Ibrahim Yavan

Persistent Mullerian duct syndrome with transverse testicular ectopia and seminoma.

Persistent Mullerian duct syndrome (PMDS) is a rare form of the 46 XY disorders of sexual differentiation, characterized by the presence of a uterus and fallopian tubes due to the failure of Mullerian duct regression in genotypically normal males. More than 150 cases have been recorded, most of them in adults. In most cases, the PMDS is discovered during surgery for inguinal hernia or cryptorchidism, or by the presence of transverse testicular ectopia (TTE). The presence of PMDS with TTE is even more uncommon. In TTE, both testes descend through the same inguinal canal into the same scrotal sac. Patients with TTE present with symptoms of unilateral cryptorchidism and a contralateral inguinal hernia. For patients with inguinal hernia and cryptorchidism associated with TTE, PMDS should be kept in mind, and radiologic evaluation such as ultrasonography or magnetic resonance imaging of the genitourinary system and karyotyping are recommended. Whereas radiologic evaluation could be helpful in the diagnosis of TTE, it cannot diagnose the malignancy itself. The case explained in this report will offer urologists additional useful treatment strategies for patients with inguinal hernia and cryptorchidism.

Endoscope-Assisted Microsurgical Removal of an Intraventricular Ependymal Cyst That Manifested with Tremor

BACKGROUND Intraventricular ependymal cysts (ECs) are rare, histologically benign neuroepithelial cysts. Most of these cysts are clinically silent and discovered incidentally. Rarely, they become symptomatic, leading to obstruction of the cerebrospinal fluid circulation. ECs located inside the ventricles may manifest with signs of increased intracranial pressure. CASE DESCRIPTION A 32-year-old woman presented with a 6-year history of tremor affecting her left hand. In the last month, she had been experiencing headache as well, and the tremor of the left hand was affecting her quality of life. The patient demonstrated a fine resting and intention tremor of the left hand and a voice tremor. Magnetic resonance imaging revealed a large cystic, nonenhancing lesion within the right lateral ventricle. The fluid within the cyst was isointense to cerebrospinal fluid on all sequences. Because of the rapid progression of her symptoms and no response to medication, surgical decompression of the cyst was considered. The cyst was removed by an endoscope-assisted microsurgical technique. Her postoperative course was uneventful. A marked reduction in her tremor was noted in the immediate postoperative period. Histopathologic diagnosis was of an EC. During the follow-up period, the patients tremor, although still present, had improved dramatically. At 6 months postoperatively, she could hold a drinking glass without spilling. CONCLUSIONS This is a unique case of an intraventricular EC that manifested with tremor, which improved by endoscope-assisted microsurgical removal of the cyst. This case also supports the important role of endoscopic surgery in the treatment of intraventricular cystic lesions.

Immunohistochemical characteristics of cystic odontogenic lesions: a comparative study.

Abstract Objective: Cystic ameloblastoma, keratocystic odontogenic tumor, dentigerous cyst, and radicular cyst are the most commonly encountered cystic odontogenic lesions. The aim of this study was to investigate the expressions of survivin, E-cadherin, CD138, and CD38 in these lesions and their potential diagnostic usage. Material and Method: A total of 20 cases, consisting 5 radicular cysts, 5 dentigerous cysts, 5 keratocystic odontogenic tumors and 5 cystic ameloblastomas were included in our series. For all cases, sections from the selected blocks were stained against the antibodies for survivin, E-cadherin, CD138, and CD38 on an automated device. Results: All cystic ameloblastomas and keratocystic odontogenic tumors showed diffuse and strong nuclear survivin expression. No specific survivin immunoreactivity was observed in the dentigerous and radicular cysts. E-cadherin expression was stronger in all dentigerous cysts and radicular cysts when compared to others. CD138 expression in stromal cells was prominent in cystic ameloblastomas, but gradually decreased in the other three lesions. All cases were negative for CD38. Conclusion: In the present study, loss of E-cadherin expression in epithelial cells, strong CD138 expression in stromal cells and strong nuclear survivin expression both in epithelial and stromal cells in cystic ameloblastomas and keratocystic odontogenic tumors were the most remarkable findings. These findings are also reinforced by the studies suggesting their role in the aggressiveness and pathogenesis of these tumors. Öz Amaç: Kistik ameloblastoma, keratokistik odontojenik tümör, dentijeröz kist ve radiküler kist en sık karşılaşılan kistik odontojenik lezyonlardır. Çalışmada bu lezyonlarda survivin, E-cadherin, CD138 ve CD38 ekspresyonları ve bunların potansiyel tanısal kullanımları araştırılmıştır. Gereç ve Yöntem: Çalışma serimiz 5 kistik ameloblastoma, 5 keratokistik odontojenik tümör, 5 dentijeröz kist ve 5 radiküler kist olmak üzere toplam 20 olgudan oluşmaktadır. Bütün olgulara ait seçilmiş bloklardan sağlanan kesitler otomatize bir cihazda survivin, E-cadherin, CD138, and CD38 antikorları ile boyandı. Bulgular: Kistik ameloblastoma ve keratokistik odontojenik tümörlerin hepsi yaygın ve kuvvetli nükleer survivin ekspresyonu gösterdi. Dentijeröz ve radiküler kistlerde spesifik survivin ekspresyonu gözlenmedi. E-cadherin ekspresyonu diğer lezyonlarla karşılaştırıldığında, dentijeröz ve radiküler kistlerde daha belirgindi. CD138 ekspresyonu kistik ameloblastomalarda stromal hücrelerde daha belirgindi, ancak diğer lezyonlarda giderek azalan oranlardaydı. CD38 olguların hepsinde negatifdi. Sonuç: Çalışmada, keratokistik odontojenik tümörlerde ve kistik ameloblastomada epitelyal hücrelerde E-cadherin kaybı, stromal hücrelerde kuvvetli CD138 ekspresyonu ve hem epitelyal hem de stromal hücrelerde kuvvetli nükleer survivin ekspresyonu en karakteristik bulgulardır. Bu bulguların bu tür lezyonların patogenezini ve agresif davranışındaki rolünü de gösterecek çalışmalarla güçlendirilmesi gerekmektedir.

Unusual Fibrillary Glomerulonephritis in a 19-Month-Old Male Patient: A Case Report and Review of the Literature

1 Health Sciences University, Gülhane Education and Research Hospital, Department of Pediatric Nephrology, Ankara, Turkey 2 Health Sciences University, Gülhane Education and Research Hospital, Department of Pediatrics, Ankara, Turkey 3 Ministry of Health, Gülhane Education and Research Hospital, Department of Pediatric Nephrology, Ankara, Turkey 4 Health Sciences University, Gülhane Education and Research Hospital, Department of Pathology, Ankara, Turkey 5 Yeniyüzyıl University Faculty of Medicine, Department of Pathology, İstanbul, Turkey doi: 10.5262/tndt.2017.1003.16

A Comparative Study of the Effects of Intravitreal Anidulafungin, Voriconazole, and Amphotericin B in an Experimental Candida Endophthalmitis Model.

ABSTRACT Purpose: To compare the safety and efficacy of intravitreal anidulafungin injection with voriconazole and amphotericin B (Amp B) in an experimental Candida endophthalmitis (CE) model. Methods: Intravitreal 1 × 105 CFU/0.1 ml Candida albicans was injected into the right eyes of 24 New Zealand rabbits, which were divided into 4 groups. Voriconazole 50 μg/0.1 ml, Amp B 10 μg/0.1 ml, and Anidulafungin 50 μg/0.1 ml were injected by intravitreal injection 72 h after inoculation. The control group was injected with 0.1 ml 0.9% NaCl. Clinical scoring was performed by assessing the cornea, conjunctiva, iris, and vitreous on days 3 and 7 of therapy. At the end of the study, the right eyes of all rabbits were enucleated and histopathological evaluation was performed. Therapy groups were compared according to the clinical, histopathological, and microbiological analysis scores. Results: Total clinical scores were significantly different between treatment groups and the control group (p < 0.05). On day 7 of the therapy, clinical scores of the anidulafungin group were found to be significantly lower when compared with the other therapy groups, while a significant improvement was observed in the eyes of rabbits in the anidulafungin group (p < 0.05). Also, microbiological scores of the anidulafungin group were lower than those of the control group (p < 0.05). Histopathological scores of the anidulafungin treatment group were significantly better than the voriconazole and control groups. Inflammation was evidently suppressed and marked retinal toxicity was not observed with anidulafungin. Conclusions: This is the first study comparing the efficacy of anidulafungin with other antifungal agents. In this CE model, an intravitreal single dose of anidulafungin was shown to be noninferior to voriconazole and Amp B. As an alternative to Amp B or voriconazole, intravitreal anidulafungin is suggested as an effective antifungal agent for the treatment of CE.