Yasemin Yuyucu Karabulut

Clinical, histopathological, dermatoscopic and digital microscopic features of dermatofibroma: a retrospective analysis of 200 lesions

Dermatology literature lacks a study investigating both histopathological and dermatoscopic features of dermatofibroma.

Three different clinical faces of the same histopathological entity: hair follicle nevus, trichofolliculoma and accessory tragus.

BACKGROUND Hair follicle nevus is a rare, congenital hamartoma with follicular differentiation characterized histologically by numerous, tiny, mature hair follicles. Trichofolliculoma, the histopathological features of which are quite similar to those of hair follicle nevus, is also a hamartoma that differs from hair follicle. Accessory tragus is a relatively common, benign congenital abnormality of the external ear with an incidence rate of 1 to 10 per 1,000 live births. OBJECTIVE This study seeks to assess the discriminatory value of currently available, histological criteria in the differential diagnosis of hair follicle nevus, accessory tragi and trichofolliculoma. METHODS Twenty-one patients comprising 9 cases of hair follicle nevus, 8 accessory tragi patients and 4 trichofolliculoma cases, were recruited to perform the study. RESULTS There were 10 males and 11 females in the study group. No significant difference was observed between the three study groups in terms of age, gender or histopathological parameters such as density of hair follicles, subcutaneous fat score and presence of connective tissue framework. Cartilaginous component was seen in 8 cases that were diagnosed as accessory tragi, while central cyst and radiating hair follicles were seen in 4 cases which were diagnosed as trichofolliculoma. CONCLUSION The results of our study showed that diagnostic discrimination of these diseases could be made only with the clinicopathologic correlation because of their clinical and histopathological similarities.

A rare cause of dysphagia in children: lymphangiomatous polyp of the palatine tonsil.

Oropharyngeal and tonsillar masses are a very rare cause of dysphagia in children. In this article, we describe a rare cause of dysphagia in children, a lymphangiomatous lesion of the palatine tonsil, and discuss the clinical and histopathologic features of these lesions.

Single dose intratympanic mesna application inhibits propylene glycol induced cholesteatoma formation.

OBJECTIVE Mesna (i.e. sodium 2-mercaptoethanesulfonate; C2H5NaO3S2) has been used in otological surgery such as cholesteatoma dissection and tympanic membrane lateralisation in atelectatic ears. However, this study aimed to investigate its effect on cholesteatoma formation. METHODS A total of 20 Wistar rats were divided into two groups of 10 animals. The right and left ears of control animals were treated with saline (saline control group; n = 10 ears) and propylene glycol plus saline (propylene glycol control group; n = 10 ears), respectively. In the mesna group, both ears were treated with propylene glycol plus mesna (n = 20 ears). On days 1, 8 and 15, the saline control group had intratympanic injections of 0.2 ml saline and the propylene glycol control and mesna groups had intratympanic injections of 0.2 ml 100 per cent propylene glycol. On day 22, the propylene glycol control group had a single intratympanic injection of 0.2 ml saline and the mesna group had a single intratympanic injection of 10 per cent mesna. Animals were killed 12 weeks after the last injection and the temporal bones were sent for histopathological evaluation. RESULTS The cholesteatoma formation rate was 88 per cent in the propylene glycol control group, but was significantly lower in the mesna group (p = 0.01). There were no significant differences in granulation tissue formation (p = 0.498), cyst formation in the bulla (p = 0.381), fibrosis (p = 0.072) and epithelial hyperplasia (p = 0.081) among experimental groups. CONCLUSION Intratympanic propylene glycol administration is an effective method of promoting experimental cholesteatoma formation. Administration of a single dose of intratympanic mesna inhibited cholesteatoma formation in an animal model.

Primary malignant melanoma of the urinary bladder: clinical, morphological, and molecular analysis of five cases.

The aim of our study was to evaluate the clinical and morphological features of primary malignant melanomas of the urinary bladder. We obtained information on five such cases from three different institutions. These were three men and two women between 52 and 76 years of age. Three tumors presented with hematuria, one with dysuria, and one was discovered incidentally on imaging studies. All were invasive to muscularis propria on transuretral resections performed for diagnosis. Neoplastic cells showed variable patterns (large cell epithelioid, small cell diffuse, storiform, or mixed) in different tumors. Pigmentation was prominent in all except one case. Each case was labeled diffusely for S-100, HMB-45, and Melan-A. Pan-cytokeratin showed a perinuclear dot-like reaction in two tumors. Three cases showed the BRAF mutation in molecular studies. Two patients were already metastatic at the time of diagnosis. Two patients died, one is alive with disease after 15 months, and two patients are disease free at 1 and 5 years of surveillance.

Intranodal palisaded myofibroblastoma - a rare case report and literature review.

Intranodal palisaded myofibroblastoma (IPM) is a benign mesenchymal neoplasm originating from smooth muscle cells and myofibroblasts. The inguinal region is the most common site of this rare tumor. As there are only about 89 such cases reported in the literature, the precise etiology and pathogenesis have yet to be explained adequately. It is characterized by spindle cells, amianthoid fibers, and by the proliferation of hemosiderin‐containing histiocytes in the lymph node. A nodular lesion was excised from the inguinal region of a 47‐year‐old female patient with the clinical diagnosis of lymphoma and/or metastase. Macroscopic examination of a section of the lesion demonstrated a solid appearance. Microscopic examination revealed spindle‐cell proliferation, amianthoid fibers, hemosiderin pigment, and extravasated erythrocytes. Nuclei of the spindle cells displayed a palisaded appearance. Compressed lymphoid tissue was observed around the lesion. Neoplastic cells were identified by the presence of vimentin, SMA, Cyclin D1, and beta‐catenin. The Ki67 index was less than 1%. Histological examination confirmed the diagnosis of IPM. Although IPM is benign, it is frequently confused with metastatic lesions and lymphomas.

Two large nodules on the scalp of a 60-year-old woman

A 60-year-old woman presented with a 2-year history of two large nodules on her head. She also reported a 1-year history of intermittent mild headache. On physical examination, two nodules were seen, located on the occipital region of the patient’s head. The larger nodule was 51 9 45 mm in size, of a greyish-white colour, and was ulcerated, lobulated and sharply demarcated from neighbouring structures (Fig. 1). The smaller nodule was smooth and rounded, with a diameter of 39 mm (Fig. 1). Both nodules were totally excised and sent for histological examination.

Sclerodermatous skin: An immunohistochemical study

Scleroderma or systemic sclerosis is a complex connective tissue disease which is characterized by vasculopathy, autoimmunity and progressive fibrosis in the skin and visceral organs [1-3]. It includes diffuse and limited subgroups. These groups are separated from each other by skin involvement [4]. Despite some characteristics distinguishing the two types from each other, they share the common feature of fibrosis involving excessive Extracellular Matrix (ECM) production that impairs usual tissue characteristics to cause organ failure late in the disease course [5]. Although a large body of novel scientific knowledge has been acquired about the molecular mechanisms of pathophysiology of SSc [6-8] we are far from stopping or even slowing down the ongoing fibrotic process characterizing the disease [9-11]. In this immunohistochemical study, we aimed to find new markers to predict prognosis and guide therapy.

Erythema multiforme and erythema nodosum lesions with cervical lymphadenopathy

A 39-year-old otherwise healthy woman presented to our dermatology clinic with a two-week history of a swelling and pain on her neck. She noted a low-grade fever and malaise for ten days. The patient reported no history of tick bite, new medication or consuming raw meat. Physical examination revealed fever (38.3°C), an enlarged, painful 4.5 x 4.8 cm sized lymphadenopathy in the right submandibular area (Figure 1), multiple targetoid erythema multiforme lesions on the palms (Figure 2), and multiple erythema nodosum lesions on the shins (Figure 3). We performed whole blood count, chest X-ray, serological tests (microagglutination test), fine needle biopsy, and neck ultrasonography. Histopathologic examination of the lymph node disclosed epithelioid histiocytes with multinuclear giant cells and a suppurative inflammation (Figure 4a and 4b).

What does the data of 354,725 patients from turkey tell US about cervical smear epithelial cell abnormalities? - the epithelial cell abnormality rate is increasing - quality control studies and corrective activity are musts

OBJECTIVE There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.