Metin Ciris

Adenomyomatosis of the gallbladder resembling honeycomb in a child.

Adenomyomatosis of the gallbladder is believed to be an uncommon pathologic condition of the gallbladder in childhood. Only three pediatric cases have been described in the literature up to now. Honeycomb gallbladder has been described in two adult patients; no patients have been reported in childhood until now. To the best of our knowledge, we report here the first case of adenomyomatosis of the gallbladder which resembled honeycomb, in a 9-year-old girl presented with recurrent abdominal pain. The diagnosis was made by ultrasound, and confirmed by magnetic resonance cholangiopancreatography and finally cholecystectomy. In conclusion, ultrasound scanning performed more generally in children presenting with recurrent abdominal pain might lead to accurate diagnosis of adenomyomotosis of the gallbladder during childhood.

Cyclooxygenase-2 expression in primary and recurrent pterygium.

Background: Pterygia are common, benign, fibrovascular, and infiltrative processes of the corneo- conjunctival junction of unknown pathogenesis. Cyclooxygenase-2 (COX-2) mediates the rate-limiting step in arachidonic acid metabolism. Extensive evidence indicates that the COX-2 prostanoid pathway is involved in inflammation. The aim of the study was to document the immunohistochemical expression of COX-2 in primary and recurrent pterygia. Materials and Methods: In this study, 21 primary pterygia and 12 recurrent pterygia from subjects undergoing pterygium surgery and six normal corneal-scleral tissue specimens were studied immunohistochemically for COX-2 expression. Results: COX-2 was expressed in primary pterygia and recurrent pterygia specimens. There was a statistically significant difference in COX-2 expressions in fibroblasts between primary and recurrent pterygium cases (P = 0.001). There were statistically significant differences in COX-2 expressions in surface epithelium (P = 0.028) and stromal inflammatory cells (P=0.000) between control tissues and primary pterygia tissues. We also detected statistically significant differences in COX-2 expressions in surface epithelium (P=0.000), stromal fibroblasts P=0.000 (stromal fibroblasts and inflammatory cells), vessels (P = 0.027) and inflammatory cells (P=0.001) between control tissues and recurrent pterygia tissues. Conclusions: This is the first study to document the expression of COX-2 in primary and recurrent pterygia. In our opinion after excision of pterygia, fibroblastic proliferation continues and this contributes to recurrence.

Investigating the effectiveness of different tea types from various thyme kinds (Origanum onites, Thymbra spicata and Satureja cuneifolia) on anemia and anticholesterolemic activity:

In a study on villagers settled on the outskirts of the Taurus Mountains and whose source of living is thyme, it was revealed that the villagers excessively consumed thyme by adding it to their tea and many of their foods; high incidences of anemia was found among these villagers. In this study, 42 male adult Wistar albino rats weighing 200–250 g were used. The rats were divided to six equal groups as follows: control, cholesterol (Chol), 80 mg/kg Origanum onites Labiatae (OOL), 80 mg/kg Thymbra spicata Labiatae (TSL), 80 mg/kg Satureja cuneifolia Labiatae (SCL), and 160 mg/kg TSL, and each group consisted of seven rats. The control group was fed with normal pellet feed. The Chol group and all the other groups, except for the control group, were fed with 2% cholesterol-containing pellet feed. Physiological serum of 4 ml was given to the control and Chol group, wheile 80 mg/kg of thymes tea was given to the OOL group, TSL group, and SCL group, and 160 mg/kg of thymes tea was given to the TSL group by means of a gavage for 30 days. In the blood samples, the hematologic parameters and the biochemical parameters of serum glucose, blood urea nitrogen, creatinine, total protein, albumin, iron (I), total iron-binding capacity, aminotransferase aspartate, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, triglyceride, and oxidized LDL levels were examined. The kidney and liver tissues were examined histopathologically. The results of the study showed that different types of thymes had an antihypercholesterolemic effect. In addition to the anemic effect detected in group TSL and the mild granular degeneration found in the liver of 80 mg/kg SCL group, distinct granular degeneration was observed in 160 mg/kg TSL group.

Expression of NGF, GDNF and MMP-9 in prostate carcinoma

The aim of the present study was to investigate the immunohistochemical expression of NGF, GDNF and MMP-9 in benign prostatic hyperplasia (BPH), high grade prostatic intraepithelial neoplasia (HGPIN) and prostate cancer (PC), and to analyse their association with the clinicopathological parameters in PC cases. Immunohistochemistry was performed on the tissue microarray (TMA) sections of 30 BPH, 40 HGPIN and 121 primary PC tissues. There was a significant difference regarding the expression of NGF and GDNF between PC and HGPIN (p<0.0001; p<0.0001), and PC and BPH (p=0.001; p<0.0001), but not between HGPIN and BPH (p>0.05). Furthermore MMP-9 expression was significantly different among all groups (PC vs. HGPIN, p<0.0001; PC vs. BPH, p<0.0001; HGPIN vs. BPH, p=0.001). NGF, GDNF and MMP-9 expression was significantly stronger in cases with high Gleason score (p<0.0001, p=0.004, p<0.0001 respectively) and pT stage (p=0.046, p=0.004, p=0.001, respectively) in PC cases. All these markers were also associated with perineural, lymphovascular and extraprostatic invasion (p <0.05). In addition, a positive correlation was found between NGF and MMP-9 (p<0.0001, r=0.435), NGF and GDNF (p<0.0001, r=0.634), and GDNF and MMP-9 (p<0.0001, r=0.670) in PC cases. According to our results we suggest an interaction between NGF, GDNF and MMP-9 during the transition to malignancy in PC. Also this interaction may involve in regulating PC cell differentiation, tumor invasion, progression, and the agressiveness of PC.

Squamous cell metaplasia of the nasopharyngeal epithelium and its association with adult-onset otitis media with effusion

Conclusion The common association between adult-onset otitis media with effusion (AO-OME) and squamous cell metaplasia (SCM) of the epithelium of Rosenmüllers fossa, which is near the Eustachian tube orifice, implies the predictive role of metaplasia, which probably compromises the drainage function of the middle ear. Objective To determine the effects of nasopharyngeal epithelial changes (SCM) on AO-OME. AO-OME is a multifactorial and insidious disease that may necessitate detailed investigation, i.e. biopsy of the nasopharynx, because of possible underlying nasopharyngeal malignancy. Material and methods Fifty-two patients with AO-OME (study group) and 29 with a unilateral neck mass in the posterior triangle without AO-OME (control group) were enrolled. Nasopharyngeal biopsies taken from all subjects were evaluated with regard to surface epithelial changes of the nasopharynx. Results Nasopharyngeal biopsies revealed SCM in 34/52 patients (65%) in the study group and 9/29 (31%) in the control group (p<0.05). During the follow-up period, recurrence of effusion occurred in 56% of the group with SCM and 22% of the group without it.

Basal Cell Carcinoma with Halo Phenomenon in a Young Female: Significance of Dermatoscopy in Early Diagnosis

Halo phenomenon of nevus may be observed as a circular reaction, although it is unusual around tumors. A 29-year-old woman presented with a pigmented lesion on the cheek since three years. She noted whitening of the skin around the lesion almost after a year following its appearance. Dermatologic examination revealed a pigmented nodular lesion with a hypopigmented halo on the left infraorbital region. The clinical impression was halo nevus, whereas basal cell carcinoma (BCC) was considered in dermatoscopic differential diagnosis. The diagnosis was infiltrative-type BCC histopathologically. The persistence of a perilesional halo around an enlarging pigmented lesion should be carefully examined with accompanying dermatoscopic findings even in young patients for early diagnosis of tumoral lesions.

Cerebral Metastasis of Small-Cell Lung Carcinoma Mimicking a Supratentorial Cystic Astrocytoma

CLINICAL PRESENTATION Brain metastases are not rare during the course of lung cancers. Most metastases appear as solid masses with considerable necrosis and severe peritumoral edema. Pure cystic lesions and accompanying solid nodules are very uncommon. A 41-year-old male patient presented with severe headache and nausea for past 1 week. While cranial magnetic resonance imaging revealed left frontal huge cystic mass with a solid mural nodule mimicking astrocytoma (Figure 1), thorax computed tomography also revealed multiple masses in the right lung lobules. Patient was confused and exhibiting features of frontal lobe syndrome. He underwent surgical removal of solid mural nodule and the drainage of cyst with the complete removal of the tumor wall via right frontal craniotomy. Patient’s neurological status improved promptly in early postoperative period and the tissue diagnosis was reported as small-cell lung carcinoma (Figure 2). Patient was transferred to the oncology unit for further treatment directed on the primary source of the malignancy. Takeda et al1 reported a patient with a solitary cystic brain metastasis of small-cell lung carcinoma treated successfully using a stereotactically placed Ommaya reservoir and this report was published by The American Journal of the Medical Sciences in 2009. However, we believe that removal of the mural nodule is essential for preventing the subsequent collection of the fluid in the cystic cavity and establishing the histopathological diagnosis. In conclusion, diagnosis of the primary lung cancers could be established via removed tumor samples from cerebral metastases, and it should be kept in mind that brain metastases of small-cell lung carcinomas may mimic cystic astrocytomas with mural nodules. REFERENCE 1. Takeda T, Saitoh M, Takeda S. Solitary cystic brain metastasis of small-cell lung carcinoma controlled by a stereotactically inserted Ommaya reservoir. Am J Med Sci 2009;337:215–7. FIGURE 1

Solunum sıkıntısı sebebi olarak tiroid papiller karsinomu

SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2005 Haziran; 12(2) Solunum sikintisi sebebi olarak tiroid papiller karsinomu Giray Aynali, Hasan Yasan, Mustafa Tuz, Metin Ciris, Orhan Oyar Ozet Papiller tiroid karsinomu (PTK) primer olarak lenfatik yol ile yayilim gosterir. Bu nedenle hastalar siklikla boyunda kitle sikayeti ile hekime basvurmaktadirlar. PTK, nadir de olsa direkt invazyon veya metastaz yoluyla larenkse yayilim gosterir ve bu bolgeye ozgu ses kisikligi, nefes darligi gibi sikayetler de boyunda kitleye eslik edebilir. Bu calismada seste bogukluk ve nefes darligi primer sikayetleriyle gogus hastaliklari poliklinigine basvuran ve KOAH tedavisi alan daha sonra klinigimizce konsulte edilen 51 yasinda PTK olgusu sunulmustur. Yapilan fizik muayenede tiroid kartilaj seviyesinde, orta hattin saginda, 3x3 cm boyutlarinda, sert kitle palpe edildi. Direkt laringoskopide larengeal lumeni sagdan daraltan, subglottik vejetan kitle saptandi. Boyundaki kitleden alinan ince igne aspirasyon biyopsi sonucu malign kuskulu sitoloji olarak geldi. Suspansiyon laringoskopi ile larenksteki vejetan kitleden alinan biyopsi papiller tiroid karsinom olarak rapor edildi. Hastaya total tiroidektomi, total larenjektomi, bilateral fonksiyonel boyun diseksiyonu uygulandi. Cerrahi sonrasinda 131I ve tiroid replasman tedavisine alindi. Solunum sikintisi ve seste bogukluk sikayetleri ile basvuran hastada larenksin PTK ile invazyonu da ayirici tanida dusunulmelidir. Anahtar kelimeler: Papiller tiroid karsinomu, Larenks, Total larenjektomi, Dispne Abstract Thyroid papillary carcinoma leading to dispnea Papillary thyroid carcinoma (PTC), metastasizes and invades primarily spreading through lymphatics. For this reason, patients mostly presents with the complaints of neck mass. PTC rarely spreads to larynx by direct invasion or by metastasis. Symptoms like hoarseness and dyspnea can accompany to the mass in the neck. In this study, a case at 51 taking current COPD treatment and with PTC who admitted to the hospital with hoarseness and dyspnea was presented. In physical examination, a rigid mass with 3 x 3 cm of diameter was palpated in the right neck, at the level of the thyroid cartilage. In direct laryngoscopy, a subglottically located vegetan mass which narrowed the laryngeal lumen from right was determined. Fine needle aspiration biopsy reealed a suspicios malignancy. Biopsy which was taken from the vegetan mass with direct laryngoscopy method resulted in papillary thyroid carcinoma. The patient underwent an operation of total laryngectomy, total thyroidectomy and bilateral functional neck dissection. After the surgery, 131I and thyroid replacement treatment was administered to the patient. PTC invasion to larynx must be kept in mind in differential diagnosis when a patient applies to the clinic with dyspnea and hoarseness Key words: Papillary thyroid carcinoma, Larynx, Total laryngectomy, Dispnea