Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors.

BACKGROUND: Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). METHODS: Data from 2577 LLDs who underwent living donor hepatectomy (n = 2511) or aborted living donor hepatectomy (n = 66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. RESULTS: A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n = 446; 17.9%), adenomyomatosis (n = 9), and papillary hyperplasia (n = 6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n = 207; 0.4%), cholelithiasis (n = 53), cholesterol polyp (n = 31), and noncholesterol polyp (n = 19), respectively. Significant differences were detected between the male and female genders in terms of age (P < .001), height (P < .001), weight (P < .001), body mass index (P < .001), gallbladder width (P = .001), gallbladder length (P < .001), histopathological finding (content) (P < .001), and lymph node around the gallbladder (P = .015). CONCLUSIONS: The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.

Spindle Variant Primary Diffuse Large B Cell Lymphoma of the Colon: Case Report and Literature Review.

Diffuse large B cell lymphoma (DLBCL) with spindle cell morphology is a rare variant that can be seen in extranodal regions. Because the spindle cell dominant morphology in lymphoma is extremely unusual, the diagnosis can easily be missed in many organ systems. We present a case of an 82-year-old male patient with complaints of abdominal pain and swelling. He operated with the preliminary diagnosis of cecum tumor and ileum perforation. Tumoral proliferation was observed originating from the submucosa and infiltrating the muscularis propria, with the features of mostly spindle-shaped, having round-shaped nuclei in some of the cells, and having relatively narrow cytoplasm. A panel of immunohistochemical stains were performed to rule out the possibilities of sarcoma, carcinoma, or melanoma. Diffuse strong positive reaction was observed for CD45, CD20, CD19, CD22, Pax5, and CD30. The case was reported as spindle cell variant of DLBCL based on the present findings. As far as we know, this is the first case described in the colon. We emphasize that pathologists should be reminded of lymphoma as a differential diagnosis of spindle cell tumors.

Gastrointestinal Kaposi Sarcoma Involving Stomach and Colon: Diagnostic Pitfall for Pathologists with Expression of CD117.

Kaposi sarcoma (KS) is a low-grade vascular tumor caused by human herpes virus type 8 (HHV8). Gastrointestinal involvement of KS is rare and most commonly clinically silent. Gastrointestinal KS may mimic gastrointestinal stromal tumors (GISTs) histologically as the tumor formed by morphologically spindle-shaped cells, which is mostly located in the mucosa and submucosa. In the present study, we describe a case of Kaposi sarcoma that was first diagnosed in the gastrointestinal tract of a 73-year-old female patient who presented to the clinic with nausea and diarrhea. Immunohistochemical staining showed cytoplasmic CD117 expression both in stomach and colon biopsies. Although involvement of KS is rarely seen in the gastrointestinal tract (GIT), the differential diagnosis of low-grade spindle cell lesions without significant pleomorphism, KS should definitely be considered, and it should be known that CD117 positivity is also present in these neoplasms.

Analysis of prognostic factors in Grade 3 endometrioid type endometrial carcinoma.

OBJECTIVE: To investigate the prognostic factors of patients with Grade 3 endometrioid endometrial cancer (G3EEC). METHODS: This four-center, retrospective study included a total of 129 women with G3EEC. Demographic, clinicopathologic, and survival data were collected. Kaplan-Meier method was used for survival analysis. Predictors of outcome were analyzed using Cox proportional hazards models. RESULTS: Median age at the time of diagnosis was 63 (range 39-87) years and median follow up was 37 (range 6-126) months. For the entire cohort, the 5-year disease-free survival (DFS) and overall survival (OS) were 54.3% and 63.6%, respectively. The 5-year DFS rates for lymphovascular space invasion (LVSI) -positive and -negative patients were 41.6% and 88.3%, respectively (P < 0.001). The 5-year OS rates for LVSI-positive and -negative patients were 54.7% and 88.3%, respectively (P = 0.001). Positive LVSI status was identified as the independent prognostic factor for decreased DFS and OS (hazard ratio [HR] 5.5, 95% confidence interval [CI] 1.65-18.86; P = 0.006 versus HR 4.4, 95% CI 1.33-14.58; P = 0.013, respectively). CONCLUSION: LVSI seems to be an independent prognostic factor for decreased DFS and OS in G3EEC patients.

Risk factors for cervical stromal involvement in endometrioid-type endometrial cancer.

OBJECTIVE: The aim of this study was to identify predictors of cervical stromal involvement in women with endometrioid-type endometrial cancer (EEC). METHODS: A total of 795 patients with EEC who underwent comprehensive surgical staging including pelvic and para-aortic lymph node dissection between January 2007 and December 2018 were retrospectively analyzed. Data including age, menopausal status, serum CA-125 levels, tumor size, lymphovascular space invasion (LVSI), depth of myometrial invasion, positive peritoneal cytology, cervical stromal involvement, histologic grade, recurrence, and follow-up duration were recorded. RESULTS: Median follow up was 49 months. Cervical stromal invasion was found in 88 patients. Multivariate analysis revealed that presence of LVSI (hazard ratio [HR] 2, 95% confidence interval [CI] 1.02-4.25, P = 0.045), a primary tumor diameter of at least 3 cm (HR 3, 95% CI 1.31-7.25, P = 0.010), and at least 50% deep myometrial invasion (HR 2.7, 95% CI 1.37-5.41, P = 0.004) were independent risk factors for cervical stromal involvement in patients with EEC. CONCLUSION: Our study results suggest that presence of LVSI, a primary tumor diameter of at least 3 cm, and LVSI of at least 50% seem to be independent predictors of cervical involvement in women with EEC.

Kaposi sarcoma associated with rituximab-based cytotoxic therapy.

Kaposi sarcoma (KS) is a low-grade mesenchymal angioproliferative disease, mostly observed in immune compromised patients. KS is mostly encountered in HIV-positive or organ transplant patients. The drugs causing immunosuppression have also been associated with KS. Here, we present a KS experience associated with rituximab-based therapy.

The investigation of serum levels of ADAMTS 5 and 8 (the A disintegrin and metalloproteinase with thrombospondin motifs) in the etiology of endometrial cancer.

The aim of this study was to investigate the serum levels of the A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 5 and 8 in patients diagnosed with endometrial cancer. Our study included 41 patients diagnosed with endometrial cancer. The control group consisted of 41 patients diagnosed with benign endometrial pathology. The serum samples were centrifuged and stored at -80 °C. The serum levels of ADAMTS were significantly higher (p<.001), whereas the levels of ADAMTS 8 were significantly lower in patients diagnosed with cancer (p<.001). In addition to the presence of known factors in the aetiology of endometrial cancer, the effect of inflammatory factors and some new proteins has centred on the causes of tumourigenesis in recent years. In this sense, these proteins, called the ADAMTS, are the source of new studies.Impact StatementWhat is already known on this subject? When the recent studies about endometrial cancer are evaluated, it is seen that the effects of chronic inflammation and cytokines have gained importance in its aetiology. The A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) gene family consist of 19 proteases that play essential role in the formation of the extracellular matrix (ECM) and interact with inflammatory cytokines. These proteases and their substrates provide a wide range of functions in different tissues, including ECM remodelling, angiogenesis, fibrosis and coagulation.What the results of this study add? ADAMTS 5, which causes the degradation of the ECM with Aggrecanase activity, was found to be significantly higher in patients diagnosed with cancer and ADAMTS 8 with anti-angiogenesis activity was significantly lower in patients diagnosed with endometrial cancer.What the implications are of these findings for clinical practice and/or further research? In this study, it is understood that the effect of inflammatory mediators is remarkably important in the aetiology of endometrial cancer, as in many types of organ specific cancer.

Protective Effects of Intralipid and Caffeic Acid Phenethyl Ester on Nephrotoxicity Caused by Dichlorvos in Rats.

The protective effects of Caffeic Acid Phenethyl Ester (CAPE) and intralipid (IL) on nephrotoxicity caused by acute Dichlorvos (D) toxicity were investigated in this study. Forty-eight Wistar Albino rats were divided into 7 groups as follows: Control, D, CAPE, intralipid, D + CAPE, D + IL, and D + CAPE + IL. When compared to D group, the oxidative stress index (OSI) values were significantly lower in Control, CAPE, and D + IL + CAPE groups. When compared to D + IL + CAPE group, the TOS and OSI values were significantly higher in D group (P < 0.05). When mitotic cell counts were assessed in the renal tissues, it was found that mitotic cell count was significantly higher in the D group while it was lower in the D + CAPE, D + IL, and D + IL + CAPE groups when compared to the control group (P < 0.05). Also, immune reactivity showed increased apoptosis in D group and low profile of apoptosis in the D + CAPE group when compared to the Control group. The apoptosis level was significantly lower in D + IL + CAPE compared to D group (P < 0.05) in the kidneys. As a result, we concluded that Dichlorvos can be used either alone or in combination with CAPE and IL as supportive therapy or as facilitator for the therapeutic effect of the routine treatment in the patients presenting with pesticide poisoning.

Do histopathologic findings improve by increasing the sample size in cholecystectomies?

BACKGROUND: Gallbladder diseases present with cholelithiasis in a wide spectrum of adenomas and cancers. Two or three specimens are sampled in cholecystectomies in routine pathology practice. The aim of this study was to investigate the increase in frequency of histologic alterations in cholecystectomies, particularly precancerous lesions, by increasing the sample size to understand the carcinoma pathway. METHODS: Cholecystectomies of 432 patients with pathology records and materials from two medical centers were collected, and two groups were created. Initial data with two or three samples were allocated to Group 1 and the new six samples with the initial ones were allocated to Group 2. Hematoxylin and eosin (HandE) sections were examined for histopathologic alterations, and periodic acid-Schiff (PAS) Alcian blue (pH 2.5) and high iron diamine (pH 2.5) stains were used to signify the mucin profile in case of metaplasias. For the comparison of findings, non-parametric tests, McNemar's tests, chi-squared tests and Fisher's exact test were performed. RESULTS: Of the 432 patients, 308 (71.3%) patients were female and 124 (28.7%) patients were male. The mean age of patients was 47.9±14.6 years. Cholesterolosis was observed in 95 (22%) patients in Group 1 and 108 (25%) patients in Group 2. Gallstones were detected in 255 (59%) of the cholecystectomies. There was a significant difference between Group 1 and Group 2 by increasing the sample size when we compared cholesterolosis, metaplasia and polyps (P<0.05). Cholecystitis and dysplasia rates were the same in both of the groups. There was no cancer determined. CONCLUSION: Increasing the sample size in cholecystectomies increased the diagnosis of some histologic alterations, but further studies with a larger number of samples over a longer period time might increase the ability to determine precancerous lesions and concomitants.

Evaluation of fetal autopsy findings in the Hatay region: 274 cases.

OBJECTIVE: The aim of this study was to present the incidence of fetal anomalies in our region of Hatay, Turkey in order to determine the efficiency of prenatal diagnosis through fetal autopsy, and to compare our statistical data with other national and international studies. MATERIAL AND METHOD: This study was conducted on 274 fetuses from terminated pregnancies due to abnormal prenatal findings and intrauterine deaths from 2005 to September 2010. Fetuses were evaluated through postmortem examination, external measurements, X-rays, Magnetic Resonance Images, Multislice Computerized Tomography and photographs. The autopsy was completed by the histological examination of each organ. RESULTS: Autopsy was conducted on 274 fetuses. A fetal anomaly was detected in 160 (58.39%) cases. The central nervous system contained the most frequent structural defects (79 cases, 49.38%), followed by malformations in the musculoskeletal system in 36 cases (22.5%). The most frequent multiple system anomalies were central nervous system defect and bilateral adrenal agenesis, musculoskeletal system malformations and urinary system defects. Fetal autopsy provided additional findings in 43 cases (26.88%). CONCLUSION: Fetal autopsy is a very important procedure and an integral part of the general prenatal management. New findings through this method may suggest invaluable data for parents about potential risks in future pregnancies.

Mature cystic teratomas in our series with review of the literature and retrospective analysis.

PURPOSE: Mature cystic teratomas are the most common benign ovarian neoplasms. Our aim is to analyse these cases by pathologic and clinical findings in our centre with the view of updated knowledge. MATERIALS AND METHODS: In our study, 50 case reports diagnosed as mature cystic teratoma (or dermoid cyst) in Mustafa Kemal University Pathology Laboratory between 2005 and 2010 have been reviewed. RESULTS: Of 50 cases, the findings on mature cystic teratomas were as follows: the number of tumours located at the right ovary was 22, the left ovary, 23, with 5 cases bilaterally. Age range was 14-58 with mean rate 35.4. In two cases, tumour markers were high, one case presented with torsion; one case was obtained incidentally during delivery. CONCLUSION: Mature cystic teratomas are benign neoplasms with low malign transformation rate. Our series are low in number but our findings show the dynamic nature of these tumours.

Retrospective analysis of basal cell carcinoma.

BACKGROUND: Basal cell carcinomas (BCCs) are the most prevalent cancer type among white-skinned populations worldwide. AIMS: To analyze the gender and age-related incidence of basal cell carcinoma (BCC) histopathologic subtypes, to classify BCCs according to their anatomical location, invasion depth, and size, and to determine the relationship between BCC subtypes and margin of surgical excision. METHODS: All BCCs analysed in our center between 2005 and 2010 were studied retrospectively. The samples, which were totally excised, were included on the basis of histopathological diagnosis of BCC, and confirmed by two pathologists. Patient data included sex, age at diagnosis, tumor location, histological subtypes, invasion depth, and size. RESULTS: We recorded 197 BCCs obtained from 181 white patients (80 females, 101 males). The mean age among males was 64.11, and 59.33 among females. Of the cases, 45.17% were nodular, 22.33% were mixed, and 15.22 were infiltrative type. 91.84% of the cases were located on the head and neck, 3.04% were on the limbs, and 1.52 % were on the trunk. In 32 cases, the margin of surgical excision was positive (17.7%): nodular 12%, infiltrative 43.3%, mixed 20.6%, micronodular 10%, and superfacial multicentric 5.5%. Of these total 32 cases, 34.4% were located on the eyes region, 28.1% were found on the nose, and 15.6% were on the ears. Invasion depth of tumors varied from 0.5 to 22.125 mm. CONCLUSIONS: The results of our study exhibit differences in anatomical distribution, sex and mean age, invasion depth, and size of BCC subtypes. The recurrence rate for incompletely excised tumors varies according to the location and type of the tumor. Infiltrative tumors are more likely to recur and have positive margin of surgical excision. The highest positive margin of surgical excision is in infiltrative BCC. Tumors at difficult-to-treat sites and large and/or deeply invasive tumors are more liable to recur.