Kursat Yildiz

Topical application of mitomycin C prevents epineural scar formation in rats

The role of topically applied mitomycin C in preventing postoperative perineural fibrosis was examined by gross anatomical dissection and histological analysis in rats. The sciatic nerve was exposed bilaterally in 24 Wistar adult male rats, and an abrasion injury was produced on the exposed surface of the biceps femoris muscle in all animals. In the experimental group, cotton pads soaked with mitomycin C (0.5 mg/ml) were placed around the nerves for 5 min, whereas cotton pads soaked with saline were applied to the control group. Four weeks after surgery, the neurolysis sites were evaluated by blinded surgical dissection. Perineural adhesions were graded using a numerical grading scheme. The scar tissue formation index was also calculated, and a grading was made according to the number of fibroblasts/fibrocytes counted around the epineurium in histological evaluation. Mitomycin C-treated nerves showed significantly less perineural adhesions than controls. Quantification of the dense connective tissue surrounding the nerves revealed a statistically significant reduction around nerves treated with mitomycin C, and the number of fibroblast/fibrocytes was also significantly reduced. Application of topical mitomycin C might be effective in preventing epineural scar formation after neurolysis of peripheral nerves.

Lues Maligna in a Chronic Alcoholic Patient

Lues maligna, which is characterized by noduloulcerative lesions, is a rare form of secondary syphilis. It is mainly seen in either HIV‐infected or malnourished patients suffering from a depression in immunity. We presented a chronic alcoholic, HIV negative male patient with noduloulcerative lesions diagnosed as lues maligna based on his skin eruptions, results of serologic tests, and, histopathologic findings. We believe that chronic alcoholism could be the cause of immunosuppression in our case and wanted to emphasize the possibility of an association between lues maligna and chronic alcoholism.

Coexisting papillary and clear renal cell carcinoma in the same kidney.

Renal cell carcinoma (RCC) is the most common solid lesion of the kidney. Bilateral synchronous benign and malignant renal tumors have been defined in some reports. However, unilateral concordance of malignant renal tumors is very rare and there are only a few cases that had synchronous different subtypes of malignant renal tumors arising within the same kidney. Herein, we describe a 67-year-old male patient who had clear cell RCC and papillary RCC in his right kidney that were successfully treated with radical nephrectomy. We also reviewed the pertinent literature.

Case of keratosis lichenoides chronica with atypical sarcoidal granulomatous inflammation.

Keratosis lichenoides chronica (KLC) is a rare chronic disease characterized by violaceous, papular and nodular lesions typically arranged in a linear and reticulate pattern. The etiology of KLC is unknown, but it may be associated with internal diseases such as hypothyroidism, glomerulonephritis and lymphoproliferative disorders. Herein, we describe the case of 44‐year‐old male patient with characteristic lesions of KLC on the trunk and extremities, present for 12 years. The clinical diagnosis was proven by histopathological examination on several occasions. In the years following the diagnosis of KLC, he developed bilateral hilar and multiple mediastinal, cervical and inguinal lymphadenopathies and hepatosplenomegaly. In 2000, diffuse interstitial and then reticulonodular pulmonary infiltrates associated with fever, weight loss, malaise and subcutaneous nodules developed. Biopsies taken from peripheral and mediastinal lymph nodes, pulmonary parenchyma, pleural tissue, bone marrow and skin showed non‐necrotizing granulomas, indicating a sarcoidal granulomatous reaction. Characteristic histopathological findings and the absence of atypical cells, clonality and a high proliferative index excluded lymphomas. Furthermore, detailed tests showed no evidence of an infectious granulomatous disease. As far as we know, this is the first reported case of KLC associated with a sarcoidal granulomatous reaction.

Segmental Lentiginosis within Nevoid Hypopigmentation

To the Editor: Segmental lentiginosis (SL) is characterized by a circumscribed grouping of lentigines on one side of the body (1). Nevoid hypopigmentation is a new term that is proposed to describe nevus depigmentosus (ND) and hypomelanosis of Ito (HI) cases. The development of lentigines within nevoid hypopigmentation has been reported rarely (2). A 33-year-old man had had a pale mark since birth on the right side of his neck and back. In the last ten years, small hyperpigmented macules had appeared within the pale area. Dermatological examination revealed a large, well-defined hypopigmented patch over the right side of the neck, proximal arm, and anterior and posterior part of the body. In addition, there were multiple 1–2 mm hyperpigmented macules within this hypopigmented lesion involving the proximal arm and the skin overlying right scapula (Figs. 1, 2). There were also a few hyperpigmented macules around the hypopigmented lesion but not on the other side of the body. Wood’s light examination showed off-white accentuation of the hypopigmented lesion. Systemic examination including neurological examination revealed no evidence of any other extracutaneous abnormalities. Routine hematological and biochemical tests were within the normal limits. Histopathological examination revealed decreased melanin staining at the dermoepidermal junction with MassonFontana in hypopigmented areas, although melanocytes were markedly increased. In lentiginous areas, the number of the melanocytes appeared to be normal, but Masson-Fontana staining revealed remarkable, increased melanin pigmentation at the dermoepidermal junction. There was pigThe Journal of Dermatology Vol. 32: 679–681, 2005

Transthoracic fine-needle aspiration cytology of non-invasive, low-grade urothelial carcinoma with lung metastasis: A case report with review of the literature

Radiological analyses in a 61-year-old patient being followed since 2005 for low-grade, non-invasive urothelial carcinoma (UC) (Ta) revealed a 5-cm pleural-based mass in the lower lobe of the right lung for which a subsequent transthoracic fine-needle aspiration cytology was performed. Upon observing the carcinoma cells consistent with UC metastasis, systemic chemotherapy was commenced. The patient underwent a metastatectomy based on the thoracic computerized tomography scan performed on the 4th month of treatment, which revealed notable regression. The resected tumor was morphologically similar to cells seen in the transthoracic fine-needle aspiration and was immunohistochemically positive for p63, uroplakin, thrombomodulin, CK7 and CK20 at varying degrees but was negative for TTF-1. We report a case of metastatic UC of the lung in a patient who had had a low-grade superficial UC of the urinary bladder and we discuss the cytopathological features of this rare entity in light of the literature.

Effect of Locally Applied Transforming Growth Factor Beta3 on Wound Healing and Stenosis Development in Tracheal Surgery

BACKGROUND: Tracheal stenosis constitutes one of the most frequently seen problems in thoracic surgery. Although many treatment modalities to prevent fibroblast proliferation, angiogenesis, or inflammation that causes tracheal stenosis have been attempted, an effective method has not yet been found. In this study, a transforming growth factor beta3 (TGF-β3)/chitosan combination was used for this purpose. METHODS: A slow-release preparation containing a thin layer of TGF-β3 with a chitosan base was made. Thirty albino Wistar rats were divided into 3 groups. A full-layer vertical incision was made in the anterior side of the trachea of each rat between the second and fifth tracheal rings. The tracheal incision was sutured. Group A was evaluated as the control group. In Group B, a chitosan-based film was placed on the incision line. In Group C, a slow-release TGF-β3/chitosan-coated substance was placed on the incision line. The rats were killed on day 30, and their tracheas were excised by cutting between the lower edge of the thyroid cartilage and the upper edge of the sixth tracheal ring together with the esophagus. Epithelialization, fibroblast proliferation, angiogenesis, inflammation, and collagen levels were evaluated histopathologically by the same histopathologist. RESULTS: Statistically significant differences were not found among the 3 groups. Cold abscesses were observed at the incision sites in both the TGF-β/chitosan and chitosan groups. These were thought to have formed due to the chitosan. CONCLUSIONS: As this was the first experiment in the literature to use this type of TGF-β3 formulation, we intend to change the formulation and perform this study again with a different TGF-β3/chitosan preparation.

Angioleiomyoma of the scrotal wall

Angioleiomyoma of the scrotum is a rare benign lesion which can mimic a paratesticular tumor. Any solid mass within the scrotum is considered malignant until proven otherwise. Here, we present a case of an angioleiomyoma of the scrotum in a 33-year-old male who presented with painful scrotal mass. Scrotal ultrasonography demonstrated a solid mass in the scrotum, and surgical excision was carried out. Pathologic examination revealed that the tumor was angioleiomyoma.

A case of Jarcho-Levin syndrome associated with bilateral cystic renal disease and wilms tumor: MR imaging findings.

Jarcho-Levin syndrome (JLS) is a congenital disorder characterized by a variety of vertebral and costal anomalies that result in thoracic deformity. Hitherto, a plethora of associated anomalies have been described in several reports. In this report, the authors describe a case of JLS who has Wilms tumor and bilateral cystic renal disease. To the authors’ knowledge, there is only a single case of JLS who presented with multiple renal cortical cysts, but none with an associated Wilms tumor in the literature. Additional anomalies seen in the present case that are related with this syndrome are also discussed.

Rosacea associated with etanercept

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 7 decembre 2013