Tahir Patiroglu

General features of gastric carcinomas and comparison of HSP70 and NK cell immunoreactivity with prognostic factors

During the period of 1996–1998 ninety-four gastrectomy specimens with gastric carcinoma referred to Erciyes University, Medical Faculty, Department of Pathology, were examined histopathologically, histochemically and immunohistochemically. General characteristics of gastric carcinomas and prognostic factors were studied. According the Lauren classification, of the 94 cases of gastric carcinomas, 56 were intestinal type, 21 were diffuse type and 17 were mixed type carcinoma. The association rates of Helicobacter pylori, chronic atrophic gastritis and intestinal metaplasia with gastric carcinomas were high. There was strong immunorectivity with HSP70 in 62,5% of the intestinal type carcinomas. This ratios were lower in diffuse and mixed type carcinomas (p<0.05). The more tumor size and invasion depth increased, the more HSP70 immunoreactivity was obtained (p<0.05). HSP70 immunorectivity was considerably higher in the patients having lymph node metastasis and vascular invasion (p<0.05). It was found that the NK cell number was low in the tumor but higher around the tumor in early gastric carcinomas, compared with advanced carcinomas (p>0.05). In the tumors larger than 10 cm with vascular invasion, NK cell number was lower around the tumor (p>0.05). Defining prognostic factors of gastric carcinomas is of importance to clinicians. It is thought that HSP70 immunoreactivity, besides invasion depth, lymph node metastasis, vascular invasion, tumor size and inflammatory reaction against the tumor, is important in prognosis and associated with advanced stage.

Lymphocytic hypophysitis in a patient with Graves’ disease

A case of lymphocytic hypophysitis is described in a patient with Graves’ disease and diabetes mellitus. The 62-year-old man was admitted to hospital with the complaints compatible with hyperthyroidism in April 1993. His medical history, physical examination, thyroid function tests, thyroid scintigraphy and thyroid ultrasonography revealed Graves’ disease. The patient had also suffered from diabetes mellitus for three years. After this, the patient’s progress was not monitored for two years. The patient presented himself again in September 1995 with complaints of hypothyroidism, hypogonadism and hypoadrenalism. Hormonal investigation showed panhypopituitarism. A magnetic resonance imaging of the pituitary gland disclosed an enlarged pituitary and a thickened infundibulum. The high intensity signal of the neurohypophysis was absent. Transsphenoidal hypophysectomy was performed which revealed a grey-white, relatively avascular pituitary mass. Histology showed diffuse infiltration of the anterior pituitary by numerous lymphocytes. The neurohypophysis also showed evidence of lymphocytic infiltration. On the basis of these findings we suggest that lymphocytic hypophysitis may be associated with Graves’ disease.

Hydatic Cyst in the Thyroid Gland Diagnosed by Fine-Needle Aspiration Biopsy

A 33-year-old man was admitted with a swelling in the right lobe of the thyroid gland of 1 years duration. Laboratory investigations and thyroid function tests were normal. Thyroid scanning showed a cold nodule in the lower pole of the right thyroid lobe. Thyroid ultrasonography showed multiple cystic nodules in the thyroid gland. To make a differential diagnosis of the thyroid nodule, fine-needle aspiration biopsy (FNAB) was performed and hydatic cyst of the thyroid gland was diagnosed. Subtotal thyroidectomy was carried out and histopathologic examination confirmed the diagnosis. During aspiration biopsy, the patient did not present a clinical picture of anaphylactic reaction. To our knowledge, this is the first case of thyroid hydatic cyst diagnosed by FNAB reported in the literature.

Colonic subepithelial collagenous thickening in diabetic patients

PURPOSE: This study was designed to investigate the effect of intestinal subepithelial collagenous thickening on diabetic diarrhea because one of the seven patients diagnosed with collagenous colitis was diabetic. METHODS: Rectosigmoidoscopic rectal biopsies were taken from 50 diabetic patients (8 with and 42 without diarrhea), 20 nondiabetic patients with diarrhea, and 10 healthy patients. Histopathologic examinations and measurements of subepithelial collagen layers were performed on these biopsies. RESULTS: In diabetic patients who had diarrhea, the subepithelial collagen layer (SCL) was thicker than it was in diabetics without diarrhea (P<0.05). In diabetic groups, the SCL was thicker than it was in both nondiabetics with diarrhea and those without diarrhea (P<0.05). There was no statistical difference between nondiabetics with diarrhea and those without (P>0.05). There was no correlation between collagen thickness, age, and diabetes duration (P>0.05). CONCLUSION: It was concluded that there was a thickening of the colonic SCL in diabetic patients.

Recurrent Pulmonary Alveolar Proteinosis Secondary to Agammaglobulinemia

Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of surfactant derived material in the lung of patients. PAP is rare in children. The patient presented with respiratory failure. In the history she was diagnosed with agammaglobulinemia at 8 months of age and has been treated by IVIG once in a month. She had two pulmonary alveolary proteinosis attacks before. Chest X‐ray showed bilateral diffuse infiltrates. Initial diagnosis were pneumonia, ARDS, and lung edema. Whole‐lung lavage revealed lipoproteinaceous material similar to surfactant. This findings and high level of LDH was as evaluated pulmonary alveolary proteinosis. She discharged from the hospital without any respiratory complication on the ninth day. This is the first case report recurrent PAP associated with agammaglobulinemia. Pediatr Pulmonol. 2008; 43:710–713.

Primary hepatic carcinosarcoma

BACKGROUND Primary hepatic carcinosarcoma is a rare malignant tumor containing an intimate mixture of carcinomatous and sarcomatous elements. Reports on risk factors, epidemiology, and pathogenesis of the tumor as well as the experience in its treatment are limited. METHOD We present a case of primary carcinosarcoma of the liver in a 69-year-old man who complained of right hypochondrial pain and weight loss for two months. RESULTS Magnetic resonance imaging revealed a 14 x 12 cm mass in segments 7-8 and 4 of the liver with vena hepatica invasion. An ultrasonography-guided biopsy showed osteoid tissue without osteoblastic rimming. Vascular structures accompanied the osteoid tissue. The patient underwent surgery after a diagnosis of hemangioma. Intraoperative frozen sections revealed a carcinosarcoma associated with an osteosarcoma and cholangiocellular carcinoma components. CONCLUSIONS Preoperative diagnosis of this rare primary hepatic malignant tumor may be difficult by biopsy owing to intratumoral heterogeneity. Highly mature areas of the osteosarcomatous component may lead to misdiagnosis of metaplastic bone tissue. Clinicopathologic features of this rare entity are discussed.

Congenital Acute Lymphoblastic Leukemia: Report of a Case with Leukemia Cutis

Congenital leukemia is an extremely rare disease, diagnosed at birth or within the first month of life. Most of the neonatal cases reported have acute nonlymphoblastic (acute monoblastic or myelomonoblastic) leukemia, in contrast to the predominance of acute lymphoblastic leukemia found in later childhood. Acute lymphoblastic leukemia (ALL) may occur but is exceedingly rare, most often of B cell lineage, and with a worse prognosis than childhood ALL.1 Generally, cases present with marked leukocytosis, petechia, ecchymoses, and extramedullary involvement, with massive hepatosplenomegaly, cutaneous nodules, and central nervous system leukemia. The clinical findings of neonatal leukemia are variable. Often the disease is characterized by a rapid downhill course, but it may be unpredictable. Some neonates show signs of leukemia at birth and die shortly thereafter, while others appear normal following delivery but clinical and hematologic problems develop later. In a third group, leukemia is not discovered until the third to sixth week of life, with a history suggestive of hematologic abnormalities dating back a few weeks earlier.2 We describe a case of congenital pre–B-cell ALL in a newborn female baby with striking features of leukemia cutis.

Hashimoto thyroiditis associated with ataxia telangiectasia.

Abstract Ataxia telangiectasia is a rare genetic disease characterized by neurological manifestations, infections, and cancers. In addition to these cardinal features, different autoimmune diseases can be seen in patients with ataxia telangiectasia. Although there were reports of positive autoimmune thyroid antibodies associated with ataxia telangiectasia, to our knowledge, we report the first cases of nodular Hashimoto thyroiditis in two patients with ataxia telangiectasia in the English medical literature. These cases illustrate that despite the rarity of nodular Hashimoto thyroiditis associated with ataxia telangiectasia, physicians should be aware of this possibility. Furthermore, thyroid examination of patient with ataxia telangiectasia is recommended for early diagnosis.

[Retrospective evaluation of the alveolar echinococcosis cases between 1980-2010 in Erciyes University Hospital].

OBJECTIVE Alveolar echinococcosis is an uncommon parasitic disesae confined to the Northern Hemisphere. There is limited data regarding the incidence of the disease in Kayseri. METHODS Clinicopathologic features of the cases with the diagnosis of alveolar echinococcosis reviewed between 1980-2010. RESULTS Twenty-nine cases of alveolar echinococcosis were found. There were no significant distribution differences during the study period. 28 of the 29 cases were localised in the liver, whereas one case was localised in the omentum. Sixteen of the 29 cases were male (55%) and 13 were female (45%). The age distribution of these cases varied between 33 and 80. Thirteen cases resided in Kayseri, 2 cases resided in Erzurum, 1 each case resided in Adana, Ardahan, Kars, Niğde, Nevşehir and Yozgat. We could not obtain information from the remaining 8 cases. Abdominal pain was the main symptom in 8 cases, jaundice in 2 cases and fatigue and fever in one case on admission. One case was detected incidentally. All of the cases were diagnosed by histologic examination. CONCLUSION The data about the alveolar echinococcosis is limited due to its low prevelance. Alveolar echinococcosis cases were detected in Kayseri with a lower incidence than in the East Anatolian region. This report will add data about the incidence of the alveolar echinococcosis.

Regression of Steatohepatitis-Related Cirrhosis

The authors document regression of cirrhosis in an obese 56-year-old man after significant weight loss by sequential liver biopsies. The patient had a known history of steatohepatitis. His initial laboratory workup 6 years earlier revealed elevated liver enzyme activities and blood triglyceride levels, and negative viral hepatitis serology screen. A liver biopsy at that time showed histological features consistent with precirrhotic stage of active steatohepatitis. A liver biopsy performed 4 years later revealed progression of the disease to cirrhosis. Following this diagnosis he went on a special strict diet and lost 49 kg. His body mass index decreased from 46 to 28 during a 2-year period and his liver enzyme activities returned to normal. A liver biopsy at this time demonstrated significant regression of the liver fibrosis and disappearance of the steatosis and necroinflammation. In conclusion, massive weight loss resulted in resolution of liver fibrosis in this obese patient with steatohepatitis-related cirrhosis.