Zerrin Calay

Apoptosis in the placenta of pregnancies complicated with IUGR

Objective: In this study we have investigated the presence of apoptosis in the placental tissue of pregnancies complicated with intra‐uterine growth restriction (IUGR). Method: Placental samples were obtained from 22 normal third trimester pregnancies and 20 pregnancies complicated with IUGR. The criteria for fetal growth impairment were clinical evidence of sub‐optimal growth, ultrasonographic demonstration of deviation from normal percentiles of growth and birth weight under 10th percentile. Terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labelling (TUNEL) staining was used to demonstrate the apoptotic cells in all samples. Student‐t, Mann–Withney U‐test, Fisher exact test and Spearman correlation were used for statistical analysis. Result: We detected apoptosis in 10 placentas in the study group vs. none in the control group. Placentas from pregnancies complicated with IUGR demonstrated 0.12% (0.1%–0.4%) apoptotic cells. The rate of apoptotic cells in the placenta was significantly higher in pregnancies complicated with IUGR than normal uncomplicated pregnancy (P=0.0019). Apoptosis were more abundant in the trophoblasts, especially cytotrophoblasts, in the placenta. We could not find a correlation between the apoptosis in the placenta of pregnancies complicated with IUGR and birth weight, multi‐parity, gestational age, birth weight percentile and mode of delivery (C/S vs. vaginal delivery). Conclusion: We believe that the increased number of apoptosis in the placenta of pregnancies complicated with IUGR may have an important compensatory role to transmit nutrition and gas exchange easily to the fetus.

The Incidence of Placental Abnormalities, Maternal and Cord Plasma Malondialdehyde and Vascular Endothelial Growth Factor Levels in Women with Gestational Diabetes Mellitus and Nondiabetic Controls

Background/Aims: To evaluate the incidence of placental abnormalities, cord plasma erythropoietin (EPO) levels and nucleated red blood cell (NRBC) counts, maternal and cord plasma malondialdehyde (MDA) and vascular endothelial growth factor (VEGF) levels in women with gestational diabetes mellitus (GDM) and nondiabetic controls. Methods: Twenty-two women with GDM, diagnosed according to the current criteria of the American Diabetes Association, were compared with 22 controls. Maternal and cord blood and placental samples were obtained from all pregnant women. Cord plasma EPO levels and NRBC counts, maternal and cord plasma MDA and VEGF levels were determined. Placental tissues were examined histologically. Results: Maternal and cord plasma levels of MDA and cord plasma EPO levels and NRBC counts were significantly higher in GDM pregnancies (p < 0.01). The presence of villous immaturity, chorangiosis and ischemia were significantly increased in the placentas of women with GDM (p < 0.05). The maternal and cord plasma levels of MDA increased (p = 0.007 and p = 0.001, respectively), whereas VEGF decreased (p = 0.046 and p = 0.001, respectively) with the presence of villous immaturity. Conclusion: The complex process of villous development and maturity might be influenced by the maternal and fetal oxidative and angiogenetic milieu. The placenta that shows abnormalities in angiogenesis and maturation may lead to fetal hypoxia and compromise.

Correlation between placental bed biopsy findings, vascular cell adhesion molecule and fibronectin levels in pre‐eclampsia

Objective To determine the correlation between placental bed biopsy findings, and blood levels of the vascular cell adhesion molecule (VCAM‐1) and fibronectin in pre‐eclampsia/eclampsia, and to evaluate the relationship between these variables and severity of the disease.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the breast

Inflammatory myofibroblastic tumor of the lung has often been reported but extrapulmonary cases are rare. Here we describe a case of inflammatory myofibroblastic tumor of the breast in a 60‐year‐old woman. This is only the eleventh case reported in the English language literature. The patient was free of disease 85 months after surgery.

Placental apoptosis and adhesion molecules expression in the placenta and the maternal placental bed of pregnancies complicated by fetal growth restriction with and without pre-eclampsia

Summary The aim of the study was to examine the expression of adhesion molecules VCAM-1 and ICAM-3 in placental tissue samples and placental bed (maternal decidual tissue) biopsies of pregnancies complicated by pre-eclampsia (PE) and fetal growth restriction (FGR), and to determine whether PE and FGR are associated with an increase in placental apoptosis. We studied placentas and placental bed samples of 49 third trimester pregnancies complicated by FGR (26 with associated PE, 23 without PE) and 25 normotensive healthy pregnant women. Placental apoptosis was assessed by the TUNEL method. Immunohistochemistry was used to assess expression of the VCAM-1 and ICAM-3. There was no significant difference in the staining intensity of VCAM-1 in placentas ( p = 0.472) and placental bed biopsies ( p = 0.754) of women delivering appropriate for gestational age and growth restricted fetuses (with and without associated PE). The amount of lymphocytes staining positively with ICAM-3 was significantly higher in both placental and placental bed biopsies of women delivering growth restricted fetuses compared with control pregnancies ( p < 0.001). Fetal growth restricted pregnancies with associated PE showed higher staining of ICAM-3 in placental compared with placental bed samples ( p = 0.049). In fetal growth restricted placentas, apoptotic nuclei were more abundant compared with control placentas ( p < 0.001). Increased expression of ICAM-3 on lymphocyte surface of both maternal and fetal side, suggests lymphocyte overactivation in PE and FGR. Increased placental apoptosis may play an important role in the pathogenesis or sequelae of PE.

Management of Idiopathic Granulomatous Mastitis Diagnosed by Core Biopsy: A Retrospective Multicenter Study

Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast, which usually mimics breast carcinoma. The aim of this study was to analyze the clinical features of IGM by identifying a more reliable diagnostic protocol, and evaluating the treatment methods and patient outcomes on follow‐up. We performed a retrospective analysis of 46 patients diagnosed with IGM and managed by the same surgical team between 1999 and 2011, at three high‐volume hospitals. The median age of the patients was 33 years. The most common symptom was painful breast mass (n = 39), followed by abscess (n = 11). All patients underwent ultrasonography (USG). Mammography (MG) and magnetic resonance imaging (MRI) were also performed in 20 patients (43%) and 17 patients (37%), respectively. The mean size of the lesions was 32.8 ± 8.8 mm and ranged from 15 to 50 mm. Preoperative diagnosis of IGM was established by core needle biopsy (CNB) under USG guidance. Eighteen patients (39%) underwent complete excision of the lesion and 25 (54%) were treated with steroids. Three patients treated with steroids subsequently underwent local excision. The mean follow‐up period was 35.4 ± 30.9 months. Eight patients (17%) developed disease recurrence; three of these were successfully treated with steroids, one with surgery, and four with both steroids and surgery. CNB in conjunction with high diagnostic accuracy has a significant role in distinctive diagnosis of IGM and hence, is useful for treatment planning. Treatment can be designated according to the extent and the severity of the disease, and the patients general health and treatment preferences. Patients with IGM must be closely followed up due to the frequency of disease recurrence.

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists’ diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted κ values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders.

The role of stimulated lipid peroxidation and impaired calcium sequestration in the enhancement of cocaine induced hepatotoxicity by ethanol

The purpose of this study was to investigate possible mechanism of cocaine-induced hepatotoxicity and its potentiation by ethanol in mice. Ethanol (2 g/kg) and/or cocaine (25 mg/kg) injections were given as binge model (five injections in 3 days). Cocaine administration with or without ethanol caused an increase in lipid peroxidation in liver homogenate and its subcellular fractions. The greatest increases were observed in mitochondrial fraction following cocaine plus ethanol treatment. Also, glutathione (GSH) levels were increased in liver homogenate and its mitochondrial fractions after cocaine and cocaine plus ethanol treatment. Microsomal calcium sequestration was found to decrease in all treatments. These results suggest that increased lipid peroxidation and decreased microsomal calcium sequestration in the liver may play a possible role cocaine-induced hepatotoxicity and its potentiation by ethanol.

Brunner's gland adenoma: A rare cause of vomiting

UNLABELLED Upper gastrointestinal system adenoma is generally seen amongst elderly patients and quite rarely seen during the childhood. A 14-y-old female patient was referred to our hospital with complaints of vomiting and abdominal pain. She had been followed up for 6 y with the diagnosis of familial intermittent fever and chronic renal failure due to amyloidosis. Endoscopic examination of the upper gastrointestinal system revealed mild hyperaemia in the corpus and antrum, and a polyp of 0.5x0.5 cm with an ulcerated and pedunculated top in the bulbus. Brunners gland adenoma was diagnosed by the histopathological examination of the lesion following polypectomy. CONCLUSION Brunners gland adenoma is usually asymptomatic; however, it may reveal clinical findings such as obstruction, bleeding or intussusception, especially in uraemic patients. Thus, we would like to emphasize that, in patients with chronic renal failure and acute onset vomiting and abdominal pain, Brunners gland adenoma should be considered in the differential diagnosis.

Mammary Pseudoangiomatous Stromal Hyperplasia Composed of Predominantly Giant Cells: An Unusual Variant

Abstract:  Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative lesion of mammarian stroma that presents as a localized mass. We describe the clinical, radiologic, cytologic, and histopathologic features of a case of PASH with giant cells that presented as a rapidly growing localized mass in the breast in a 32‐year‐old woman. An unusual feature of our case was the presence of multinucleated giant cells lining pseudovascular spaces and dispersing in collagenous stroma. To the best of our knowledge, this is the second case in the English literature and PASH with predominance of multinucleated giant cells has never been described previously in a female patient.