Osteoplastic flap approach versus orbitotomy in case of orbitofrontal cholesterol granuloma.

A 44-year-old man developed a slow-growing painless left superolateral orbital mass that extended into the frontal sinus with a complaint of ptosis. Magnetic resonance imaging revealed a heterogenous hyperintense lesion confined to the left frontal bone and superior orbit. The osteoplastic frontal sinus approach was performed to drain supraorbital cholesterol granuloma cyst and for curetting the capsule. Orbitofrontal cholesterol granuloma characteristically arises in the diploe of the superolateral frontal bone. The traditional approach for a primarily orbitofrontal cholesterol granuloma is the transorbital approach including anterior orbitotomy or lateral orbitotomy. However, the osteoplastic approach should be kept in mind as an alternative aprroach for the management of supraorbital lesions in patients with well-pneumatized frontal sinus.

Coexistence of gastrointestinal stromal tumors (GISTs) and pheochromocytoma in three cases of neurofibromatosis type 1 (NF1) with a review of the literature.

It is well known that neurofibromatosis type 1 (NF1) is uncommonly associated with pheochromocytoma development and also, to a larger extent, with gastrointestinal stromal tumors (GISTs). We herein document three cases with the rare condition of NF1 coexisting with GIST and pheochromocytoma, while one of them also has a composite tumor and another has papillary thyroid carcinoma.

Respiratory epithelial adenomatoid hamartoma: a rare nasopharyngeal mass lesion.

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare and nonneoplastic lesion of upper respiratory tract characterized by an abnormal mixture of tissues which are peculiar to the involved anatomic region. The most common site reported is nasal cavity and its nasopharyngeal origin is extremely rare. The lesion can be confused with a variety of benign and malignant entities. In this article, we report a 22-year-old female case of REAH of posterior nasopharyngeal wall. The clinical and radiological features of the lesion are discussed in the light of literature data.

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.

Fine needle aspiration cytology of head and neck masses: a cytohistopathological correlation study with emphasis on false positives and false negatives.

OBJECTIVES: This study aims to evaluate the accuracy ratio of fine needle aspiration (FNA) cytology in the diagnosis of non-thyroidal head and neck masses. PATIENTS AND METHODS: Between 2000 January and 2003 December, the pathology reports of 571 patients (297 males, 274 females; mean age 45 years; range 4 to 83 years) with non-thyroidal head and neck masses who underwent FNA cytology during a four year period were retrospectively analyzed. Cytopathological and histopathological results of the samples were recorded. The smear results indicating an inconsistency were reviewed. The possible causes of the false positivity and false negativity were investigated. RESULTS: Of a total of 571 patients, 181 had a confirmed histopathological diagnosis. The overall accuracy ratio, specificity, sensitivity, negative predictive value and positive predictive value of FNA in the diagnosis of the head and neck masses were 83%, 85%, 81%, 84%, 83%, respectively. CONCLUSION: The FNA has a high accuracy, sensitivity, specificity, negative and positive predictive values in the diagnosis of head and neck masses. If the major causes of misdiagnosis including inadequate sampling and misinterpretation are avoided, the diagnostic accuracy ratio of FNA in the head and neck and will be improved.

The value of touch imprint cytology of core needle biopsy in the diagnosis of spinal lesions.

AIM: We aimed to investigate the contribution of the touch imprint cytology (TIC) of core needle biopsies (CNBs) to the diagnosis in spinal lesions. MATERIAL AND METHODS: Sixty cases with spinal CNB and TIC were included in the study. Hematoxylin and Eosin (H&E) and May-Grunwald- Giemsa (MGG) stained TIC slides and CNB of each case were blindly reevaluated by two pathologists. TIC and CNB findings were categorized as follows: 1-Nondiagnostic 2- Benign nonneoplastic 3- Benign neoplastic 4- Malignant 5-Malignant lesions that can be typed. RESULTS: TIC and CNBs were nondiagnostic in 62% and 45% of all cases, respectively. Malignancy could be identified and typed in 23% of imprint preparations and 35% of CNBs. When TIC and CNB diagnosis were compared, it was seen that diagnostic categories were just the same in 70% of the cases. In 37% of the cases benign and malignant groups could be distinguished. In 20% of the cases diagnostic categories were totally different. CONCLUSION: The percentage of the nondiagnostic material in CNBs can reach up to 45%. The findings in TIC and CNBs were compatible with each other. We observed that TIC was diagnostic on its own especially in carcinoma metastasis and contributed to the assessment of cytologic detail in hematologic malignancies.

Solid tumors in Turkish children: a multicenter study.

BACKGROUND: This paper presents a detailed incidence study on childhood solid tumors comprising a histopathology-based documentation of benign and malignant lesions. METHODS: The Ankara Pediatric Pathology Working Group collected databases of pediatric solid tumors from six pediatric reference centers in order to analyze the incidence, distribution and some epidemiologic characteristics of the tumors and to establish a multicenter database for further studies. A five-year retrospective archive search was carried out. Excluding epithelial tumors of the skin, leukemia, lymphoreticular system neoplasias, metastatic tumors, and hamartomas, 1362 solid tumors in 1358 patients were classified according to age, sex, localization, histopathology and clinical behavior. RESULTS: The male/female ratio was 0.9; 14.8% (201) of the patients belonged to 0-1 year age group, 20.7% (281) to 2-4 years, 25.9% (352) to 5-10 years, 22.2% (301) to 11-14 years, and 16.4% (223) to 15-18 years. Among all tumors, 708 (52.0%) were malignant, 645 (47.4%) benign tumors, 2 (0.1%) borderline tumors, and 2 (0.1%) unknown behavioral tumors. Malignant tumors were found in 50.2% (357) of female patients and in 54.0% (349) of male patients. A balanced distribution between benign and malignant entities among children under 18 years was observed. Comparison between the age groups revealed malignant cases outnumbered benign cases under 4 years of age while benign tumor numbers increased after 10 years of age. The most common entities in the malignant group were of sympathetic nervous system origin, while soft tissue tumors far outnumbered the others in the benign group. CONCLUSIONS: We conclude that the cancer patterns of children in the Ankara region mostly resemble with those of the western population. This study provides useful information on the diagnosis of solid tumors in children and highlights variations in cancer incidence in different age groups.

Detection of prostate cancer with magnetic resonance imaging: optimization of T1-weighted, T2-weighted, dynamic-enhanced T1-weighted, diffusion-weighted imaging apparent diffusion coefficient mapping sequences and MR spectroscopy, correlated with biopsy and histopathological findings.

PURPOSE: The aim of this study was to optimize and predict the most efficient magnetic resonance imaging (MRI) sequences; T1-weighted (T1W), T2-weighted (T2W), dynamic contrast-enhanced (DCE) T1W, diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) mapping sequences and proton MR spectroscopy (H-MRS) for the detection of prostate cancer. MATERIALS AND METHODS: After institutional review board approval and informed consent taken from all the patients, 40 patients with prostate cancer were included in this research. Two readers independently evaluated the results of T1W, T2W, DCE T1W, and DWI-ADC mapping sequences and proton H-MRS for the depiction of prostate cancer. Reference standard was the transrectal ultrasonography-guided biopsy and the surgical histopathological results. Statistical analysis was assessed by the Fisher exact t test, Wilcoxon signed rank test, variance analysis test with kappa (κ) values and receiver operating characteristics (ROC) curve for ADC values, choline (Cho)/citrate (Cit) and Cho+creatine (Cre)/Cit ratios for each observer. RESULTS: Based on both readers' results, sensitivity declined to 31% and specificity to 75% for the T1W sequence, sensitivity declined to 43% and specificity to 67% for the DCE T1W sequence, sensitivity declined to 46% and specificity to 68% for the T2W sequence, sensitivity declined to 29% and specificity to 82% for the DWI-ADC mapping; and specificity was 49% for the Cho/Cit and Cho+Cre/Cit ratios, sensitivity was 69% for the Cho/Cit ratio, and sensitivity was 70% for the Cho+Cre/Cit ratio for H-MRS. The T2W sequence and H-MRS presented significant statistical differences for the depiction of prostatic cancer (P < 0.05), the most efficient sequence to detect prostatic cancer was H-MRS: Cho+Cre/Cit and Cho/Cit ratios. CONCLUSION: Instead of using either sequences alone owing to low sensitivity and specificity rates, combined use of MRI techniques could easily improve the detection and staging of prostate cancer.

Basal cell adenoma with extensive squamous metaplasia and cellular atypia: a case report with cytohistopathological correlation and review of the literature.

Basal cell adenoma (BCA) is a rare benign basaloid neoplasm of the salivary gland. There are four histopathological types of BCA: solid, tubular, trabecular, and membranous. It is known that focal squamous metaplasia may be seen in some BCAs, but it is rare to see extensive squamous metaplasia, especially with cellular atypia. Here, a 25-year-old male with right parotid swelling is presented. Ultrasonography revealed a 2-cm well defined mass in his parotid gland. Fine-needle aspiration (FNA), performed prior to surgical excision, showed a highly cellular tumor composed of basaloid cells, forming small duct-like or tubular structures containing basement membrane-like material, as well as squamous cells with hyperchromatic, enlarged, pleomorphic, and bizzare nuclei. We made a cytopathological diagnosis of "basaloid neoplasm" and also reported that the differential diagnosis included BCA, cellular pleomorphic adenoma, basal cell adenocarcinoma, and carcinoma ex pleomorphic adenoma. The patient underwent total parotidectomy. Both frozen and permanent sections showed a BCA with membranous, tubulotrabecular pattern, and extensive squamous metaplasia. Some of the squamous cells showed significant nuclear hyperchromasia, enlargement, and pleomorphism. As far as we know, this is the first case of BCA with extensive squamous metaplasia and prominent cellular atypia. This case has been presented to show that squamous metaplastic cells with hyperchromatic, enlarged, bizarre, and pleomorphic nuclei can be seen on FNA smears of a benign tumor like BCA. Also, the differential diagnosis of BCA of the salivary gland is discussed here.

Childhood fibroblastic and myofibroblastic tumors: a multicenter documentation and review of the literature.

OBJECTIVE: In this study, we aimed to give a documentation of 37 cases of childhood fibroblastic/myofibroblastic tumors retrieved from the archives of 6 reference centers in Ankara along with a comprehensive review on the subject. MATERIAL AND METHOD: A retrospective archive search was carried out for the period between 2006-2010 in 6 reference centers in Ankara covering patients with ages ranging between 0-18 years. All the tumors categorized under fibroblastic and myofibroblastic group according to World Health Organization criteria were collected. RESULTS: The study comprised 407 soft tissue tumors in total. Fibroblastic/myofibroblastic tumors constituted 9,1 % (37 cases) of these tumors. According to histopathology; 16 cases were categorized as fibromatosis, 8 cases as inflammatory myofibroblastic tumor, 6 cases as infantile fibrous hamartoma, 3 cases as nodular fasciitis and 2 cases as infantile myofibroblastic tumor/myofibromatosis and 1 case as cranial fasciitis. The only malignant case was an infantile fibrosarcoma. CONCLUSION: Infantile fibrosarcoma was lower than reported series and a male predominance was noted. The low incidence of newly described entities as well suggests that these tumors may have been unrecognized.

CD117 and CD34 staining patterns in childhood benign mammary lesions.

OBJECTIVE: CD117 and CD34 are markers that have both been implied in cancer progression in adult breast lesions. This study was conducted in order to create a retrospective documentation and to analyze the expression patterns of these markers on childhood benign lesions along with a comparison with adult breast lesions' staining patterns. MATERIAL AND METHOD: Nine fibroadenomas, 2 tubular adenomas, 1 mammary hamartoma, 2 gynecomastias, 1 benign phyllodes tumor were retrieved from pathology archives of two reference centers between 2005-2010. RESULTS: CD117 staining was identified in the epithelium of all cases in fibroadenoma/tubular adenoma group and focally positive in 1 mammary hamartoma, 2 gynecomastias, and 1 benign phyllodes tumor. CD117 staining was detected in the stroma of 8 cases. Three fibroadenomas, 1 mammary hamartoma, 2 gynecomastias and 1 benign phyllodes tumor lacked stromal labelling for this marker. All cases were strongly and diffusely positive for CD34 except the benign phyllodes tumor case. This case presented marked loss of stromal CD34 staining when compared to the surrounding stroma. Additionally, pseudoangiomatous stromal hyperplasia was noted in 2 gynecomastias and in the peritumoral stroma of benign phyllodes tumor case. CONCLUSION: Our study demonstrated that fibroadenoma was the most commonly encountered breast lesion in childhood and that adolescent fibroadenomas showed similar staining patterns for CD117 and CD34 as for adult counterparts. On the other hand, different expression patterns of CD117 and CD34 between adenoma group and the gynecomastias and benign phyllodes tumor group may implicate different mechanisms of development and tumorigenesis among these groups.

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.

Intrathyroidal oncocytic parathyroid adenoma: a diagnostic pitfall on fine-needle aspiration.

Oncocytic parathyroid adenoma is a rarely seen benign neoplasm of the parathyroid and intrathyroidal location of this lesion is also uncommon. It can be easily misdiagnosed as Hürthle cell thyroid neoplasm on fine-needle aspiration (FNA). Here, an intrathyroidal oncocytic parathyroid adenoma in a 32-year-old male is reported. Ultrasonography showed a nodule 2 cm in largest diameter in the left thyroid lobe. FNA revealed cellular smears containing monotonous oncocytic cells arranged in monolayered sheets, pseudopapillary structures and clusters within a rich vascular network. The case was reported as "suspicious for Hürthle cell thyroid neoplasm" on FNA. Frozen section examination showed intrathyroidal oncocytic parathyroid adenoma with a rim of normal parathyroid tissue. The diagnosis was also confirmed with immunohistochemical stains (TTF-1, PTH, thyroglobulin) performed on permanent sections. Cytopathologic features of oncocytic parathyroid adenoma and Hürthle cell thyroid neoplasm are similar. It is important to keep oncocytic parathyroid adenoma in mind in the differential diagnosis of Hürthle cell thyroid neoplasm. Prior knowledge of clinical, radiological and laboratory data will avoid wrong cytopathologic diagnosis.

Mechanoreceptor evaluation of hip joint capsule and ligamentum capitis femoris in developmental hip dysplasia: a preliminary study.

We aimed to determine if there are mechanoreceptors in the hip joint capsule and ligamentum capitis femoris (LCF) of patients with developmental dysplasia of the hip (DDH). We took capsule and LCF biopsies from 20 hips of 20 patients who were operated on because of DDH. The mean age was 10.2 months (range 6-20 months) at the time of surgery. There were 12 girls and eight boys. Teratologic and secondary hip dislocations were not included in this study. Full thickness, 0.5 x 0.5 cm anterior capsule and LCF portions were taken for biopsy specimen. Specimens were stained with hemotoxylin eosin and examined immunohistochemically using monoclonal antibody against S-100 protein. In both analyses no mechanoreceptor was found in any samples of capsule or LCF. In this preliminary study we could not find mechanoreceptors in the local anterior joint capsule and LCF of the hip in children with DDH. We think that additional studies are necessary in order to understand the mechanoreceptor characteristics of the hip joint in children not only with DDH but also in children with healthy hips.