Metin Akbulut

Chorangiosis : The potential role of smoking and air pollution

Chorangiosis is considered to be strongly associated with various fetal, maternal, and placental disorders, including pre-eclampsia, diabetes, hypertension, and major congenital anomalies, and has been found to correlate with increased fetal morbidity and mortality. In this study, we investigated the pathologic effects of maternal smoking and air pollution on the pathogenesis of chorangiosis. We investigated 92 placentas macroscopically and microscopically over a 3-month period (March 2006-May 2006) at Denizli State Hospital to identify the frequency of chorangiosis and the potential role of maternal smoking and air pollution. Placental changes were examined by light microscopy after hematoxylin and eosin (H&E) staining and immunohistochemical evaluation of CD 34 and CD 68; muscle-specific actin was used to confirm the diagnosis. Among the 92 mothers included in the study, 33 were smokers (group I), 31 were thought to have been exposed to air pollution (group II), and 28 were living in rural areas free of air pollution and maternal smoking (group III). Chorangiosis was found in 14% (13/92) of all placentas: 7 (53.8%) cases were assigned to group I, 5 (38.5%) to group II, and 1 (7.7%) to group III. Vascular changes were found mainly in the smoking and air pollution groups. There appeared to be no correlation of these vascular changes with placental weight, parity, gestational age, major congenital anomalies, and maternal factors, including diabetes and pre-eclampsia. We presume that smoking and air pollution may contribute to the development of chorangiosis. We suggest that chorangiosis may be an adaptive response to maternal hypoxia, and studies addressing the role of smoking and air pollution in chorangiosis may provide new insights into the pathogenesis of this condition.

1–Alpha, 25–Dihydroxyvitamin D3 Regresses Endometriotic Implants in Rats by Inhibiting Neovascularization and Altering Regulation of Matrix Metalloproteinase

Abstract Background: The exact pathogenesis of endometriosis has not been completely discerned. 1–alpha,25–dihydroxyvitamin D3 (1,25[OH][2]D[3]) has been shown to have an anti–angiogenic effect and extracellular matrix–proteases–degrading properties. We hypothesized that 1,25(OH)(2)D(3) may have therapeutic value in the treatment of endometriosis. Methods: Endometrial tissue was implanted into the abdominal peritoneum of 21 Wistar albino rats; the rats were randomized into 3 groups. In Group A (simultaneous group), we simultaneously induced endometriosis and began 1,25(OH)(2)D(3) treatment. Group B rats (sequential group) were treated after endometriosis was documented. Animals in Group C (control group) were followed without any treatment after the development of endometriosis. Results: Histologic score, mean volume, and weight of the explants in Group A and B were found to be significantly lower than those of the control group. Levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase–9 (MMP–9) immunoreactivities in Group A and B were also significantly lower compared with Group C. In contrast, intensities of immunoreactivity staining for tissue inhibitor of metalloproteinase–2 (TIMP–2) in Group A and B were significantly higher than that of the control group. Conclusion: 1,25(OH)(2)D(3) regresses endometriotic implants in rat models by altering implant levels of VEGF, TIMP–2, and MMP–9.

Infarction after fine needle aspiration biopsy of pleomorphic adenoma of the parotid gland.

BACKGROUND Fine needle aspiration (FNA) is a well-established and safe method for the rapid diagnosis of pleomorphic adenoma. A few clinically important complications, including bleeding, infection and inflammatory reactions, result from FNA. In a small number of cases FNA has been followed by varying degrees of necrosis in some organs. In the literature there are a few reports associated with necrosis in a pleomorphic adenoma of the parotid gland following FNA. CASE A 27-year-old female had a two-year history of a right parotid mass. FNA revealed pleomorphic adenoma. A histologic diagnosis of pleomorphic adenoma of the right parotid with infarction was made. CONCLUSION Necrosis associated with infarction may cause diagnostic problems. It is not a sufficient sign of malignant transformation.

Primary infiltrating ductal carcinoma arising in aberrant breast tissue of the axilla: a rare entity. Report of a case

A 52-year-old woman presented with a palpable nodule in the right axilla. Physical examination revealed a 2.5 × 2.5 cm, nontender, firm, brownish, and peripherally hyperemic mass with overlying skin retraction on the right anterior axillary fold. Bilateral mammogram was negative. Ultrasonography of the right axillary region showed a 1.8 × 1.1 cm, poorly defined hypoechoic mass with irregular margins and posterior acoustic shadowing. Fine-needle aspiration biopsy of the mass revealed malignant epithelial cells. The patient underwent a wide local excision of the right axillary lesion with en bloc axillary lymph node dissection. Histopathological examination revealed an infiltrating ductal carcinoma. Here we report this case of carcinoma originating from aberrant breast tissue in the axilla. It is suggested that subcutaneous lesions of uncertain origin around the periphery of the breast should be suspected for breast carcinoma and treated appropriately.

Ovarian hemangioma occurring synchronously with serous papillary carcinoma of the ovary and benign endometrial polyp.

Ann Saudi Med 28(2) March-April 2008 www.kfshrc.edu.sa/annals 128 Ovarian hemangiomas are extremely rare tum mors, most of which are asymptomatic and of the cavernous type.1 Considering the rich vasm cular supply of the ovary, the low incidence of ovarian hemangiomas is somewhat surprising. There are about 50 documented cases in the literature. The 12 described in Table 1 were associated with gynecologic tract dism ease including endometrial hyperplasia, endometrial carcinoma and endometriosis.1m34 Ovarian hemangiom mas have been reported in both adults and children and most of the reported cases have been unilateral and small.2,3 Although often an incidental finding at operam tion, ovarian hemangioma may rarely be associated with gynecologic cancers.4m8 The tumor in our case was an additional and incidental finding in a surgical specimen removed because of a serous papillary carcinoma involvm ing the left tuba and ovary.

PRIMARY NEUROENDOCRINE CARCINOMA OF THE BREAST: A CASE REPORT

Primary neuroendocrine carcinoma of the breast is an extremely rare tumor. We present our experience of primary neuroendocrine carcinoma of the breast in a 76-year-old woman. Surgical biopsies from breast and axillary lymphadenopathy showed a neuroendocrine carcinoma. Immunohistochemical staining of tumor cells with GCDFP15, NSE and chromogranin were positive. Computed tomography scans of the chest and abdomen showed no lesion for metastasis or another primary origin. Adjuvant hormone therapy was given, since the tumor was immunohistochemically receptor positive.

Giant lipoleiomyoma of the uterine corpus

ObjectiveLipoleiomyoma is a rare and easily recognized, benign uterine fatty tumor, composed of an admixture of mature adipocytes and smooth-muscle cells. They may associate with metabolic disorders and rarely reach giant size.CaseWe report a case of symptomatic giant lipoleiomyoma of the uterine corpus that may be associated with diabetes mellitus and hypothyroidism.ConclusionLipoleiomyoma must be thought in the differential diagnosis of the giant uterine tumors and should be removed when diagnosed, because malignancy cannot otherwise be excluded. Also the peculiar features of this giant neoplasm, histogenesis, concomitant metabolic disorders and the diagnostic methods are discussed.

Mannitol attenuates acute lung injury induced by infrarenal aortic occlusion-reperfusion in rats

PurposeMannitol is used as a treatment for ischemia/reperfusion (IR) injury of various organs in humans, despite the fact that its effectiveness in vivo is still disputed. The purpose of this study was to determine the effects of mannitol on acute lung injury (ALI) induced by infrarenal aortic occlusion.MethodsMale Wistar-albino rats were allocated into five groups: (i) sham-operated group, which received a laparotomy without IR injury (n = 12); (ii) IR group, which received 3 h of ischemia followed by 2 h of reperfusion (n = 12); (iii) IR + inferior caval phlebotomy (ICP) group, which was identical to group 2 except for 1 ml of blood aspiration from the inferior caval vein (n = 12); (iv) IR + mannitol-treated group, for which rats were subjected to IR and received a bolus injection of mannitol (n = 12); and (v) IR + ICP + mannitol-treated group, which underwent the same procedures as described for the previous groups. Arterial blood gas parameters were studied and bronchoalveolar lavage (BAL) was performed. Evans blue dye was injected into half of the rats. We biochemically assessed the degree of pulmonary tissue injury by investigating oxidative stress markers and enzymatic and nonenzymatic antioxidant markers, and evaluated ALI by establishing pulmonary leukosequestration and ALI scoring, histopathologically. Pulmonary edema was estimated by using Evans blue dye extravasation and wet/dry weight ratios.ResultsHypertonic mannitol treatment significantly reduced oxidative stress markers, and significantly increased enzymatic and nonenzymatic antioxidant markers in the lung tissues (P < 0.05). Arterial blood gas parameters were significantly ameliorated (P < 0.05), the BAL cytology was significantly better (P < 0.05), pulmonary leukosequestration and ALI scores were significantly decreased (P < 0.05), and pulmonary edema was significantly alleviated (P < 0.05) by mannitol administration.ConclusionThis study clearly showed that mannitol treatment significantly attenuated the aortic IR-induced ALI. Further clinical studies are required to clarify whether mannitol has a useful role in ALI during surgeries in which IR-induced organ injury occurs.

Investigation of galectin-3 and heparanase in endometrioid and serous carcinomas of the endometrium and correlation with known predictors of survival

IntroductionInhibitors of tumor angiogenesis and metastasis are emerging as important new drug candidates for cancer therapy. Galectin-3 and heparanase have been shown to function in tumor progression and metastatic spread. Both of them exert pleiotropic effects; proliferation, cell migration, differentiation and tissue remodeling. The aim of this study was to investigate heparanase and galectin-3 expression in endometrioid and serous carcinomas of the endometrium and their relation with well-known prognostic factors, in addition to estrogen, progesterone, C-erbB-2, Ki-67 and p53.Materials and methodsSixty-four endometrial cancers, which include 24 serous types, were obtained from previously untreated patients. Immunohistochemical analysis of 64 carcinomas, 20 endometrial hyperplasia (ten of simple hyperplasia and ten of complex atypic hyperplasia) and 20 normal endometrium (ten of proliferative and ten of secretory) was performed.ConclusionThis investigation suggests that the decreased expression of galectin-3 may be involved in the pathogenesis of endometrial carcinomas from normal endometrium to carcinoma. Also down-regulated stromal expression of galectin-3 in endometrial carcinoma may be involved in lymph node metastasis. Further studies on a larger advanced stage (FIGO stage 3–4) endometrial carcinoma group may determine the value of heparanase in the endometrial carcinoma.

Florid vascular proliferation in mature cystic teratoma of the ovary: case report and review of the literature

A case of mature cystic teratoma that contained florid vascular proliferation is reported. The ovarian tumor occurred in a 9-year-old girl; symptoms consisted of vomiting, abdominal pain and a palpable mass. The microscopic findings were mostly typical of a mature cystic teratoma, but also abundant vascular proliferation mimicking hemangioma in association with mature neural tissue was observed. There was a disorganized arrangement of medium- and large-sized spaces lined by cuboidal endothelial cells. Immunohistochemical staining for vascular proliferation showed immunoreactivity for CD31 and smooth muscle actin. Florid vascular proliferation may be seen in association with neural tissue of ovarian teratomas and should not be misdiagnosed as immature teratoma or a vascular neoplasm.