Ozlem Aydin

Actinomycosis of the middle turbinate : an unusual cause of nasal obstruction

Actinomycosis is a rare chronic infectious disease caused by Actinomyces israelii, which is an anaerobic filamentous, gram-positive saprophyte organism of the oral cavity. Historically, these bacteria were known as fungi because of their light microscopic appearance. Actinomycosis consists of three different forms: cervico-facial (the most common form), abdominal and pulmonothoracic. It commonly involves the head and neck region including the mandible, paranasal sinuses, lacrimal gland, parotid gland and orbit. Poor oral hygiene and dental diseases have been known to be the source of actinomycosis. Actinomycosis is diagnosed with positive culture or detecting actinomyces colonies and sulfur granules in histopathologic specimens. The treatment of choice is surgical excision of the lesion and long-term penicillin therapy. Actinomycosis of the internal nose is extremely rare. There was only one nasal septum actinomycosis reported in the English literature, but there was no lateral nasal wall actiomycosis regarding the turbinate. Therefore, actinomycosis should not be overlooked for the differential diagnosis of intra-nasal lesions for the initiation of appropriate and early treatment.

Bronchiolitis obliterans organizing pneumonia associated with sulfasalazine in a patient with rheumatoid arthritis

Pulmonary toxicity and blood dyscrasias are rare side effects of sulfasalazine. Pulmonary pathology is variable, the most common being eosinophilic pneumonia with peripheral eosinophilia, and interstitial inflammation with or without fibrosis. We here present the case of a 68-year-old female patient treated for 6 months with sulfasalazine for rheumatoid arthritis. On laboratory examination, eosinophil count was 97×103 mm3. Thorocoscopic biopsy was performed . Histopathologic diagnosis was bronchiolitis obliterans organizing pneumonia (BOOP). This is the first case in the literature to present with sulfasalazine-induced BOOP in a patient with seronegative RA.

The Effects of Methyl Methacrylate on Nasal Cavity, Lung, and Antioxidant System (An Experimental Inhalation Study)

Methyl methacrylate (MMA) is a monomer, commonly used in neurosurgery, orthopedic surgery, and in dental clinics. The adverse effects of this monomer are well described in the literature. This study was designed to evaluate the effects of MMA on nasal cavity, lung, and antioxidant status. For this purpose, two experimental groups of rats were exposed to MMA (at 1000 ppm, 6 h/day, 5 days/week for 4 weeks) by inhalation under poor (group A, n = 12) and normal ventilation (group B, n = 11) conditions. A control group (group C, n = 10) received normal air. Degeneration of olfactory epithelium, bronchopneumonia , interstitial pneumonia, hemorrhage, atelectasis, edema, emphysema, and bronchial epithelial hyperplasia were observed in groups A and B. Emphysema was the most common lesion. Bronchopneumoni a with abscesses was only observed in group A. Glutathione levels were signifi cantly decreased and malondialdehyde levels were signifi cantly increased in group A. No signifi cant difference was observed in superoxide dismutase levels between the groups. The data presented indicate that before using MMA, adequate protection systems should be in place to prevent occupationally related MMA respiratory-tract injuries.

Clinical importance of “low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H)” terminology for cervical smears: 5-year analysis of the positive predictive value of LSIL-H compared with ASC-H, LSIL, and HSIL in the detection of high-grade cervical lesions with a review of the literature

OBJECTIVE We compared follow-up biopsy findings and positive predictive values (PPVs) for cervical intraepithelial neoplasia 2 or worse (CIN 2+) in cases that were cytologically interpreted as low-grade squamous intraepithelial lesions (LSIL); high-grade squamous intraepithelial lesions (HSIL); LSIL, cannot exclude HSIL (LSIL-H); and atypical squamous cells, cannot exclude HSIL (ASC-H) during a 5-year period to evaluate the clinical significance of LSIL-H as a distinct cytological category. METHODS All Pap tests with a diagnosis of LSIL-H, ASC-H, LSIL, and HSIL (January 1, 2004-July 20, 2009) were retrieved from our computer database. PPVs of cytological diagnostic categories for detecting CIN 2+ were compared. RESULTS Of all Pap tests (n=163,315), 1713 cases that had histological confirmation were included in the study. The LSIL-H diagnosis represented only 0.23% (n=387) of all Pap tests and 9.3% of all cytological SILs (n=4119). LSIL alone was associated with a significantly lower risk for CIN 2+ (PPV=21%) as compared with LSIL-H (PPV=40%). The results showed that the risk of CIN 2+ was intermediate for LSIL-H compared with unqualified LSIL (p<0.005) and HSIL (p<0.0001). CONCLUSIONS The current study is one of the largest LSIL-H series to date. Because of its intermediate status between LSIL and HSIL, LSIL-H should be considered a distinct diagnostic category, and specific cytomorphological criteria should be defined. The results suggest that an LSIL-H diagnostic category would aid in more rapid detection and treatment in some patients with CIN 2+.

Bcl-2, iNOS, p53 and PCNA expression in normal, disordered proliferative, hyperplastic and malignant endometrium

We attempted to determine Bcl‐2, inducible nitric oxide synthase (iNOS), p53 and proliferating cell nuclear antigen (PCNA) expression, and the relationships between them, in endometrioid adenocarcinomas and precursor lesions. Expression of Bcl‐2, iNOS, p53 and PCNA were investigated immunohistochemically in 91 samples from benign (proliferative (pEM), secretory (sEM), disordered proliferative (dEM), inactive/atrophic (aEM), hyperplastic endometrium) and malignant endometrial tissue. Staining scores for Bcl‐2 in the dEM, endometrial hyperplasia (EMH) and endometrioid cancer (ECA) groups were higher than in the pEM group (P = 0.004; P = 0.036 and P = 0.020, respectively). A significant difference in proliferating cell nuclear antigen staining was found between simple and complex EMH samples (P = 0.000). An inverse relationship was found between iNOS and p53 in the hyperplasia group (r = −0.533, P = 0.019). While a significant difference was found in p53 staining in ECA between the pEM, dEM and EMH groups, no such difference was found in iNOS staining. In addition, there was no direct relationship between iNOS and p53 in the ECA group. It was concluded that the interaction between iNOS, p53 and Bcl‐2 in proliferative processes in the development of type 1 endometrioid adenocarcinomas is different from that in tumors originating in other organs.

Prevention of laryngotracheal stenosis with carnitine after tracheotomy: an experimental study on rats

OBJECTIVE We investigated the effect of carnitine on wound healing of trachea in tracheotomyzed rats. This study was undertaken to test the hypothesis that treatment with carnitine would protect the wound tissue, which was evaluated by measuring nitrite and nitrate, thus nitric oxide, malondialdehyde and cholinesterase in blood, and examining the histopathological changes. METHODS Standard vertical tracheotomy was performed on 24 Wistar-Albino type rats. Then the animals were randomly divided into two groups; group A (the study group) was administered intraperitoneal carnitine 100 mg/kg for 10 days; group B (the control group) was administered intraperitoneal saline for 10 days. On the 10th day, all animals were decanulated. Three weeks later, cardiac blood samples were taken for biochemical assays and trachea specimens were harvested for histopathologic examination. RESULTS In the carnitine-administered group, granulation tissue thickness resulting from the wound healing in the level of tracheotomy incision was lower compared to the control group (P < 0.01). When serum malondialdehyde levels were considered, a lower malondialdehyde level was found in the carnitine-administered group (P < 0.01). However, serum nitric oxide levels were close to each other in both groups (P > 0.05), while serum cholinesterase level was higher in the carnitine-administered group than in the control group (P < 0.01). CONCLUSION Carnitine treatment partially prevents and significantly reduces the severity of tracheotomy induced laryngotracheal stenosis.

Intramuscular benign lipoma of the sternocleidomastoid muscle: a rare cause of neck mass

Intramuscular benign lipoma commonly is found on the extremities, but is extremely rare in the head and neck region. Intramuscular type lipomas arise between the muscle fibers and pass through the intermuscular septa, infiltrating the surrounding tissue. A 29-year-old male patient presented with the complaint of a painless and slowly growing lateral neck mass on the left side. Physical examination revealed a 4×5-cm mass adjacent to the sternocleidomastoid (SCM) muscle. CT examination revealed a lobulated, well-circumscribed 5.5×2.5-cm diameter mass with adipose tissue signal density inside the SCM muscle. The surgical exploration of the mass was done under general anesthesia, and it was excised totally. Recurrence was not seen in the 3-year follow-up. This rare entity should be considered in the differential diagnosis of intramuscularly located neck masses. Complete removal of the tumor can only succeed if planned and performed after a thorough preoperative clinical and radiological assessment in order to prevent recurrences.

Immunohistological analysis of mast cell numbers in the intratumoral and peritumoral regions of prostate carcinoma compared to benign prostatic hyperplasia.

Recently, some studies reported the presence of mast cells in various malignancies and their role in tumor growth. The aim of the study was to determine the utility of mast cell numbers in evaluating benign and malignant prostate lesions, and to ascertain whether there are variations in the numbers of mast cells with the Gleason grade. The relationship between mast cell numbers and patient age was also investigated. Retrospectively, 104 prostate specimens were examined for the presence of mast cells. The study group consisted of 57 benign prostatic hyperplasias and 47 prostate carcinomas. The paraffin sections were stained with anti-human mast cell tryptase immunohistologically. The numbers of positively staining cells in five high-power fields were counted, and their mean was calculated. There was no relationship found between mast cell numbers and age statistically. The mean mast cell numbers of the intratumoral region were significantly different from those of the peritumoral region (p = 0.0001). While the difference between benign hyperplasia and the intratumoral region was found to be significant (p = 0.0001), no difference between hyperplasia and the peritumoral region was noted (p = 0.762). There was no statistical difference between Gleason score groups (p = 0.452), and there was no interaction between score groups and intraperitumoral regions (p = 0.355).

Persistent pupillary membranes in 3 siblings

We report 3 siblings from a nonconsanguineous white family with bilateral persistent pupillary membranes with dissimilar forms of severity. Two of the patients required no treatment; 1 was treated surgically for occlusion of the pupillary axis and moderate visual acuity decrease. Anterior segment examination was otherwise normal in the siblings. Although persistent pupillary membranes are usually sporadic, cases in which they are associated with other anterior chamber abnormalities might be inherited autosomal dominant. To our knowledge, this is the first report of a familial isolated persistent papillary membrane case with no other anterior chamber abnormality.

Salivary duct carcinoma ex pleomorphic adenoma: Analysis of the findings in fine-needle aspiration cytology and histology

Salivary duct carcinoma (SDC) is an uncommon and highly aggressive neoplasm that reveals histopathologic features resembling infiltrating duct carcinoma of the breast and prostate. SDC arising on the basis of preexisting pleomorphic adenoma (PA) is very rare. This report describes the fine‐needle aspiration (FNA) cytology of a case of SDC ex PA. FNA smears were cellular with cells with large, pleomorphic nuclei, some prominent nucleoli, and finely vacuolated cytoplasm. The neoplastic cells were forming groups, sheets, and papillary structures and a cribriform pattern was present in some sheets. Mitotic figures were frequently seen. Necrosis was prominent in the background. Histologic sections of the tumor revealed areas of comedo carcinoma, papillary carcinoma, and infiltrative carcinoma as well as multiple foci of PA. The presence of a cribriform pattern, tumor cells resembling breast ductal carcinoma cells, and a necrotic background are helpful features for an accurate cytodiagnosis of SDC. Diagn. Cytopathol. 1998;19:201–204.