Histopathological Analysis of Central Nervous System Metastases: Six Years of Data From a Tertiary Center.

INTRODUCTION: The most common cause of neurological symptoms in patients with systemic malignant tumors is central nervous system (CNS) metastases, and CNS metastases are one of the important causes of morbidity and mortality in these patients. The most common metastatic tumors to the CNS are lung, breast, malignant melanoma, genitourinary, and gastrointestinal tumors. We aimed to analyze our data on patients with CNS metastases in our department, which belongs to a large archive in the field of neuropathology. METHODS:  The data of patients who had CNS metastases between January 2015 and August 2021 in our department were reviewed retrospectively. The patients were grouped in terms of demographic data, location, histopathological diagnosis, and primary origin characteristics, and their frequency and immunohistochemical staining characteristics were investigated. RESULTS: There were 256 patients with CNS metastases in our study. The mean age was found to be 56.12. Of the patients, 30.5% were female and 69.5% were male. Astrocytic and oligodendral tumors (25.3%), followed by meningiomas (24.1%), and then CNS metastases (21.3%) were the most common CNS tumors. Among the CNS metastases, the most common primary sites were the lung (58%), breast (16%), tumors of unknown primary origin (TUP) (5%), colon (4%), and gynecologic tract (3.1%). Localization was found as cerebral (69.5%), cerebellar (28.1%), and spinal (2.3%). CONCLUSION: In CNS system metastases, an accurate histological diagnosis should be made by histomorphological evaluation supported by compatible immunohistochemical results in the presence of clinical history and radiological findings. Despite performing a larger immunohistochemical panel, it should be kept in mind that a primary site of origin cannot be found in a significant number of cases.

Effectiveness of Milan Classification in Salivary Gland Aspirations.

OBJECTIVE: To determine the effectiveness of Milan system for the evaluation of aspiration cytology to salivary gland lesions classification. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Department of Pathology, Tertier Centre, University of Health Sciences, Adana City Education and Research Hospital, Adana, Turkey from January 2014 to December 2020. METHODOLOGY: Salivary gland aspiration cytology of the last six years was recategorised, according to Milan classification. Risk of malignancy (ROM) and risk of neoplasm (RON) were determined among the subgroups in the cytological materials of 233 patients, who had undergone excisional biopsy. RESULTS: Forty hundred and eighty salivary gland aspiration cytologies were available, in which 250 (52.1%) cases were males and 230 (47.1%) were females. The mean age was 52.36 ± 16.05 years. When aspiration cytology of 233 patients with resection were evaluated, according to Milan classification, ROM in non-diagnostic category was 9.5%, ROM in non-neoplastic category was 19.2%, and ROM in neoplasm-benign category was 8.2%. ROM were found 100% in the suspected malignancy and malignancy categories. There were no patients in the atypia category of undeterminate significance. CONCLUSION: In aspiration cytology of salivary gland lesions, Milan system provides useful information in classifying patients for clinical follow-up and treatment. However, it can be said that it is difficult to distinguish between the atypia of uncertain significance and neoplasm categories. Key Words: Salivary glands, Biopsy, Fine-needle, Milan classification.

Treatment of open wounds secondary to trauma using polyurethane foams with boric acid particles.

BACKGROUND: To investigate the efficacy of new foams with boric acid particles combined with a negative pressure wound treatment (NPWT) system in open fractures with tissue defects secondary to trauma. METHODS: Forty-nine patients with open fractures secondary to trauma with soft tissue defects who were admitted between 2016 and 2018 were included in the study. Patients were examined in two groups. In Group 1, boric acid-impregnated foams combined with the NPWT system were used in 27 patients, and in Group 2, silver nitrate-impregnated foams combined with NPWT systems were used in 22 patients. In addition to evaluating the broad-spectrum antibacterial feature of silver nitrate, the antimicrobial, angiogenetic, and epithelializing effects of boric acid were investigated macroscopically and histopathologically. RESULTS: A reduction in wound size and granulation was observed in each group. Macroscopically, the reduction in wound size, epithelialization and granulation were pronounced in Group 1 and in Group 2. Microscopically, the number of fibroblasts, collagen synthesis, and angiogenesis were significantly increased in Group 1 compared with Group 2. CONCLUSION: In this clinical trial, both the broad spectrum antimicrobial feature of boric acid and its positive effect on the cells responsible for wound healing were found to be an alternative compared with silver nitrate. The use of new foams with boric acid particles combined with the NPWT system may be a good alternative method in the treatment of open wounds due to trauma.

The Correlation of the Neutrophil-Lymphocyte Ratio and the Platelet-Lymphocyte Ratio With Pathological Findings in Neuroendocrine Tumors.

Introduction The relationship between clinical prognostic factors and blood neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in some tumors has been investigated. In this study, we examined whether there is a relationship between pathological prognostic factors and NLR as well as PLR only in neuroendocrine tumors (NETs). Methods A total of 115 patients with a NET diagnosis between 2014-2020 were included in the study. The efficiency of NLR and PLR in predicting distant metastases was determined by analyzing the receiver operating characteristic (ROC) curve. The relationship between histopathological parameters was also compared. Results The cut-off value of NLR was 3.01 for predicting distant metastasis. At this value, the specificity was 73.7%, the sensitivity was 70.7%, and the likelihood ratio was 2.51. There was a significant relationship between NLR and tumor localization, histological grade, mitosis, Ki-67, distant metastasis, and lymphovascular invasion (all p<0.001). The cut-off value of the PLR in predicting distant metastasis was 134.4. At this value, the specificity was 59.6%, the sensitivity was 58.6%, and the likelihood ratio was 1.44. There was no significant relationship between PLR and the histopathological findings (all p>0.05). Conclusions In our study, a high histological grade, high mitosis, a high Ki-67 proliferation index, distant metastasis, and lymphovascular invasion were found in patients with NLR at a cut-off value above 3.01. However, we could not attain the same results for PLR. For trucut and endoscopic biopsies in particular, follow-up of patients with grades 1 and 2 NETs along with histopathological findings and evaluation of NLR in peripheral blood may be useful. NLR, which is an easily accessible inflammatory marker, can be used as an independent predictive factor in NETs.

Relationship between Lymph Node Metastasis and a Low 18F-FDG PET/CT Axillary SUVmax Value in Breast Cancer.

OBJECTIVE:  To evaluate breast cancer patients with low F18-fluorodeoxy-glucose positron emission tomography/computed tomography scan (FPET) of axilla standardised maximum uptake value (SUVmax) along with their histopathological findings regarding axillary lymph node metastasis (LNM). STUDY DESIGN: A descriptive study. Place and Duration of the Study: Adana City Education and Research Hospital, Turkey, from January 2015 to October 2018. METHODOLOGY: The current study analysed the findings of 113 patients according to age, histopathological axillary LNM, estrogen and progesterone receptor status, tumour size, histological grade, Ki-67, HER2 and preoperative FPET SUVmax findings. Histopathological and immunohistochemical comparisons were made between FPET axilla SUVmax and univariate and multivariate parameters in breast carcinoma in terms of LNM. RESULTS: The authors analysed the receiver operator characteristic curve for the FPET axilla SUVmax and set the cut-off value to 1.84 to predict LNM. However, it was also found that the SUVmax detected metastases in the axilla at values lower than 1.84. In the multivariate analysis, a statistically significant relationship was found between axilla LNM cases that have FPET axilla SUVmax less than 1.84, a Ki-67 index greater than 15% and tumour size greater than 2 cm (p <0.05). CONCLUSION: Values that were above the axilla SUVmax limit of 1.84 in FPET helped determine LNM. However, further evaluation of patients is needed comparing axilla SUVmax of less than 1.84 in FPET together with the Ki-67 proliferation index and tumour size. Key Words: Breast, Cancer, Lymph nodes, Metastasis, PET, Pathology.

The Impact of Myeloperoxidase in the Rupturing of Cerebral Aneurysms.

OBJECTIVE: In this study, we aimed to examine the effect of myeloperoxidase on aneurysm rupture in patients with cerebral aneurysms with and without rupture. METHODS: The study included 53 patients with subarachnoid hemorrhage operated on due to cerebral aneurysm in our clinic, and 49 patients without subarachnoid hemorrhage. After the operation, the domes taken from the aneurysms were embedded in paraffin blocks and scored after hematoxylin and eosin and immunohistochemical staining was carried out. RESULTS: The myeloperoxidase score was 1 in 29.4% of the patients, 2 in 40.2%, 3 in 12.7%, and 4 in 17.6%. Multiple aneurysms were detected in 24.5% of the patients. The median myeloperoxidase score was higher in patients with bleeding aneurysms than those that did not bleed (3 vs. 1; P < 0.001). In addition, the ratio of patients with a myeloperoxidase score of 2 or above was higher among patients with bleeding aneurysms. CONCLUSIONS: In our study, finding myeloperoxidase scores higher in cases of ruptured aneurysms compared with unruptured aneurysms reveals the relationship of myeloperoxidase with ruptured cerebral aneurysms.

Evaluation of radiologic diagnostic criteria and treatment options in skeletal muscle hydatid cysts.

AIM: To investigate the diagnosis and treatment methods of soft tissue involvement of hydatid cysts (HCs). MATERIALS AND METHODS: Eleven patients who were diagnosed as having HC with muscular tissue (soft tissue) involvement between 2010 and 2016 were evaluated retrospectively. Seven patients had typical HC magnetic resonance imaging (MRI) and four patients had cysts with an unusual appearance. We evaluated how to diagnose the cysts using imaging methods, their characteristic radiologic images, and treatment alternatives against the disease. The patients were treated with antihelminthic chemotherapy preoperatively and postoperatively. RESULTS: Of the 11 patients who underwent treatment, 7 were diagnosed using MRI and 4 were diagnosed with histopathologic examinations. The mean follow-up period was 16 (range, 6-24) months, and the mean age was 39.4 (range, 24-56) years. In seven patients, multivesicular appearance with specific MRI findings, T2-hypointense rim appearance, double-rim sign, membrane dissociation, and appearance of daughter cysts were identified as diagnostic criteria. Two patients underwent ultrasound assisted percutaneous aspiration-injection-reaspiration (PAIR) treatment. Seven patients underwent total pericystectomy, and two patients underwent subtotal pericystectomy with serum saline injection into the cyst. Two patients showed signs of mild anaphylaxis, one during the diagnosis and one during treatment. CONCLUSION: There may be difficulties in the diagnosis and treatment of HCs of the musculoskeletal system. It should be known that there are alternative methods in the treatment (cyst excision and PAIR treatment). Clinical, serologic, and radiologic findings should be used in the diagnosis. To avoid complications during the histopathologic diagnosis, MRI should be examined in detail. It is thought that atypical cysts can be diagnosed (double-layer appearance and peripheral rim sign) in addition to typical cysts (detached membrane and multivesicular appearance), and diagnosis and treatment can be planned without anaphylactic complications.

Relationship between tissue and serum eosinophilia in children undergoing adenotonsillectomy with allergic rhinitis

Background/aim: Previous reports suggested that allergic/eosinophilic inflammation affects the adenoid and tonsillar tissue. The aim of this study is to evaluate and compare the tissue and serum eosinophilia in children undergoing adenotonsillectomy with allergic rhinitis. Materials and methods: The clinical registers of 125 children undergoing adenoidectomy/tonsillectomy due to adenoid/tonsil hypertrophy were examined and reviewed retrospectively. Fifty-seven children with positive skin prick test and symptoms of allergic rhinitis were included in the study as the atopic group, whereas 68 children with no allergic symptoms and negative skin prick test were included as the nonatopic group. Consequently, the total immunoglobulin E level and the serum and tissue eosinophilia of the atopic and nonatopic groups were compared. Results: Serum eosinophilia in the atopic group was found to be significantly higher than in the nonatopic group (P = 0.045). A significantly higher eosinophil count was found in adenoid/tonsil tissue of the atopic group (P < 0.001, P = 0.023, respectively). However, no significant correlation between tissue and serum eosinophilia was found. Conclusion: The inconsistency between tissue and serum eosinophilia in atopic children would particularly indicate a role of local atopy in adenotonsillar hypertrophy. Further studies are needed to better understand the effect and usefulness of serum and tissue eosinophilia in children with allergic rhinitis.

The role of p53, Ki-67 and laminin expression in the differential diagnosis of keratoacanthoma and well-differentiated SCC.

INTRODUCTION: We have aimed to evaluate the difference between the expression of p53, Ki-67, and laminin in keratoacanthoma and well-differentiated SCC (SCC) and to determine its importance in differential diagnosis. METHODS: This study totally included 46 cases consisting of 23 cases with keratoacanthoma and 23 with SCC. As well as age, gender, localization, and diameter of the lesion, the expression of p53, Ki-67 and laminin was evaluated. RESULTS: No statistically significant difference was found between KA and well-differentiated SCC in terms of diameter, age, and localization. There was a statistically significant difference between KA and well-differentiated SCC in terms of p53 and Ki-67 staining (P < 0.001). Increased expression of p53 and Ki-67 was found in well-differentiated SCC. A statistically significant correlation was present between the expression of p53 and Ki-67 in KA. A statistically significant difference was detected between KA and well-differentiated SCC in terms of laminin staining (P = 0.018). Increased laminin expression was determined in well-differentiated SCC. CONCLUSION: We have determined in this study that p53, Ki-67 and laminin may be used as adjuvant immunohistochemical markers in differential diagnosis of KA and well-differentiated SCC.

Can the number of eosinophils in adenoid and tonsil tissue determine the allergy in children?

OBJECTIVE: Previous reports have indicated the association of allergy with Waldeyer's ring. The aim of this prospective study was to evaluate the correlation between the allergy and the number of eosinophils in the adenoid and tonsil tissue. METHODS: 101 children who were underwent adenoidectomy and/or tonsillectomy were prospectively enrolled in this study. 46 children who had positive skin-prick test for at least one of the allergen panel were sensitized and 55 children were nonsensitized as a result of skin-prick test. Hematoxylin-eosin stained sections were examined under 400× magnification in a blinded fashion in 10 random sections for all samples and compared the groups. RESULTS: The number of eosinophils in adenoid and tonsil tissue was significantly higher in sensitized patients. The number of eosinophils in the adenoid and tonsil samples also were interrelated too (p < 0.001, kappa coefficient: 0.617). As a result of ROC analysis, patients with a cut-off of ≥5 eosinophils was in the sensitized group for adenoid samples [Sensitivity value: 72.09 and specifity value: 91.84]. Patients with a cut-off of ≥3 eosinophils are in the sensitized group for tonsil samples [Sensitivity value: 52.94 and specifity value: 92.11]. CONCLUSION: Presence of sensitization can be distinguished by looking at the number of eosinophils in the adenoid and tonsil tissue. It can be used to determine whether the patient is allergic or not. Examination of the routine hematoxylin-eosin stained adenotonsillary specimen for eosinophilia will guide us the diagnosis and treatment of allergic rhinitis and also reduce the cost considerably.

Association of ICAM-1, VCAM-1, CYCLIN D1 and Cathepsin D with Clinicopathological Parameters in Breast Carcinoma; an Immunohistochemical Study.

OBJECTIVE: Breast carcinoma is the most common malignant tumor detected in women. The hypothesis that increased levels of adhesion molecules and Cathepsin D affect cancerous cells moving away the primary tumor and contributes to migration of the cancerous cell and may cause remote organ metastases is defended. The aim of the present study was to search the association of intracellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), Cyclin D1, cathepsin D immunohistochemically with clinicopathological parameters in the patients diagnosed with invasive ductal breast carcinoma. MATERIALS AND METHODS: The pathological slides of 153 patients diagnosed with invasive ductal carcinoma were evaluated retrospectively. Three groups were created. Group 1 consisted of patients with positive lymph node metastasis and extranodal tumor invasion; Group 2 consisted of patients with positive axillary lymph node metastasis and negative extranodal tumor invasion and Group 3 consisted of the patients with negative axillary lymph node metastasis. In all groups, 20 paraffin blocks belonging to the primary tumor in the breast were stained by ICAM-1, VCAM-1, Cyclin D1 and Cathepsin D. Findings were examined by comparing with clinicopathological parameters. RESULTS: The highest number of metastatic axillary lymph nodes and the highest rate of cathepsin D staining were statistically found in the cases with positive axillary lymph node metastasis and extranodal tumor invasion. CerbB2 was negative in the cases with negative ICAM-1 whereas estrogen receptor and progesterone receptor were positive in the cases with positive VCAM-1. CONCLUSION: The present study reveals significant results for the patients diagnosed with invasive ductal carcinoma through breast biopsy especially before mastectomy in terms of increased number of metastatic axillary lymph nodes and extranodal tumor invasion by immunohistochemical Cathepsin D stain without any additional invasive intervention. Results of the present study may contribute to monitoring and treatment of the patients in the future.