Clinicopathologic features and survival outcomes of ocular melanoma: a series of 31 cases from a tertiary university hospital

Background@#We aimed to determine the effect of clinicopathologic features on overall survival among Caucasian ocular melanoma patients in the Central Anatolia region of Turkey. @*Methods@#This single-center study included conjunctival (n = 12) and uveal (n = 19) melanoma patients diagnosed between January 2008 and March 2020. Clinicopathologic features and outcomes were reviewed retrospectively. Five cases were tested for BRAF V600 mutations with real-time polymerase chain reaction, and one case was tested with nextgeneration sequencing. Survival was calculated using the Kaplan-Meier method. @*Results@#Thirty-one patients had a mean initial age of 58.32 years (median, 61 years; range 25 to 78 years). There were 13 male and 18 female patients. The median follow-up time was 43.5 months (range, 6 to 155 months) for conjunctival melanoma and 35 months (range, 8 to 151 months) for uveal melanoma. When this study ended, eight of the 12 conjunctival melanoma patients (66.7%) and nine of the 19 uveal melanoma patients (47.4%) had died. The presence of tumor-infiltrating lymphocytes was related to improved overall survival in conjunctival melanoma (p = .014), whereas the presence of ulceration (p = .030), lymphovascular invasion (p = .051), tumor in the left eye (p = .012), tumor thickness of > 2 mm (p = .012), and mitotic count of >1/mm² (p = .012) reduced the overall survival in conjunctival melanoma. Uveal melanoma tumors with the largest diameter of 9.1–15 mm led to the lowest overall survival among subgroups (p = .035). Involvement of the conjunctiva (p=.005) and lens (p = .003) diminished overall survival in uveal melanoma. BRAF V600 mutation was present in one case of conjunctival melanoma, GNAQ R183Q mutation was present in one case of uveal melanoma. Patients with uveal melanoma presented with an advanced pathological tumor stage compared to those with conjunctival melanoma (p = .019). @*Conclusions@#This study confirmed the presence of tumor-infiltrating lymphocytes as a favorable factor in conjunctival melanoma and conjunctival and lens involvement as unfavorable prognostic factors in uveal melanoma for overall survival, respectively.

Uterine smooth muscle tumor of uncertain malignant potential: fertility and clinical outcomes / 부인종양

OBJECTIVE: In this study, we aimed to evaluate the clinicopathological features, obstetric, and oncological outcomes of patients diagnosed with a uterine smooth muscle tumors of uncertain malignant potential (STUMP). METHODS: A dual-institutional, database review was carried out to screen patients with STUMP who were treated with upfront surgery between January 2006 and December 2017. Data including age at the time of diagnosis, recurrence rate, disease-free survival, overall survival, and fertility outcomes were retrospectively analyzed. RESULTS: Fifty-seven patients with STUMPs were included in the study. The median age at the time of diagnosis was 42 (range, 16 to 75) years. The median follow-up was 57 (range, 16 to 125) months. Eight patients (14%) had recurrence during follow-up. Recurrent STUMPs were seen in seven patients and leiomyosarcoma after 14 months in one patient. Seven patients with a recurrent STUMP survived, while the remaining patient died. Recurrence rates were similar for women who underwent myomectomy and those who underwent hysterectomy. The presence of uterine localization of tumor (subserosal vs intramural-submucosal) statistically significantly affected recurrence rates (odds ratio=5.72; 95% confidence interval=1.349–24.290; p=0.018). Ten of 27 patients who underwent myomectomy for uterine myoma had fertility desire. Seven pregnancies were recorded. CONCLUSIONS: Our study results suggest that fertility-sparing approaches are feasible in patients with STUMP, although recurrence may be seen.

Effects of Ankaferd® on controlling cerebrospinal fluid leakage after dural puncture in rats

Objective: Unintentional dural puncture with an epidural needle is common and indisputably one of the most important complications of epidural anesthesia. When no regression of the complaints are observed after conservative treatment, epidural blood patch [EBP] should be planned for the treatment of patients. However, EBP is not the optimal choise because the success rate is low and the risk of potential serious complications is high. Ankaferd Blood Stopper® [ABS], which is a medicinal plant extract, has been used as a antihemorrhagic agent against various types of bleeding. The purpose of this study is to investigate the effects of ABS administration, on fibrin formation and cerebro-spinal fluid [CSF] leakage after dural puncture in a rat model

Methodology: The study was performed at Gazi University Experimental Research Center, Ankara, Turkey between May and July 2013. Eighteen rats were grouped randomly as control [Group C, n=6], dural punctured [Group DPC, n=6] and ABS application after dural puncture at the level of L4-L5 [Group A, n=6]. Methylene blue was applied to the cervical level of the rat spine, in order to observe leakage from dural puncture in Group DPC, and Group A. Medulla spinalis tissues of the rats were evaluated histopathologically

Results: CSF leakage was obtained in all rats in Group DPC [100%] that were dural punctured with spinal needle and given methylene blue. However, in the group of rats that ABS was performed before methylene blue [Group A] application, CSF leakage could be obtained in only half of the rats [50%], and in none of the rats in Group C. CSF leakage ratio in Group DPC was 100% and significantly higher than that in Group C [X[2]=5.178, p=0.002]. Following Ankaferd administration, CSF leakage was identified in only 50% of rats in group A and this result was similar with achieved result in Group C [X[2]=1.778, p=0.182]

Conclusion: We opine that Ankaferd Blood Stopper® [ABS] is effective in preventing CSF leakage after post dural puncture and does not cause necrosis in rat medulla spinalis tissues

Effect of synthetic cell- binding peptide on the healing of cortical segmental bone defects

To determine the effect of inorganic bone matric/Pepgen P-15 [ABM/P-15] on the healing of a critical sized segmental defect in a rat radius using a radiological and histological grading system. We carried out this study at the Research Laboratories, Gazi University School of Medicine in 2004. Critical sized segmental defects were created in the radius of 36 Wistar rats. Thirteen defects were filled with ABM/P-15 Flow [gel form], 12 defects were filled with ABM/P-15, and 11 defects were used as a control group. The rats were sacrified at the tenth week, and healing of the defects was evaluated radiographically and histologically. The usage of ABM/P-15 and ABM/P-15 Flow were demonstrated to improve healing of segmental bone defects compared with the control group. Statistical evaluation showed that there were significant differences between control sites, and the sites treated with P-15 and P-15 Flow [p=0.011]. The highest radiological and histological grades were achieved by P-15. Segmental cortical bone defects may be treated with ABM/P-15 instead of bone allografts, and autografts. According to the radiological and histological parameters measured in this study, the implantation of ABM/P-15 resulted in optimum healing of the segmental cortical bone defects. Pepgen P-15 has a positive effect on bone healing, without any immunogenic features and disease transmission risk. Therefore, ABM/P-15 can also be used for orthopedic surgery

Nonalcoholic fattty liver disease. Correlation with histology and viral hepatitis

Nonalcoholic fatty liver disease [NAFLD] involves a heterogeneous group of diseases that places some patients at risk of progression to cirrhosis. In this study, our aim was to investigate the relationships between the histopathological features of NAFLD, hepatic stellate cell activation, and capillarization to find a marker related to fibrosis, for NAFLD. We studied liver biopsies from 62 patients with NAFLD, 21 patients with hepatitis B, and 19 patients with hepatitis C from the archives of the Department of Pathology, Gazi University Medical School, between 1997 and 2004. We performed immunoperoxidase stains for a-smooth muscle actin [a-SMA] and CD31 to identify activated hepatic stellate cells and capillarization. We investigated the relationships between histopathological features and both a-SMA and CD31 expressions. Most NAFLD cases were in low grades and stages. We found a relationship between both necroinflammatory grade and ballooning degeneration, and fibrosis. Pure steatosis did not relate to fibrosis. Immunohistochemical analysis revealed that CD31 expression was significantly higher than a-SMA expression in all groups. We determined a correlation between the fibrotic stage and CD31 expression, but not with a-SMA expression. In NAFLD cases, we detected the highest staining scores of CD31 in zone 3, while the portal/septal area was the dominant zone for control groups. There was no significant zone for a-SMA expression. Our results suggest that we can use CD31, rather than a-SMA, as a marker of endothelial damage and sinusoidal capillary transformation, both of which might precede fibrogenesis in chronic liver diseases, particularly in NAFLD

Polymyositis and hepatitis concurrent with breast cancer

To present a rare case of breast cancer associated with both inflammatory muscle disease and liver disease as a paraneoplastic syndrome. Clinical Presentation and Intervention: A woman with breast cancer presented with elevated liver enzymes and progressive proximal muscle weakness. Liver biopsy was consistent with hepatitis and muscle biopsy revealed myositis. The start of corticosteroid therapy was followed by relief of the myopathic symptoms and regression of hepatitis histopathologically. A case of polymyositis and hepatitis associated with breast cancer and their flare-up with recurrence of malignancy is presented. In this case, the temporal relation with malignancy following its concurrent remission and relapse suggests a paraneoplastic mechanism