Effects of phenytoin injection on vocal cord healing after mechanical trauma: An experimental study

Background/aim: Phenytoin is an anticonvulsant drug which causes fibroblast proliferation, collagen synthesis, and an increase in epidermal growth factor. Therefore, the aim of the present study is to evaluate the effect of phenytoin injection on the wound healing process in rats with vocal cord injury by histopathological methods. Materials and methods: The vocal cords of 10 albino Wistar rats were damaged bilaterally; the left vocal cord was kept as the control group. Phenytoin was injected in the right vocal cord. Ten rats were sacrificed. The thickness of the lamina propria and density of the fibroblast and collagen were evaluated histopathologically. Results: Thickness of the lamina propria was 18.0 ± 7.1 µm in the control group, 65.5 ± 10.7 µm in the phenytoin group. The density of fibroblast and collagen were statistically lower in the control group compared the phenytoin group (P < 0.05). Conclusion: Phenytoin injection in rats after vocal cord injury significantly increased the thickness of the lamina propria and density of fibroblast and regular and mature collagen in the lamina propria. The findings in our study provide a feasible scientific view for adding phenytoin treatment to vocal cord surgeries in otolaryngology practice, but further studies are needed in order to evaluate the use of phenytoin in preventing the formation of scar tissue and possible effects on vocal cord vibration in humans after vocal cord injury.

Clinicopathological features of metaplastic breast carcinoma.

BACKGROUND: Metaplastic carcinoma of the breast (MpBC) is defined as a group of heterogeneous malignant neoplasms that contain glandular and non-glandular components with mixed epithelial and mesenchymal differentiations. OBJECTIVES: The aim of this study was to research the clinical and pathological characteristics of MpBC determining its rank among all breast cancers. MATERIAL AND METHODS: Metaplastic carcinoma of the breast was found in 7 out of 1,164 patients who had been diagnosed with breast cancer within the period of 12 years in our hospital. Demographic and clinical characteristics of the patients were retrieved from the patient files, and their final status was verified by a phone call. Diagnoses of the patients were confirmed by examining hematohylen and eosin (H&E) preparations. They were stained immunohistochemically for estrogen receptor (ER), progesterone receptor (PR), C-erbB-2, CK5/6 (Sitokeratin5/6), and EGFR (epidermal growth factor receptor), and the subgroups were determined according to the WHO classification. RESULTS: All patients were female with a median age of 61 years (41-87 years). Three of them were diagnosed with stage IIB, 2 with IIIB and 1 with IV. Four patients had squamous type of metaplastic cell differentiation, 1 spindle, 1 adenosquamous, and 1 osteosarcomatous. In 6 out of 7 patients, ER, PR and C-erbB-2 expressions were negative immunohistochemically. In the case of squamous metaplasia, estrogen receptor was 10% and progesterone receptor was 5% positive. CK5/6 was positive in 5 cases. Epidermal growth factor was positive in all cases. CONCLUSIONS: Metaplastic carcinoma of the breast is relatively rare and, in our series, its incidence was 0.6%. According to its immunohistochemical characteristics, MpBC can be interpreted as a subgroup of triplenegative breast cancers (TNBC). Five of the presented patients resembled the subgroup of TNBC with a basaloid phenotype. The chemotherapy regimens suggested in the treatment of MpBC are platin in the epithelial subgroup and high-dose anthracycline in the mesenchymal subgroup. There is a need of new studies that evaluate different choices of treatment as MpBC has a bad prognosis and an aggressive nature.

Thymoma with an incidental benign laryngeal mass mimicking laryngeal carcinoma: Case report.

Thymic carcinomas are rarely seen. Because of recurrent laryngeal nerve involvement, hoarseness is a common presenting symptom. Persistent hoarseness in a male smoker past his fifth decade is also a distinctive symptom for laryngeal carcinoma. Stroboscopic laryngeal examination and biopsy are required for the diagnosis. In this article we describe a case involving a patient with thymic carcinoma who, interestingly, also presented with a benign laryngeal mass with unilateral vocal fold fixation. We emphasize the importance of keeping in mind nonlaryngeal pathologies invading the recurrent laryngeal nerve in patients with persistent hoarseness and a nonspesific laryngeal mass.

The Impact of Systemic and Local Administration of Ascorbic Acid on Traumatic Perforation of Tympanic Membrane and Myringosclerosis.

OBJECTIVE: In the present study, tympanic membranes (TM) harvested from myringotomized rats were analyzed histopathologically to compare the systemic and local effects of ascorbic acid on the development of myringosclerosis. MATERIALS AND METHODS: Forty male Wistar-Albino rats weighing between 350-400 g were included in this study. Under otomicroscopic examination, a standard 2-mm myringotomy incision was made on the posteroinferior quadrant of the TM of both ears. Rats were randomized into five groups as control, topical ascorbic acid 50 mg/kg, systemic ascorbic acid 50, 100, and 200 mg/kg groups, each group containing eight rats. On the 15th day of the study, the rats were decapitated, and bullas of the rats were extracted. Sections were stained with hematoxylin-eosin and examined through light microscopy. Inflammation, distribution width of plaques, edema, and neovascularization were observed on the lamina propria. Thickness of the TM was evaluated under the microscope and scored semiquantitatively. RESULTS: When intergroup comparisons of parameters related to total TM thickness were performed, differences between the control group and topical AA (ascorbic acid) or systemic treatment groups were found to be statistically significant (p<0.005). A statistically significant difference was detected among control, topical and systemic 200 mg/kg ascorbic acid groups for the edematous lamina propria (p=0.003 and p<0.05, respectively). CONCLUSION: For the total TM thickness, systemic and topical ascorbic acid use was effective when compared with the control group. It has been concluded that systemic use of higher doses of (200 mg/kg) ascorbic acid is beneficial in the resolution of the edematous lamina propria.

The use of urinary nuclear matrix protein 22 (NMP22) as a diagnostic adjunct to urine cytology for monitoring of recurrent bladder cancer--institutional experience and review.

BACKGROUND: This prospective study compares urine NMP22 immunoassay and cytomorphology for detecting recurrent urothelial carcinoma (UC) of the bladder and correlates between NMP22 levels and grade, multiplicity, and size of the tumor. We aimed refining the use of NMP22 test in the management of UC at our institution. METHODS: Urine specimens, collected prior to a cystoscopic biopsy either from patients with a history of bladder cancer (n = 50) or from controls (n = 15) were studied. Cytology and NMP22 results were compared with subsequent biopsies and performance characteristics were measured. RESULTS: Overall sensitivity and specificity of cytology was 62.5% and 87.5%, respectively while NMP22 had a sensitivity of 85.4% and specificity of 76.5%. NMP22 was superior to cytology for detecting low-grade UC (82.6% vs. 54.5%) and in terms of NPV (65% vs. 44.4%) while cytology reached 100% detection rate for high-grade UC. And, the sensitivity of 98% was achieved when NMP22 was combined with atypical cytology. Optimal performance of NMP22 has been detected around the reference value of 6.4 U/ml. The mean NMP22 values in control and study groups were 2.5 U/ml and 36 U/ml, respectively. The mean NMP22 value was 20.9 U/ml in low-grade UC and 53.2 U/ml in high-grade category. CONCLUSIONS: The NMP22 values displayed higher sensitivity for low-grade UC while cytology was highly sensitive and spesific in detection of high-grade UC. Combining urine NMP22 assay with atypical cytology improved sensitivity for detection of recurrent UC. The inclusion of the adjunctive NMP22 test in monitoring protocols for low-grade UC in combination with cytology for high-grade UC could enable clinicians to decrease the frequency of follow-up cystoscopies.

Aneurysmal bone cyst in the middle turbinate: a case report.

Aneurysmal bone cyst is a benign and locally destructive bone lesion usually seen in the younger population. Its etiology is unknown. Its yearly incidence rate has been reported to be 0.14/100,000, comprising 1% of all bone tumors. It may develop primarily or arise from primary bone tumors. Hemorrhagic fluid content with a septated appearance is the characteristic feature of aneurysmal bone cyst. It is most commonly seen in the metaphysis of the long bones. In rare cases, the cyst is located in the skull. Primary treatment is surgical excision, and the recurrence rate after treatment is 10 to 30%. Based on a review of the current literature, there have been no previous reports of aneurysmal bone cyst located in the middle turbinate. We report a case of aneurysmal bone cyst with an atypical location and discuss the treatment of the patient with endoscopic surgery in light of relevant literature.

Interobserver agreement in salivary gland neoplasms by telepathology: An analysis of 47 cases.

OBJECTIVE: To assess the discrepancies that prevailed among the members of the Head and Neck Pathology Working Group in Turkey in diagnosing salivary gland tumors, classified primarily according to myoepithelial origin, by utilizing telepathology. STUDY DESIGN: At least 4 representative images were obtained from each case of a total of 47 salivary gland tumors, and these were studied by 14 participants. The tumors examined were classified into 2 categories under behavior as malignant or benign, and also grouped into 2 categories under differentiation: those showing and those not showing myoepithelial differentiation. Representative areas from hematoxylin and eosin-stained slides were imaged by experienced pathologists. Images from the cases were recorded and distributed via compact disc. RESULTS: The participants in this study had a mean of 12.8 years' experience in pathology. The agreement ratios on tumors showing myoepithelial differentiation and malignancy were 86% and 81%, respectively. Basal cell adenocarcinoma gathered the lowest agreement of the myoepithelial differentiation among the tumors by 64%. The highest agreement (100%) was for 17 myoepitheliomas. While adenoid cystic carcinoma attained the highest ratio (95%), myoepithelial carcinoma had the lowest ratio (47%) of agreement on malignancy among the 19 observers. Accordingly, regarding benign tumors the ratio of agreement on the benignancy was 70%, with the highest percentage being 91% for basal cell adenoma. CONCLUSION: Electronic media acting as a usable technological tool for the distribution of pathology expertise may be used to obtain a second opinion about salivary gland tumors.

Inter-observer agreement in laryngeal pre-neoplastic lesions.

In this series, laryngeal preneoplastic lesions were evaluated by the classifications of the World Health Organization (WHOC), Ljubljana (LC) and squamous intraepithelial neoplasia (SINC) by multiple observers. The inter-observer agreement (IA) by WHOC for laryngeal lesions had been previously evaluated, but to the best of our knowledge, there are no data for LC and SINC. H&E stained slides from 42 laryngeal biopsies were evaluated by fourteen participants according to WHOC and LC, and SINC was additionally applied by 6. The results were analyzed statistically. The diagnoses which were favored by most participants for each case, according to WHOC, were as follows: squamous cell hyperplasia (n = 5; 12%), mild dysplasia (n = 11; 26.2%), moderate dysplasia (n = 12; 28.6%), severe dysplasia (n = 7; 16.7%), carcinoma in situ (n = 5; 12%), and invasive squamous cell carcinoma (n = 2; 4.8%). There was a significant difference between the participants for all three classifications; some participants gave lower or higher scores than the others. The mean correlation coefficients (MCC) of the participants were higher for WHOC compared to LC (0.55 ± 0.15 and 0.48 ± 0.14, respectively). The mean linear-weighted kappa (wKappa) values of participants were not significantly different (0.42 ± 0.10, 0.41 ± 0.12 and 0.37 ± 0.07 for WHOC, LC and SINC, respectively). The kappa values in this series are in agreement with those in previous literature for WHOC, and the similar results obtained for LC and SINC are novel findings. Although the MCC of WHOC was higher, as the wkappa was not significantly different, the findings in this series are not in favor of any of the classifications for better IA for pre-neoplastic laryngeal lesions.

[Diagnostic value of fine needle aspiration cytology in salivary gland masses]. / Tükürük bezi kitlelerinde ince igne aspirasyon sitolojisinin tanisal degeri.

OBJECTIVES: In this study, we investigated the diagnostic value of fine needle aspiration cytology (FNAC) in salivary gland masses retrospectively. We compared FNAC and postoperative histopathologic results of patients who had undergone FNAC and had been operated on because of salivary gland masses. PATIENTS AND METHODS: Seventy six patients (40 females, 36 males; mean age 50.4 years; range 20 to 80 years) having salivary gland masses who underwent FNAC and surgical treatment between January 2001 and June 2008 were included in the study. Fine needle aspiration cytology and histopathologic results were compared retrospectively. The sensitivity, specificity, positive and negative predictive values and accuracy rate of the FNAC in salivary gland masses were evaluated in the light of the results. RESULTS: The most common benign and malign FNAC results were pleomorphic adenoma (22 patients; 29.7%) and mucoepidermoid carcinoma (4 patients; 5.4%), respectively. Fine needle aspiration cytology results of two patients were non-diagnostic and these patients were excluded. According to the FNAC and histopathologic results of 74 patients, sensitivity was found to be 80.9%, specificity 94.3%, positive predictive value 85% and negative predictive value 92.5% and accuracy rate of FNAC 90.5%. CONCLUSION: Fine needle aspiration cytology is a reliable method that has high sensitivity to distinguish between benign and malign salivary gland lesions. In case of suspicious FNAC reports, reliability and diagnostic value of the method is decreased.

Cyclooxygenase-2 expression and its association with angiogenesis, Helicobacter pylori, and clinicopathologic characteristics of gastric carcinoma.

Cyclooxygenase-2 (COX-2) is upregulated in gastric carcinoma, and its increased levels were found to have a prognostic significance in some studies. Both angiogenesis and Helicobacter pylori infection have been reported to be associated with COX-2 expression of gastric cancer in recent studies. In this study, COX-2 expression and its association with CD31 staining, H.-pylori infection, and well-known clinicopathological factors were investigated in 65 gastric cancer patients. COX-2 and CD31 expression assessment was done by immunohistochemical methods. Whartin Starry stain was performed for H.-pylori infection. Of 65 patients, 32 (49%) revealed intense COX-2 immunostaining. Among various clinicopathologic characteristics, COX-2 expression was inversely correlated with tumor size, TNM stage, and lymph node status. Thirty-two (49%) patients revealed intense CD31 immunostaining. Among various clinicopathologic characteristics, CD31 expression was associated only with lymph node metastasis. COX-2 expression was not correlated with CD31 staining and H.-pylori infection. Both COX-2 and CD31 staining had no prognostic significance. In conclusion, we found that COX-2 expression was significantly higher in earlier stages of gastric cancer. It can be suggested that COX-2 expression may be important in the initial development of gastric cancer but not in progression of the disease. Other factors which may be associated with COX-2 in gastric cancer, including angiogenesis and H.-pylori infection, should be investigated in further studies.

Tall cell variant of papillary carcinoma arising from a thyroglossal cyst: report of a case with diagnosis by fine needle aspiration cytology.

BACKGROUND: Papillary carcinoma arising from a thyroglossal duct cyst (TDC) is the most frequent malignancy arising from this embryologic remnant of the thyroglossal duct. The preoperative fine needle aspiration cytology (FNAC) of such neoplasms has rarely been cited. Approximately 170 TDC cases have been reported in the literature worldwide, diagnosed solely on histopathology. CASE: A 63-year-old woman presented with an anterior midline neck mass of years' duration. A hypodense cyst was located at the level of the hyoid bone. FNAC of the midline neck mass showed bloody, mucoid material and numerous atypical, elongated cells. The aspirated material was reported as "papillary carcinoma possibly arising from the thyroglossal duct," and the diagnosis was confirmed by histopathologic investigation on resection material. CONCLUSION: Tall cell variant is a rare variant of papillary carcinoma and has a poor prognosis. The differential diagnosis includes Hürthle cell lesions, oncocytic papillary thyroid carcinoma and Warthin-like papillary carcinoma.

Clinical value of cell counts and indices in testicular fine needle aspiration cytology in primary infertility: diagnostic performance compared with histology.

OBJECTIVE: To compare the diagnostic value of testicular fine needle aspiration (FNA) cytology with that of open biopsy in primary infertility and nonobstructive azospermia or severe oligozoospermia, to evaluate the reliability of percentage cell counts and cell indices. STUDY DESIGN: Thirty patients (21 azospermic and 9 severe oligozoospermic) who had samples for testicular FNA obtained from both testis (mean age = 28.7) and open biopsy were included in the prospective study. Primary infertility, history, complete physical examination, hormonal assay and testicular ultrasound data were evaluated. One case was excluded because of an unsatisfactory result in aspiration cytology. The percentage population of Sertoli cells and spermatogenetic cells, in addition to spermatic index, sertoli cell index and sperm-Sertoli cell indexes, was calculated. The statistical analysis was determined using the paired t test. RESULTS: Progressively increasing values of the Sertoli cell index and progressively decreasing values of the sperm--Sertoli cell index were seen in maturation arrest, hypospermatogenesis and Sertoli cell-only syndrome. The difference between mean counts and indices in normal spermatogenesis and other histologic categories was statistically significant (p < 0.05). CONCLUSION: Percentage cell counts and cell indices in testicular FNA significantly correlate with histological categories. In primary male infertility, testicular FNA can be performed instead of open biopsy.

Prognostic importance of COX-2 expression in patients with colorectal cancer.

A relationship between cyclooxygenase-2 (COX-2) expression and the pathogenesis of colorectal cancer has been reported in recent studies. Moreover, it has been indicated that COX-2 expression may have a prognostic role in colorectal cancer patients. In this study, we investigated the prognostic significance of COX-2 expression in 83 patients with colorectal cancer. COX-2 expression was assessed using immunohistochemical methods and was evaluated by grading both staining intensity and staining extension. The relationships between COX-2 expression and clinicopathological features of the patients and patient survival were evaluated. There was no relationships between COX-2 expression and tumor size (tm < 3 cm or tm > or = 3 cm), tumor histopathological differentiation (poorly differentiated or moderately + well differentiated), number of metastatic lymph nodes (< 4 or 3 > or = 4), histopathology of the tumor, localization of the tumor (colon or rectum), distant metastasis, and vascular invasion of the tumor. In the multivariate analysis, COX-2 expression was not found as an independent prognostic factor. We demonstrated that COX-2 expression was not correlated with clinicopathological characteristics of colon carcinoma and disease outcome.

Oropharyngeal chordoma diagnosed by fine needle aspiration: a case report.

BACKGROUND: Due to its rarity, chordoma may be difficult to differentiate from other neoplasms with a similiar myxoid background. We describe a case of chordoma involving the oropharynx inferiorly that was diagnosed by transoral fine needle aspiration (FNA) cytology (FNAC) and confirmed by histologic studies. This appears to be 1 of the few reported applications of FNA in the diagnosis of chordoma of the oropharynx in the English-language literature. CASE: A 50-year-old male presented with nocturnal dyspnea and rare hemoptysis for 6 months. A hypodense mass was located in the left posterior side of the oropharynx. FNAC of the mass showed classic physaliferous cells with a bubbly appearance and myxoid fibrillary background. The aspirate was reported as "myxoid tumor suggestive of chordoma," as confirmed by histopathologic investigation of the excisional biopsy. CONCLUSION: The cytologic features of chordoma are quite characteristic, especially on May-Grünwald-Giemsa (MGG)-stained slides. The cytoplasmic vacuoles of the physaliferous cells and the mucoid matrix of the tumor become conspicuous on MGG staining. When Papanicolaou staining is used as the only staining procedure, the cytoplasmic vacuoles of the physaliferous cells and mucoid matrix of chordomas may be overlooked. The differential diagnosis of myxoid tumors is of utmost importance for therapy and prognosis.

[The importance of the Delphian lymph node in subtotal laryngeal surgery]. / Subtotal larenks cerrahisinde Delphian lenf nodunun önemi.

OBJECTIVES: The study was designed to investigate the incidence of the Delphian lymph node in patients who underwent supracricoid laryngectomy (SL) for squamous cell carcinoma of the larynx and to evaluate our surgical approach to the primary tumor and the neck. PATIENTS AND METHODS: Twenty patients underwent SL for squamous cell carcinoma of the larynx. Laryngeal reconstruction was performed with cricohyoidopexy in 17 patients and cricohyoidoepiglottopexy in three patients. The presence of the Delphian lymph node was evaluated, together with its effect on the surgical technique, tumor metastasis, and prognosis. RESULTS: Preoperatively, no Delphian lymph nodes were detected by palpation. Intraoperative exploration revealed 13 lymph nodes in eight patients. Histopathologic examination showed metastatic spread in only one patient, the other nodes were found reactive. Surgical resection of the patient with Delphian node metastasis included the perichondrium of the cricoid cartilage as the lowest surgical margin, and neck dissection was extended to include the sixth level and postoperative radiation therapy was administered including the superior mediastinum. The patient died eight months after surgery from lung metastasis and neck recurrence. CONCLUSION: Evaluation of the Delphian lymph node existence particularly in patients with tumors involving the anterior commissure, anterior subglottic area, epiglottic petiole, and the pyriform sinus is important in excluding the possibility of leaving metastatic nodes behind in surgical techniques in which partial or total preservation of the cricoid cartilage is considered.