Turkish Journal of Pathology - 2009; 25(1)

Editorial

I��n KILI�ASLAN — 2009-01-01

Needle core biopsies for renal masses and diagnostic difficulties

Sait �EN, Banu SARSIK, Adnan ��M��R, Erkan KISMALI, Erhan G�KMEN — 2009-01-01

Aim: Renal needle core biopsies for mass lesions are being used frequently in advanced renal cell carcinoma or multipl mass lesions (e.g., primary renal cell carcinoma or metastatic renal mass). The problems and clues of core biopsy interpretation from a pathologist's perspective have not been fully reported. Current study aims to document our experience. Materials and Methods: Cases with renal needle core biopsies from 2000 to 2008 were retrospectively evaluated and categorized in 9 groups based on histologic pattern: Category 1-Clear cell lesions; Category 2-Eosinophilic granular cell lesions; Category 3-Tubulopapillary lesions; Category 4-Spindle cell lesions; Category 5-Infiltrating tumors; Category 6-Small blue cell tumors; Category 7-Cystic lesions; Category 8-Necrotic and/or fibrohistiocytic lesions; and Category 9-Inadequate materials. Different immunohistochemical stain panels for each category were used. Results: In this study, 52 core biopsies from 47 cases were evaluated. An adequate sample was obtained in 46 (88%). Renal cell carcinoma (49%) was most common followed by metastatic tumors (15%) lymphoma (9%) and urothelial carcinoma (4%). Benign tumors were identified in 3 cases (6%). 19% of the biopsies were non-diagnostic. Most of the cases need immunohistochemical panels for differential diagnosis. Category 2 and 5 was the most problematic, requiring frequently immunohistochemistry and clinical correlation. Conclusion: A wide spectrum of neoplasms is encountered and diagnosable by renal needle core biopsy. The above- mentioned categories would facilitate the approach to the biopsy and provide a diagnostic tool. Clinical correlation and contemporary immunohistochemistry work-up is often essential in eosinophilic-granular cell lesions and infiltrating tumors and would allow more accurate diagnosis.

A survey on the overall characteristics of pathology laboratories in Turkey

Kutsal Y�R�KO�LU, Alp USUB�T�N, �ner DO�AN, Binnur �NAL, �zlem AYDIN — 2009-01-01

Aim: This reports presents the results of a recent survey on the condition of pathology laboratories in Turkey based on a written questionnaire. Materials and Methods: We have submitted a survey that consisted of 68 questions to 250 various pathology laboratories throughout Turkey. We received 84 responses that were reviewed and analyzed. Results: We have determined the total number of pathologists, pathology technicians, and administrative support for each category of laboratories, and the overall numbers were found to be lower than universally recommended. We have identified significant challenges in the number and the distribution of the pathology material reviewed and processed by residents. The time of retention and archival of pathology material were done in various forms, but there were no adopted limit standards. The available space in most laboratories were insufficient and fell below the accepted international norms. The number and the type of equipments, and conventional histochemical techniques positively correlated with the total number of surgical specimens. Conclusion: Our findings underline serious and significant issues concerning pathology laboratory work area, equipment, and staffing. These deficiencies point to the need for standard national guidelines for each type of laboratory, and the results of our survey can aid in the preparation of such guidelines. These guidelines will be instrumental in establishing a national quality assurance program that can address the needs unique to our country. Such an effort should be the mission of the Federation of Turkish Pathology Societies, and all Turkish Pathology Societies.

Quality control of pathology laboratories in Turkey

Kutsal Y�R�KO�LU, Alp USUB�T�N, �ner DO�AN, Binnur �NAL, �zlem AYDIN — 2009-01-01

Aim: The aim of this study is to determine the standards of quality control and assurance programs adopted in pathology laboratories in Turkey by the aid of a questionnaire-based survey. Materials and Methods: We have submitted a survey that consisted of 68 questions to 250 various public and private pathology laboratories located in university hospitals, Ministry of Health research hospitals, and private hospitals throughout Turkey. We received 84 responses, and the responses were analyzed with the aid of a statistics program (SPSS). Results: None of the pathology laboratories that responded to the survey used a quality control program that was unique to pathology, and many of the responders were using general hospital quality control programs. There were no standards in the use and calibration of histopathology equipment. Half of the laboratories had written guidelines of their quality control procedures. The written protocols were most common for macroscopic examination and reporting of specimens. Adult autopsies were very low to null, but there were large number of pediatric and perinatal autopsies performed in most of the laboratories. We identified many problems concerning the safety procedures. Conclusion: Our results showed that pathology quality control programs adopted elsewhere may not be entirely suitable to pathology laboratories in our country. We propose development of quality assurance programs that consider the specific circumstances of the pathology laboratories in our country, and such programs should be better implemented.

Follicular-patterned thyroid lesions

2009-01-01

Aim: Our aim is to determine the minimal cytopathologic criteria needed to make differential diagnosis in follicular-patterned lesions of the thyroid gland. Materials and Methods: We reviewed 56 fine needle aspiration cytology specimens which were reported as “suspicious for follicular-patterned lesions of thyroid” between years 2001 and 2005 in our hospital and their histological slides. Parameters for cytopathologic assesment are cellularity, colloid formation, multilayered rosette formation, follicular cell rings, monolayered sheets, intact follicles, hyperplastic papillae, hyaline stromal fragments, intranuclear inclusions, nuclear grooves, angulated nuclei, nucleoli, cerebriform nuclei, nuclear size, macrophages, flame cells and Hurthle cells. Statistical analysis was performed using χ² and Fisher's-exact tests and Kolmogorov-Simirnov test. Results: Four cytopathologic features–cerebriform nuclei, angulated nuclei, nuclear grooves and intranuclear inclusion- were constantly observed in the follicular variant of papillary carcinoma (p< 0.05). Diluted colloid, monolayered sheet, nuclear size, macrophage and nucleoli were frequently seen in nodular hyperplasia (p< 0.05). The nuclear size was the sole differential cytopathologic criteria between follicular adenoma and follicular carcinoma (p<0.05). Conclusion: Detailed cytopathologic examination was found to be important in differentiating follicular variant of papillary carcinoma from nodular hyperplasia. On the other hand, none of the cytopathologic findings were sufficient to distinguish follicular adenoma from follicular carcinoma. Therefore, cytopathologists should report such lesions as “follicular neoplasms”.

Laryngeal lipoid proteinosis (Urbach-Wiethe's disease): A case report

�i�dem VURAL, �pek I��k G�N�L, Ay�e DURSUN — 2009-01-01

Lipoid proteinosis (Urbach-Wiethe's disease/hyalinosis cutis et mucosae) is a rare autosomal recessive disease. The characteristic pathology which is responsible for the clinical findings of the disease is the deposition of periodic acid-Schiff (PAS) positive hyaline, amorphous material in the extracellular and perivascular spaces of skin, mucous membranes and organs. Skin involvement consisting of the small-beaded papules along the eyelid and lip margins is the dominant clinical finding in most cases. However larynx, pharynx and other visceral organs may also be affected. We present here the light and electron microscopic findings of cord vocal biopsy from a 17 year-old female patient with the complaint of hoarseness. Although more than 200 cases were published in the literature, lipoid proteinosis is still a very rare entity. The late appearance of the clinical symptoms of our patient is not typical and therefore clinical and pathological misdiagnoses are possible.

Tumor-like myxoid change in decidualized scar endometriosis of pregnancy: a case report and review of literature

2009-01-01

A case of cesarean scar endometriosis with myxoid change and decidualization in a 24 year-old pregnant is presented. Patient in the second trimester complained of mass in the scar tissue of previous cesarean section. At 40th week of gestation, pregnancy was terminated and subcutaneous mass was removed. Microscopic examination revealed a lesion with lobular pattern and prominent myxoid change in the stroma. Each lobule was containing dilated cystic spaces resembling lymphatic vessels. Also signet-ring like vacuolated cells were present in myxoid stroma. The diagnosis was decidualized scar endometriosis with myxoid change. However, histological features of the lesion may cause diagnostic confusion with benign or malignant tumors such as myxoma, myxoid sarcomas and mucinous adenocarcinoma. Immunohistochemical study and thus recognizing cellular characteristics could help to prevent this misinterpretation.

Soft tissue osteoma: A case report

Peyker TEM�Z, Olca BA�T�RK, Semin AYHAN, G�lg�n YILMAZ OVALI, G�venir OK�U — 2009-01-01

Soft tissue osteomas are very rare and should be differentiate from other osseous lesions of soft tissue. We present two patients and discuss their clinical, radiologic and histopathological features with literatures. The first patient was 17-year-old boy, amateur football player. The other was a 43-year-old man had a firm, painless mass at his right knee. Their medical history had both trauma to their knees. Radiologically, heterogenous nodular calcification areas were observed near the proximal metaphysis of their tibias. Hardly lobulated lesions without bone attachment at the ligaments were excised. These lesions were gray-white coloured, well-circumscribed, firm masses. Microscopically, welldefined, lobulated lesions were involved mature lamellar bone trabeculae and enchondral ossification areas at peripherial portion. Both of our patients are survived healty for four years.

Papillary villoglandular carcinoma of cervix with multiple HPV genome

Haldun UMUDUM, Almora G�LERY�Z, Ahmet G�KSEL, Hakan �ERM�K, Abdullah �ANDAR — 2009-01-01

We report a case of well differentiated villoglandular adenocarcinoma with adenocarcinoma in situ component. Patient was an asymptomatic premenopausal woman, which was referred with atypical glandular cells of undetermined significance (AGUS) diagnosis established with cervicovaginal smear. Chromogenic in situ hybridization showed the presence of dual HPV (subtype 16/18 and 31/33) genomes. P53 overexpression and increased Ki 67 expression were detected on both invasive and in situ component. No evidence of disease was detected sixty-five months after staging laparotomy. This case is an uncommon example of multiple HPV infections leading to unusual cervical tumor.