Peyker Demireli

Expression of matrix metalloproteinases (MMP‐2, MMP‐3, and MMP‐9) and fibronectin in lichen planus

Background:  Keratinocyte damage and lichenoid‐interface reaction are the two major pathologic findings in lichen planus (LP). Matrix metalloproteinases (MMPs) are proteinases that participate in extracellular matrix (ECM) degradation and may play an important role in basal membrane (BM) damage in LP. Fibronectin (FN) mediates a variety of cellular interactions with ECM and plays important roles in cell adhesion, migration, growth and differentiation.

Examination of bcl‐2 and p53 expressions and apoptotic index by TUNEL method in psoriasis

Background:  Psoriasis is characterised by hyperproliferation and by aberrant differentiation. Blockage of the normal apoptotic process is one of the factors implicated in the pathogenesis.

A case of mycetoma successfully treated with itraconazole and co‐trimoxazole

A 29‐year‐old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill‐defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomoris methenamine silver stain. As minimal regression was seen on MRI with 4 months’ itraconazole (200 mg day−1) treatment, co‐trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.

Long-term effect of pentoxifylline and NG-nitro-L-arginine methyl ester on testicular function in spermatic artery ligation

Objective. To investigate long-term testicular function in pentoxifylline- and NG-nitro-L-arginine methyl ester (L-NAME)-treated rats prior to spermatic artery ligation by assessing serum inhibin B concentration, a reliable endocrine marker of spermatogenesis. Material and methods. Forty prepubertal rats were randomly divided into four equal groups. Right orchiectomy was performed in all rats. Intraperitoneal pentoxifylline and L-NAME were administered to Groups 1 and 2, respectively. Rats in Group 3 did not receive any medication. The spermatic arteries of the left testes were ligated in all groups with the exception of the sham controls (Group 4). One month postoperatively, a histopathologic evaluation was performed and serum inhibin B concentrations were assessed in all groups. Results. There were no statistically significant differences in testis size or serum inhibin B concentration between Groups 1, 2 and 3. However, the testes were significantly smaller (p1=0.01, p2=0.01, p3=0.01) and serum inhibin B levels were significantly decreased (p1=0.01, p2=0.01, p3=0.01) when Groups 1–3 were compared with Group 4. Histopathological evaluations revealed necrosis and calcification in all specimens with the exception of the sham-operated group. Conclusions. The long-term outcomes of spermatic artery ligation were poor and testicular atrophy developed in rat testes in all study groups. Testicular atrophy could not be reversed by preoperative administration of pentoxifylline and L-NAME.

Flexural follicular lichen planus.

A 71-year-old woman presented with a 2-month history of itchy papules in the axillae, submammary region and groin. She had been taking digoxin for cardiac insufficiency, metformin hydrochloride for type II diabetes mellitus, quinapril hydrochloride for hypertension and atorvastatin calcium for hyperlipidaemia. On physical examination, fine scaly violaceus papules tending to coalesce bilaterally in the axillae, submammary region and groin were seen (Fig. 1). Scarce tiny red papules on the abdomen and brownish macules in the submammary region were also seen. Oral and genital mucosae, nails and hair were not involved. Histological examination of a skin biopsy taken from the submammary lesions revealed hyperkeratosis, hypergranulosis, acanthosis and basal-layer destruction in the epidermis, chronic inflammatory-cell infiltration predominantly around hair follicles, and melanin pigment incontinence in the superficial dermis (Fig. 2). Results of full blood count, erythrocyte sedimentation rate and routine blood investigations were within normal limits except for serum cholesterol and triglyceride levels. Results of serological tests for hepatitis B and C infections were negative. The patient was started on oral fexofenadine 180 mg ⁄ day and fluticasone propionate ointment, and all lesions improved with 3 weeks, leaving brown macules at their sites. There was no recurrence during 18 months of follow-up. There are many clinical variants of lichen planus (LP) such as linear, annular, hypertrophic and ulcerative. Rarely, flexural sites like axillae, groins and inframammary regions may be involved. Reports on flexural LP in the literature are either associated with lichen planus pigmentosus (LPP) or erosive variants. Pock et al. reported seven patients with LPP showing a regressive lichenoid reaction with intensive pigment incontinence and suggested that compensatory keratinocyte proliferation cannot develop in the presence of immediate intensive hydropic degeneration. Erosive LP is known to occur on mucosal surfaces but two cases affecting primarily flexural sites have been reported previously. Localization of LP to follicles is described clinically as lichen planopilaris. Three clinicopathological variants have been described. The first is characterized clinically by individual keratotic follicular papules and histologically by a lichenoid inflammatory cell infiltrate confined to the

Chondroid chordoma of the thoracic spine: case report

Sir, Chordomas are slow-growing, locally destructive tumours derived from remnants of the notochord. They occur mostly along the axial skeleton. The thoracic region is the least common area of involvement within the spine. Chondroid chordoma is defined as a chordoma with prominent cartilaginous foci, an entity which has better prognosis than classical chordoma. To our knowledge this is the first published case of chondroid chordoma in the thoracic spine. Chondroid chordoma should be considered in differential diagnosis of classical chordoma and other thoracic tumours. A 50-year-old male presented with progressive hemiparesia developing within 1 month and was admitted to the neurosurgery department of the Celal Bayar University Hospital. There was no history of trauma and his laboratory findings were normal. On computed tomography (CT) an extradurally located soft tissue mass with granular calcifications and relative stenosis of the spinal canal were seen. Lytic multiple lesions were approximately 20610 mm in size on both sides in T7, T8, T9 vertebral corpuses. On T1 weighted magnetic resonance imaging (MRI) the soft tissue mass was of predominantly low signal intensity and was causing significant compression of the cord at the level of T8. It was 40 mm in dimension at the saggital plane. The mass showed marked enhancement after contrast administration (Fig. 1). The patient underwent surgical excision as T8 corpectomy and stabilisation, followed by radiotherapy. There was no sign of recurrence 14 months post-operatively. Macroscopically, the mass was an extramedullar, encapsulated, grey-white lobular and cystic neoplasm. Microscopically, it contained areas showing chords or nests of cells with partly vacuolated cytoplasm (physaliphorous cells) embedded in a myxoid matrix and extensive cartilage formation with degenerative calcification (Fig. 2). Immunohistochemically, neoplastic cells showed strong staining for S-100 protein, vimentin, epithelial membrane antigen (EMA), pancytokeratin (Fig. 3), cytokeratin (CK)7 and CK20. Cartilaginous areas were negative except for S100 protein and vimentin. The mass was diagnosed as chondroid chordoma with these findings. Chordomas are rare locally aggressive tumours which arise from the primitive notochord. They may develop at any point along the original notochordal tract and have a slow growth pattern. Patients usually present with symptoms related to compression of the involved neural structures or other organs. Chondroid chordoma is an uncommon variant and is defined as a chordoma with prominent cartilaginous foci. Chordomas most commonly arise in the sacro-coccygeal or spheno-occipital regions. Spinal chordomas arise more frequently in the cervical than

An unusual association of Goldenhar syndrome

Goldenhar syndrome is well known for its classical triad of epibulbar dermoids or lipodermoids, auricular appendages and pretragal fistulas. Here we report a case of Goldenhar syndrome with an unusual association of a fibroepithelial polyp attached to a limbal dermoid. A case of Goldenhar syndrome in a 5-month-old male infant presented with the features of a fibroepithelial polyp attached to a limbal dermoid, right-sided polydactylia with hypoplastic thumb, and accessory preauricular appendages on the left side. The association of a fibroepithelial polyp attached to a limbal dermoid with Goldenhar syndrome is a rare report in the literature. In these cases, regular follow-up with an ophthalmologist is important to monitor the visual development of the patient. Ideally, a multidisciplinary approach is required to manage the other associated anomalies.