Hilal Erinanç

Expression of a disintegrin and metalloproteinase 33 protein in nasal polyposis: an immunohistochemical study.

Background A disintegrin and metalloproteinase (ADAM)-33 is a member of matrix metalloproteinases. This protein takes a role in angiogenesis and airway remodeling in asthma. Because histopathological findings of airway remodeling in asthma and nasal polyposis (NP) are similar, the aim of this study was to evaluate the ADAM-33 expression in NP. Methods Immunohistochemical staining of specimens of 47 patients with NP and 8 patients with concha bullosa was performed to detect the expression of ADAM-33. Paraffin blocks were used to identify the expression of ADAM-33 polyclonal antibodies. Immunostaining of epithelial cells, stroma, mesenchymal cells of vessels, and inflammatory cells were analyzed by using light microscopy. Results Immunopositivity scores in epithelial cells in NP (median, 2; range, 1–3) were significantly higher than those of controls (median, 1.5; range, 1–2; p < 0.001). ADAM–33 staining was increased in the mesenchymal cells of vessels of nasal polyps (median, 2; range, 1–3) compared with control tissues (median, 1.5; range, 1–2; p = 0.006). Although the staining scores of fibroblasts in nasal polyp specimens were also high (median, 3; range 1–3), there was no statistical significance when compared with controls (median 2; range, 1–3; p = 0.228). ADAM–33 immunostaining was not related with the presence of allergies, asthma, and aspirin intolerance (p > 0.05). Moreover, no relationship was found between increased expression of ADAM–33 and the stages of polyp or computerized tomography scores (p > 0.05). Conclusion This study suggests that the increased expression of ADAM-33 protein may have a role in the pathogenesis of NP.

Unusual Region for Pericardial Malignant Mesothelioma: Cutaneous Manifestation in a Turkish Woman

Malignant mesothelioma is a disease that originates from mesenchymal cells. It is related to the occupational or environmental exposure to asbestos. The treatment remains controversial because it is commonly diagnosed at a very late stage, and the prognosis is very poor. In this report, we present a 37-year-old female patient who was admitted with shortness of breath, palpitation and inability to sleep on her back for the previous 10 days. A large pericardial effusion was detected on echocardiography. Pericardiocentesis was performed and the patient’s symptoms were alleviated. However, approximately 7 months later, she was readmitted to the clinic with complaints of a mass at the incision site. Pathological examination of the mass yielded a diagnosis of pericardial malignant mesothelioma. Malignant mesothelioma is a rare occurrence, and to our knowledge, there are no reports in the English literature of pericardial malignant mesothelioma local invasion to an incision site.

Lesion of Aggregated Monocytes and Mesothelial Cells: Mesothelial/Monocytic Incidental Cardiac Lesion

A 58-year-old woman with a history of childhood acute rheumatic fever and resultant mitral valve stenosis was admitted to our cardiovascular surgery clinic complaining of tachycardia, dyspnea, and chest pain. After clinical and radiological findings were evaluated, mitral valve replacement, tricuspid De Vega annuloplasty and plication, and resection of giant left atrium were performed. Atrial thrombus was removed from the top of the left atrial wall. Operation material considered as thrombus was sent to a pathology laboratory for histopathological examination. It was diagnosed with mesothelial/monocytic incidental cardiac lesion (cardiac MICE). Microscopic sections revealed that morphological features of the lesion were different from thrombus. The lesion was composed of a cluster of histiocytoid cells with abundant cytoplasm and oval shaped nuclei and epithelial-like cells resembling mesothelial cells within a fibrin network. Epithelial-like cells formed a papillary configuration in the focal areas. Mitotic figures were absent. Here we present a case which was incidentally found in a patient who underwent mitral valve replacement surgery, as a thrombotic lesion on the left atrium wall.

Predictive values of vascular endothelial growth factor and microvessel-density levels in initial biopsy for prostate cancer.

Angiogenesis is an important factor in the development and progression of prostate cancer (PCA). We aimed to investigate the values of vascular‐endothelial‐growth‐factor (VEGF) expression level and microvessel density (MVD) in the prediction of PCA diagnosis at repeated prostate biopsy (re‐PBx). We retrospectively evaluated 167 patients with re‐PBx according to elevated prostate‐specific antigen levels, suspicious digital rectal examination, and the presence of premalignant lesions. Patients with PCA on re‐PBx were included in the cancer group (n = 17). Patients with benign prostatic hyperplasia or normal tissues on re‐PBx were included in the control group (n = 21). The groups were compared according to the expression level of VEGF and MVD in initial prostate biopsy. There was no statistically significant difference between groups according to age and serum prostate‐specific‐antigen values. The mean VEGF scores of the cancer and control groups were 232.64 ± 11.14 and 183.09 ± 14.56, respectively (p < 0.05). The mean MVD of the biopsy samples in the cancer and control groups were 246.47 ± 17.59 n/mm2 and 197.33 ± 16.26 n/mm2, respectively (p < 0.05). The cutoff values of VEGF scores and MVD were set as 200 and 215, respectively, for PCA detection in our study. Our results showed that the expression level of VEGF and MVD significantly increased in the initial prostate‐biopsy samples of patients with PCA diagnosed with re‐PBx. The evaluation of VEGF expression level and MVD might have an important value in the prediction of PCA at re‐PBx. The expression level of VEGF and MVD should be kept in mind as PCA‐related histopathological changes that indicate the increased angiogenesis in prostatic tissue.

An unusual case of Candida infection producing a fungus ball in the left atrial cavity.

We report the case of a 75-year-old male patient who was treated in our clinic for septicemia and subacute infective endocarditis caused by toxigenic Candida albicans. Transthoracic echocardiography revealed the presence of a thrombus in the left atrial cavity, and the diagnosis was confirmed by computerized tomography. The patient was operated on urgently. Histological examination of the embolic material removed from the left atrium showed the presence of yeast and hyphal forms of Candida albicans through periodic acid-Shiff stain. The patient was readmitted to the hospital on postoperative day 15, because of reembolism, and died later on. Here we present our approach to the diagnosis and treatment of this rare condition.

Expression of a disintegrin and metalloproteinase 8 by inflammatory cells in nasal polyps.

We have read the article of Park et al.1 entitled “Increased Expression of a Disintegrin and Metalloprotease 8 in Allergic Rhinitis” with great interest. These authors have studied the relationship between a disintegrin and metalloproteinase (ADAM) 8 protein and allergic rhinitis and showed ADAM-8 expression in the nasal mucosa of both allergic rhinitis patients and normal controls. Several studies have also focused on and presented the link between different members of ADAMs and asthma.2,3 Asthma and nasal polyposis have similar histopathological features. Inflammatory cell infiltration and remodelling are the factors that are interrelated with the clinical course in both diseases. However, data regarding the relation of ADAMs with nasal polyposis is limited. In a previous study, we had found increased expression of ADAM-33 protein in vessels and stroma of the nasal polyp (NP) tissues.4 Those results encouraged us to search for a link with ADAM-8, another asthma-related protein,5 and NP. We then looked for the expression of ADAM-8 in the specimens of the same patient group that had been used for our ADAM-33 study. Paraffin blocks were used to identify the expression of ADAM-8 polyclonal antibodies (dilution 1:100; Santa Cruz Biotechnology, Santa Cruz, CA) as described in the previous study.4 The number of ADAM-8 subepithelial inflammatory cells were semiquantitatively counted in 10 randomly selected fields (magnification, 400) of each slide. Immunostaining ratios of inflammatory cells in NP tissues and nasal mucosa were compared with each other. Data were collected in SPSS software (Statistical Package for the Social Sciences, Version 17.0; SSPS, Inc., Chicago, IL). The Mann-Whitney U test and Spearman analysis were used to analyze the data. A value of p 0.05 was considered statistically significant. Epithelial and stromal layers in both NP and control groups showed a weak immunopositive staining pattern, and ADAM-8 immunoreactivity was marked in subepithelial layers. Immunostaining ratios of inflammatory cells in NPs (median, 70%; interquartile range, 30–80%) and control mucosa (median, 70%; interquartile range, 50– 80%) were statistically not different from each other (p 0.948). In the NP group, immunostaining was more prominent as the total inflammatory cell count increased, i.e., the number of the immunopositive inflammatory cells correlated with the total number of inflammatory cells ( 0.316; p 0.031). On the other hand, there was no correlation between the number of ADAM-8 cells and total number of inflammatory cells in control mucosa ( 0; p 1.0). The number of ADAM-8 inflammatory cells in asthmatic and nonasthmatic patient groups did not show a statistically significant difference (p 0.139). Similarly, the presence of allergies had no impact on the amount of immunopositive ADAM-8 cells in polyp tissues (p 0.171). Consistent with the findings of Park et al.,1 we found ADAM-8 immunopositivity in normal nasal mucosa. This may be caused by the inherent nature of the nasal mucosa because it is the first line of defense in human respiratory tract. Still, the finding of positive correlation between the strength of ADAM-8 immunostaining and the level of inflammation in NP tissues warrant further research on the role of ADAM-8 protein in NP pathogenesis.

Pulmonary coccidioidomycosis after a renal transplant in a nonendemic region.

Coccidioidomycosis is a fungal infection caused by the Coccidioides species, endemic to the southwestern United States. In healthy people, manifestations range mainly from asymptomatic to mild influenza-like signs, whereas in immunosuppressed patients (eg, transplant recipients) this infection is often a severe disseminated disease. We report a case of primary pulmonary coccidioidomycosis in a 61-year-old man with a renal transplant 7 months earlier. The patient had nonspecific symptoms of pulmonary infection, including weakness, anorexia, and weight loss. Both spherules and endospores of Coccidioides immitis were seen histologically after a transbronchial biopsy of a cavitary lesion. The patient was treated with amphotericin B. At the time of this writing (8 months), he remains disease free.

Expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma.

OBJECTIVE Proteases of the disintegrin and metalloproteinase family (also known as ADAM proteins) are involved in various physiological and pathological processes. This study assessed the expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma. MATERIALS AND METHODS The study evaluated cholesteatoma specimens from 19 patients, and external ear canal skin samples from 7 of the same patients (as controls), for the expression of disintegrin and metalloproteinase family proteins 10, 12 and 17, using immunohistochemical methods. RESULTS AND ANALYSIS The study observed over-expression of proteins 10 and 17 in blood vessels, and over-expression of proteins 12 and 17 in cholesteatoma stroma. Immunostaining scores for proteins 10, 12 and 17 in epithelial and inflammatory cells from cholesteatoma specimens versus control specimens showed no statistically significant differences. CONCLUSION Over-expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma may be related to cholesteatoma pathogenesis. These proteins deserve further study as they may represent potential targets for cholesteatoma treatment.

A Rare Cause of Urachal Adenocarcinoma: Urachal Diverticle

Urachus is the remnant of the embryologic allantois and the fetal bladder, extending form the bladder roof to the umbilicus. It degenerates in the prenatal period into a tissue band known as the median umbilical ligament. Incomplete degeneration may lead to urachal diverticle development. It is difficult to diagnose unless it is considered in differential diagnosis and imaging modalities are employed. This paper describes a patient treated with partial cystectomy for urachal diverticle, and the pathologic examination revealed urachal adenocarcinoma.

A Retrospective Analysis of Oral Mucosa Pathologies: A Single-Center Trial

Amac: Oral skuamoz hucreli karsinom dunyada en sik gorulen 6. tumor olarak karsimiza cikmaktadir. Bununla birlikte pek cok hastalik oral mukozada lezyon olusturabilmektedir. Bu calismada 10 yillik surecte kendi hasta serimize ait oral mukoza patolojierini olusturan lezyonlar histopatolojik tanilara gore siniflandirilmis ve tanilara gore lezyonlarin yeri, yas ve cinsiyet dagilimlari tespit edilmis ve malignite ile iliskileri belirlenmeye calisilmistir. Hastalar ve Yontem: Calismamiz 2002-2014 yillari arasinda Baskent Universitesi, Tip Fakultesi Konya Uygulama ve Arastirma hastanesi kulak burun bogaz hastaliklari bolumu tarafindan tani amaciyla biopsi alinarak patoloji laboratuarina gonderilen 288 hastaya ait oral mukoza lezyonunun retrospektif analizini icermektedir. Hastalara ait histopatolojik tani, yas, cinsiyet ve lokalizasyon bilgisi patoloji rapor arsivinden elde edilmistir. Istatistiksel tanimlayici analiz SPSS17.0 programi ile yapilmistir. Bulgular: Olgularin buyuk cogunlugunu benign epitelyal proliferasyon ve reaktif patolojiler olusturmaktadir(%22,7). Bu grupta en sik skuamoz papillom(n: 31; % 9,9) gorulmus olup bunu fibroepitelyal polip (n:24; %7,7) ve irritasyon fibromu (n:16; %5,1) izlemektedir. Benign patolojiler icerisinde oral mukozal dermatozlar en sik gorulen ikinci lezyondur (n:63, % 21,8). Calismamizda 288 oral mukozal lezyonun % 15,3’unu (n:44) malign patolojiler ve % 17,7’sini (n:51) prekanseroz lezyonlar olustumaktadir. Skuamoz hucreli karsinom tum malign patolojilerin %95,5’idir.Tespit edilen premalign lezyonlar; skuamoz hucreli hiperplazi (n:47; 16%), orta dereceli displazi (n:2; % 0,7) ve likenoid displazidir (n:2; % 0,7). Skuamoz hucreli karsinom en sik dudakta lokalizedir. Kadin erkek orani premalign lezyonlar icin hemen hemen esit olup skuamoz hucreli karsinom erkeklerde biraz daha fazladir (p>0.1). Sonuc: Skuamoz hucreli karsinom, benign lezyonlar ve premalign lezyonlara gore daha yasli hastalarda gorulmektedir. Cok genis spektrumdaki bircok oral mukozal patolojinin benzer bir klinik goruntusu olmasi klinisyenleri tani asamasinda zorlayici bir unsurdur. Ozellikle malign lezyonlarda erken teshis hayat kurtarici olabilir. Bu nedenle patolojilere yonelik kendi serilerimizi olusturmak onemlidir. Histopatolojik tanilarina gore siniflandirilmis lezyonlarin lokalizasyon, yas ve cinsiyet gibi bazi klinik ozelliklerine gore dagilimini veren bu serimiz klinik tanida yol gosterici ve kolaylastirici olacaktir.