Turkish Journal of Pathology - 2006; 22(1)

Editorial

I��n KILI�ASLAN — 2006-01-01

Invasive breast carcinoma cases showing both estrogen and progesterone receptor positivity and c-erb B2 overexpression (a clinicopathologic study of 66 cases)

Ali BAli BA�, Ekrem YAVUZ, S�tk� TUZLALI, R�dvan �LHAN, Oktar ASO�LU, Ne�e G�NEY — 2006-01-01

We analyzed clinicopathologic characteristics of invasive breast carcinomas, where both hormone receptor positivity and c-erb B2 overexpression were detected by immunohistochemical methods. The rate of hormone receptor positivity for invasive breast carcinomas with c-erb B2 overexpression was 27.61% (66/239). The majority of the cases showed high levels of immunopositivity for hormone receptors. The mean age of patients was 52.96 while pre and postmenopausal patients were equal in number. The vast majority of the cases were high grade-invasive ductal carcinomas of low stages. Of 36 cases with available clinical follow-up, 8 displayed either local recurrence or distant metastasis in a relatively short duration (1-17 months). Our findings reveal that invasive breast carcinomas with both hormone receptor positivity and overexpression of c-erb B2 have a tendency to occur in premenopausal patients and have adverse prognostic characteristics even at low stages.

Mast cell density in pterygium, and its association with ultraviolet exposure in different climatic conditions: A series of 140 cases

Nebil BAL, Fazilet KAYASEL�UK, Aysel PEL�T, Filiz BOLAT, Beyhan DEM�RHAN — 2006-01-01

This study compared the number of mast cells and histopathologic findings in 140 randomly selected pterygium and 30 normal conjunctival specimens. The pterygium specimens came from medical centers in two regions of Turkey with different climatic conditions (Adana with high sunlight exposure and Ankara with relatively low UV ray exposure). Slides were stained with routine H&E and toluidine blue to detect mast cells. The mean mast cell counts for 140 pterygium and control specimens were 17.9�8.39 and 9.23�6.86 and the difference was statistically significant (p<0,05). The mean counts estimated in Adana and Ankara specimens were 18.44�8.77 and 16.51�7.23 respectively without any statistically significant difference. The pterygium specimens from Adana (n=101) had demonstrated a significantly higher frequency of inflammation (six times higher) than those from Ankara (n=39). This finding is related to increase of mast cell degranulation via ultraviolet rays. The results suggest that mast cells are actively involved in the pathogenesis of pterygium and ongoing changes in these lesions and many factors other than UV rays might directly influence or induce mast cell-related effects that are involved in the pathogenesis of pterygium.

c-KIT in thyroid papillary carcinomas

O�uz AYDIN, Levent YILDIZ, Mehmet KEFEL�, Canan Y�KSEL, Yurdanur S�LL� — 2006-01-01

In this study, slides of 91 thyroid papillary carcinoma cases, which were recruited from the archives of the Department of Pathology, Faculty of Medicine, Ondokuz Mayis University, between years 1990 and 2006 were examined. Seventy eight of 91 cases were considered as classical type and the remaining 13 as follicular variant. Immunohistochemistry with c-kit (CD117) was applied on the selected appropriate blocks. Seventy six of 91 cases (83,51%) were positively stained. The cases were evaluated comparatively for their histological subtypes in terms of the density and intensity of the staining. Ckit showed stronger and more diffuse staining in thyroid papillary carcinomas compared to adjacent non-neoplastic thyroid tissue and also to the follicular variant of the classical type. This finding suggests that c-kit can provide new evolutionary information related to thyroid papillary carcinomas in terms of diagnostic and therapeutic perspectives.

Diagnostic utility of glandular arrangement in endometrial polyps

�zlem �ZEN, Aydan KILI�ARSLAN, Z�beyde ARAT, Beyhan DEM�RHAN — 2006-01-01

Endometrial polyps can be difficult to diagnose, especially when they are encountered in specimens obtained by biopsy or curettage. We evaluated 71 cases of grossly identifiable polyps from hysterectomy or polypectomy specimens for various histologic features and correlated the frequency of these features with variables such as menstrual state, histopathologic type, and shape of the polyps in order to find out diagnostic parameters in biopsy or curretage specimens. The most frequently observed histologic findings in both premenopausal and postmenopausal women were the presence of thick walled vessels and irregularly shaped glands (91.5% and 97.2%, respectively). In addition, we evaluated another histologic feature, the parallel arrangement of the long axes of endometrial glands to the surface epithelium in 33 of 71 (46.4%) endometrial polyps. It was more common in polyps excised from premenopausal (56.4%) than in postmenopausal women (34.3%) and was found in 7 of 8 (87.5%) functional polyps, while 40.6% of hyperplastic polyps showed this feature. The presence of thick walled vessels is the most frequently identified histologic feature in endometrial polyps. Parallel arrangement, when present, could be an additional clue in the diagnosis of endometrial polyp in routine curettage specimens.

CD44 and Ki67 expression in gastric adenocarcinomas (correlation with clinicopathologic parameters)

Sema ARICI, F�gen KIVAN�, Hatice �ZER, Reyhan E��LMEZ, �ahande ELAG�Z — 2006-01-01

CD44, a cell adhesion molecule, has been proposed to be important in promoting tumor progression and dissemination. There are many studies about expression of CD44 in many tumors such as gastrointestinal tract, lung, cervix, and liver. Different data have been found about CD44 expression. Ki67 is an indicator that is used to predict the proliferative capacity as well as the prognosis of tumors. The aim of this study was to investigate the expression of CD44 and Ki67 in gastric carcinoma and their relationship between clinicopathologic parameters such as grade, depth of invasion, lymph node metastases and vascular invasion. Immunohistochemical study for CD44 was carried out in 48 formaldehyde fixed, paraffin embedded sections of gastric carcinoma. The results showed that, CD44 and Ki67 did not correlate with the clinicopathologic parameters except grade. High levels of CD44 and Ki67 expressions observed with higher grades. It is concluded that CD44 and Ki67 may be related with the differentiation of gastric carcinoma however they are not correlated with the tumor progression and dissemination. However further studies are required to understand the role of CD44 in metastases and progression of gastric carcinoma.

Paratesticular adenomatoid tumor (morphologic and immunohistochemical study of 9 cases)

Ebru KARAY��T, �zg�r METE, I��n KILI�ASLAN, Veli UYSAL — 2006-01-01

Almost all solid scrotal masses are malignant tumors. Among these, tumors originating from mesothelium, are usually benign. Adenomatoid tumors constitute the majority of the solid tumors with mesothelial origin. Although adenomatoid tumor can be seen at all ages, it is mostly common in the third and fifth decades. These tumors, which are treated surgically, may pose some diagnostic difficulties. Adenomatoid tumor occurs mostly in the lower pole of the epididymis and rarely in the tunica albuginea and spermatic cord. When localized at the tunica albuginea, it can be confused with sex cord tumors, benign mesenchymal tumors and malign mesothelioma. Vascular tumors mostly take place in the differential diagnosis of these tumors. Adenomatoid tumors, which are mainly composed of spindle and signet ring cells can simulate a metastatic tumor. Therefore the discrimination of adenomatoid tumor, which is known to originate from mesothelium, necessitates additional immunohistochemical studies, which will emphasis morphologic findings.

Anorectal malignant melanoma: Report of three cases

2006-01-01

Anorectal malignant melanoma, originating from the anorectal canal, is a very aggressive and rare tumor. They account for 0.8-1% of malignant tumors of this region and 0.7% of all malignant melanomas. It is claimed that malignant melanomas of this region originate from the melanocytes or melanocytic proliferation among the stratified squamous epithelium, transitional epithelium of anus or the columnar epithelium of rectum. In this study, one female and two male patients, aged 62, 62 and 55, admitted to our hospital between years 2001 and 2003 with rectal bleeding and diagnosed as malignant melanoma are discussed. The diagnosis of the rectal biopsy of one patient was undifferentiated carcinoma, and malignant melanoma in the other two, initially. Miles operation was performed. All the tumors were adjacent to the dentate line and they were polypoid masses with partial ulcerations. The greatest diameters of these masses were 5,5, 6 and 10 cm, respectively. Tumor cells showed positive immunoreactivity with HMB45, S100 protein and Melan-A, but immunoreactivity with pancytokeratin was not detected. Anorectal malignant melanoma is a rare tumor whose morphological features can mimic undifferentiated carcinomas and mesenchymal tumors and especially immunohistochemical examinations of endoscopic biopsy specimens can be helpful in differential diagnosis.

Angiomyomatous hamartoma in the inguinal lymph node: A case report

Yurdanur S�LL�, Seda G�N, Nevzat DABAK, Filiz KARAG�Z — 2006-01-01

Angiomyomatous hamartoma is a rare tumour of lymph nodes. This report describes a case of angiomyomatous hamartoma in the inguinal lymph node. The patient was a 33-year-old woman who underwent surgery because of a right inguinal mass. The excised specimen consisted of a grossly enlarged lymph node covered with fatty tissue, measuring 4.5 cm in diameter. On microscopic examination, the lymph node parenchyma was replaced by haphazardly dispersed thick-walled vessels and smooth muscle cells in a fibrous background. This process extended to the cortex from the hilum, and there was a thin cortical lymphoid tissue. Immunohistochemical actin staining indicated smooth muscle cells dispersing into the fibrous background. Although angiomyomatous hamartoma of lymph nodes is very rare, its recognition is important for differential diagnosis from angiomatous malignant tumors of lymph nodes.

Oxyphilic clear cell carcinoma of the ovary: Report of a unique case

Metin AKBULUT, Esra Canan KELTEN, Mehmet E. SOYSAL, S. Ender D�ZCAN — 2006-01-01

Clear cell carcinoma (CCC) of the ovary is a rare and easily recognized, malignant tumor, composed of typically polyhedral cells which have distinct cell membranes, and contain abundant clear cytoplasm and eccentric nuclei. They may be associated with endometriosis and often have a poor prognosis. Here, we report a case of bilateral oxyphilic variant CCC of the ovary with widespread metastasis, and peculiar features and differential diagnosis of this rare neoplasm are briefly discussed. In conclusion, clear cell carcinomas must be thought in the differential diagnosis of the ovarian tumors which contain oxyphilic cells

Mixed endocrine-exocrine carcinoma of appendix vermiformis: A case report

2006-01-01

Mixed endocrine-exocrine carcinoma of the appendix is a rare tumor which exhibits histopathologic features of both adenocarcinoma and an endocrine tumor. It is well known that, clinic course of these tumor is more aggressive than conventional endocrine tumor. A 45-year old man complaining of abdominal pain and fever, underwent appendectomy with the preliminary diagnosis of acute abdomen. During gross examination of appendectomy specimen, a perforation area with 0.6 cm in diameter was determined. Microscopic examination of the cross-sections of this perforated area revealed tumoral infiltration beneath the surface epithelium attacking all layers of the appendix. The tumoral infiltration is composed of atypic cells, forming small glandular structures with Goblet cells with a benign appearance, and tending to nest with its large nucleus and eosinophilic cytoplasm in desmoplastic stroma. Intra and extracellular mucin accumulation is determined within the tumor with mucicarmine reaction. Mitotic count was ≤3 in 10 high power field. Immunohistochemically, tumor cells showed diffuse reaction with ephitelial membrane antigen, choromogranin A, carcinoembrionic antigen and reactivity with p53 (5-10 %). With respect to these findings, the diagnosis was 'mixed endocrine-exocrine carcinoma'. Due to malignant potential of the tumor, after an intense investigation for any focus, the patient underwent to right hemicolectomy. At 5 months of follow -up postoperatively, neither metastasis nor any recurrence was observed. This case is reported for its rarity and malignant potential.

Secondary chondrosarcoma arising from a solitary enchondroma at the index finger of the right hand: A case report

2006-01-01

Enchondromas are benign cartilaginous tumors and tend to present in small bones of hands and feet. Malignant transformation, though rare, is seen more often in multiple rather than solitary enchondromatous. A 70- year-old woman presented with swelling and pain lasting for years at the index finger of the right hand. Excisional curettage material of the mass revealed to be entirely an enchondroma. Seven months later, the lesion recurred at the same localization and amputation of the finger was performed. This time the tumor was found to be transformed into an intermediate grade (grade II) which demonstrated chondrosarcoma intermingled with classical enchondromatous areas. Enchondromas arising at the hands and feet very rarely transform into chondrosarcomas. Since enchondromas at this site often show histological and clinical features suggestive of malignancy, it is often is difficult to make a histological distinction between benign cartilaginous tumors and chondrosarcomas. Detection of radiological as well as pathological findings are essential for differential diagnosis. This case is remarkable for she has a solitary enchondroma located at the index finger of the right hand that transformed into chondrosarcoma in seven months.

Cytologic diagnosis of toxoplasma gondii lymphadenitis: A case report

Aptullah HAHOLU, ��kr� YILDIRIM, �zg�r KORU, Nurittin ARDI�, H�seyin BALO�LU — 2006-01-01

The aim of this study is to present cytologic features of fine needle aspiration (FNA) of lymph node suggesting toxoplasmosis with demonstration of histiocytes containing tissue bradyzoites. A 3-year-old female presented with a mobile, tender, 3 cm diameter swelling in submandibular region. FNA smears showed features of reactive lymphoid hyperplasia with polymorphic cells including groups of histiyocytes. Many epitelioid histiocytes containing intracytoplasmic particules suggesting toxoplasma bradyzoites were also seen in a Papanicolaou -stained smear. Although serologic tests did not reveal a high titer of IgG and IgM-specific antibodies to Toxoplasma gondii, the diagnosis of Toxoplasma lymphadenitis was confirmed by demonstrating the sequence specific for toxoplasma genom of the DNA in the material scraped from the stained slides with PCR technique. FNA cytology is a valuable diagnostic tool for toxoplasma lymphadenitis, which especially demonstrates epithelioid histiocytes containing tissue bradyzoites. Although serology may not be supportive, PCR study may confirm the diagnosis.