Acitretin-induced spiny follicular hyperkeratosis.

Spiny follicular hyperkeratosis (SFH) is follicular flesh-colored hyperkeratotic spicules that are linked to different situations including drug reactions. Previously suspected drugs are BRAF inhibitors and cyclosporine. We described a 51-year-old psoriasis patient with SFH who had been using acitretin.

Acquired capillary hemangioma of the eyelid in a 49-year-old woman from Turkey.

A 49-year-old woman developed a dark brown nodular mass in the lower eyelid. The lesion had grown fast for 2 months and then had remained stable in size. Excisional biopsy was performed. Histopathological examination of an excisional biopsy specimen pointed to proliferative vessels lined by increased endothelial cells without nuclear atypism. The nodular mass evaluated as a capillary hemangioma.

Relationship of PCNA, C-erbB2 and CD44s expression with tumor grade and stage in urothelial carcinomas of the bladder.

In the present study, the intention was to reveal the relationship of histological grade and stage with c-erbB2, CD44s, and PCNA immunoreactivity in bladder urothelial carcinomas (UC). In our study, we evaluated 46 items of transurethral resection material of patients submitted by YYU Faculty of Medicine, Main Department of Pathology, with a mass revealed in their bladder after clinical and radiological studies at our laboratories and who were diagnosed with urothelial carcinomas. PCNA, c-erbB2, and CD44s were applied in an immunohistochemical manner comprised from nine low-malignant potential papillary urothelial neoplasia, 23 low-grade papillary urothelial carcinoma, and 14 high-grade papillary urothelial carcinoma. Immunostaining was scored according to the percentage of positive cells. The immunohistochemical study demonstrated that the c-erbB2 and PCNA staining ratio increased when an increase occurred in stage and grade. The CD44s staining ratio decreased. C-erbB2, PCNA, and CD44s appear to be a useful marker in the assessment of the prognosis and treatment options in urothelial carcinomas.

Clear cell variant of follicular thyroid carcinoma with normal thyroid-stimulating hormone value: a case report.

INTRODUCTION: Clear cell carcinomas of the thyroid gland with normal thyroid-stimulating hormone value are very rare, but clear cell changes are described in most reported cases of thyroidal lesions. CASE PRESENTATION: In this report, we describe the case of a 50-year-old Caucasian woman with a normal thyroid-stimulating hormone level who underwent surgery to treat a multi-nodular goiter. The pathology was a clear cell variant of follicular thyroid carcinoma. The tumor was 1cm in diameter and consisted of pure clear cells. CONCLUSION: Clear cell variants of follicular thyroid carcinoma are rarely seen, especially it is misdiagnosed with metastatic renal cell carcinoma. In this report, we describe the case of a patient with a clear cell variant of follicular thyroid carcinoma with an interesting pathology.

The diagnostic importance of matrix metalloproteinase-7 and nestin in gastrointestinal stromal tumors.

BACKGROUND: The importance of the matrix metalloproteinase-7 (MMP-7) and nestin immunomarkers, C-kit proto-oncogene (CD117), and the efficiency of the Ki-67 proliferation index for gastrointestinal stromal tumors were evaluated. MATERIAL AND METHODS: This study was conducted by examining the microscope slides of 72 patients with gastrointestinal stromal tumors that were sent to the pathology laboratory between 2007 and 2012. Immunohistochemical staining for CD117, MMP-7, nestin, and marker of proliferation Ki-67 was performed. The correlations between the positive results for Ki-67, CD117, MMP-7, and nestin were evaluated relative to the tumor characteristics of size, localization, grade, cellular type, cellularity, cytology type, growth pattern, ulceration, necrosis, hemorrhage, invasion depth, and lymph node metastasis. RESULTS: The tumor was localized in the stomach in 42 of the patients, the intestines in 19, the colon in 7, and the rectum in 4. Comparisons among the groups showed that MMP-7 was correlated with the tumor grade (p<0.001), cellularity (p<0.009), cytologic atypia (p<0.001), ulceration (p=0.002), necrosis (p<0.001), and tumor size (p=0.001). Nestin was correlated with the tumor grade (p=0.013), and tumor size (p=0.024). Correlations among CD117, MMP-7, nestin, and Ki-67 were examined. Nestin and Ki-67 were both significantly correlated with CD117 and MMP-7 [(r=0.279, p=0.018), (r=0.322, p=0.006), (r=0.386, p=0.001), (r=0.386, p=0.002)], respectively. CONCLUSIONS: MMP-7 and nestin may be beneficial as markers, given their sensitivity to gastrointestinal stromal tumors.

Cerebellar malignant fibrous histiocytoma.

Malignant fibrous histiocytoma (MFH) is uncommon within the central nervous system. MFH is a malignant tumor composed of a mixture of fibroblastic and histiocytic cells, and is also known as pleomorphic fibrous xanthoma, malignant fibrous xanthoma, and pleomorphic fibrous histiocytoma. It is a pleomorphic sarcoma originally found in soft tissue and there are few reported cases within the central nervous system, in particular the cerebellum. To the best of my knowledge, this is third case arising from the cerebellum. This tumor is difficult to diagnose and may be difficult to treat.

Liver alveolar echinococcosis metastasized to the breast.

BACKGROUND: Alveolar echinococcosis (AE) is a potentially fatal and chronically progressive infestation produced by the multivesicular metacestode of Echinococcus multilocularis, which most commonly affects the liver, lungs, and brain. CASE REPORT: We present a case of AE in which an alveolar cyst, as a result of exophytic growth, adhered to intra-abdominal and pelvic organs and metastasized to the breast. Exploration showed that the exophytic cyst in the liver filled the entire abdominal cavity, reaching to the uterus and bladder, and was adherent to the neighboring tissues and organs. This cystic lesion was totally excised, as was the 7×6 cm cystic lesion in the right breast. CONCLUSIONS: The liver is the most common site for echinococcal cysts of the pastoral strains (>65%), followed by the lungs (25%); the cyst is seen less frequently in the spleen, kidneys, heart, bone, and central nervous system. AE must be considered in areas where liver cysts are endemic and in the presence of a liver cyst, and the organs where a metastasis is possible must be thoroughly investigated. Furthermore, in these areas, when cystic disorders of the breast are present, AE should not be discounted among possible definitive diagnoses.

Ki-67 and Bcl-2 in colorectal polyps with breast cancer.

BACKGROUND: The most common second primary cancer in women who survive breast cancer is colorectal cancer. Population cohort studies suggest that the risk of colorectal cancer is also high in female relatives of women with breast cancer compared to the general population. The histological distinction between a large hyperplastic polyp and a serrated adenoma is not straightforward and there is probably no sharp division between hyperplastic polyposis and 'serrated adenomatous polyposis'. AIM: The aim of the study was to define the distribution of Ki-67 and Bcl-2 protein in hyperplastic colorectal polyps of women with breast cancer. MATERIALS AND METHODS: A cross-sectional, controlled study was conducted in 40 women with and without breast cancer who had hyperplastic colorectal polyps. The patients were divided into two groups: Group A (a control group of women without breast cancer, n = 20) and Group B (a study group of women with breast cancer, n = 20). The expression of Ki-67 and Bcl-2 protein was assessed on the basis of quantity of immunostaining, by counting antigen positive cells, in comparison with normal mucosa. Student's t-test and the chi-square test were used to analyse Ki-67 and Bcl-2 expression, respectively. RESULTS: Statistical significance was established at P < 0.05. The mean percentage of Ki-67 stained nuclei in Groups A and B was 25.11 ± 2.07 and 41.51 ± 1.86, respectively (P < 0.003), whereas the percentage of cases with cells expressing Bcl-2 in Groups A and B was 15% and 85%, respectively (P < 0.002). CONCLUSIONS: In the present study, greater proliferative activity and greater expression of the antiapoptotic protein Bcl-2 was found in the hyperplastic colorectal polyps of women with breast cancer.

High mobility group box protein-1 (HMGB-1) as a new diagnostic marker in patients with acute appendicitis.

BACKGROUND: The aim of this prospective study was therefore to evaluate the diagnostic value of preoperative serum High Mobility Group Box Protein-1 (HMGB-1) levels in patients with Acute Appendicitis (AA) who show normal white blood cell count (WBC) counts. METHOD: Our study was carried out from October 2010 through November 2010 and included 20 healthy control group participants and 60 patients who presented at the emergency department of Erzurum Training and Research Hospital in Turkey with acute abdominal pain complaints, who were pathologically diagnosed with AA after laparotomy, and who agreed to participate in the study. RESULTS: Of the 60 patients who underwent appendectomies, 36 were male and 24 were female, and of the healthy group, 12 were male and 8 female. The age averages of the patients in Groups 1, 2 and 3 were, respectively, 31.3+15.4, 34.0+16.3 and 31.0+13.1 years. The WBC averages of Groups 1, 2 and 3 were, respectively, 7.41+2.02 (x109/L), 15.71+2.85 (x109/L) and 8.51+1.84 (x109/L). The HMGB-1 levels for Groups 1 (healthy persons), 2 (AA patients with high WBC counts ) and 3 (AA patients with normal WBC counts) were, respectively, 21.71±11.36, 37.28+13.37 and 36.5±17.73 ng/ml. The average HMGB-1 level of the patients with AA was 36.92±15.43 ng/ml while the average HMGB-1 value of the healthy group was 21.71±11.36 ng/ml. CONCLUSION: The significantly higher levels of HMGB-1 in AA patients compared to healthy persons infer that HMGB-1 might be useful in the diagnosis of AA. Use of HMGB-1, especially in patients with normal WBC counts, will reduce the number of unnecessary explorations.

Cutaneous ciliated cyst in the subcutaneous area.

A 25-year-old woman was seen for a painless subcutaneous mass of 2 years duration. On excisional biopsy, a collapsed cystic structure lined by stratified, ciliated, columnar epithelium was noted. These linning cells did not produce mucin. Immunohistochemical staining for progesterone receptor, estrogen receptor and epithelial membrane antigen was positive, whereas it was negative for carcinoembryonic antigen. Findings were consistent with cutaneous ciliated cyst (CCC). CCCs are rare, predominantly occurring on the lower extremities of young women. Most of them have been regarded as Mullerian remnants. A case of a CCC in the subcutaneous area is reported.

Left ovarian gonadoblastoma with yolk sac tumor in a young woman.

Gonodoblastomas with ovarian germ cell tumors other than dysgerminoma coexists very rarely with yolk sac tumor (YST). Because of this rarity, we report a case of gonadoblastoma with YST. An 18-year-old female patient was admitted to our hospital with an abdomino-pelvic mass. Ultrasonographical examinations revealed a 15X14 cm heterogenous pelvic mass with calcific foci in the left adnexal area. Macroscopically, the resected mass was oval and measured 18X15X15 cm and weighed 3150 gm. Histological examination showed both gonadoblastic and YST areas. There were many gonadoblastic nests in the subcapsular areas of the tumor. The gonadoblastic nests were composed of large and small cells. The YST areas showed enteric differentiation and numerous hyaline globules. Immunohistochemical examination may help in the diagnosis of these gonadoblastoma with YST.