Comparison of Histopathological Findings in Psoriasis According to the Lesion Location From Biopsy.

ABSTRACT: The aim of this study was to investigate whether the histopathological findings of psoriasis varied by the biopsied lesion location. Age, gender, age at disease onset, lesion locations, presence or absence of a preliminary diagnosis of psoriasis, and histopathological findings of 307 patients were recorded. The sections prepared from the patients' paraffin blocks were reexamined microscopically, the severity of the observed findings was graded, and various histopathological features were recorded. The female-to-male ratio was 1.2 to 1. Family history for psoriasis was positive in 30% of patients. A clinically preliminary diagnosis of psoriasis was present in 232 patients. The most common histopathological features included hyperkeratosis, parakeratosis, Munro/Kogoj microabscesses, suprapapillary thinning-hypogranulosis, and vascular dilation-capillary proliferation. Hyperkeratosis was least common in the trunk. A linear and moderately strong correlation was found between the histopathological findings of inflammation, capillary proliferation, and suprapapillary thinning. For the first time, the clinical and demographic features of psoriasis are evaluated and the severity of the histopathological findings is compared by the biopsied lesion location in a large number of patients.

Massive Skull Base Ameloblastic Carcinoma with Intracranial Extension.

Ameloblastic carcinoma (AC) is a rare and aggressive malignant epithelial odontogenic tumor that may arise either from the mandible (66.6%) or the maxilla (33.3%). Besides being formed de novo, the tumor can develop from a pre-existing ameloblastoma or odontogenic cyst. The clinical course of AC is typically aggressive with extensive local destruction. AC has also been reported to spread to various parts of the body through lymphatic system. Skull base location and intracranial extension of this tumor are uncommon. In this case report we present the clinical course, management and follow up of an uncommonly large AC that destructed the anterior skull base and extended into the intracranial space.

The efficacy of diffusion weighted imaging and apparent diffusion coefficients mapping for liver metastasis of colonic adenocarcinomas.

OBJECTIVES: To establish retrospectively the relation between the histopathologic grade of colorectal liver metastasis and apparent diffusion coefficient (ADC) values of hepatic metastases of colorectal adenocarcinomas. METHODS: The diagnoses of liver metastases were confirmed with biopsy, surgery, and follow-up imaging findings. Twenty-six patients with 94 liver metastasis were included in the study. Of 94 masses, 59 were poorly-differentiated adenocarcinoma, 18 were moderately-differentiated adenocarcinoma, and 17 were well-differentiated regarding the diameters, ADC values, and ratio index (RI) values. Kolmogorov-Smirnov normality test, Kruskal-Wallis analysis of variance, Mann-Whitney U test with Bonferroni correction, Spearman correlation analysis, and receiver operating characteristics curve methods were applied to evaluate the statistical relations. RESULTS: There was a statistically significant difference in terms of ADC values and RI between poorly-differentiated adenocarcinoma and moderately-differentiated adenocarcinoma plus well-differentiated adenocarcinomas. Poorly-differentiated adenocarcinomas have the lowest ADC values and highest RI values among other groups. CONCLUSION: Use of ADC values alone can be executed for the diagnosis of focal hepatic masses and also can aid in the differentiation of benign and malignant hepatic lesions.

Mallory-Denk bodies: Correlation with steatosis, severity, zonal distribution, and identification with ubiquitin.

BACKGROUND/AIMS: Intermediate filament proteins contain few aggregates as their main component. Among those, Mallory-Denk bodies (MDBs) are by far the best recognized component. To identify the presence of MDBs in individuals having chronic liver disease and to evaluate the correlation among MDBs and steatosis as well as the severity and zonal distribution of hepatocyte balloon degeneration. Tertiary reference hospital. MATERIALS AND METHODS: Three hundred consecutive liver specimens derived from our patients with chronic liver disease were included in the current study. Immunohistochemistry analysis was conducted on frozen liver biopsies fixed at room temperature with acetone anti-rabbit antibody to ubiquitin. In addition, histological activity was evaluated by the routine staining of liver biopsy sections with hematoxylin-eosin and periodic staining by acid-Schiff stain, reticulin, Masson trichrome, and iron. The presence of MDBs, steatosis, severity, and the zonal distribution of hepatocyte balloon degeneration were evaluated in every patient. RESULTS: Histopathologic diagnosis were chronic hepatitis B (n=219), alcoholic steatohepatitis (n=23), non-alcoholic steatohepatitis (n=20), chronic hepatitis C (n=20), overlap syndrome (n=10), and primary biliary cirrhosis (n=8). The distribution of MDBs stained positive for ubiquitin was 80% in the overlap syndrome, 86% in chronic hepatitis B, and 100% in alcoholic steatohepatitis, NASH, chronic hepatitis C, and primary biliary cirrhosis. There was a correlation between the severity of steatosis and ubiquitin positivity, particularly in zone 2. A conspicuous correlation existed between the severity of hepatocyte balloon degeneration and ubiquitin positivity. CONCLUSION: These findings have demonstrated that the observation of MDB together with ubiquitin positivity will be helpful in the evaluation of the models of diagnosis, staging, and therapy in patients with chronic liver disease.

What is gastritis? What is gastropathy? How is it classified?

Stomach endoscopic biopsies are made to determine the diagnosis of the illness, its stage, and follow-up after the treatment. It is very significant to collaborate with the clinician while evaluating endoscopic biopsies. Besides the clinical and laboratory information of the patient, the endoscopic appearance of the lesion should be known. The clinician and pathologist should use the same language and the same terminology. Although new classifications have been made to prevent the confusion of terminologies in neoplastic processes recently, most centers around the world have reported non-invasive neoplasias without giving any certain diagnosis by just commenting on it. The clinician should understand what the pathologist wants to say; pathologists should know the approach of the clinician (repetition of the biopsy, endoscopic resection, surgery). There is Helicobacter pylori (HP) in most of the stomach pathologies as the etiologic agent. No matter if the factor is HP or other etiologic agents, the tissue gives similar responses. That is why clinical-endoscopic indications should be taken into consideration, as well as histological indications, and the reports of the endoscopy should be seen. A good clinicopathologic correlation increases the accuracy of the diagnosis.

[Cervical lymphadenopathy: progressive transformation of germinal centers]. / Boyunda lenfadenopati: Germinal merkezlerin progresif transformasyonu.

Enlarged lymph node in the head and neck region is a common reason for referral to ear nose throat specialists. In the differential diagnosis of chronic lymphadenopathies, infection, lymphoproliferative disorders and progressive transformation of germinal centers should be considered. In this article, we report two cases of progressive transformation of germinal centers in the neck.

The diagnostic value of non-invasive tests for the evaluation of liver fibrosis in chronic hepatitis B patients.

BACKGROUND: Liver biopsy, which is considered the gold standard for the evaluation of hepatic fibrosis in patients with chronic hepatitis B (CHB), has certain limitations. The aim of this study was to investigate the diagnostic performance of non-invasive markers of hepatic fibrosis as potential alternatives to liver biopsy. METHODS: The medical records of 221 patients with a diagnosis of CHB who underwent a liver biopsy were reviewed. Indirect indicators of fibrosis were calculated for each patient based on previously described formulas [Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet index (API), cirrhosis discriminant score (CDS), AST-platelet ratio index (APRI), Forns index, FIB-4, Pohl score, AAR-platelet score (AARP), fibro-quotient (FibroQ), AST/platelet/Gammaglutamyl transpeptidase (GGT)/Alphafetoprotein (AFP) (APGA) index, Platelet/Age/Phosphatase (ALP)/AFP/AST (PAPAS) index, Lok's model, Goteborg University Cirrhosis Index (GUCI)]. Diagnostic adequacy of these indices was evaluated by receiver operating characteristic curve analysis. RESULTS: Area under the receiver operating characteristic curves for the FIB-4, Forns, GUCI, APRI, PAPAS, APGA and FibroQ indices were 0.701, 0.680, 0.670, 0.670, 0.639, 0.638 and 0.588, respectively. The AAR, API, CDS and AARP indices, Pohl score and Lok's model were all deemed diagnostically inadequate. FIB-4 had the best diagnostic adequacy whereas AAR had the worst. CONCLUSIONS: Our results suggest that out of the 13 indices evaluated, only FIB-4 index may be useful in estimating the extent of fibrosis in patients with CHB. There is a need for more comprehensive prospective studies to help determine the diagnostic value of non-invasive tests for liver fibrosis.

Acquired reactive perforating collagenosis.

Acquired reactive perforating collagenosis (ARPC) is commonly recognized as an unusual skin reaction to superficial trauma that is observed in patients with a certain genetic predisposition or underlying diseases, such as diabetes mellitus or renal diseases. We present the unusual case of a 55-year-old female diabetic patient with numerous characteristic dome-shaped nodules, which consisted of central umbilication containing firm keratotic plugs.

Understanding mechanisms of the pathogenesis of nonalcoholic fatty liver disease.

A central issue in the understanding of the pathogenesis of nonalcoholic fatty liver disease is the problem of the underlying mechanisms which are not fully understood. In the setting of excessive central adiposity, insulin resistance is the major underlying cause of fat accumulation in hepatocytes. Because of the difficulties with human trials, several animal models have been developed for this purpose mainly characterized as follows: genetically disturbed or murine fatty liver, methionine-choline deficient diet fed or murine steatohepatitis, and high-fat or sucrose diet fed models. Although these animal models have provided useful information, none of them accurately reflect genetic, metabolic and biochemical characteristics of the human disease.

Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy.

Liver penetration is a rare but serious complication of peptic ulcer disease. Usually the diagnosis is made by operation or autopsy. Clinical and laboratory data were no specific. A 64-year-old man was admitted with upper gastrointestinal bleeding. Hepatic penetration was diagnosed as the cause of bleeding. Endoscopy showed a large gastric ulcer with a pseudotumoral mass protruding from the ulcer bed. Definitive diagnosis was established by endoscopic biopsies of the ulcer base.