Clone: 56C6). The most important point from this paper is the fact that anti-CD10 expression has not been previously reported in adrenocortical carcinomas. This suggests that CD10 does not seem to be a useful marker for discriminating clear cell RCCs from adrenocortical tumors since CD10 expression does not rule out the possibility of adrenocortical tumors. This feature should be kept in mind when constructing an antibody panel for an epithelial tumor that involves the adrenal gland and kidney, especially in small biopsy specimens.