Mucinous Pancreatic Cysts: Comparison of Cyst Size and Location in Certain Mucinous Cyst Subgroups.

BACKGROUND: There are studies reporting that the location of intraductal papillary mucinous neoplasia (IPMN) predicts malignancy. Therefore, we evaluated the cyst location's relationship with malignancy, and the possibility of using cyst size and location to distinguish between non-main duct (non-MD)-IPMNs, mucinous cystic neoplasia (MCN), and cystic pancreatic ductal adenocarcinoma (PDAC). METHODS: We performed a retrospective analysis of data from 122 patients with a definite cyto-histological diagnosis of non-MDIPMNs, LR-MCNs, and cystic PDACs via endoscopic ultrasound fine-needle aspiration between October 2011 and October 2020. We grouped the cyst locations as head, uncinate, neck (HUN), and corpus or tail (CT). On histology, low-grade dysplasia and intermediategrade dysplasia were considered low risk (LR), whereas high-grade dysplasia and invasive carcinoma were considered high risk (HR). RESULTS: Of the 122 patients (61 (50%) women, median age 61.5 years (range 19-85), there were 34 (27.9%) LR-non-MD-IPMNs, 33 (27%) HR-non-MD-IPMNs, 19 (15.6%) LR-MCNs, and 36 (29.5%) cystic PDACs. We found no significant difference between LRand HR-non-MD-IPMN locations (P = .803). Low-risk non-MD-IPMNs were significantly smaller than HR-non-MD-IPMNs (P < .001), LR-MCNs (P = .002), and cystic PDACs (P < .001). The area under the receiver operating characteristic curve (AUROC) was 0.819 (95% CI: 0.716-0.902; P < .0001), and demonstrated a cyst size cut-off <2.2 cm to differentiate LR cysts, while cysts <1.6 cm had a negative predictive value (NPV) of 100% in non-MD-IPMNs. CONCLUSION: Cyst location is not predictive of malignancy in non-MD-IPMNs. Low-risk non-MD-IPMNs were smaller than HR-non MDIPMNs, LR-MCNs, and cystic PDACs. The cyst size cut-off was 2.2 cm; however, <1.6 cm had a 100% NPV differentiating LR- from HR-non-MD-IPMNs.

The Impact of Everolimus and Radiation Therapy on Pulmonary Fibrosis.

Background and objectives: Everolimus (EVE) is a mammalian target of the rapamycin (mTOR) inhibitor that is widely used in cancer patients. Pulmonary toxicity, usually manifesting as interstitial pneumonitis, is a serious adverse effect of this drug. Radiation therapy, which is often administered in conjunction with chemotherapy for synergistic effects, also causes pulmonary fibrosis. In view of pulmonary damage development in these two forms of cancer treatment, we have examined the effect of EVE administration individually, in combination with radiation given in varying sequences, and its relation to the extent of pulmonary damage. Materials and Methods: We performed an experimental study in albino rats, which were randomized into five groups: (1) control group, (2) EVE alone, (3) EVE 22 h after radiation, (4) EVE 2 h after irradiation, and (5) only radiation. Sixteen weeks after thoracic irradiation, rat lung tissue samples were examined under light microscopy, and the extent of pulmonary damage was estimated. After this, we calculated median fibrosis scores in each group. Results: The highest fibrosis score was noted in Group 4. Among the five groups, the control group had a significantly lower median fibrosis score compared to the others. When the median fibrosis score of the group that received concurrent EVE with radiation therapy (RT) (Group 4) was compared with that of the control group, the difference was statistically significant (p = 0.0022). However, no significant differences were achieved among the study groups that received EVE only or RT only, whether concurrently or sequentially (p > 0.05). Conclusion: EVE is an effective treatment option for the management of several malignancies and is often combined with other therapies, such as radiation, for a more efficient response. However, an increased risk of pulmonary fibrosis should also be anticipated when these two modalities are combined, as they both can cause pulmonary damage, especially when administered concurrently.

The Protective Effect of Naringin against Bleomycin-Induced Pulmonary Fibrosis in Wistar Rats.

The aim of the current study was to investigate the protective effect of naringin on bleomycin-induced pulmonary fibrosis in rats. Twenty-four Wistar rats randomly divided into four groups (control, bleomycin alone, bleomycin + naringin 40, and bleomycin + naringin 80) were used. Rats were administered a single dose of bleomycin (5 mg/kg; via the tracheal cannula) alone or followed by either naringin 40 mg/kg (orally) or naringin 80 mg/kg (orally) or water (1 mL, orally) for 14 days. Rats and lung tissue were weighed to determine the lung index. TNF-α and IL-1ß levels, hydroxyproline content, and malondialdehyde (MDA) levels were assayed. Glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were determined. Tissue sections were stained with hematoxylin-eosin, Masson's trichrome, and 0.1% toluidine blue. TNF-α, IL-1ß, and MDA levels and hydroxyproline content significantly increased (p < 0.01) and GPx and SOD activities significantly decreased in bleomycin group (p < 0.01). Naringin at a dose of 80 mg/kg body weight significantly decreased TNF-α and IL-1ß activity, hydroxyproline content, and MDA level (p < 0.01) and increased GPx and SOD activities (p < 0.05). Histological evidence supported the results. These results show that naringin has the potential of reducing the toxic effects of bleomycin and may provide supportive therapy for conventional treatment methods for idiopathic pulmonary fibrosis.

Expression of FHIT, p16, p53 and EGFR as prognostic markers in thyroid tumors of uncertain malignant potential.

PURPOSE: Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. The purpose of this study was to analyze the relationship between immunohistochemical panels, prognostic parameters and TT-UMP. METHODS: Group I was composed of patients diagnosed as differentiated thyroid carcinoma (DTC) and Group II of patients diagnosed as TT-UMP. The prognostic scores of patients were calculated using data according to the well-known prognostic scoring systems MACIS, AMES, AGES. Evaluations of antibodies were based on the presence of nuclear staining for p16 and p53, membranous and cytoplasmic staining for epidermal growth factor receptor (EGFR) and cytoplasmic staining for fragile histidine triad (FHIT). RESULTS: Statistically significant difference was noted (p< 0.05) between Group I and Group II according to MACIS and AMES. No statistical difference was found in terms of immunostaining between groups when stained with p16, p53 and FHIT. On the other hand, in Group II a moderate positive correlation was detected between MACIS and EGFR. CONCLUSION: According to our findings p53 was not important in tumor genesis at early stages in well-differentiated thyroid carcinomas and p16 loss of expression could be used as a finding to help in difficult microscopic diagnosis. TT-UMP is a gray zone of lesions requiring specific therapeutic procedures and postoperative follow-up. A positive correlation was detected between EGFR and TT-UMP, leading to assume that this situation could be used as a new tool in the follow-up of these patients in the future.

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.

Management of neuroendocrine carcinomas of the breast: A rare entity.

Neuroendocrine (NE) carcinoma of the breast is extremely rare and constitutes less than 0.1% of all breast tumors. Only a few studies are currently available in the literature and a standard approach to treating this tumor has yet to be established. The aim of this study was to apply pathological treatment modalities in clinical practice and to select the most appropriate treatment accordingly. Six female patients were diagnosed with primary NE carcinoma of the breast. The patients underwent modified radical mastectomy with axillary dissection. Pathological specimens were stained with hematoxylin and eosin and an immunohistochemical panel of antibodies [neuron-specific enolase (NSE), chromogranin, synoptophysin, estrogen and progesterone receptor, c-erbB2 and Ki-67]. The results showed that tumor size ranged from 2 to 4.5 cm in diameter. Lymph node metastasis was detected in 4 (67%) patients. Estrogen and progesterone receptor expression was found in 5 (83%) patients. None of the patients expressed c-erbB2. Chromogranin was found to be positive in 5 (83%) patients. Synoptophysin expression was detected in 5 (83%) patients. NSE was stained in 4 (67%) patients. An intraductal component was found in 5 (83%) patients. Lymphovascular invasion was found in 5 (83%) patients. Adjuvant chemotherapy was administered to patients with a Ki-67 index of ≥10%. Radiotherapy was administered to 4 (67%) patients, and 4 (67%) patients received hormonal therapy. The mean follow-up time was 31.1 months (range 12-52). All 6 patients survived, although following chemotherapy and tamoxifen, the disease progressed in 1 patient who received second-line hormonal therapy. In conclusion, NE carcinoma of the breast is a distinct entity. Management of this rare tumor may include surgery and radiotherapy depending on the size of the tumor and lymph node status. However, the exact role of chemotherapy and hormonal therapy has yet to be established. Adjuvant chemotherapy is recommended for patients with a Ki-67 index of ≥10%, and hormonal treatment appears to be feasible in patients who are positive for estrogen and/or progesterone receptor.

Neoplasms of the salivary glands in a Turkish adult population

Objective: This retrospective study aimed to investigate the types and distribution of neoplasm of salivary glandsin a Turkish population.Study Design: The histological diagnosis records of the Department of Pathology at Cumhuriyet University were reevaluated for 125 patients who were treated for salivary gland tumors from 1987 to 2008. The neoplasms were analyzed for histological diagnosis, age, sex, and site. The histological diagnoses were analyzed according to the2005 WHO classification.Results: A total of 125 primary salivary gland neoplasms, consisting of 95 (76%) benign and 30 (24%) malignant groups were recorded. The most common major and minor salivary gland sites were the parotid (61.6%) and palatalglands (9.6%), respectively. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin’stumor. Among the malignant group, adenoid cystic carcinoma was the most prevalent. Age for all cases rangedfrom 16-80 years; mean age was 41.97 years, with a female to male ratio of 1:1.15.Conclusions: Although there were some discrepancies, the characteristics of salivary gland tumors of Turkish patients are in line with those of patients from other countries according to tumor type, tumor site distribution,and age and sex of patients (AU)

No disponible

Genetic analysis of intraoral KIT-positive gastrointestinal stromal tumor (GIST).

Gastrointestinal stromal tumors (GISTs), mesenchymal neoplasms originating from the cells of Cajal, usually appear in the gastrointestinal tract and abdomen. They often mimic other lesions, including smooth muscle cell tumors and neurogenic tumors. This study presents a case in which a GIST appeared over a 2-month period and was treated by excision and curettage, with no sign of recurrence during the next 42 months. The study also aims to characterize the GIST. Histopathologic analysis and KIT gene amplification and sequencing were performed. On mutation analysis of the GIST material, the novel 69338Tdel mutation was found in exon 11, and the diagnosis of intraoral stromal tumor was made. GISTs in the intraoral region display pathologic properties similar to others developed throughout the gastrointestinal system. Diagnosis is the first step of treatment for a patient. The discovery of oncogenic KIT mutations in GISTs has led to the development of targeted molecular therapy using tyrosine kinase inhibitors. This study investigates the histopathologic and molecular diagnostics of GISTs, and, to the authors' knowledge, it represents the first genetic study of a GIST developing in the intraoral region.

Neoplasms of the salivary glands in a Turkish adult population.

OBJECTIVE: This retrospective study aimed to investigate the types and distribution of neoplasm of salivary glands in a Turkish population. STUDY DESIGN: The histological diagnosis records of the Department of Pathology at Cumhuriyet University were reevaluated for 125 patients who were treated for salivary gland tumors from 1987 to 2008. The neoplasms were analyzed for histological diagnosis, age, sex, and site. The histological diagnoses were analyzed according to the 2005 WHO classification. RESULTS: A total of 125 primary salivary gland neoplasms, consisting of 95 (76%) benign and 30 (24%) malignant groups were recorded. The most common major and minor salivary gland sites were the parotid (61.6%) and palatal glands (9.6%), respectively. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin's tumor. Among the malignant group, adenoid cystic carcinoma was the most prevalent. Age for all cases ranged from 16-80 years; mean age was 41.97 years, with a female to male ratio of 1:1.15. CONCLUSIONS: Although there were some discrepancies, the characteristics of salivary gland tumors of Turkish patients are in line with those of patients from other countries according to tumor type, tumor site distribution, and age and sex of patients.

Signet ring cell adenoma of the thyroid: a very rare entity.

OBJECTIVES: To report a case of signet ring cell adenoma of the thyroid which is an extremely rare thyroid lesion. CLINICAL PRESENTATION AND INTERVENTION: A 25-year-old female patient presented with a goiter and dysphagia that had been present for the last 1 year before admission. Physical examination revealed a palpable solitary nodule in the right lobe of the thyroid. The ultrasonogram demonstrated multiple nodules among which the most remarkable one was 15 x 24 mm in size, in the right lobe of the thyroid. After surgical excision, the lesion was found to be consistent withsignet ring cell adenomacharacterized by the presence of round to oval signet ring cells with large cytoplasmic vacuoles and hyperchromatic eccentric nuclei. Intracytoplasmic thyroglobulin, periodic acid-Schiff (PAS) with and without diastase and combined Alcian-blue-PAS were all positive. CONCLUSIONS: Pathologists should keep this rare primary tumor of the thyroid in mind when examining thyroid lesions and should not confound it with metastatic signet ring cell carcinoma of the thyroid.

Pulmonary lymphangitic sarcomatosis and a review of the literature.

Intrapulmonary spread of a sarcoma via lymphatics is a rare cause of death in a young adult. A 31-year old man was admitted to our hospital complaining of dyspnea and malaise of 2 months' duration. A chest radiography revealed bilateral hilar enlargement, and reticulonodular infiltrations. Thoracic CT-scans demonstrated mediastinal lymphadenopathy, thickening of interlobular septa, polygonal lines, and thickening of bronchovascular bundles. The diagnosis was made by open-lung biopsy. The patient died within 3 months after diagnosis. Pulmonary lymphangitic sarcomatosis is a rare but important manifestation of an angiosarcoma. Optimal treatment of these patients is not well defined, but a trial of chemotherapy may be warranted.

Nasopharyngeal teratoma causing airway obstruction in the neonate.

Teratomas are the most common congenital tumours, but teratomas of the nasopharynx are rare in neonates. The present report concerns a premature 30-week-old infant girl with an extensive nasopharyngeal teratoma protruding from the oral cavity. The tumour completely obstructed the airway and necessitated immediate intubation. The tumour was successfully resected directly via the transoral route without needing external incisions. Histological examination of the specimen revealed it to be a mature teratoma. The management and differential diagnosis is discussed, accompanied by a review of the literature.

Benign metastasizing leiomyoma.

A 41-year-old woman presented with chest pain and a cough. There was a solitary pulmonary nodule in the upper-left lobe. The patient had no history of neoplasm except a hysterectomy for uterine leiomyoma five years before. Six months after the first presentation, the tumor showed a gradual increase in size; an explorative thoracotomy was performed. The histopathologic examination showed a tumor consisting of well-differentiated spindle-shaped cells with intervening collagen. She was readmitted 8 months after the operation because of right-sided spontaneous pneumothorax. Multiple pulmonary nodules appeared when the lung was re-expanded by chest tube drainage. In conclusion, uterine leiomyomas can metastasize to various organs, such as lungs, despite having a benign pathologic appearance.

Karyometric analysis of nasal polyps.

OBJECTIVES: Nuclear characteristics of epithelial cells in nasal polyps were analyzed. PATIENTS AND METHODS: The slides of 35 patients who underwent surgery for nasal polyposis and 18 slides of normal mucosa were examined. The specimens were stained with hematoxylin-eosin. Tissue sections were analyzed by a CCD camera and the Karyotype Program of Human Cytogenetics Nomenclature System on a Macintosh computer (OS 9). Fifty epithelial cells in each slide were randomly selected and transferred to the automated karyotyping system and photographed. The diameters of the nuclei were measured and some peculiar nuclear features were examined, including unsmooth appearance of the nuclear membrane, anaphase-bridge, and binucleation. RESULTS: There were significant differences between nasal polyp and normal mucosa groups in terms of nuclear diameter, perimeter, and volume, with all variables being greater in the nasal polyp group (p=0.001). Unusual nuclear features differed significantly (unsmooth nuclear membrane appearance, p<0.001; anaphase-bridge, p=0.041; binucleation, p=0.018), as well. CONCLUSION: Epithelial cells of nasal polyps exhibit nuclear instability.

The diagnostic value of ultrasonography-guided fine needle aspiration biopsy from liver and pancreas.

BACKGROUND/AIMS: The aim of this study was to evaluate the results of ultrasonographic guided fine needle aspiration biopsy conducted at our clinic between 1999 and 2000. METHODS: Biopsy was taken from either the liver or pancreas of 40 patients (29 male, 21 female) with a mean age of 59.7+/-11.99 years. RESULTS: The diameter of lesions was 2-15 cm, with 26 of 33 lesions in the liver being malignant. There was a solitary lesion in the liver being malignant. There was a solitary lesion in the pancreas in seven cases and these were found to be adenocarcinomas. CONCLUSIONS: This procedure is concluded to be a highly accurate diagnostic method, which is both fast and practical in clinical practice.

Alveolar hydatid cyst with lung metastasis: a case report.

Alveolar hydatid disease is a serious and often fatal condition caused by infection with the metacestode form of echinococcus multilocularis. Liver involvement is seen in 90% of the cases. The parasite develops within the liver as a rapid invasive pseudomalignant growth and may make distant metastasis. We present the case of a 37 year old woman admitted to our gastroenterology department with obstructive jaundice and then diagnosed as alveolar hydatid cyst with lung metastasis. This case is presented due to its rare prevalence.