Mehmet Kefeli

Fascin expression in uterine smooth muscle tumors.

The diagnosis of malignant, uncertain malignant potential, and benign uterine smooth muscle tumors is derived from histologic criteria such as tumor cell necrosis, mitotic activity, and cytologic atypia. Morphologically, some variants of leiomyoma can be confused with leiomyosarcoma (LMS). In this study, we compared fascin expression in cases of leiomyoma, leiomyoma variants (LVs), uterine smooth muscle tumor of uncertain malignant potential (STUMP), and LMS, and sought to determine the potential role of fascin in differential diagnosis. Fascin expression was investigated through the immunohistochemistry of paraffin-embedded tissue in 79 cases of uterine smooth muscle tumor including 22 usual leiomyoma, 31 LV, 4 STUMP, and 22 LMS cases. The cases were scored on the basis of staining extent (from 0 to 4) and intensity (from 1 to 3), and were assigned a combined score. Fascin expression was present in 20 of 22 (90.9%) LMS, 2 of 4 (50%) STUMP, 1 of 31 (3.2%) LV, and 1 of 22 (4.5%) usual leiomyoma cases. There was a statistically significant difference in fascin extent and intensity between the LMS and benign groups, but no difference between the LMS and STUMP groups. The results of this study indicate that more distinct fascin expression exists in LMS than in the benign groups. Fascin can serve as a reliable immunohistochemical marker in distinguishing uterine LMS from LVs and usual leiomyoma, and it may usefully be used with histologic criteria in diagnosing problematic cases.

Rhabdomyosarcoma arising in a mature cystic teratoma with contralateral serous carcinoma: case report and review of the literature.

SUMMARY Malignant transformation of a mature cystic teratoma of the ovary is rare, and occurs in approximately 2% of all cases. The most common malignancy arising in mature cystic teratoma is squamous cell carcinoma. Sarcomas very rarely develop in mature cystic teratoma. We describe the case of a 65-year-old patient with mature cystic teratoma, and with rhabdomyosarcomatous transformation and contralateral serous carcinoma. To our knowledge, this is the first case of a pure rhabdomyosarcoma arising in a mature cystic teratoma. The clinicopathologic and immunohistochemical findings of this exceptional case are reported and the literature is reviewed.

Amyloid goiter: two cases and a review of the literature.

Although involvement of the thyroid gland by amyloid is a relatively common phenomenon , clinically significant enlargement of the thyroid owing to amyloid deposition is an extremely rare occurrence. We describe two cases of amyloid goiter and review the relevant literature. The first case was systemic amy--loidosis secondary to familial Mediterranean fever. The second case was a chronic renal failure patient who presented with an enlarged thyroid and upper airway obstructive symptoms. To date , true amyloid goiter secondary to amyloidosis associated with familial Mediterranean fever has only been reported in twelve patients.

Effect of vitamin C on the growth of experimentally induced endometriotic cysts

The aim of this study was to investigate the effect of vitamin C on the growth of experimental endometriotic cysts.

Arthroplasty for the treatment of joint degeneration caused by ochronosis in two cases

Ochronosis is a rare metabolic disease caused by the deficiency of the homogentisic acid oxidase enzyme. With increasing age, accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We presented two female patients, with ages 55 and 60 years, who underwent staged bilateral uncemented total hip and bilateral cemented total knee arthroplasty, respectively, for osteoarthritis caused by ochronosis. Both patients had no significant complaints at final follow-up examinations made 12 months and 10 months after the second operation in the hip and knee, respectively. Plain radiographs did not show any abnormality in the components of the prostheses. Histopathologic examination of surgical specimens showed brown-black pigment deposits in the connective tissue and cartilage tissue.

The coexistence of invasive ductal carcinoma and malignant phyllodes tumor with liposarcomatous and chondrosarcomatous differentiation in the same breast in a post-osteosarcoma case.

Malignant phyllodes tumors of the breast are rare biphasic neoplasms, the stromal component of which may show homologous and heterologous sarcomatous elements. Malignant epithelial transformation is rare. It has been reported in a few cases of in situ and infiltrating ductal or lobular carcinoma. Rarely, breast carcinomas and phyllodes tumors may also develop in the same breast independent of each other. To our knowledge, this is the first case of two different types of tumor occurring in the same breast at the same time in a post-osteosarcoma case.

Peritoneal tuberculosis in premenopausal patients with elevated serum CA 125

IntroductionPeritoneal tuberculosis predominantly involves the omentum, intestinal tract, liver, spleen, and genitourinary tract and occurs in 1–4% of patients with pulmonary tuberculosis. Peritoneal tuberculosis may mimic a pelvic mass in imaging studies and also may increase CA-125 levels. Peritoneal tuberculosis may also produce massive ascites, and intraperitoneal gross appearance might be similar to the peritoneal carcinomatosis. Therefore, peritoneal tuberculosis is often confused with advanced-stage epithelial carcinoma because of similar clinical, radiologic, and laboratory findings and later intraoperative findings.Materials and methodsThe pathology records between January 2000 and August 2008 were retrospectively reviewed at 19 Mayis University Hospital. Twenty-two patients were found to have peritoneal caseating necrosis. A total of 13 out of 22 patients were found to have high CA 125 level.ResultsAmong these 13 patients, 8 patients received/are receiving anti-tuberculous therapy after they were incidentally diagnosed with peritoneal tuberculosis.ConclusionIncreased CA 125 levels should be evaluated carefully prior to aggressive surgical approach, especially in premenopausal women and frozen section evaluation should be done before extensive surgical procedure if there is any suspicion.

The Effects of Experimental Left Varicocele on the Epididymis

Most of the studies investigating the relationship between varicocele and male infertility are mainly focused on the testicles. It is obvious that varicocele would affect the morphology and function of the epididymis which is an intrascrotal organ. In this study, the effects of experimental left varicocele (ELV) on the epididymal morphology were investigated in adult rats. ELV was induced via partial obstruction of the left renal vein in 20 Sprague-Dawley adult rats. An additional twelve rats served as controls, and another twelve served as shams. Half of the rats in the groups were sacrified by the end of the first month of the experiment, and the rest were sacrified by the end of the second month. Epididymides were weighed; tubular diameters of the caput, corpus, and cauda of the epididymis were measured. The TUNEL assay was used to assess apoptosis within the epididymal tubules. The mean weight of each right and left epididymis in the varicocele group was lower than that in the control and sham groups (p < 0.01). In the varicocele group, the left epididymis weighted less than the right by the end of the second month (p < 0.01). The mean tubular diameter in the varicocele group was narrower than that in the control and sham groups (p < 0.001). Tubular diameter was significantly narrower in the caput segments in rats with varicocele by the end of the second month (p < 0.001). Apoptosis was significantly increased in principal cells of the epididymal epithelium in the varicocele groups. The apoptotic cells in the caput epididymis epithelium were more numerous than those in the other segments. In conclusion, ELV significantly decreases epididymal weight and tubular diameters presenting increased apoptosis within the principal cells. There is a positive correlation between the epididymal damage and the duration of varicocele.

Thymosin β4 is a novel potential prognostic marker in gastrointestinal stromal tumors.

Thymosin beta‐4 (Tβ4) is a major actin‐sequestering molecule that contributes to cell growth, differentiation, motility, survival, mitosis and angiogenesis. It is overexpressed in certain type of carcinoma and fibrosarcoma cell lines and is associated with metastatic potential. The aim of this study was to investigate the relationship between Tβ4 expression and clinicopathologic features and VEGF status in gastrointestinal stromal tumors (GISTs). Retrospectively, 60 GISTs were re‐examined and immunohistochemistry for Tβ4 and VEGF was performed. Increased expression of Tβ4 and VEGF was observed in 26 (43.3%) and in 19 (31.6%) of the tumors, respectively. Tβ4 expression was positively correlated with VEGF expression (p < 0.01). Tβ4 and VEGF expression were significantly associated with tumor size (p = 0.00 and p = 0.02, respectively) and high mitosis (p = 0.03 and p = 0.00, respectively). Although Tβ4 expression was positively associated with pleomorphism (p = 0.01), VEGF expression was positively associated with necrosis (p = 0.03). Tβ4 expression was related with local recurrence and/or metastasis (p = 0.03), but VEGF expression was not (p = 0.12). We firstly demonstrate the presence of Tβ4 protein in GISTs. Our study reveals that increased expression of Tβ4 could be considered as an indicator of aggressive behavior of tumor.

Fascin expression in melanocytic lesions of the skin

Fascin is a globular actin cross-linking protein that is important in carcinogenesis. It shows differential staining in various tumors, dependent on grade and stage. The purpose of this study was to compare fascin expression in benign, dysplastic and malignant (metastatic and non-metastatic) melanocytic lesions of the skin, and also to investigate the potential role of fascin in their differential diagnosis. Fascin expression was investigated through the immunohistochemistry of paraffin-embedded tissue in 73 cases of melanocytic lesions of the skin, including 20 benign nevi, 12 dysplastic nevi, 4 lentigo malignas, 25 malignant melanomas and 12 metastatic melanomas. The cases were scored on the basis of staining extension (from 0 to 4) and intensity (from 1 to 3), and were assigned a combined score. Fascin expression was present in 19/20 (95%) benign nevi, 8/12 (67%) dysplastic nevi, 1/4 (25%) lentigo malignas, 7/25 (28%) malignant melanomas and 3/12 (25%) metastatic melanomas. There was significantly less frequent expression of fascin in malignant melanoma than in benign nevi (p < 0.001) and dysplastic nevi (p = 0.036). The results of this study indicate that differential fascin expression exists between benign nevi and malignant melanomas. Fascin can therefore serve as a reliable immunohistochemical marker in distinguishing malignant melanomas from melanocytic nevi and dysplastic nevi, and it may be used with histological criteria for differential diagnosis.