Gamze Mocan Kuzey

Juvenile xanthogranuloma of the corneal limbus: report of two cases and review of the literature.

PURPOSE To report the clinical and histopathologic findings of limbal juvenile xanthogranuloma lesions in 2 pediatric cases. METHODS Case report and literature review. RESULTS Two cases (a 7-month-old girl and a 7-year-old boy), both of whom developed a yellowish corneoscleral limbal mass not associated with other ocular or systemic findings, were evaluated. Both cases underwent simple excision of the lesion followed by local steroid treatment. Histopathologic examination in both cases revealed foamy histiocytes within an inflammatory infiltrate. One of the lesions also harbored multinucleate giant cells. Immunohistochemical staining was positive for CD68 and negative for S-100 and CD1a in both cases. CONCLUSIONS Juvenile xanthogranuloma may rarely present with an isolated lesion occurring only at the corneoscleral limbus. The diagnosis in the early stages of this disorder may be established with immunophenotyping and characteristic histopathologic features even without the presence of the multinucleate giant cells.

Aggressive angiomyxoma of the vulva and vagina. A common problem: misdiagnosis.

Aggressive angiomyxoma (AA) is a rare myofibroblastic tumor, usually affecting young women. Two patients, one with a vaginal and the other with a vulvar mass underwent surgical intervention with different preoperative diagnoses; the former as vaginal cyst and the latter as vulvar hernia. Unfortunately, the pathological evaluation of the specimens revealed aggressive angiomyxoma. Misdiagnosis of this tumor is a common problem.

Expression of adhesion molecules in first trimester spontaneous abortions and their role in abortion pathogenesis.

Background. Early placental development is associated with complex regulatory mechanisms, and molecular communication problems that arise during the developmental process are dangerous for continuation of the pregnancy. As studies on the process of invasion and migration of trophoblast cells have shown the importance of cell–cell and cell–matrix interactions, we examined the effects of adhesion molecules on the mechanism(s) of spontaneous abortions and compared them to elective abortion materials using histopathological and immunohistochemical methods. To the best of our knowledge, this is the first study to investigate adhesion molecules in spontaneous abortions. Methods. Curettage materials from abortions were examined retrospectively in the Department of Pathology, Zonguldak Karaelmas University School of Medicine, Zonguldak, Turkey. CD31/PECAM‐1 (endothelial cell marker), CD44v (variant 3), E‐cadherin, CD54/ICAM‐1, and CD106/VCAM‐1 expression profiles were evaluated by immunohistochemistry, and cellular localization was determined under light microscopy. The results of spontaneous abortions were compared to those of elective abortions. Results. The staining percentages of CD31, CD44, CD106, and E‐cadherin decreased in cases of spontaneous abortion, but CD54 (ICAM‐1) expression increased. Statistically significant differences were detected between spontaneous and elective abortion materials with regard to cytotrophoblasts (CTs), syncytiotrophoblasts (STs), and extravillous trophoblasts (EVTs) with the anti‐CD31 antibody (p = 0.0001). In addition, CD54 (p = 0.007 and p = 0.002) and E‐cadherin (p = 0.002 and p = 0.02) expression in CTs and STs, respectively, were significantly different. Furthermore, CD44 expression (p = 0.003) in decidual (D) cells and CD106 (p = 0.0001) expression in vessels of endometrial (E) and villous tissues were also significantly different. Conclusions. Decreased CD31 expression in CTs that invade the spiral arterioles and mimic E cells in spontaneous abortion cases suggests that CD31/PECAM‐1 is an important molecule in uteroplacental adequacy. Moreover, diminished expression of CD44 in D cells caused impaired stroma–villous connections. Enhancement of ICAM‐1 in placental and invading STs may be useful as a diagnostic marker for patients who may have a tendency to have spontaneous abortions. A down‐regulation of E‐cadherin was observed, which may be responsible for impaired CT differentiation and loss of the pregnancy. Furthermore, decreased VCAM‐1 expression in spontaneous abortions may be consistent with the importance of VCAM‐1 in trophoblast–endothelial cell interactions. Many adhesion molecules are known to be effective in the normal development of a pregnancy, and the analysis of adhesion molecules in spontaneous abortions will provide useful information for clarifying the physiopathology of spontaneous abortions.

Aggressive angiomyxoma of vulva recurring 8 years after initial diagnosis

BackgroundAggressive angiomyxoma is an uncommon soft tissue tumor which preferentially involves pelvic and vulvoperineal regions of young adult females. The typical characteristics include gelatinous appearance and locally infiltrative nature without evidence of nuclear atypia or mitosis. Treatment involves surgery, but local recurrence is high in spite of apparently complete surgical resection.CaseA 28-year-old woman who had had a history of surgically excised aggressive angiomyxoma of vulva presented with a complaint of vulvar mass. The mass was removed and histopathologic examination revealed an aggressive angiomyxoma without necrosis, atypia, and mitosis.ConclusionAggressive angiomyxoma should be kept in mind when an asymptomatic and slow-growing vulvar mass is detected in young females. The surgery should aim wide local excision and long-term follow-up is necessary due to high rate of local recurrence.

Ectopic pancreas associated with choledochal cyst and multiseptate gallbladder.

Congenital choledochal cyst is a rarely seen malformation of childhood, particularly when associated with multiseptate gallbladder or ectopic pancreas. The current case represents a 15-day-old boy with jaundice. Ultrasonography suggested a cystic lesion, probably of the common bile duct. The patient underwent a total excision of type I choledochal cyst and gallbladder with Roux-en-Y anastomosis, and a wedge biopsy from the liver. Gross examination revealed multiple septa dividing the gallbladder into multiple compartments. The outer and inner surfaces of the choledochal cyst were unremarkable. Microscopically, the cyst wall was composed of dense fibrous tissue with a single layer of cubic to columnar cells constituting the overlying epithelium. Serial sections incidentally revealed ectopic pancreatic tissue lying along the cyst wall characterized by acini, islets, and ductal structures with endocrine cells reactive for chromogranin A. Septa dividing the gallbladder were composed of fibrotic stalks containing smooth muscle fibers. Areas of papillary hyperplasia and intestinal metaplasia of gallbladder epithelium were also noted. The liver biopsy specimen demonstrated the presence of intrahepatic bile ducts, subsequently confirmed by cytokeratin 7. To our knowledge, this case represents the 1st one associated with these 3 entities and only the 2nd choledochal cyst with ectopic pancreatic tissue in its wall.

Four synchronous female genital malignancies: the ovary, cervix, endometrium and fallopian tube.

AbstractObjectiveTo present a unique case of a 63 year-old woman with coexistent adenocarcinoma of the ovary, endometrium, cervix and fallopian tube.Materials and methodsA case report from a tertiary health center.ResultsA woman presenting with postmenopausal bleeding and abdominal distantion was assessed by endometrial biopsy and explorative surgery. The frozen section of the mass on the right adnex revealed malign mucinous carcinoma of the ovary. As usual, optimal debulking was performed as initial surgical staging procedure of ovarian cancer. The microscopic examination of the right ovary revealed a typical mucinous cystadenocarcinoma. Furthermore, the focal endometrial irregularity at the left uterine cornus turned out to be a well differentiated endometrial carcinoma of the endometrioid type with <1/3 myometrial invasion. The pale infiltrative lesion in the cervix also turned out to be an adenocarcinoma of the endocervical type with deep stromal invasion and areas of diffuse glandular dysplasia and in-situ glandular neoplasia at the periphery. Besides, several sections from the left fallopian tube uncovered diffuse dysplasia in the lining epithelium and a focus of adenocarcinoma with papillary and cribriform pattern.DiscussionWhen compared with patients having metastatic lesions, most synchronous female malignancies are accompanied with early stage and low-grade with a more favorable prognosis. However, there is paucity of data for the exact criterion to distinguish primary tumors from metastatic lesions. In such cases, the validity of immunohistochemical and cloning studies are not clear.

Fine-needle aspiration cytology of solitary thyroid nodules: how far can we go in rendering differential cytologic diagnoses?

Fine-needle aspiration cytology (FNAC) is a diagnostic tool used in the clinical workup of solitary thyroid nodules; however, differential cytologic diagnosis of these nodules often is challenging. With the goal of identifying cytologic findings that could improve predictions regarding the presence of neoplastic lesions, the authors performed a retrospective review of cases in which FNAC led to diagnoses of solitary cellular nodules or cellular microfollicular lesions at two university hospitals. FNAC smears associated with cases for which surgical specimens subsequently were obtained were reviewed. FNAC accurately detected follicular neoplasms in 76% of cases at one hospital and in 67% of cases at the other. In the current report, the cytologic findings made in these cases are reevaluated, and the potential diagnostic contribution of available clinical data is discussed. Cancer (Cancer Cytopathol) 2004.

Fine‐needle aspiration cytology of solitary thyroid nodules

Fine-needle aspiration cytology (FNAC) is a diagnostic tool used in the clinical workup of solitary thyroid nodules; however, differential cytologic diagnosis of these nodules often is challenging. With the goal of identifying cytologic findings that could improve predictions regarding the presence of neoplastic lesions, the authors performed a retrospective review of cases in which FNAC led to diagnoses of solitary cellular nodules or cellular microfollicular lesions at two university hospitals. FNAC smears associated with cases for which surgical specimens subsequently were obtained were reviewed. FNAC accurately detected follicular neoplasms in 76% of cases at one hospital and in 67% of cases at the other. In the current report, the cytologic findings made in these cases are reevaluated, and the potential diagnostic contribution of available clinical data is discussed. Cancer (Cancer Cytopathol) 2004.

Mucosal Malignant Melanoma of Nasal Cavity Recurring a Year After Radiotherapy.

Objective: Sinonasal mucosal malignant melanoma is a rare entity. In this report we present a nasal mucosal malignant melanoma case with its histopathological and clinical features. Case Report: An 88-year-old female patient presented with epistaxis a month ago. Examination revealed a polypoid mass lesion of right nasal cavity originating from the middle concha. Her medical history revealed that she had been found to have a mass lesion in the right nasal cavity 15 months ago. She then underwent a punch biopsy from that lesion. A definitive histopathological diagnosis was not made but it was declared that the lesion had been a malignant epithelial tumor. The patient then had radiotherapy and the lesion showed complete regression. One year after completion of radiotherapy, the lesion recurred. Her last PET-CT showed multiple metastatic foci. Endoscopic excisional biopsy was performed for her recurrent lesion. Fragmented tumoral tissues were measured as 3,6x3x0,5 cm. Macroscopically the tumor was brownish in color. Histopathologically the tumor consisted of spindled and epitheloid cells. Immunohistochemically the tumor cells displayed positivity for S-100, HMB-45 and Melan-A. Findings were consistent with malignant melanoma. Discussion: Mucosal malignant melanomas have a poor prognosis despite chemotherapy and radiotherapy. Five-year survival for sinonasal melanoma is reported to be lower than 35%. Sinonasal melanomas show a high recurrence rate. The immunohistochemical markers showing high specificity for malignant melanoma such as S-100, HMB-45 and Melan-A are used in order to reach a correct diagnosis. In our case the tumor showed recurrence and multiple metastases 1 year after completion of radiotherapy. For this recurrent tumor, chemotherapy and radiotherapy have been planned.OBJECTIVE Sinonasal mucosal malignant melanoma is a rare entity. In this report we present a nasal mucosal malignant melanoma case with its histopathological and clinical features. CASE REPORT An 88-year-old female patient presented with epistaxis a month ago. Examination revealed a polypoid mass lesion of right nasal cavity originating from the middle concha. Her medical history revealed that she had been found to have a mass lesion in the right nasal cavity 15 months ago. She then underwent a punch biopsy from that lesion. A definitive histopathological diagnosis was not made but it was declared that the lesion had been a malignant epithelial tumor. The patient then had radiotherapy and the lesion showed complete regression. One year after completion of radiotherapy, the lesion recurred. Her last PET-CT showed multiple metastatic foci. Endoscopic excisional biopsy was performed for her recurrent lesion. Fragmented tumoral tissues were measured as 3,6x3x0,5 cm. Macroscopically the tumor was brownish in color. Histopathologically the tumor consisted of spindled and epitheloid cells. Immunohistochemically the tumor cells displayed positivity for S-100, HMB-45 and Melan-A. Findings were consistent with malignant melanoma. DISCUSSION Mucosal malignant melanomas have a poor prognosis despite chemotherapy and radiotherapy. Five-year survival for sinonasal melanoma is reported to be lower than 35%. Sinonasal melanomas show a high recurrence rate. The immunohistochemical markers showing high specificity for malignant melanoma such as S-100, HMB-45 and Melan-A are used in order to reach a correct diagnosis. In our case the tumor showed recurrence and multiple metastases 1 year after completion of radiotherapy. For this recurrent tumor, chemotherapy and radiotherapy have been planned.

Characteristics of women with abnormal cervical cytology

Aim To review the characteristics of women with abnormal cervical cytology. Methods Women who had abnormal cervical cytology on Papanicolaou (Pap) test obtained at Hacettepe University Hospital in 2007 constituted the study group. Cytological and pathological diagnoses, human papillomavirus (HPV) status, and follow-up procedures were investigated. Results Among 10713 women with smear tests, 190 (1.8%) with cytological abnormalities constituted the study group. Mean age was 43.9 years. 17.2% were asymptomatic, while infections and menstrual abnormalities were the most common symptoms. 76.8% of abnormalities were detected by liquid-based cytology (LBC). Squamous cell abnormalities were detected in 87.4%. Most common diagnoses were atypical cells of undetermined significance (ASC-US;40.0%) and low grade squamous intraepithelial lesion (LSIL;27.9%). High grade changes were detected in 10.0%. 11.6% had squamous cell carcinoma (SCC) or adenocarcinoma. Of 61 patients with HPV-DNA test, 27.9% were oncogenic. 51.7% underwent pathological diagnosis. Intraepithelial lesions were detected in 17.9% and invasive lesions were detected in 10.0%. 83.1% had normal cytology during follow-up. Conclusions Although organised cytological screening programs have reduced incidence and prevalence of cervical cancer, it still represents a considerable burden in developing countries due to some problems in screening. 1–3 LBC overcame some of these problems. 4 Especially, annual gynaecological examination should be encouraged in such countries to reduce the incidence of invasive cancer.