Handan Aker

Placental teratoma : A case report

We present a rare case of a placental teratoma found within the fetal membranes of an otherwise normal placenta. Lack of a recognizable umbilical cord and no recognizable skeletal development are used as differential diagnostic criteria for a placental teratoma. In our case, an umbilical cord was absent; nevertheless, the tumor contained two vascular channels covered only by fetal membranes without Whartons jelly.

Effect of Conjunctival Structure and Inflammatory Cell Counts on Intraocular Pressure after Trabeculectomy

Purpose: To evaluate the conjunctival structure and inflammatory cell counts and to determine the predictive value of these histological parameters for postoperative intraocular pressure (IOP) levels after trabeculectomy. Methods: A clinical and histological study was performed on consecutive patients. Postoperative (mean 32.8 ± 18.4 months; range 6–60 months) conjunctival biopsies of 36 eyes of 28 primary open-angle glaucoma patients who had trabeculectomy between 1992 and 1995 were included in the study. According to postoperative pressure control, patients with ≤16 mm Hg and those with >16 mm Hg were taken as groups 1 and 2, respectively. The control group (group 3) consisted of 15 age-matched patients without glaucoma, who had received no topical therapy. We compared the conjunctival structure and cell counts within these groups. Goblet cells, acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharides and collagen compositions were determined in groups 1, 2 and 3. Results: The number of goblet cells was significantly higher in group 1 (6.74 ± 7.23) than group 2 (3.09 ± 2.77; p = 0.017). No statistical difference was observed in the number of acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharide or collagen compositions between groups 1 and 2 (p > 0.05). In addition, when groups 1 and 2 were compared with the control group, there was a significant decrease in goblet cells (p < 0.001), an increase in acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness and vascular density (p < 0.001), but there was no significant difference in mucopolysaccharide and collagen compositions (p > 0.05). Conclusions: This study suggests that at the time of surgery a high number of goblet cells may be a predictor of lowered IOP (≤16 mm Hg) following trabeculectomy without antimetabolite.

Relationship between FIGO grade and AgNOR, S100‐positive Langerhans cells in endometrial adenocarcinoma

Cell kinetic information is an important adjuvant to histological grading in some malignant tumors. In the current study, 20 endometrial adenocarcinomas were graded according to the 1988 International Federation of Gynecology and Obstetrics (FIGO) and nuclear grading system and the expression of silver‐stained nucleolar organizer regions (AgNOR) and S100‐positive Langerhans cells were determined. According to the FIGO grade, eight patients were in grade 1, seven were in grade 2 and five were in grade 3. Nuclear grade 1, 2 and 3 was determined in six, eight and six cases, respectively. Although an overlap was seen in some grade 2 and 3 cases, AgNOR counts were the highest in grade 3. S100‐positive Langerhans cells were depleted when the grades elevated. It is concluded that AgNOR and Langerhans cells can be correlated with grades. Further studies, including survival data of the patients, could be performed and AgNOR and Langerhans cells can be correlated with prognosis.

Orbital metastasis of endocervical stromal sarcoma: a rare tumor and an uncommon metastasis

Endocervical stromal sarcoma (ECSS) is a very rare uterine sarcoma. The most common presentation is pelvic mass and vaginal bleeding. The mainstay of treatment is surgery. There is no consensus on the adjuvant treatment. Relapses are usually in the pelvic and abdominal regions. To a lesser extent, lung, liver and bone metastases may be seen. A 46-year-old woman had total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) performed due to endometrial polyp and leiomyoma. Six months after the TAH-BSO, she was admitted to the hospital with cough and hemoptysis. A thoracic mass was detected, and a biopsy was done. The diagnosis was low-grade ECSS metastasis. One week after thoracotomy, she was admitted to the hospital with loss of vision in the left eye. An orbital mass was detected with magnetic resonance imaging. Endometrial and cervical pathology preparations were reassessed and were compatible with ECSS. We performed mammography, thorax, and abdomen and cranial imaging to rule out other malignancies that may cause lung and orbital metastasis. Partial remission was achieved with systemic chemotherapy and orbital radiotherapy. Orbital metastasis may be seen in ECSS patients. Although we have less knowledge about the choice of chemotherapeutic agents, ifosfamide and doxorubicin are effective in treating ECSS.

The evaluation of our intraoperative consultation results in ovarian lesions for five years

Aim. Intraoperative consultation has an important role in the diagnosis and treatment of ovarian masses. During surgery, the correct classification as benign, borderline or malignant (primary/metastatic) provides to appropriate surgical staging. This retrospective study was undertaken to determine the accuracy of intraoperative consultation results in ovarian lesions and to review the diagnostic problems that may be causing the error. Method. Between January 2007December 2011, the diagnoses of 246 intraoperative consultations applied to the ovarian lesions were examined retrospectively. Twenty-five out of 246 of these sections belonged to the same patient. Frozen section diagnoses were compared with paraffin section diagnoses. Results. The mean age of the patients was 46.7±16 (17-87). There was an agreement in diagnosis between frozen and paraffin section in 96.3%. The sensitivity of malignant cases, 96.9%, specificity was 100%. The positive predictive value of malignant cases was 100%, negative predictive value of benign cases was 100%. In series had no false positive, false negative rate was 6%. Diagnosis had been deferred in 2.4% of the cases. The incompatible diagnoses caused by limited sampling during intraoperative consultation. There were metastatic tumors in 3.7%, mixed type tumors in 2%. Conclusion. The concensus between the gynecologist and the pathologist is very important in intraoperative consultation process. In our series, the sensitivity and specificity of the frozen application in ovarian lesions were high, and the our results are reliable. It was concluded that increasing the number of samples for especially in large tumors will decrease the false-negative rate.