Keratoacanthoma developing in previous cryotherapy site for solar keratosis.

Keratoacanthoma is a relatively common benign squamous neoplasm that may show spontaneous clearing. Although the cause of the tumour is unknown, there are some reports describing keratoacanthoma following various types of trauma or secondary to other skin lesions. Thermal burns are reported to be important preceding traumas in the development of keratoacanthomas. whereas there is only one report of cold trauma of cryotherapy. We report a rare case of keratoacanthoma arising in the site of cryotherapy applied for solar keratosis.

Ichthyosiform eruption associated with lamivudine in a patient with chronic hepatitis-B infection.

The side-effects of antiretroviral agents have been widely reported in the literature. Lamivudine is an antiretroviral agent, and skin eruption because of this agent has been rarely reported. Previous reports regarding these few side-effects of lamivudine include angioedema, urticaria, anaflactoid reactions, allergic contact dermatitis and alopecia. There is no report of an ichthyosiform eruption associated with lamivudine. The authors present a case of 43-year-old female patient presenting with an ichthyosiform eruption during lamivudine therapy for chronic hepatitis-B for the first time.

Vesicular and pustular eruption related to cytomegalovirus in an immunocompetent patient.

Cytomegalovirus (CMV), a member of the herpesviridae family, can cause various dermatologic and systemic disorders especially in immunosuppressed subjects. However, immunocompetent individuals rarely present with cutaneous eruptions related to CMV. We describe an immunocompetent patient who developed a skin eruption and mild hepatitis related to CMV.

Bilateral chylothorax caused by pleuropulmonary lymphangiomyomatosis: a challenging problem in thoracic surgery.

Massive left-sided pleural effusion in a 35-year-old man was initially diagnosed as idiopathic spontaneous chylothorax and treated with serial thoracenteses and left thoracotomy. Six weeks later, a right thoracotomy was performed for contralateral chylothorax, and histologic examination revealed lymphangiomyomatosis. The patient survived this rare and potentially fatal disease. We have found no previously published case of bilateral lymphangiomyomatosis treated with separate thoracotomies because of bilateral chylothorax.

The relation between p53 overexpression and lymph node metastases in clinical stage t2 and t3a transitional cell bladder carcinoma.

Mutant p53 protein overexpression is generally associated with poorly differentiated invasive bladder tumors. The survival in such cases is also expected to be poor. The objective of the present study was to determine whether immunohistochemical staining for p53 was predictive of lymph node metastases in early muscle invasive transitional cell bladder cancer. Immunohistochemical staining for mutant p53 was performed on formalin fixed transurethral resection specimens of 31 patients who underwent radical cystectomy. Eleven tumors were grade II and 20 tumors were grade III. There were 16 stage T2 and 15 stage T3a tumors. Staining with p53 was categorised as positive if distinct nuclear staining was observed in > or = 20% of the cells. Results were compared according to grade, stage (T2 versus T3a) and lymph node metastases. Seventeen tumors (55%) were positive for mutant p53. Eleven cases had lymph node metastases which could not be assessed preoperatively. The distribution of p53 positive rate between grade II and grade III cases, and T2 and T3a tumors was not different. All the 11 patients with lymph node metastases had positive tumors for p53. We assume that p53 positive rate can be used to distinguish high risk patients for lymph node metastasis. Patients with stage T2 or T3a and p53 positive bladder cancer should be considered for early aggressive treatment options.

Unusually high frequency of a 69-bp deletion within the carboxy terminus of the LMP-1 oncogene of Epstein-Barr virus detected in Burkitt's lymphoma of Turkish children.

Burkitt's lymphoma (BL) in Turkish children is commonly associated with Epstein-Barr virus (EBV) infection. The C-terminus of the latent membrane protein 1 (LMP-1) of EBV is essential for transformation and the 30-bp deletion detected in this region has been implicated to be associated with a more aggressive malignant phenotype. To understand the molecular mechanisms underlying EBV pathogenesis in BL of Turkish children, we analyzed 30-bp deletion and 33-bp variable repeat regions of the LMP-1 gene from paraffin-embedded tumor tissues of 30 BL patients (mean age 5.9 years). Primer pairs spanning the 30-bp deletion and 33-bp repeat regions were designed for amplification by polymerase chain reaction (PCR). The PCR-amplified products were analyzed by gel electrophoresis, Southern blot hybridization, and DNA sequencing. Twenty-eight (93%) of 30 BL biopsy samples were EBV positive as determined by PCR. Variable copy numbers (ranging from 4.5 to 7) of the 33-bp repeat of LMP-1 gene were detected in these EBV-containing tumor samples. To determine the frequency of the 30-bp deletion of the LMP-1 gene, we sequenced the amplimers encompassing this region. Analyses of DNA sequence of 28 Turkish BLs have disclosed four patterns: the first (32% (9/28)) is identical to B95-8 with no deletion, the second (11% (3/28)) is identical to Asian NPC CAO strain with 30-bp deletion, the third (46% (13/28)) is prevalent in Turkish BLs with a longer deletion (69 bp), and the fourth (11% (3/28)) consists of a mixture of 30-bp and 69-bp deletion. The occurrence of high frequency of the 69-bp deletion appears to have no correlation with the disease site. Mutations found in the CAO strain were also detected in the Turkish BL clustering at the amino acids 322, 334, 338 and 342; whereas mutations specific for Turkish BL were clustered at amino acids 326, 352 and 361. To assess the EBV genotype with the changes in C-terminus of LMP-1 gene, we performed genotyping by PCR to differentiate type A and B strain. All 28 patients were infected by type A EBV. Such a high frequency of the larger size (69 bp) deletion has never been reported. Ascertaining the role of this deletion in BL pathogenesis will require further study.

Subcutaneous sacrococcygeal myxopapillary ependymoma.

We report an 8-year-old boy with a primary subcutaneous sacrococcygeal ependymoma, a rare tumor that is thought to arise in embryologic rests. The lesion was completely removed in our patient, who has been followed without recurrence for 20 months. Our experience, together with that of the other 15 cases in the world literature, supports surgical excision as the mainstay of treatment.

Leiomyosarcoma of the vagina.

Vaginal leiomyoma is uncommon and borderline leiomyoma of the vagina is an extreme rarity. Leiomyoma of the vagina may undergo malignant change to become borderline malignancy or leiomyosarcoma. A 38-year-old woman, complaining of foul vaginal discharge and dyspareunia with 2 months duration, underwent total excision of tumor. The removed tumor was diagnosed as borderline case of leiomyoma histologically. Unfortunately, she had tumor recurrence within 4 months. Thus, it was more likely that the primary diagnosis was incorrect and that the diagnosis leiomyosarcoma has been missed. She underwent total abdominal hysterectomy, bilateral salphingo-oophorectomy and total vaginectomy. The final diagnosis was leiomyosarcoma. Three months later tumor recurred again and re-excision followed by chemotherapy was performed. However, she died of her disease on her 5th month following three courses of chemotherapy.

Vulvar syringoma exacerbated during pregnancy.

Although syringoma of the eyelids and the cheeks are well known and defined, vulvar syringoma is a rare clinical variant of this benign eccrine tumor. A case of syringoma of the vulva exacerbated during pregnancies with regression in the periods in between is presented. Histopathological examination showed typical features of syringomas. Only 20 patients with vulvar syringoma have been previously reported in the literature.

Surgical treatment of splanchnic artery aneurysms secondary to medial degeneration: report of two cases.

Although splanchnic artery aneurysms are an uncommon form of vascular disease, splenic artery aneurysms are the third most common intraabdominal aneurysms, followed by aneurysms of the infrarenal aorta and iliac arteries. In this report, we present two splanchnic artery aneurysms, one symptomatic located in the superior mesenteric artery and one found incidentally in the splenic artery. In the first case reconstructive surgery was carried out. In the second patient the splenic artery aneurysm was excised and splenectomy was performed. The incidence, clinical presentation, pathophysiology, evaluation, and treatment modalities are discussed.

Tubal histopathology in ectopic pregnancies.

A histopathologic study in eighty six patients with ectopic pregnancy and in eighty six control patients was undertaken to evaluate the association between ectopic pregnancy and tubal pathology in our population. Fifty six (65%) and nine (10.4%) cases with chronic salpingitis (CS) were diagnosed in the study group and in the control group, respectively. This difference was statistically significant (p < 0.001). Twelve of 56 cases with chronic salpingitis were salpingitis isthmica nodosa (SIN) and no patient with SIN was observed in the control group. SIN was always concomittant with chronic salpingitis in our study. Based on these findings, we concluded that chronic salpingitis and SIN have an important role in the etiology of ectopic pregnancy in our population and SIN is significantly associated with chronic salpingitis.

Accuracy of pipelle endometrial sampling in endometrial carcinoma.

In this prospective study, we compared the histological results of Pipelle endometrial sampling (PES) with that of hysterectomy to examine whether endometrial sampling with the Pipelle device can accurately diagnose endometrial carcinoma. PES was performed in 26 patients with known endometrial carcinoma whose initial therapy consisted of hysterectomy. Discomfort and pain during the biopsy were reported to be mild by 22 patients, moderate by 3 patients and severe by only 1 patient. All of the samples were found to be adequate. Twenty-four of 26 PES confirmed endometrial carcinoma, a correlation of 95%, and the histological grade reported on PES agreed with that of hysterectomy specimens in 87.5% of the patients. On the other hand, the tumor grade in the specimens obtained at dilation and curettage correlated with hysterectomy specimens in 95% of the patients. We conclude that Pipelle is an accurate device in patients with endometrial carcinoma.