Pigmented purpuric dermatosis after taking a dietary supplement.

Pigmented purpuric dermatoses (PPDs) are a group of histologically similar skin eruptions characterized by a perivascular lymphocytic infiltrate with extravasated erythrocytes. The etiologies of these conditions are unknown, but triggering factors such as systemic diseases, infections, drugs, and foods have been described. Here, we present a patient who developed pigmented purpura 30 days after initiating a dietary supplement that contained selenium, natural vitamin E, and a parsley concentrate, specifically, Parselenium E. One month after stopping the dietary supplement, the lesions disappeared and no new lesions have developed.

Fine needle aspiration cytology of head and neck masses: a cytohistopathological correlation study with emphasis on false positives and false negatives.

OBJECTIVES: This study aims to evaluate the accuracy ratio of fine needle aspiration (FNA) cytology in the diagnosis of non-thyroidal head and neck masses. PATIENTS AND METHODS: Between 2000 January and 2003 December, the pathology reports of 571 patients (297 males, 274 females; mean age 45 years; range 4 to 83 years) with non-thyroidal head and neck masses who underwent FNA cytology during a four year period were retrospectively analyzed. Cytopathological and histopathological results of the samples were recorded. The smear results indicating an inconsistency were reviewed. The possible causes of the false positivity and false negativity were investigated. RESULTS: Of a total of 571 patients, 181 had a confirmed histopathological diagnosis. The overall accuracy ratio, specificity, sensitivity, negative predictive value and positive predictive value of FNA in the diagnosis of the head and neck masses were 83%, 85%, 81%, 84%, 83%, respectively. CONCLUSION: The FNA has a high accuracy, sensitivity, specificity, negative and positive predictive values in the diagnosis of head and neck masses. If the major causes of misdiagnosis including inadequate sampling and misinterpretation are avoided, the diagnostic accuracy ratio of FNA in the head and neck and will be improved.

Identification of endogenous reference genes for qRT-PCR analysis in normal matched breast tumor tissues.

Quantitative gene expression measurements from tumor tissue are frequently compared with matched normal and/or adjacent tumor tissue expression for diagnostic marker gene selection as well as assessment of the degree of transcriptional deregulation in cancer. Selection of an appropriate reference gene (RG) or an RG panel, which varies depending on cancer type, molecular subtypes, and the normal tissues used for interindividual calibration, is crucial for the accurate quantification of gene expression. Several RG panels have been suggested in breast cancer for making comparisons among tumor subtypes, cell lines, and benign/malignant tumors. In this study, expression patterns of 15 widely used endogenous RGs (ACTB, TBP, GAPDH, SDHA, HPRT, HMBS, B2M, PPIA, GUSB, YWHAZ2, PGK1, RPLP0, PUM1, MRPL19, and RPL41), and three candidate genes that were selected through analysis of two independent microarray datasets (IL22RA1, TC22, ZNF224) were determined in 23 primary breast tumors and their matched normal tissues using qRT-PCR. Additionally, 18S rRNA, ACTB, and SDHA were tested using randomly primed cDNAs from 13 breast tumor pairs to assess the rRNA/mRNA ratio. The tumors exhibited significantly lower rRNA/mRNA ratio when compared to their normals, on average. The expression of the studied RGs in breast tumors did not exhibit differences in terms of grade, ER, or PR status. The stability of RGs was examined based on two different statistical models, namely GeNorm and NormFinder. Among the 18 tested endogenous reference genes, ACTB and SDHA were identified as the most suitable reference genes for the normalization of qRT-PCR data in the analysis of normal matched tumor breast tissue pairs by both programs. In addition, the expression of the gelsolin (GSN) gene, a well-known downregulated target in breast tumors, was analyzed using the two most suitable genes and different RG combinations to validate their effectiveness as a normalization factor (NF). The GSN expression of the tumors used in this study was significantly lower than that of normals showing the effectivity of using ACTB and SDHA as suitable RGs in this set of tumor-normal tissue panel. The combinational use of the best performing two RGs (ACTB and SDHA) as a normalization factor can be recommended to minimize sample variability and to increase the accuracy and resolution of gene expression normalization in tumor-normal paired breast cancer qRT-PCR studies.

A case of granulomatous rosacea successfully treated with pimecrolimus cream.

A 43-year-old male attended with lesions on his face that had been present for 3 months. On dermatological examination, multiple papules and pustules were seen on the forehead, nose, bilateral cheeks and lower eyelids. The patient used systemic clindamycin and doxycycline and topical benzoyl peroxide therapies, but the lesions did not regress. Routine laboratory tests were normal. Histopathological examination of the lesions confirmed the diagnosis of granulomatous rosacea. Pimecrolimus cream 1% was applied to the lesions. The regression of lesions began in the first month and complete improvement was observed at the end of the fourth month of therapy. Rosacea is a chronic, inflammatory skin disorder characterized by remissions and relapses. Although it is known that the disease is a treatable disorder, it may be resistant to standard therapies and there is a need for new therapy alternatives in some patients. We present a case of granulomatous rosacea successfully treated with pimecrolimus cream and believe that pimecrolimus may be a good alternative for the treatment of granulomatous rosacea.

Coexistence of familial Mediterranean fever and psoriasis in a patient with seronegative spondyloarthropathy.

Familial Mediterranean fever (FMF) is a self-limited disease characterized by fever and polyserositis attacks. Arthritis caused by synovitis is either in acute monoarthritis or chronic mono-oligoarthritis form, usually affecting the lower extremities. Another potential but rare form of involvement is spondyloarthropathy (SSpA). Psoriatic arthritis (PsA) is inflammatory arthropathy of peripheral joints, spine and enthesis areas. Some PsA cases are classified as psoriatic spondyloarthropathy. A 43-year-old male patient with concomitant FMF and psoriasis presenting with bilateral sacroiliitis, chronic hip and knee arthritis has been presented along with follow-up findings and treatment options used.

A resampling-based meta-analysis for detection of differential gene expression in breast cancer.

BACKGROUND: Accuracy in the diagnosis of breast cancer and classification of cancer subtypes has improved over the years with the development of well-established immunohistopathological criteria. More recently, diagnostic gene-sets at the mRNA expression level have been tested as better predictors of disease state. However, breast cancer is heterogeneous in nature; thus extraction of differentially expressed gene-sets that stably distinguish normal tissue from various pathologies poses challenges. Meta-analysis of high-throughput expression data using a collection of statistical methodologies leads to the identification of robust tumor gene expression signatures. METHODS: A resampling-based meta-analysis strategy, which involves the use of resampling and application of distribution statistics in combination to assess the degree of significance in differential expression between sample classes, was developed. Two independent microarray datasets that contain normal breast, invasive ductal carcinoma (IDC), and invasive lobular carcinoma (ILC) samples were used for the meta-analysis. Expression of the genes, selected from the gene list for classification of normal breast samples and breast tumors encompassing both the ILC and IDC subtypes were tested on 10 independent primary IDC samples and matched non-tumor controls by real-time qRT-PCR. Other existing breast cancer microarray datasets were used in support of the resampling-based meta-analysis. RESULTS: The two independent microarray studies were found to be comparable, although differing in their experimental methodologies (Pearson correlation coefficient, R = 0.9389 and R = 0.8465 for ductal and lobular samples, respectively). The resampling-based meta-analysis has led to the identification of a highly stable set of genes for classification of normal breast samples and breast tumors encompassing both the ILC and IDC subtypes. The expression results of the selected genes obtained through real-time qRT-PCR supported the meta-analysis results. CONCLUSION: The proposed meta-analysis approach has the ability to detect a set of differentially expressed genes with the least amount of within-group variability, thus providing highly stable gene lists for class prediction. Increased statistical power and stringent filtering criteria used in the present study also make identification of novel candidate genes possible and may provide further insight to improve our understanding of breast cancer development.

Hyoid chondroma presenting as an external neck mass.

Chondromas of the larynx are rare neoplasms; only a few examples of cartilaginous tumors affecting hyoid bone have been reported. A 33-year-old woman presented with a neck mass on the left carotid triangle. The patient's computed tomography and magnetic resonance imaging revealed a heterogenous mass, which seemed to originate from the left greater cornu of hyoid. The mass was excised using a transcervical approach with left greater cornu of hyoid bone. The pathologic diagnosis was chondroma of hyoid. Expert radiologic and pathologic review is mandatory in cartilaginous neoplasms of the larynx. Cartilaginous neoplasms of the hyoid should be included in the differential diagnosis of neck masses at the carotid triangle.

Extranasopharyngeal angiofibroma of the cheek.

Angiofibromas rarely localize in extranasopharyngeal sites. The most common site for extranasopharyngeal angiofibromas is the maxillary sinus. The ethmoid and sphenoid sinuses, nasal septum, middle and inferior turbinates, conjunctiva, molar and retromolar region, and larynx are other sites where extranasopharyngeal angiofibromas have been reported. Only one case of buccal extranasopharyngeal angiofibroma has been reported to date. We present a case of buccal extranasopharyngeal angiofibroma that was excised completely following embolization and we also review the literature.

A complication of brucellosis: epididymoorchitis.

BACKGROUND: Epididymoorchitis is the most frequent genitourinary complication of brucellosis. METHODS: This prospective study was conducted between February 2001 and January 2004, prospectively. Male patients diagnosed with brucellosis were included in this study and evaluated for testicular involvement. RESULTS: Epididymoorchitis was detected in 17 out of 134 (12.7%) male patients with brucellosis. Mean age of the patients was 36.9+/-7.1 years. Twelve patients (70.6%) had acute, four patients (23.5%) had subacute, and one patient (5.9%) had chronic brucellosis. The most common symptoms were scrotal pain (94%) and swelling (82%). Eleven patients had unilateral epididymoorchitis, four had unilateral orchitis and two had unilateral epididymitis. A testicular abscess was detected in one patient. Sperm analysis was performed on 14 patients. Five patients had aspermia and eight had oligospermia. Combined antibiotic therapy was started and continued for 6-8 weeks. Orchiectomy was required for two patients and granulomatous orchitis was detected in the resected specimens. Relapse occurred in only one patient. Three patients had permanent oligospermia and one patient had permanent aspermia after the antibiotic therapy. Younger age, high C-reactive protein level and blood culture positivity were statistically significant differences between the patients with and without epididymoorchitis. CONCLUSIONS: Brucellosis should be considered in the diagnosis of scrotal diseases in endemic areas. A conservative approach is usually adequate for managing brucellar epididymoorchitis. However, infertility problems may develop in these patients. Well-designed further investigations are needed to explain the relationship between brucellar epididymoorchitis and infertility in man.

Myoepithelial carcinoma in the nasopharynx: an unusual localization.

Myoepithelial carcinoma is an extremely rare, malignant epithelial tumor which is usually encountered in the parotid region. In this report, a myoepithelial carcinoma arising from a minor salivary gland in the nasopharynx is presented, along with a discussion of the clinical, histopathological and immunocytochemical characteristics of this rare disorder. Larger clinical series and longer follow-up periods are needed in order to establish the best therapy option for these patients.

Cystic nephroma: a rare clinical entity.

We report a rare benign renal tumor, the cystic nephroma (CN) in a 35-year old man. CN should be considered in the differential diagnosis when clinical and radiological examinations reveals a multilocular cystic renal mass, but histopathological examination is the unique diagnostic mean.