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EgeUn###, Objective: Diagnosis of metastatic liver carcinomas (MLCs) vs. hepatocellular carcinomas (HCCs) may be problematic especially in the non-cirrhotic liver. Glutamine Synthetase (GS), Glypican3 (GPC3, and Arginase-1 (Arg-1) immunohistochemistry can demonstrate the hepatocellular origin of a given tumor. This study aims to investigate the characteristics of GS, GPC3, and Arg -1 expression and the value of their combination in MLCs and in HCCs. Patients and Methods: Tissue samples were obtained from 86 patients with liver tumors, (16 HCCs, 70 MLCs) who underwent liver transplantation or resection. Immunohistochemical staining for GS, GPC3, and Arg-1 was performed on formalin fixed paraffin embedded sections. Demographic, laboratory, and clinical data obtained from patient files were analyzed for the confirmation of the primary origin of the tumors. Statistical analyses were made using the SPSS version 19.0 (IBM, Armonk, NY, USA). Results: Staining pattern of GS and GPC3 was cytoplasmic. Arg-1 staining was cytoplasmic in MLCs vs. cytoplasmic and nuclear in HCCs. Among HCCs, 100%, 38%, and 94% showed positive staining with GS, GPC3, and Arg-1, respectively. Overall, MLCs showed positive staining with GS, GPC3, and Arg-1 in 73%, 4%, and 4% of the cases, respectively. The combination of GS+/GPC3+/Arg-1+ was detectable in 38% of HCCs, but in 0% of MCTs. The specificity of GS, GPC3, and Arg-1 for HCC was 27%, 96%, 96%, and sensitivity was 100%, 38%, and 94%, respectively. Conclusions: Expression of GS in MLCs is high, therefore GS/GPC3/Arg-1 should be used as a panel in addition to other markers when the differential diagnosis of MLC vs HCC is challenging. Cytoplasmic and nuclear Arg-1positivity should be a prerequisite for the diagnosis of HCC.

Objective: The purpose of this study is to evaluate the diagnostic value of scalene lymph node biopsy performed in patients with hilar and/or mediastinal lymphadenopathy and/or bilateral parenchymal lesions which could not be diagnosed by other invasive or noninvasive diagnostic procedures during their hospitalization in Department of Chest Diseases. Patients and methods: Between the years 1998-2004, scalene lymph node biopsy was performed under local anesthesia by the same surgical team in 46 patients (28 women, 18 men) with a mean age of 48.72 + 16.40 (2078) and the results are evaluated retrospectively. Results: Histopathological examination results of the specimens obtained by biopsy were as follows: 22 patients (47.9%) had non-caseating granulomatous lymphadenitis, 1 patient (2.1%) had caseating granulomatous lymphadenitis, 1 patient (2.1%) had Hodgkin’s disease and 22 patients (47.9%) had reactive lymph nodes. No complications occured related to the procedure. Conclusion: The diagnostic yield of scalene lymph node biopsy, which can be performed under local anesthesia before more invasive procedures such as mediastinoscopy and videothoracoscopy, was found to be 52.1%. Scalene lymph node biopsy can be performed with almost no morbidity and with less cost but also with a less diagnostic yield when compared to mediastinoscopy and videothoracoscopy, Giriş ve amaç: Göğüs hastalıkları kliniğinde yatmaktayken, uygulanan noninvaziv ve invaziv tanısal yöntemlere karşın tanı konamamış, bilateral parankimal lezyonu ile hiler ya da mediastinal lenfadenopatisi bulunan olgulara uygulanmış skalen lenf düğümü biyopsisinin tanısal verimliliğinin değerlendirilmesi amaçlandı. Gereç ve yöntem: 1998-2004 yılları arasında, 28’i kadın 18’i erkek toplam 46 olguya (yaş aralığı 20-78, ortalama yaş 48.72 ± 16.40), aynı cerrahi ekip tarafından lokal anestezi ile uygulanan skalen lenf düğümü biyopsisi sonuçları retrospektif olarak incelendi. Bulgular: Biyopsi sonucu elde edilen materyallerin histopatolojik incelenmesi sonucunda, olguların 22’sine (% 47.9) nonkazeifiye granülomatöz lenfadenit, 1’ine (% 2.1) kazeifiye granülomatöz lenfadenit, 1’ine (% 2.1) Hodgkin lenfoma tanısı konurken, 22 olguda (% 47.9) sonuç reaktif lenf düğümü olarak rapor edildi. İşlem sonrası olguların hiçbirinde komplikasyon gözlenmedi. Sonuç: Genel anestezi altında uygulanması gereken mediastinoskopi veya videotorakoskopik akciğer biyopsilerinden önce, tanısal incelemeleri süren olgulara, lokal anestezi ile uygulanabilen skalen lenf düğümü biyopsisinin tanısal verimliliği % 52.1 bulundu. Skalen lenf düğümü biyopsisi mediastinoskopi ya da videotorakosopik parankim biyopsilerinden önce uygulanabilecek, maliyeti oldukça düşük, morbiditesi bulunmayan, ancak tanısal verimliliği yukarıda tanımlanan invaziv yöntemlerle kıyaslandığında daha düşük olan bir tanı yöntemidir

PubMed ID: 26456962, Objective: Lung cancer is still the leading cause of cancer mortality. Antiapoptotic genes and protease inhibitors play an important role in the development of lung cancer. Material and Method: p63, TTF-1 and maspin expression and their role in the differential diagnosis, overall survival, progression-free survival and other clinicopathological characteristics of the patients were investigated in 80 surgically-resected non-small cell lung carcinomas. Results: The maximal tumor diameter range was 1.5–11 cm (mean: 4.06±1.8 cm). Forty-five (56.3%) tumors were adenocarcinoma, 23 (28.8%) squamous cell carcinoma, four (5%) large cell carcinoma, six (7.5%) large cell neuroendocrine carcinoma, one (1.2%) sarcomatoid carcinoma while one was (1.2%) both adenocarcinoma and squamous cell carcinoma. The patients with advanced TNM stage and a tumor diameter more than 3 cm had markedly poor survival. Immunohistochemically, p63 staining was present in 87.5% of squamous cell carcinomas, 4.3% of adenocarcinomas, 25% of large cell carcinomas, and 16.7% of large cell neuroendocrine carcinomas. Similarly, maspin was positive in 66.7% of squamous cell carcinomas and 17.4% of adenocarcinomas. The TTF–1 staining rate was higher in adenocarcinomas (84.8%). There was no immunoreactivity in squamous cell carcinomas (p0.05) while maspin has a negative prognostic effect in adenocarcinoma (p=0.048). Conclusion: This study suggests that p63 and TTF–1 are reliable markers in non-small cell lung carcinoma and can be used in differential diagnosis. Maspin has been identified as a prognostic marker in adenocarcinoma. However, more studies are required to elucidate the significance of maspin. © 2015, Federation of Turkish Pathology Societies. All rights reserved.

PubMed ID: 25944390, Objective: It is now important to distinguish between adenocarcinoma and squamous cell carcinoma of the lung because of target-specific treatments. Our study aimed to study the efficiency of Thyroid Transcription Factor-1 (TTF-1), cytokeratin 5/6 (CK5/6) and p63 in distinguishing between adenocarcinoma and squamous cell carcinoma and to study the contribution of these markers to the diagnosis in non-small cell lung cancer. Material and Method: Immunohistochemically, TTF-1, CK 5/6 and p63 were used in 72 cases of squamous cell carcinoma, 19 cases of adenocarcinoma, and 29 cases of non-small cell lung cancer whose final diagnosis was decided with the subsequent resection material. The specificity, sensitivity, and positive and negative predictive value were calculated for each marker. Results: TTF-1 positivity was seen in none of the 72 squamous cell carcinomas but in all of 19 adenocarcinoma cases. CK5/6 negativity was seen in all cases of adenocarcinoma and in two cases of squamous cell carcinoma. p63 was positive in all squamous cell carcinomas and in 4 adenocarcinomas. Cytokeratin 5/6, p63 positivity and TTF-1 negativity were observed in 17 non-small cell lung cancers whose final diagnosis was squamous cell carcinoma. None of the 12 non-small cell lung cancers whose final diagnosis was adenocarcinoma exhibited positive staining for CK5/6. However, p63 staining was not seen in the biopsy but was focal in the surgical specimen in one case. All the 12 non-small cell lung cancers whose certain diagnosis was adenocarcinoma were positive for TTF-1. TTF-1, CK 5/6 and p63 seem to be useful for differentiating adenocarcinoma from squamous cell carcinoma with 100% specificity, 100% sensitivity and 100% specificity, 97% sensitivity and 87% specificity, and 100% sensitivity, respectively. Conclusion: We concluded that TTF-1 is a reliable marker for sub typing lung cancer. Different staining patterns can be seen with CK5/6 and p63; however, if they are used together with TTF-1 and interpreted correctly, they can be of help for the final diagnosis even in cases in which the morphology is unclear. © 2015, Federation of Turkish Pathology Societies. All Rights Reserved.

PubMed ID: 24506744, Introduction: Ventilator associated pneumonia (VAP) is one of the most important causes of mortality in patients treated with invasive mechanical ventilation (IMV) in intensive care unit (ICU). Microbiological examinations are required as clinical and radiological findings are usually insufficient in the diagnosis. Materials and Methods: Twenty four patients who were receiving IMV because of respiratory failure, had a Clinical Pulmonary Infection Score (CPIS) of ? 6 in the follow-up and died with the suspicion of VAP were enrolled in our study. Six patients were excluded as post-mortem biopsy could not be performed. The patients who had pre-mortem CPIS ? 6, in whom a causative organism was identified from the culture of post-mortem lung biopsy and/or histopathological examination of lung biopsy was compatible with pneumonia were diagnosed as VAP. In the 18 patients in whom a post-mortem lung biopsy was performed, quantitative culture results of endotracheal aspirate performed 48 hours prior to death were compared with microbiological and histopathological results of post-mortem lung biopsy specimens, and the role of endotracheal aspirate in the diagnosis of VAP was evaluated retrospectively. Results: Out of 18 patients (12 men, mean age 67.0 ± 13.0 years) included in the study, 11 (61.1%) were diagnosed as VAP. The quantitative culture of endotracheal aspirate was positive in 9 (81.8%) out of 11 patients diagnosed as VAP. The sensitivity, specificity, positive and negative predictive values of endotracheal aspirate culture for identifying VAP were found to be 81.8%, 14.3%, 60.0% and 33.3%, respectively. Conclusion: Our study shown that quantitative culture of endotracheal aspirate is a practical and reliable method that can be used for the diagnosis of VAP in patients receiving IMV in ICU and having CPIS ? 6.