Semsi Altaner

Value of Dynamic Contrast-Enhanced MRI and Correlation with Tumor Angiogenesis in Bladder Cancer

OBJECTIVE The aim of this study was to investigate dynamic contrast-enhanced MRI (DCE-MRI) for the noninvasive measurement of bladder cancer angiogenesis by correlation with microvessel density, histologic grade, and tumor staging, and to predict the outcome of local recurrence. MATERIALS AND METHODS Twenty-four patients with bladder cancer were examined using DCE-MRI. Hemodynamic parameters obtained by DCE-MRI included peak time enhancement in the first minute (E(max/1)) after contrast administration, second minute (E(max/2)), third minute (E(max/3)), fourth minute (E(max/4)), and fifth minute (E(max/5)), and the steepest slope. Microvessel density was identified by immunostaining of endothelial cells using FVIII-related antigen. The Mann-Whitney U test, multivariate discriminant analysis, Spearmans correlation coefficient, and analysis of variance were used for statistical analysis. RESULTS Correlation was seen between DCE-MRI parameters (E(max/1) and steepest slope) and microvessel density (p < 0.05). E(max/1) and steepest slope were found to have a statistically significant correlation with histologic grade (p < 0.05 and p < 0.01, respectively). A significant difference was seen between groups of patients with and without local recurrence with regard to two of the DCE-MRI parameters (p < 0.05 for E(max/1) and E(max/2)). CONCLUSION The contrast enhancement patterns on DCE-MRI are influenced by tumor angiogenesis, as reflected by elevated microvessel density expression. Therefore, they are valuable indicators for assessing tumor angiogenic activity and tumor neovascularization in bladder cancers.

Inflammatory pseudotumor of the spleen with EBV positivity: report of a case

Inflammatory pseudotumor (IPT) of the spleen is a rare benign tumor with unknown etiology. It causes problems in the diagnosis because of mimicking some hematopoetic malignancies. Here we report the case of a 36‐yr‐old woman complaining of nausea and insomnia. Laboratory investigations were limited to increase of leukocyte and thrombocyte count. Ultrasonography and magnetic resonance (MR) imaging showed circumscribed solid lobulated mass, measuring about 6.5 cm in diameter, located in the dorsal region of the spleen. Splenectomy was performed with the differential diagnosis including hamartoma and lymphoma of the spleen. Histological examination of the sharply demarcated splenic mass consisted of myofibroblasts and admixture of inflammatory cells. Immunohistochemistry and in situ hybridization were performed. IPT of the spleen was diagnosed. Epstein–Barr virus (EBV) was detected in the tumor by in situ hybridization. This rare entity is presented because of its clinical, radiological and pathological difficulties in the differential diagnosis.

Prognostic value DCE-MRI parameters in predicting factor disease free survival and overall survival for breast cancer patients

PURPOSE The aim of the study is to assess the predictive power of DCE-MRI semi-quantitative parameters during treatment of breast cancer, for disease-free (DFS) and overall survival (OS). MATERIALS AND METHODS Forty-nine women (age range, 28-84 years; mean, 50.6 years) with breast cancer underwent dynamic contrast enhancement MRI at 1.0T imaging, using 2D FLASH sequences. Time intensity curves (TICs) were obtained from the regions showing maximal enhancement in subtraction images. Semi-quantitative parameters (TICs; maximal relative enhancement within the first minute, E (max/1); maximal relative enhancement of the entire study, E(max); steepest slope of the contrast enhancement curve; and time to peak enhancement) derived from the DCE-MRI data. These parameters were then compared with presence of recurrence or metastasis, DFS and OS by using Cox regression (proportional hazards model) analysis, linear discriminant analysis. RESULTS The results from of the 49 patients enrolled into the survival analysis demonstrated that traditional prognostic parameters (tumor size and nodal metastasis) and semi-quantitative parameters (E(max/1), and steepest slope) demonstrated significant differences in survival intervals (p<0.05). Further Cox regression (proportional hazards model) survival analysis revealed that semi-quantitative parameters contributed the greatest prediction of both DFS, OS in the resulting models (for E(max/1): p=0.013, hazard ratio 1.022; for stepest slope: p=0.004, hazard ratio 1.584). CONCLUSION This study shows that DCE-MRI has utility predicting survival analysis with breast cancer patients.

Colonic Metastasis from Carcinoma of the Breast that Mimicks a Primary Intestinal Cancer

Although the lung, liver, or bones are the most common location for distant metastases in breast cancer patients, metastases to the intestinal tract are very rarely recognized in the clinic. We will present an unusual case of colonic metastasis from a carcinoma of the breast that mimics a primary intestinal cancer, along with a through review of English language medical literature. Despite the fact that isolated gastrointestinal (GI) metastases are very rare and much less common than benign disease processes or second primaries of the intestinal tract in patients with a history of breast cancer, metastatic disease should be given consideration whenever a patient experiences GI symptoms.

Curcumin attenuates the organ dysfunction caused by endotoxemia in the rat.

OBJECTIVE Curcumin has antioxidant, antitumor, and anti-inflammatory properties. However, it remains unknown whether curcumin has any protective effects on sepsis. The purpose of this study was to demonstrate whether curcumin prevents organ dysfunction in animals with sepsis. METHODS Rats were randomized into four groups. The control group (group I, n = 7) did not receive any treatment. The curcumin group (group II, n = 10) only received 1.2 g/kg of curcumin. Escherichia coli were injected into the remaining groups intraperitoneally after general anesthesia. Five hours after injection, 12 rats received placebo (group III), and 10 rats received 1.2 g/kg of curcumin (group IV) for 7 d. All rats were sacrificed on postsepsis day 8 and a midline laparotomy was performed. Livers, kidneys, and small bowels were excised for evaluation of the degree of inflammation and tissue alterations histopathologically. RESULTS In the liver, widespread hydropic degeneration of hepatocytes were seen in the sepsis group. There was no hydropic degeneration of hepatocytes and no portal inflammation in the sepsis/curcumin group. With respect to the small bowel, the sepsis group showed edema and prominent intraepithelial infiltration of neutrophil leucocytes and plasma cells. Inflammation and hyperemia in the lamina propria in the sepsis/curcumin group were less than those in the sepsis group. With respect to the kidneys, the sepsis group showed severe acute tubular necrosis that was more restricted in the sepsis/curcumin group than in the sepsis group. CONCLUSION Curcumin reduced organ dysfunction in rats with experimentally formed sepsis. We propose that curcumin may be useful in the therapy of organ dysfunction due to sepsis, shock, and other diseases associated with local or systemic inflammation.

Oncocytic Carcinoma of the Parotid Gland

Background: Oncocytic carcinoma is a rare tumor of major salivary glands. Despite being described 5 decades ago, not much is known about these rare tumors. Histochemical or electron microscopic confirmation of the oncocytic nature of the tumor cell is needed for differential diagnosis. The main treatment modality is surgery with or without adjuvant radiotherapy. Malignant oncocytomas have the potential risk of developing distant metastases and demand long term follow-up after therapy. Case Report: A 58-year old man presented with a recurrent mass in the left parotid gland with a prior diagnosis of monomorphic adenoma in the same localization which had been treated by tumor excision in July 2002. Left superficial parotidectomy followed by radiotherapy into tumor bed and upper neck were carried out in September 2004. To date, he has had no evidence of recurrence for 14 months. Conclusion: For an accurate approach in the management of patients, oncocytic adenocarcinoma should be considered in the differential diagnosis of lesions of the parotid gland, most of which are benign.

Amifostine use in radiation-induced kidney damage. Preclinical evaluation with scintigraphic and histopathologic parameters.

Purpose:To assess the degree of protective effects of amifostine on kidney functions via semiquantitative static renal scintigraphy and histopathologic analysis.Material and Methods:30 female albino rats were divided into three equal groups as control (CL), radiotherapy alone (RT), and radiotherapy + amifostine (RT+AMI). The animals in the CL and RT groups were given phosphate-buffered saline, whereas the animals in the RT+AMI group received amifostine (200 mg/kg) by intraperitoneal injection 30 min before irradiation. RT and RT+AMI groups were irradiated with a single dose of 6 Gy using a 60Co unit at a source-skin distance of 80 cm to the whole right kidney. They were followed up for 6 months. CL, RT, and RT+AMI groups underwent static kidney scintigraphy at the beginning of the experiment and, again, on the day before sacrificing. Histopathologically, tubular atrophy and fibrosis of the kidney damage were evaluated.Results:After irradiation, the median value of right kidney function was 48% (44–49%) and 50.5% (49%–52%) in RT and RT+AMI groups, respectively (p = 0.0002). Grade 1 kidney fibrosis was observed to be 60% in the RT group, while it was only 30% in the RT+AMI group. Grade 2 kidney fibrosis was 30% and 0% in the RT and RT+AMI group, respectively. Grade 1 tubular atrophy was 70% and 50% in the RT and RT+AMI group, respectively. Grade 2 tubular atrophy effect was the same in both groups (10%).Conclusion:Static kidney scintigraphy represents an objective and reproducible method to noninvasively investigate kidney function following irradiation. Amifostine produced a significant reduction in radiation-induced loss of renal function.Ziel:Beurteilung der protektiven Wirkung von Amifostin auf die Nierenfunktion mittels semiquantitativer statischer szintigraphischer und histopathologischer Analyse.Material und Methodik:30 weibliche Albinoratten wurden in drei Gruppen mit jeweils zehn Tieren aufgeteilt: Kontrolle (CL), alleinige Radiotherapie (RT) und Radiotherapie + Amifostin (RT+AMI). Die Ratten in der CL- und RT-Gruppe erhielten eine Plazebosalzlösung, die Ratten in der RT+AMI-Gruppe 200 mg/kg Amifostin intraperitoneal 30 min vor der Bestrahlung. Die rechten Nieren in der RT- und RT+AMI-Gruppe wurden mit 6 Gy Einzeldosis mit einem 60Co-Gerät bestrahlt. Die Nachbeobachtungszeit betrug 6 Monate. Eine Nierenszintigraphie wurde direkt vor der Bestrahlung und vor Sektion bei den Tieren der RT- und RT+AMI-Gruppe durchgeführt. Der Nierenschaden wurde in der histopathologischen Untersuchung mit Tubulusatrophie und Fibrose qualitativ beurteilt.Ergebnisse:Die mediane Nierenfunktion der rechten Niere betrug in der RT- und RT+AMI-Gruppe 48% (44–49%) und 50,5% (49–52%; p = 0,0002). Grad-1-Fibrose lag in der RT-Gruppe bei 60% und in der RT+AMI-Gruppe bei 30%. Grad-2-Fibrose betrug in der RT-Gruppe 30% und in der RT+AMI-Gruppe 0%. Tubulusatrophie Grad 2 war in beiden Gruppen vergleichbar (10%).Schlussfolgerung:Die statische Nierenszintigraphie ist eine objektive, wiederholbare und nichtinvasive Methode zur Beurteilung der Nierenfunktion nach Bestrahlung. Im Tiermodell konnte Amifostin die strahleninduzierten Nierenschäden verringern.

Multifocal mesenchymal hamartoma of the chest wall

Abstract:  Chest wall hamartomas are extremely rare. Frequently mesenchymal hamartomas are presented as a single mass and contain some primitive mesenchymal elements such as chondroid and trabecular bone structures. A 60‐year‐old man presented to hospital with chest pain. Thirteen years earlier, his CXR and thoracic CT showed three masses on the right and two masses on the left, but he had not received any treatment thereafter. His CT showed the same masses present 13 years earlier, but they were bigger and right thoracotomy was undertaken. At thoracotomy, two sections of the mass in the right posterior mediastinum and one section of the mass in the right apex were excised. They had an occasional bloody appearance and contained small cystic areas, and some areas were extremely hard. Microscopic examination showed that the lesions consisted of mature adipose tissue, a large number of veins of different diameters and collagen tissue. Besides, primitive mesenchymal elements, lymphoid cell accumulations and trabecular bone structures were seen focally. Bilateral chest wall hamartomas are extremely rare and may be confused with malignancy.

Protective Effects of L-Arginine on Rat Terminal Ileum Subjected to Ischemia/Reperfusion

Objectives: Studies have shown that nitric oxide (NO) may play a major role in sustaining mucosal integrity; however, NO has been also implicated in the pathogenesis of ischemia/reperfusion (I/R)–related tissue injury. We investigated the effects of L-arginine and NG-nitro L-arginine methyl ester (L-NAME) on the acetylcholine-induced contractile response of ileum and the levels of malondialdehyde (MDA) and reduced glutathione (GSH). Histopathological changes were also evaluated in ileal preparations. Materials and Methods: Male Wistar Albino rats were subjected to mesenteric ischemia (30 min) followed by reperfusion (3 hours). Four groups were designed: sham-operated control; I/R; I/R and L-arginine pretreatment; and I/R and L-NAME pretreatment. After reperfusion, ileum specimens were collected to determine the parameters mentioned above. Results: Following reperfusion, a significant decrease in acetylcholine-induced contractile response, an increase in lipid peroxidation, a decrease in GSH content, and mucosal damage of the ileal preparations were observed. We showed that decreased contractility, increased lipid peroxidation, and reduced GSH content have been reversed by L-arginine but not by L-NAME. Mucosal injury was significantly lowered in the L-arginine group. Conclusions: Treatment with L-arginine exerted a protective effect in intestinal I/R injury, which was mediated in part by regulating MDA and GSH levels, consequently ameliorating impaired contractile response and mucosal injury.

Nebulized surfactant as a treatment choice for otitis media with effusion: an experimental study in the rabbit

Exogenous surfactant can improve eustachian tube function in experimentally induced otitis media with effusion (OME). Performing tympanometric recordings, the efficacy of inhaled nebulized surfactant, as compared with inhaled nebulized physiological saline was investigated, for the treatment of OME experimentally induced in the rabbit by intrabullar inoculation of heat-killed Streptococcus pneumoniae. In addition, the histological changes in middle ears after the treatment were investigated in order to establish whether the pathological findings correlated with the results. Middle-ear pressure values before, and after, treatment were analyzed by the Wilcoxon statistical method, and the Mann-Whitney U test was used to compare the post-treatment values between groups. In all ears with OME in the affected animals, which were treated with nebulized surfactant inhalation, a positively significant (p<0.05) increase of pressure more than 20 daPa was recorded. In the control group, after inhalation of nebulized physiological saline, there was no positive increase in the affected middle-ear pressures; on the contrary, more negative pressure changes were recorded. In the histological evaluation, middle-ear epithelia and sub-epithelial space were normal in surfactant-treated ears with OME, whereas mucosal thickening with an oedematous sub-epithelial space containing occasional inflammatory cells and increases in connective tissue and vascularity, and effusions on the epithelial surface were present in the ears with OME in the control group. The significant improvement in the negative middle-ear pressure after nebulized surfactant treatment and the histological findings shown in our study can support the theory that surface-active agents are of importance in eustachian tube function even under pathologic conditions, such as OME.