Turkish Journal of Pathology - 2007; 23(2)

Development of pathology in Turkey

Alp USUB�T�N, G�khan GED�KO�LU — 2007-05-01

Autospy is an important tool for the development of pathology as a science. In western civilisation dissection of human body became widespread with Renaissance, in contrast in the Ottoman Empire first dissection was not performed until the 19th century. Mustafa Beh�et Efendi, head physician of the Empire, was one of the Ottoman physician who suggested the importance of dissection in the medical education. The first dissection was however performed by Charles Ambroise Bernard, a foreign physician who had been invited to help establishing a new medical school; “Mekteb-i T�bbiye-i Adliye-i ��h�ne”, in 1843. The first modern medical schools called “T�phane” and “Cerrahhane-i Amire” which were founded in 1827, did not have pathology courses. Pathology courses began in “Mekteb-i T�bbiye-i Adliyei ��h�ne”. Dr. Hamdi Suat (Aknar), educated in anatomic pathology in Germany, was the first pathologist who established the modern pathology in Turkey in “�stanbul Dar�lf�nun” medical school. In 1933 “Dar�lf�n�n” was closed and �stanbul University was built and the “University Reform Commission” invited many scientists escaping from Nazi government to study in �stanbul University. Dr. Philipp Schwartz had an important role both in the invitation of these scientists and establishment of the pathology department in �stanbul University. Practical courses were increased, clinicopathologic courses were organized for the first time and a lot of autopsies were performed, as high as 1000 autopsy per year, by Dr. Philipp Schwartz. More progress has takes place in Turkey over the years since pathology was first established. Today Turkey has many pathology departments which keep up with the worldwide advances in the field.

Handling and reporting of radical prostatectomy specimens: A practice survey among pathologists

Ba�ak DO�ANAV�ARG�L, �lke NALBANTO�LU, Mine HEK�MG�L — 2007-05-01

There are controversies on how to best sample and report radical prostatectomy specimens in order to accurately assess prognostic factors. The propensity for obedience to proposed guidelines are controversial likewise. We conducted a survey among Turkish pathologists and residents to assess the attitudes on this issue. Participants were asked about their pathology practice and how they fix, cut and sample the gland or report histologic-based prognostic factors. The results are discussed in the light of the current literature. Fifty-five percent of the 103 participants were studying in centers reporting over 10000 surgical specimens per year, 20% of which were non-university settings. The results showed that submission of whole gland (55%) and volume assessment (25%) were usually practiced in university hospitals (p<0.001 and p=0.02, respectively). Whole mount sectioning was not performed in any center. None of the participants use an alternative grading system, 19% comment upon tertiary Gleason pattern but define it as either the third most frequent pattern (10%) or the highest grade constituting less than 5% of tumor (8%). Prognostic factors of proven significance as Gleason score, extraprostatic extension, vesicula seminalis invasion, and margin status are searched and commented by all respondents while the factors that require validation in multivariate studies are generally assessed by university members.

Histogenesis of lipomatous component in uterine lipoleiomyomas

Filiz BOLAT, Fazilet KAYASEL�UK, Tuba CANPOLAT, Serkan ERKANLI, �lhan TUNCER — 2007-05-01

Uterine neoplasms composed of an admixture of smooth muscle and adipose tissue are rare and have been designated as lipoleiomyomas. The origin of this tumor is stil controversial and it has not been sufficiently studied. The aim of our study was to investigate the immunohistochemical phenotype of fat cells in uterine lipoleiomyomas so as to clarify their origin. Archived tissue samples of 10 uterine lipoleiomyomas were selected and analyzed immunohistochemically for vimentin, desmin, and HMB-45 expression. The patients ranged from 31 to 63 years of age (mean age 53.5�9.9). Seven tumors which affected the uterine corpus, showed intramural location; while two cases were subserosal, and one was in the cervix. All tumors were constituted by irregular bundles of smooth cells and mature large adipose cells. The amount of adipose component varied from 5 to 95% of the tumor mass. Cytological atypia and necrosis were not seen. Immunohistochemical investigations revealed obvious reactivity to vimentin and desmin in perivascular immature mesencyhmal cells and tumoral smooth muscle cells. Adipose cells in the tumors demonstrated uniform vimentin expression and inconsistent desmin immunoreactivity. All adipose cells were negative for HMB-45 antigen. However, HMB-45 antigen was weakly positive in spindle shaped tumor cells of two cases. In our study, the immunohistochemical findings suggest a complex histogenesis for these tumors, which may arise from perivascular immature mesencyhmal cells or direct transformation of smooth muscle cells into adipocytes by means of progressive intracellular storage of lipids.

A quality improvement program in pathology

Alp USUB�T�N, �zay G�K�Z, P�nar FIRAT, Arzu SUNGUR — 2007-05-01

Quality becomes an important measure for pathology reporting. Accreditation is one of the principal ways for quality assurance. In this study, Anatomic Pathology Checklist defined by College of American Pathologists is used as a guide by Quality Control Committee formed as a prerequisite for laboratory accreditation of our department to evaluate 1 year period, compare the results with previous periods and test the reliability of this reference. The committee choose 94 relevant criteria out of 104. Unmet criteria and causes for these are searched for. A Physician Satisfaction Survey was applied. A problem record notebook was put on desk to ascertain the problems throughout the process. Last results are compared with the first data; problems and solutions are discussed. At the end of the study, 87.2% of criteria were met. Priority was given to some of the problems according to the results of survey and evaluation of parameters. Average turnaround time decreased to 3.5 days when the pathologists were informed about this measurement. Frozen section turnaround time decreased to less than 20 minutes in 63% of cases after frozen section unit was transferred to the operating theatre. Notebook served for the quick catch up of problems and work-ups of solutions or prevention. Controls were formed for histochemistry and immunohistochemistry. Unmet 8 criteria were about turnaround time, intra- and interdepartmental consultation which requires extra work and concensus among people and, technical issues. Quality control and quality assurance methods should be used for reports bearing accurate diagnosis and data concerning treatment and, preparation for accreditation. By this way, working procedures are formed, problems are easily seen, favourable results as compared to pre-evaluation period could be obtained by discussion of suggested solutions.

The nervous system tumors diagnosed between 2002-2006 in Zonguldak Karaelmas University Faculty of Medicine Department of Pathology

2007-05-01

In this study it is aimed to determine the frequency of diagnostic and epidemiologic data that has been reviewed in the Pathology Department of Zonguldak Karaelmas University, Department of Pathology. From January 2002-February 2006, the pathology reports and clinical data of the patients were evaluated from the archive material. In the five years period, nervous system tumor ratio was 0.51%. When grouped according to their biological behavior 55% benign, 43.5% malignant and 1.5% were classified as borderline. Of all the nervous system tumors, the percentages of central and peripheral nervous system tumors were 78.3% and 21.7% respectively. The ratios of malignant, benign and borderline tumors of 54 cases were 55.6%, 42.6% and 1.8%, respectively. Males constituted 66.7% and females 33.3% of all malign central nervous system tumors. The most frequent location was cerebrum (57.4%), followed by pituitary, cerebellum, spinal cord, posterior fossa and pontocerebellar region. Between the primary brain tumors, the distribution of histological types were astrocytoma (26.7%), pituitary adenoma (22.2%), meningioma (17.8%) and other tumors (33.3%). The proportion of metastatic tumors was 16.7% (9/54) in all central nervous tumors. The proportion of childhood central nervous system tumors was 7.4%, the most frequently seen histological type was medulloblastoma (50%). When peripheral nervous system tumors were evaluated, 80% of the patients were male and 20% were female. All cases were benign and histopathological diagnosis were neuroma (46.6%), Schwannoma (26.7%) and neurofibroma (26.7%). In this study, diagnostic and epidemiologic data of nervous system tumors have been determined and constituting systematic and continuous data transfer from Zonguldak Karaelmas University Pathology Department, which represents the Western of Black-Sea population was aimed.

Adenomatoid tumor of the female genital tract: Report of three cases

Filiz BOLAT, N. Emrah KO�ER, Nebil BAL, �mran K��KG�Z — 2007-05-01

Adenomatoid tumors are benign proliferations that are most often encountered in the female and male genital tracts. The mesothelial phenotype of these unusual tumors has been established by a variety of ultrastructural and immunohistochemical studies, although their histogenesis is by no means certain. In this paper we report three cases that were diagnosed as genital tract adenomatoid tumors and discussed the clinical signs, origin and immunohistochemical characteristics of the this type of tumor. Immunohistochemical expression of calretinin, HBME-1, vimentin, pancytokeratin, EMA, and CD31 were analyzed in three ATs, using formaline-fixed, paraffin-embedded archival tissues. The age of the patients were ranging from 40 to 46 years with a median of 43.3. Tumors were located in uterus (one), and fallopian tube (two). Tumor sizes were ranging between 0.6-5 cm. Immunohistochemically all tumors exhibited strong and diffuse positivity for pancytokeratin, calretinin, HBME-1 and vimentin, but negativity for EMA, and CD31. The immunohistochemical results support histogenetic theories of the adenomatoid tumor that claim it as a type of benign mesothelioma. Immunohistochemical phenotypes can play an important role in the differential diagnosis.

Uterus-like mass of the ovary

Duygu G�REL, Bur�in TUNA, Kutsal Y�R�KO�LU — 2007-05-01

We report an incidental case of uterus-like mass located in the right ovary. A mass, measuring 7 mm in its largest dimension was noted in the right ovary of a 54-year-old women. Histologically, the lesion was resembling a miniature uterus with a cavity lined by a tubal-like epithelium, and surrounded with circumscribed smooth muscle bundles. Since 1981, 8 cases of uterus-like mass arising from the ovaries have been reported and their pathogenetic mechanism has been explained by two basic theories; congenital anomaly and metaplasia. The present case was incidentally found. The uterus was unicornus secondary to fusion defect of m�llerian duct during embriogenesis supporting the congenital anomaly theory.

Duodenal gangliocytic paraganglioma: A case report

2007-05-01

Duodenal gangliocytic paraganglioma is a rare tumor that characteristically occurs in the second portion of the duodenum and typically presents with gastrointestinal bleeding. Duodenal gangliocytic paraganglioma have a good prognosis after surgical resection but metastatic spread to regional lymph nodes and recurrence may rarely occur. A 41-year-old man underwent pancreaticoduodenectomy for the proposed diagnosis of carcinoma of the ampulla vateri. Macroscopically, the tumor measuring 2,7 cm in its greatest diameter, located in the ampulla without infiltration of the pancreas was detected. Histologically, the tumor composed of epitheloid cells, ganglion cells with abundant cytoplasm and vesicular nuclei, and spindle cells arranged in broad fascicles. Immunohistochemically, tumor cells were strongly positive for S-100 protein, cytokeratin AE1/AE3 cocktail, chromogranin A, and synaptophysin. There was no metastasis in the regional lymph nodes. We present here a rare case of duodenal gangliocytic paraganglioma and review the differential diagnosis of this infrequent tumor.

A pigmented calcifying cystic odontogenic tumor

Yasemin �ZL�K Yersu KAPRAN, Ahmet B�lent KAT�BO�LU, Cem TANYEL — 2007-05-01

A case of a pigmented calcifying cystic odontogenic tumor (CCOT) localized in the mandible occuring in a 16-year-old white female - is reported, and the characteristic histomorphologic features of CCOT and the pathogenesis of melanin and melanocytes present in the pigmented type is discussed under the light of histochemical and immunohistochemical data.

Adenomyoepithelioma of the breast misdiagnosed as invasive ductal carcinoma

Sibel BEKTA�, Burak BAHADIR, Banu DO�AN G�N, Sacide �OLAK, ��kr� O�uz �ZDAMAR — 2007-05-01

The consultation material of total mastectomy and axillary lymph node dissection specimens taken from a 34-year-old female with a previous diagnosis of invasive ductal carcinoma was evaluated. Microscopic examination of the 6,5 cm well-circumscribed tumor revealed rounded tubules lined by both epithelial and myoepithelial cells in a myxomatous stroma. Obvious smooth muscle differentiation and area of fibroadenoma were also noted. Immunohistochemically, myoepithelial cells and cells with smooth muscle differentiation exhibited vimentin and smooth muscle actin. Myoepithelial cells were also reactive for S100 protein and epithelial membrane antigen. Luminal epithelial cells revealed positive reaction for epithelial membrane antigen and pan-cytokeratin (AE1/AE3), but displayed only focal staining with carcinoembryonic antigen. Based on these findings a final diagnosis of adenomyoepithelioma was made. Differential diagnosis of adenomyoepithelioma from its malignant counterpart and invasive ductal carcinoma may occasionally be challenging. Moreover, although considered an indolent neoplasm but with a potential risk for recurrence and sometimes metastasis, adenomyoepithelioma of the breast requires long-term followup.

Megacystis-microcolon-intestinal hypoperistalsis syndrome

�zg�r EK�NC�, Hasan Aktu� ��M�EK, Nuri Y��T, Aptullah HAHOLU, H�seyin BALO�LU — 2007-05-01

Megacystis-microcolon-intestinal hypoperistalsis syndrome is a rare, congenital, autosomal recessive syndrome characterized by excessive dilatation of the urinary bladder without true outlet obstruction, hypoperistaltism and malrotation of intestines, and a very poor prognosis. It was proposed that neuropathic and myopathic disorders underlie the functional obstruction and dilatation of the bladder while the syndrome exhibits heterogenous histopathological features. Our case was a male fetus diagnosed by autopsy after intrauterine death, with typical findings of the syndrome. A discussion of the gross features in autopsy and histopathological-pathophysiological correlation is presented.