Turkish Journal of Pathology - 2008; 24(1)

Erratum

2008-01-01

Editorial

I��n KILI�ASLAN — 2008-01-01

Evaluation of the relationship of Epstein-Barr virus by Eber in-situ hybridization in cases of Enteropathy-type T-cell lymphoma

2008-01-01

Enteropathy-type T-cell lymphoma (ETTCL), is a type of “mature extranodal T- and NK-cell lymphoma”, derived from intraepithelial T-lymphocytes, representing <%1 of all non-Hodgkin lymphomas. It is pathogenetically related to gluten hypersensitivity (Coeliac disease), however some cases, reported from South and Central America have been associated with Epstein-Barr virus (EBV). We searched the relationship of EBV and ETTCL in five cases by chromogenic in situ hybridization method using early RNA probe of EBV (EBER). The cases were retrieved from a series of 94 patients diagnosed as T- and NKcell lymphoma, excluding the leukemic and cutaneous subtypes between 1997-2007 in our department. They accounted for 5.3% of all cases. Three of the cases were male, two were female, with a mean age of 47.2�13.6 years (range: 27-63). The most common presentation symptoms were diarrhoea, abdominal pain and weight loss. All tumors were located in small bowel and ulcerated. Neoplastic cells were atypical and large in two cases, small to mediumsized in the rest. They expressed CD3+, CD4-, CD8� immunophenotype and showed cytotoxic granules. All cases had enteropathy related morphology. Modified Marsh classification was Type IIIA in one case, Type IIIB in three cases and Type IV in the remaining case. EBER in situ hybridization was positive in minority of cells (<%5) of one case having a history of renal transplantation and were thought to represent isolated reactive lymphoid cells and immunoblasts. In our study, no reliable evidence was found relating ETTCL to EBV. The higher proportion of ETTCL cases within the T- and NK-cell lymphoma group in our series, compared especially with Far-East series, was attributed to the higher prevalence of Coeliac disease in our country. Further multicenter studies combining immunohistochemistry and molecular methods are needed to achive reliable epidemiological data.

Concordance of nuclear morphometric analysis with Fuhrman nuclear grade and pathologic stage in conventional renal cell carcinoma

2008-01-01

Quantitative image analysis has been applied to renal cancers for diagnostic and prognostic purposes. The aim of this study was to investigate whether there is any correlation between the results of morphometric measurements and Fuhrman nuclear grade, pathologic stage and size of conventional (clear cell) renal cell carcinoma. Morphometric nuclear parameters such as roundness factor, form ellipse, area, length, breadth and perimeter were evaluated in hematoxylin-eosin stained slides of 37 conventional renal cell carcinomas by using computer assisted image analysis system. The relationship between Fuhrman nuclear grade, pathologic stage, tumor size and morphometric results were determined by correlation analysis. Mean nuclear areas correlated with pathologic stages (r:0.413, p=0.05) and with Fuhrman nuclear grade (r:0.588, p=0.01). Mean nuclear length correlated with pathologic stage (r:0.446, p=0.01) and with Fuhrman nuclear grade (r:0.580, p=0.01). Mean nuclear breadth were correlated with pathologic stage (r:0.377, p=0.05) and with Fuhrman nuclear grade (r:0.544, p=0.01) and with tumor size (r:0.366, p=0.05). Mean nuclear perimeter correlated with pathologic stage (r:0.449, p=0.01) and Fuhrman nuclear grade (r:0.593, p=0.01). Mean nuclear roundness factor correlated with pathologic stage (r:0.418, p=0.05) and Fuhrman nuclear grade (r:0.456, p=0.01). In this study, the relative concordance of morphometric results and pathologic stage and Fuhrman nuclear grade, exhibited the importance of nuclear morphometric analysis in the assessment of conventional renal cell carcinoma.

Resident training in pathology: The current status of ten institutions and general evaluation

Beyhan DEM�RHAN — 2008-01-01

Resident training in pathology: From resident's point of view

2008-01-01

In many recent studies in the literature have described and commented on “competency based resident training” in pathology. According to this model, competencies are subclassified in 6 main categories: Patient care, medical knowledge, practice based learning and improvement, interpersonal and communication skills, professionalism, and systems based practice. Assessment of competency forms the main component of this model. Under the framework of Ankara Society of Pathology, a working group, composed of 11 residents, 6 of which representing the Training and Research Hospitals of Ministry of Health and the rest representing the university hospitals in Ankara, was established in order to participate in the think-tank about resident training in pathology. A questionnaire, composed of 12 questions, was prepared. According to this questionnaire, the number of trainers in the university hospitals is much higher than in the commercial hospitals. While the total number of cases and cases per resident do not differ between the university and commercial hospitals, microscopes used for the educational purposes are significantly less in the commercial hospitals, that is due to less number of binocular microscopes. The amount of resident training program, which consists of intra and intersectional meetings, are similar in the university and commercial hospitals, however, theoretic lectures are given only in 3 departments. Residents working in the university hospitals have obviously heavier burden than in the commercial hospitals. Lastly, residents generally exclaimed that the time dedicated to the macroscopy training is less sufficient than time used for the microscopy training. The factors affecting the training of resident in pathology are divided into two main groups: 1) Factors directly affecting training (quality of trainer, time dedicated for education, feed back, eg.) and 2) Conditions which waste residents' time. For instant, workload which does need qualified staff and increases the burden on residents may be reassigned to medical secretary or pathology assistants; therefore energy of residents can be saved for educational activities. Optimization of physical working conditions, assortment of training programs, rotation in lacking subjects and consultations will enhance the quality of the education of the resident. Feedback assessment of trainer and trainee is an essential part of a training program. In conclusion, an ideal resident from the resident's point of view is the person who is endowed with medical and pathological knowledge, orderly interrelates with staff, professionally communicates with clinicians, manages a laboratory and is trained hard to achieve all the above mentioned competencies.

Resident training in pathology: Results of questionnaires

2008-01-01

The aim of this study is to discuss the training of pathology residents from the points of wave of themselves and their tutors and reveal the problems. For this purpose, representatives of 4 Universities, 5 State hospitals and G�lhane Military Medical Academy have prepared 2 types of questionnaires in order to the serving capacities of their institutions and the opinions of the tutors working in that departments on training of pathology residents. According to the results, the number of biopsy and cytological materials together with number of faculty is sufficient for all institutions. Both histochemistry and immunohistochemistry have been applied in all institutions. However, only one state hospital has been performing immunoflourescence technique. It is noticeable to see 2 state hospitals do not have any documents on written job description, which summarizes the authority and responsibility of the pathology residents. Another significant conclusion is that the answers of the tutors for the assistant's job description and their responsibility in the training process are very heterogeneous. Time spent for gross examination by tutors was found to be insufficient by 58% of themselves. Although “written feedbacks for residents and tutors” is only being applied in 2 Universities, the majority of the tutors who have participated in the questionnaire have agreed upon the necessity of them for all institutions (95.4% and 93.8%, respectively).

Resident training in pathology: Expectations and suggestions

2008-01-01

In this report, we summarized the result of the panel discussion about pathology residency training program. Especially, training atmosphere including laboratories, rotations, evaluation of autopsy, macroscopy, microscopy, and general resident responsibilities were discussed. Obligation of standardization of residency training program was stressed.

Resident training in pathology: General overview

Beyhan DEM�RHAN — 2008-01-01

The chaos in the law related to “regulations of medical specialty” has negative effect on the training of pathology residency programs in our country. There are enormous effort to close the gap by the medical specialists via their societies or federations. Training in pathology commission of Federation of Turkish Pathology Societies has finished their work related to “The schedule of training of pathology residency” and “logbook”. The panel deals with training in pathology residency are part of these efforts. Requirements of rotations to the other institutions were treated too. It is considered more appropriate that the federation regulates rotations for sub specializations. Systematic approach is requiring for education. Each pathology department should have an education team. It is recommended that a senior pathologist become the head of the team. This organization could solve the most of the problems. Satisfaction of residents and trainers will be increased by the schedule of training of pathology residency; logbook, written feedbacks and competency based resident training and assessment that organized by these education teams/units.

Acral myxoinflammatory fibrablastic sarcoma: Report of six cases

Esen G�l UZUNER, Misten DEM�RYONT, Bilge B�LG��, Harzem �ZGER — 2008-01-01

Acral myxoinflammatory fibroblastic sarcoma was first described in 1998. The tumor typically involves distal extremities; especially fingers and toes. It is usually located in subcutaneous tissue. The age range is broad (mean age 40). The size of tumor varies between 1-8 cm. Microscopically, myxoid and hyaline zones are characteristic. Inflammatory cells are abundant and there are large cells resembling Reed-Sternberg or ganglion cells and multivacuolated cells having lipoblast-like appearance. We present 6 cases of acral myxoinflammatory fibroblastic sarcoma, locations were ankle, 1st toe and hand. The most presenting symptoms were swelling with or without pain and they have lasted for 3,5 months-4 years. Immunohistochemical studies of our cases, revealed vimentin (5/5), CD68 (5/5), CD34 (1/3) positivity. Ki-67 proliferation indices varied between 2-10%. Five patients underwent tumor excision, while in one patient amputation had been performed. This tumor is a low grade sarcoma but has the potential of recurrence and even metastasis, though it is rare. In one of our cases, recurrence was observed; in none of our cases metastasis has been determined. It included many tumoral and non-tumoral lesions in differential diagnosis.

Low-grade leiomyosarcoma of renal vein: A case report

Nalan NE�E, Demet K. �AVDAR, Bilal G�M��, Ayd�n ��SA� — 2008-01-01

Leiomyosarcomas originating from renal vein are quite rare malignant tumors since only 30 cases have been reported in the literature. Clinical symptoms which are due to a renal mass along with radiological findings, usually mislead to a preoperative diagnosis of renal cell carcinoma. The correct diagnosis is frequently made on nephrectomy specimens. Low-grade leiomyosarcomas need to be differentiated from leiomyomas. Increased mitotic activity and necrosis are known to be gold standards for differential diagnosis. In this report, we present a case of a 62 year old woman whose tumor in the left kidney diagnosed as low-grade leiomyosarcoma together with a brief review of the literature.

Incidental anaplastic thyroid carcinoma: A case report

Pembeg�l G�NE�, F�gen Vardar AKER, Murat ERKAN, Pelin DEM�RT�RK, Ender DULUNDU — 2008-01-01

Anaplastic thyroid carcinoma is one of the most aggressive of all human malignant diseases. It has an unfavorable prognosis and responsible for most of the mortality and morbidity rates due to thyroid carcinomas. We present a case of incidental anaplastic thyroid carcinoma and discuss the epidemiology, biology, risk factors, prognostic factors of the disease and the approach to treatment, in the light of the current medical literature. The prognosis is much better in cases with incidental carcinoma compared to the classical type and surgical excision of the tumor has a favorable effect on the results. Our case was followed-up for 1.5 years with no evidence of recurrence or metastasis.

Malignant mixed mullerian tumor of the uterus: A case report

2008-01-01

Malignant mixed mullerian tumor is a rare neoplasm and derives from mullerian mesoderm that differentiates in epithelial and stromal elements. In this case report, pathological and immunohistochemical profile and diagnostic difficulties in malignant mixed mullerian tumor of the uterus were discussed. The case is a 53-year- old patient who complained of pelvic pain and postmenopausal genital bleeding. Computerized tomography was revealed an intrauterine mass measuring 8x5 cm. After the evaluation of the curettage material that was diagnosed as high grade stromal sarcoma; total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy were performed. Histopathologically, the tumor contained squamous cell carcinoma admixed with high grade stromal sarcoma. Additionaly, areas of adenomyosis in the neighbouring of the tumor were noted. Immunohistochemically, malignant stromal cells exhibited diffuse vimentin, smooth muscle actin, myoglobin and focal CD10 and S100 protein positivity. Malignant epithelial cells revealed diffuse positive reaction for epithelial membrane antigen, pancytokeratin (AE1/AE3), vimentin and focal reaction for HCG. A diagnosis of uterin malignant mixed mullerian tumor (carcinosarcoma) with unilateral ovarian and cervix invasion was made. The patient died one week after the pathologic diagnosis because of renal failure. This case is an interesting example of the focal HCG positivity in the malignant epithelial component of the tumor that may represent focal choriocarcinomatous differentiation. Potential relationship between malignant mixed mullerian tumor and adenomyosis was evaluated.

Sarcomatoid carcinomas of the lung: Report of three cases

Mehmet KEFEL�, Levent YILDIZ, O�uz AYDIN, O�uz UZUN, Bedri KANDEM�R — 2008-01-01

Sarcomatoid carcinoma is a rare tumor group accounting for 0.3-1.3% of all malignant lung neoplasms. It is a heterogeneous group of nonsmall cell lung carcinomas containing a sarcoma or sarcoma-like component. In this paper, we describe three cases of sarcomatoid carcinoma of the lung and the histopathologic and clinical features of this rare tumor are discussed.