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We have investigated the distribution of chemokine receptor 4 (CXCR4) and CD8-positive, tumour-infiltrating T lymphocytes (CD8+ TILs) in breast cancer subtypes and explored the relationship between them and the well-established conventional prognostic markers, including axillary lymph node involvement. A total of 250 breast cancer patients were included in the study. The patients were separated into luminal A+B, HER2 enriched/overexpressed (HER2+), and triple- negative, on the basis of their staining characteristics, via conventional staining methods. Immunohistochemical (IHC) staining for CXCR4 and CD8+ TILs were performed on the archival tissues from each patient. With increasing intensity of CXCR4 staining, there was a higher incidence of lymph node metastasis (p < 0.01). Similarly, there was a positive correlation between the primary tumour size, HER2+ subtype, lymphovascular invasion, and axillary lymph node involvement. Dense lymphocytic infiltration was observed in HER2+ and triple-negative patients. No correlation between CD8+ TILs in all sites and breast cancer subtypes was discovered. A reverse correlation was discovered with CD8+ TILs stained only intratumorally and CXCR4 expression. In conclusion, lymph node involvement correlates with higher CXCR4 expression in all breast cancer subtypes. Conversely, no such correlation is found with CD8+ TILs.

Background: Gastric cancer is a common malignancy and nutritional factors are believed to play an important role in its development. Isoflavones in soybean products are an important nutritional source, especially in some Asian Countries, having protective role against development of gastric cancer.In our study, we have prepared soybean extracts via different methodologies and assessed their apoptotic role and proliferation index in gastric mucosa of the rodents.Methodology: We have fed 2 months old 64 rats for a period of 1 month with soybean extracts prepared by 3different methodologies and in 6 different concentrations. Subsequently, the rodents were subjected to euthanasia and their gastric mucosal linings were processed accordingly for H & E, Bcl-2, and Ki 67 staining. Thereafter, the specimens were evaluated under light microscopy.Results: In all the experimental groups fed with soybean extracts, weak staining was observed with Bcl-2, moresignificantly in the group of rodents fed with 100 mg/kg and 200 mg/kg ethanol extract as well as in the group fed with high ethyl acetate extract (p0.05).Conclusions: We have discovered that soybean extracts and specifically genistin and daidzein induces apoptosis at high concentrations. This observation makes us believe that soybeans have a protective role in the development of gastric cancer.

Skin is one of the rare areas of the metastasis of malig­nancies and metastasis of the lung cancer extremely rare. Although it can be seen in all areas, it usually develops in areas close to the main tumor. Cutaneous metastasis as it may be the first sign of the lung cancer; it can occur in the follow up and is associated with poor prognosis. Skin metastasis of lung cancer is not owner a characteristic view but is seen mostly in the nodular type. Herein, we presented an eighty-two-year-old patient with lung carci­noma who developed ulcerated skin lesions at the lower extremity that did not respond to the nonspecific antibiotic therapy and squamous cell cancer metastasis was deter­mined from excisional biopsy specimen that was obtained from these areas.

Pilar sheath acanthoma is an uncommon, benign follicular hamartoma that frequently presents as an asymptomatic, skin-colored papule or nodule with central opening. Pilar sheath acanthoma generally appears on the upper lip of elderly patients, although a few cases have been described on other locations such as lower lip and cheeks. In this article, we present a 62-year-old male who presented with multiple pilar sheath acanthoma on the scrotal and anal regions.

Purpose: To investigate the role of CXCR4 and cyclooxygenase-2 in pterygium recurrence.Methods: A total of 18 primary and 9 recurrent pterygium samples were analyzed. Immunohistochemical staining using primary antibodies against cyclooxygenase-2 and CXCR4 was performed. The cyclooxygenase-2 and CXCR4 expressing cells were calculated separately on the epithelium and stroma. In addition, a correlation between the area of pterygium and CXCR4 and cyclooxygenase-2 levels was investigated.Results: In the primary pterygium group, cyclooxygenase-2 staining was more intense in the epithelium and more dominant in the stroma of the recurrence samples. The CXCR4 expression was more intense in the stroma of both groups. The highest CXCR4 expression was observed in the recurrent pterygium group. There was a strong correlation between the area of pterygium and CXCR4 and cyclooxygenase-2 of stroma.Conclusions: CXCR4 and cyclooxygenase-2 may play an important role in the recurrence of pterygium.

To evaluate the effects of letrozole and cabergoline in a rat model of ovarian hyperstimulation syndrome (OHSS). In this prospective, controlled experimental study, the 28 female Wistar rats were divided into four subgroups (one non-stimulated control and three OHSS-positive groups: placebo, letrozole, and cabergoline). To induce OHSS, rats were injected with 10 IU of pregnant mare serum gonadotropin from day 29 to day 32 of life, followed by subcutaneous injection of 30 IU hCG on day 33. Letrozole rats received with a single dose of 0.1 mg/kg letrozole via oral gavage, on the hCG day. Cabergoline rats received with a single dose of 100 µg/kg cabergoline via oral gavage, on the hCG day. All animals were compared in terms of body weight, vascular permeability (VP), ovarian diameter, ovarian tissue VEGF expression (assessed via immunohistochemical staining), and blood pigment epithelium-derived growth factor (PEDF) levels. The OHSS-positive placebo group (group 2) exhibited the highest VP, ovarian diameter, extent of VEGF staining, and lowest PEDF level, as expected. No significant difference was evident between the letrozole and cabergoline groups in terms of any of body weight; VP; PEDF level; ovarian diameter; or the staining intensity of, or percentage staining for, VEGF in ovarian tissues. Letrozole and cabergoline were equally effective to prevent OHSS, reducing the ovarian diameter, VP, and PEDF and VEGF levels to similar extents.

Objectives: Parathyroid carcinoma (PC) is a rare parathyroid tumor compared to parathyroid adenoma (PA) and atypical parathyroid adenoma (APA). Recent studies have suggested parafibromin has a role in the differential diagnosis of parathyroid tumors. We sought to determine the role of parafibromin as well as galectin-3, Ki-67, and HBME-1 as diagnostic markers in the differential diagnosis of parathyroid tumors. Methods: A total of 92 cases diagnosed with PA, APA, or PC at Sifa University and Private Ege Pathology Laboratory between 2006–2012 were included in the study. Parafibromin (microarray), galectin-3, Ki-67, and HBME-1 were evaluated using immunohistochemistry in all parathyroid tumors. Results: Eighty-four cases were diagnosed with PA, six with APA, and two with PC. The study group consisted of 82 females and 10 males. Their mean age was 50.9 years, and the mean tumor diameter was 1.97 cm. Parafibromin was negative in the two PC cases but positive in all APA and PA cases. Positivity was observed with galectin-3 in 17 adenoma cases, three atypical adenomas, and two carcinoma cases. Positivity with HBME-1 was found in 26 PA cases and one PC case. Parafibromin and galectin-3 expression was significant between the three tumor groups but not for HBME-1 expression. Parafibromin expression increased in PA whereas galectin-3 expression decreased. A statistical significance was found between the three tumor groups according to the Ki-67 score (p=0.010). Additionally, the Ki-67 proliferation index was under 1% in PAs. Conclusion: The number of PCs in our series was small so our data mostly reflects the immunohistochemical characteristics of PAs. Parafibromin expression, galectin-3 negativity, and a Ki-67 proliferation index under 1% were estimated as beneficial in the differential diagnosis of difficult parathyroid tumors. © 2015, Oman Medical Specialty Board. All rights reserved.

Objective: The aim of this study was to evaluate the expression of cyclooxygenase 2 (COX-2) and its association with the development of premalignant lesions in gland structures of the endometrium in patients with uterine prolapse, a condition which exposes the uterus to mechanical and infectious stress. Methods: The study included 102 patients who underwent hysterectomy to correct grade 3-4 uterine prolapse and 105 patients who underwent hysterectomy for other causes. Endometrial gland structures underwent immunohistochemical staining and COX-2 expression was graded. Grades 0 and 1 represent low expression; grades 2 and 3 correspond to high levels of COX-2 expression. Results: The prevalence of grade 2-3 COX-2 expression was significantly higher in the endometrial gland structures of patients with prolapse and hyperplasia compared to the remaining patients (p = 0.014). Grade 0-1 COX-2 expression was significantly more common in the endometrial gland structures of patients without uterine prolapse or hyperplasia (p = 0.004). Among the patients without endometrial hyperplasia, COX-2 expression was elevated in the endometrial gland structures of those with uterine prolapse compared to those without prolapse. Conclusion: Elevated COX-2 expression may explain the presence of unexpected premalignant lesions of the endometrium in patients with uterine prolapse.

Basaloid follicular hamartoma (BFH) is a benign rare neoplasm of the hair follicles whose clinical and histological appearance is very similar to basal cell carcinoma. Although these hamartomas are considered to be benign lesions, malignant differentiations have been reported. It may be generalized or localized, familial or sporadic, and BFH can be accompanied by systemic diseases. Although there are many clinical forms of BFH, they all have the same histopathological features. Basaloid follicular hamartoma is a folliculocentric tumor limited to the superficial dermis. Involvement of the deep reticular dermis or soft tissue is not seen in BFH [1]. We present a 52-year-old man with a solitary, hyperpigmented, asymptomatic, slow growing skin tumor on his left upper eyelid. A 52-year-old man presented with a slowly developing asymptomatic left upper eyelid lesion (over 4 years). Dermatological examination showed a solitary, smooth surfaced, hyperpigmented nodule measuring 1 cm in diameter (Figure 1), and there were no other similar skin lesions or significant internal diseases exhibited. He had no family history of similar lesions. The lesion was locally excised, and the specimen was grossly measured to be 1.2 × 0.7 × 0.2 cm. Figure 1 A solitary, smooth surfaced, hyperpigmented 1 cm nodule is located on the left upper eyelid of a 52-year-old man Low-power light microscopy revealed a well-circumscribed and completely removed lesion in the dermis, without connections to the epidermis (Figure 2). Microscopically, the tumor revealed strands and cords of small basaloid cells emanating from the infundibular portion of the hair follicle. The tumor stroma was scant and mildly fibrocellular. There was no nuclear pleomorphism, mitotic activity, apoptotic cells, or cleft formation between the tumor and the stroma (Figure 3), and upon immunohistochemical examination, Bcl-2 stained only in the outermost basal cells (Figure 4). Cd34 was positively stained in the peritumoral stroma and blood vessels (Figure 5), and CD10 was stained in the peritumoral stroma as well as the matrical cells (Figure 6). Figure 2 Low-power light microscopy revealed a well-circumscribed and completely removed lesion in the dermis, without connections to the epidermis (hematoxylin-eosin, original magnification at 40×) Figure 3 A biopsy specimen with basaloid follicular hamartoma shows strands and cords of small, basaloid cells emanating from the infundibular portion of the hair follicle. The tumor stroma was scant and mildly fibrocellular. There was no nuclear pleomorphism, ... Figure 4 Bcl-2 stains only the outermost basal cells in BFH (Bcl-2, 100×) Figure 5 CD34 is positive in the peritumoral stroma and blood vessels (CD34 100×) Figure 6 CD10 stains the peritumoral stroma of BFH, as well as the matrical cells (CD10 100×) Basaloid follicular hamartoma was first described in 1969 by Brown et al. as “generalized hair follicle hamartoma” with associated alopecia, aminoaciduria, and myasthenia gravis [2]. The term “basaloid follicular hamartoma” was first used for a patient who had a localized and solitary type of the lesion, without associated abnormalities, by Mehregan and Baker in 1985 [3]. Morohashi et al. described BFH as an abortive growth of secondary hair germs with a limited differentiation toward the upper follicular portion of the hair shaft [4]. Basaloid follicular hamartoma may manifest with different clinical presentations, such as a solitary lesion, or as multiple lesions with a generalized or localized distribution. Basaloid follicular hamartoma may present as individual or linearly distributed, small, skin-colored to brown papules or plaques, or as multiple lesions in a generalized distribution on the face, scalp, and occasionally, the trunk. Basaloid follicular hamartoma may be a familial, congenital, or acquired condition. Several forms of generalized BFH have been described: (1) sporadic form, multiple BFH without systemic disease; (2) generalized acquired form, female patients with generalized BFHs associated with alopecia and autoimmune diseases, such as myasthenia gravis or systemic lupus erythematosus, in which the lesions are found mainly on the face and periorificial areas; (3) generalized familial form, an autosomal dominant disease that may or may not be associated with hypotrichosis, hypohidrosis, and palmoplantar pitting, which appears on the face and genital region; (4) generalized congenital form, generalized BFH associated with other ectodermal defects, such as hypotrichosis and punctate keratotic pits, on the palms and soles and with cystic fibrosis [1]. The localized forms of BFH present as linear unilateral lesions or as plaques with alopecia [3–6]. The linear unilateral type of BFH is associated with lines of Blaschko and presents at birth or appears in early childhood [3, 5, 6]. Solitary BFH was first described in 1992 as a smooth plaque or a papule appearing most commonly on the face or scalp [7]. The pathogenesis of BFH has been linked to a mutation in the PTCH (patched) gene on chromosome band 9q23. However, this mutation is thought to be less severe than the PTCH gene mutation demonstrated in nevoid basal cell carcinoma syndrome (NBCS) [8–10]. The clinical differential diagnosis for BFH depends on its presentation. The most common misdiagnoses for individual lesions include basal carcinoma (BCC), intradermal melanocytic nevus, seborrheic keratosis, sebaceous hyperplasia, syringoma, angiofibroma, trichilemmoma, steatocystoma, trichoepithelioma (TE), basal cell hamartoma with follicular differentiation, and hamartoma of the sebaceous follicles. When presenting as a plaque, nevus sebaceous, lupus erythematosus, and sarcoidosis should be considered. Basaloid follicular hamartoma in a linear distribution may mimic linear epidermal nevus, lichen striatus, linear morphea, and basal cell nevus. The differential diagnosis of generalized BFH could include generalized follicular hamartoma syndrome, tuberous sclerosis, Cowden disease, multiple trichoepitheliomas, nevoid basal cell nevus syndrome, Rombo syndrome, and multiple tumors of the follicular infundibulum [11]. Basaloid follicular hamartoma is often misdiagnosed as trichoepithelioma or basal cell carcinoma, histopathologically [1]. Specifically, BFH consists of malformed and distorted hair follicles composed of cords and strands of basaloid cells. These cells are arranged in a radial, anastomosing fashion and may arise from the follicles and/or show an epidermal attachment. The tumor cells are bland, without nuclear pleomorphism, and mitotic activity is rare or absent, with little to no single cell necrosis. While the presence of peripheral palisading has been reported, this feature is typically lacking to the degree seen in BCC. The stroma is scant or absent, and when present, consists of eosinophilic compact collagen with no fibrocytes. Clefts within the fibrous stroma have been reported, and minimal clefting between the tumor and stroma has been observed, but it is not a well-accepted feature of BFH. Mucinous ground substance, if present, is usually subtle; furthermore, BCC displays a variety of histological patterns. The neoplastic cells may involve and destroy preexisting hair follicles and the interfollicular dermis, and sometimes, infiltrate the deeper dermis, subcutaneous fat, and skeletal muscle [12]. Differentiating BFH from BCC can be the most difficult aspect of the diagnosis, and additional immunohistochemical stains may help to separate BFH from BCC. Ki-67 (a proliferative marker associated with mitosis) and Bcl-2 staining are more prominent in BCC than in BFH. Bcl-2 stains only the outermost basal cells in BFH. CD 34 is an intercellular adhesion protein and cell surface glycoprotein; the ligand is CD62L (L-selectin). It is also called hematopoietic progenitor cell antigen and is a commonly used marker of hematopoietic progenitor cells and endothelial cells. CD34 also stains stromal cells and dendritic cells. In differential diagnosis it is important that the stromal cells of the BFH stain positive for CD34, but the stromal cells of BCC are negative [1, 12]. Although in BCC the stromal and tumor cells stain with CD10, in BFH, the peritumoral stroma and matrical cells stain with CD10 [13]. Histologically, TE has distinct islands of basaloid cells in a lacelike or adenoidal network and, occasionally, as solid aggregates; additionally, they exhibit a more nodular growth pattern than BFH. The tumor islands show peripheral palisading as in BCC; however, the stroma lacks the retraction artifact seen in BCC. In TE, the fibrocystic stroma is more prominent than in BFH, and it predominates over the epithelial portion. Additionally, in TE, normal follicular bulbs and papillae are seen [11]. While both BFH and TE have keratin cysts consisting of a fully keratinized center, surrounded by basophilic cells without high-grade atypia and mitoses, they are more prominent in TE. We report a case of solitary BFH that developed on the left upper eyelid of a man. Since only a few cases have been reported, presenting case reports will increase awareness of this disorder. Although BFH is a benign rare neoplasm of the hair follicles, it is important to differentiate it due to the malignancy risk and similar characteristics to other benign tumors.

Background: Cervical cancer is the second most common gynecologic cancer worldwide. Human papillomavirus (HPV) infection is a leading etiological factor in cervical carcinoma.The aim of this study was to compare HPV positivity, EGFR and TOP2A gene copy number variations and cervical cytologic findings. Materials and Methods: The study group comprised 100 female volunteers between 21-64 years old. Cytologic analysis was performed using the liquid-based cytology technique. HPV DNA testing was performed in all cases. Copy number variations that belong to EGFR and TOP2A genes evaluated by using FISH analysis. Results: Cytologic analysis of the cervical samples revealed abnormal findings in 13 of the 100 study subjects. ASCUS , LSIL, HSIL were determined in 8, 2 and 3 cases respectively as the result of cytologic analysis on all cases. Forty-one (41%) of the 100 women were HPV-positive. Chi-square analysis confirmed that HPV-positive women showed significantly more abnormal cytology (P = 0.035). EGFR deletion, TOP2A deletion and both EGFR and TOP2A deletion were determined in 1, 8 and 1 cases respectively. We found no statistical difference in abnormal cytologic findings between subjects with these gene deletions and subjects with normal gene copy numbers (P > 0.05 for both). No cases of amplification were determined for either gene. Conclusion: As a result, HPV positivity and the determination of changes that may occur in the gene copy number in patients with abnormal cytology can be an important tool on account of prognosis. Research with more patients may be suggested.

Introduction: It has been reported that the risk of malignant transformation is doubled in patients with mature cystic teratoma aged over 50 years. It is rare to encounter benign forms of mature cystic teratoma in elderly women. We aimed to report a 72-year-old woman with a benign cystic teratoma. A 72-year-old woman detected by ultrasonography to have a pelvic mass with a size of 14x12x10 cm was admitted to our department for detailed investigations. A mature cystic teratoma was diagnosed on the basis of transvaginal ultrasonography, magnetic resonance imaging, and serum concentrations of tumor markers. Postoperative pathology examination confirmed the diagnosis. This report once again showed that although mature cystic teratoma is rare in elderly women, it still occurs.

Human papillomavirus (HPV) is increasingly recognized as an important cause of the non-melanoma skin cancers. Thus, screening, early diagnosis and treatment of lesions associated with HPV infection has a great importance. We present a case of HPV 58-positive penile skin squamous cell carcinoma (SCC), a carcinogenic HPV type with low prevalence in cervical cancer. To our knowledge, this is the first case of HPV 58-positive penile skin SCC reported in Turkish literature.

Evaluation of the primary spindle cell sarcoma prostate, which is seen extremely rare, is aimed. Literature search was made through a search in the MedLine database using PubMed and Scopus for the articles published between January 1988 and September 2013. Electronic search was limited to the following keywords: “ spindle cell sarcoma”, “primary prostate sarcoma”. Primary prosatate sarcoma was reported as 100 patients in literature. High-grade primary spindle cell sarcoma of the prostate was encountered as 16 patients in literature. This patients was reported as the 17th case. It is a difficult cancer due to diagnosis and treatment b ecause of the short average life expectancy , high potential of asymptomatic aggressive and metastatic . Histopatogenesis is not exactly known . In 50 % of composed of patients who are previously diagnosed with prostate adeno carcinom. The case was reported as high-grade primary prosatate sarcoma at an early age. The case is different from other cases because of not being adenocarcinom component. World J Oncol. 2013;4(6):258-261 doi: http://dx.doi.org/10.4021/wjon757w

Objective The purpose of this study is to investigate the value of susceptibility-weighted imaging (SWI) for the evaluation of cyclic morphological and hemorrhagic changes in abdominal wall endometriomas (AWE). Materials and methods Fourteen patients with a total of 17 lesions who were admitted with complaints of abdominal wall mass and cyclic pain were evaluated by MRI. Patients were scanned during the first three days of the menstrual cycle and during the mid-cycle phase (day 13–15). In addition to conventional images SWI was performed. The signal changes within the lesions on SWI were compared and graded on both studies. Results There was no significant difference in the size of the lesions in the early days of the menstruation compared to the mid-menstrual period. The SWI taken on mid-cycle phase showed that the center was hyperintense and the peripheral zone was hypointense in all lesions. A signal void related to increased blood and the shrinkage of complete disappearance of hyperintensity in the venter of the lesion was seen 15 (88%) of the 17 cases on the SWI series performed during the menstrual phase scan. Conclusion SWI is a sensitive technique and has the capability to show hemorrhage and deposition of hemosiderin within the lesions. For patients suspected with AWE, valuable diagnostic findings may be obtained if the MRI examination including SWI is performed during the early and mid phase menstrual cycle.

BACKGROUND/AIMS We aimed to investigate the value of diffusion-weighted magnetic resonance imaging in the differentiation of benign-malignant diffuse bowel wall thickening (scirrhous colon carcinoma) and to discuss the diagnostic importance and potential use of apparent diffusion coefficient measurements. MATERIALS AND METHODS A total of 41 patients (32 males, 9 females; mean age, 57 years) with diffuse bowel wall thickening diagnosed on computed tomography were included in this study. The magnetic resonance imaging was performed on a 1.5 T scanner (Siemens-Espree). Changes in the signal intensity of the lesions were determined by their appearance in images at b800 s/mm 2 , and apparent diffusion coefficient values were also calculated. Lesions were classified in two groups according to the presence of hyperintensity on b800 images and results of endoscopic biopsies. The differences in mean apparent diffusion coefficient values between the two groups were compared with the Mann-Whitney U test, and threshold values were determined with receiver operating characteristic curve analysis. RESULTS The difference between the mean apparent diffusion coefficient values of benign and malignant groups was statistically significant, and the apparent diffusion coefficient values of benign lesions were significantly higher than of malignant lesions (p

Crohn’s disease is a chronic, or long lasting inflammatory disease in the gastrointestinal (GI) tract. Most commonly, Crohn’s disease affects the small intestine and the beginning of the large intestine. Treatment for Crohn’s disease usually involves drug therapy or, in certain cases, surgery. Several side effects develop from the use of drugs. A case with Crohn’s disease refractory to 5-ASA, corticosteroid and azathioprine treatments who developed breast carcinoma following infliximab treatment is being presented in this report. Case: SE, aged 44 years, presented to our polyclinic with weight loss, abdominal pain and flatulence. The patient had no response to mesalazine, steroid and azathioprine therapy. Upon identifying inflammatory stricture with abdominal MR, the medicines the patient has been using was discontinued and anti-TNF alpha (infliximab) treatment was initiated after receiving the consent of the patient. At 3rd month of treatment, the patient detected a small mass at the left breast. Mastectomy was performed and axillary lymph nodes were resected. Because breast cancer was detected following infliximab treatment in this case, we believe that a breast examination (physical examination, mammary USG) must be performed in female patients prior to infliximab therapy. How to cite this article: Goral V, Unsal B, Sivrikoz ON. A Case of Breast Cancer Following Infliximab Treatment for Treatment-Refractory Crohn’s Disease. Euroasian J Hepato-Gastroenterol 2014;4(2): 104-106.

Gossypiboma (textiloma) is a rare but preventable complication occurring due to oblivion of the surgical material during an operation that carries important diagnostic difficulties as well as high morbidity and mortality risks. The actual incidence is unknown because of its medicolegal aspects. Our case is a 36-years-old female patient, who had a caesarean section two years ago in another center. Clinical examination and radiological investigations gave the impression of "gastrointestinal stromal tumor" and the surgically taken out mass was sent to our pathology department. The case was reported as a "gossypiboma"' and presented here to emphasize the diagnostic difficulties in the preoperative period, the life-threatening nature of the condition and as well as the rarity of the reported cases.

Erythema dyschromicum perstans (EDP) is an acquired dermatosis characterized by ash gray (ashy dermatosis) or blue macules. It can appear at any ageo but is more common in young adults. Lesions may occur on the neck, chest arms and face, but most frequently on the back. It does not generally lead to subjective complaints, but may rarely cause itching. Diagnosis is made with clinical findings and can be corroborated by histopathological examination. This report describes the case of a 15-year-old female patient diagnosed with EDP and is intended to emphasize the need to include the condition at differential diagnosis.

The aim of this study is to investigate the effects of resveratrol in a rat model of ovarian hyperstimulation syndrome (OHSS) and compare with cabergoline.Randomized controlled, animal study.Female Wistar rats.A rat OHSS model was used to investigate the effects of resveratrol compare with cabergoline administration for preventing OHSS. Body weight, ovary weight, diameter, vascular permeability (VP), vascular endothelial growth factor (VEGF), cyclooxygenase-2 (COX-2) expression (immunohistochemistry), and serum estradiol (E2) levels were then compared.The ovarian VEGF concentration was significantly increased in the OHSS Groups (Groups 3-5) compared with the control groups (1 and 2). But vascular permeability, VEGF, and COX-2 expressions were reduced in animals treated with the resveratrol group compared with the cabergoline group (group 5) and the severe OHSS (group 3) group. Blood E2 levels were decreased in group treated with the resveratrol group compared with the cabergoline group (group 5) and severe the OHSS (group 3) group.Our results in a rat model suggest that resveratrol has a beneficial effect on OHSS by reducing the increases in ovarian daimeter, VP, and VEGF expression associated with OHSS. These effects may be mediated by the COX-2 inhibitory capacity of resveratrol.

Gingival enlargements modified by medications are becoming more common because of the increased use of inducing drugs, and may create speech, mastication, tooth eruption, periodontal, and aesthetic problems. We hereby present a case of a 54-year-old man with 12-month history of generalized gingival enlargement in the keratinized gingiva was referred to our clinic. The patient had a history of kidney transplant and was under medication of cyclosporine and nifedipine. After medical consultation, cyclosporine was changed to tacrolimus and nifedipine was changed to captopril. Gingivectomy was performed using a diode laser, and scaling and root planning were performed. At five months postoperative, the gingival enlargements relapsed and diode laser-assisted surgery was repeated. The patient was followed-up on second postoperatively at 18 months and no relapse was seen. Diode laser-assisted gingivectomy was found to be useful for coagulation during surgery and decreased postoperative bleeding. Recurrence risk of cyclosporine and nifedipine-induced gingival overgrowth is high, thus, there is a great need for prolonged care of patients following treatment and prosthetic restoration.

Objectives: To determine the efficacy of montelukast in comparison with cabergoline in the prevention of ovarian hyperstimulation syndrome (OHSS) in rats. Material and methods: An experimental OHSS model was formed in 35 female Wistar rats. Rats (22 days old) were randomized into 5 groups, each containing 7 animals. The control group received no therapy; the mild OHSS group was administered pregnant mare serum gonadotropin (PMSG) 10 IU for 4 days, hCG 10 IU on the 5th day; the severe OHSS group received PMSG 10 IU for 4 days, hCG 30 IU on the 5th day. The montelukast group: received montelukast 10 mg/kg/day and the cabergoline group was administered cabergoline 100μg/kg/day via oral gavage for 6 days (days 22–27), in addition to those of severe OHSS. All groups were sacrificed on 28th day. Body weight, ovarian diameter and weight, vascular permeability, vascular endothelial growth factor (VEGF), semiquantitative VEGF receptor-1, and VEGF receptor-2 (VEGFR-2) immunohistochemistry were evaluated. Results: Ovarian diameter and VEGF expression were significantly lower in the montelukast and cabergoline groups than in the severe OHSS group. While montelukast was more effective in limiting vascular permeability in the severe OHSS, cabergoline was superior to montelukast with respect to the limiting effect on increased body weight and VEGFR-2 expression. Conclusions: The VEGF/VEGFR-2 interaction plays an important role in OHSS pathogenesis. Montelukast limits VEGF expression, and cabergoline reduces both VEGF and VEGFR-2 expressions; they are both effective therapies for the prevention of severe OHSS.

To investigate the effect of vitamin D in ovarian hyperstimulation syndrome (OHSS). In this animal study, 28 immature female Wistar rats were divided into four groups: group 1 (control); group 2 (ovarian stimulation); group 3 (OHSS group); group 4 (OHSS + vitamin D group). All groups were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight, ovarian diameter, vascular endothelial growth factor (VEGF) expression (immunohistochemistry) in ovarian tissue and pigment epithelium-derived factor (PEDF) level in the serum (ELISA test) with the Kruskal–Wallis and Mann–Whitney U tests. VEGF expression in the vitamin D group was similar to that in the OHSS group. However, the PEDF level was significantly higher in the vitamin D group (p = 0.013). Prophylactic vitamin D supplementation is not sufficiently effective in preventing OHSS. Vitamin D effectively increases PEDF, which has an opposing effect on VEGF, which plays a key role in OHSS. Thus, the protective effect of Vitamin D on OHSS should be investigated with a vitamin D deficient model in the study group.

Objective: To discuss the pathological features of sirenomelia in the light of our 10 cases and review the current theories.Methods: We identified 10 patients with sirenomelia from our hospital database. All clinical details and the autopsy features of 10 cases were noted.Results: Of the 10 children with sirenomelia seven had bilateral renal agenesis, three had bladder agenesis and one had a renal hypoplasia. Single umbilical artery was found in 60% of children with sirenomelia. External genitalia was ambiguous in seven of 10 patients.Conclusions: Even though the etiology of caudal regression syndrome (CRS) and sirenomelia remains unknown we tend to believe that sirenomelia and CRS might be different entities.

A 46-year-old male patient diagnosed with ankylosing spondylitis presented to our polyclinic with complaints of pain, swelling, and limitation in joint mobility in both ankles and erythema nodosum skin lesions in both pretibial sites. The sacroiliac joint graphy and the MRI taken revealed active and chronic sacroiliitis. On the thorax CT, multiple mediastinal and hilar lymphadenopathies were reported. Mediastinoscopic excisional lymph node biopsy was taken and noncalcified granulomatous structures, lymphocytes, and histiocytes were determined on histopathological examination. The patients were diagnosed with ankylosing spondylitis, sarcoidosis, and Löfgren’s syndrome. NSAIDs, sulfasalazine, and low dose corticosteroid were started. Significant regression was seen in the patient’s subjective and laboratory assessments.

Sarcoidosis is a multisystem granulomatous disease characterized by hilar lymphadenopathy, involvement of internal organs, and diverse skin lesions. Systemic sclerosis is an autoimmune disease characterized by skin hardening and different internal organ fibrosis, including vascular abnormality. Immune response associated with Th-2 has been shown in the early and active stage of the disease. In this paper, we report coexistence of systemic sclerosis with sarcoidosis in a female patient presenting with granulomatous dermatitis, interstitial lung disease, and Raynaud's phenomenon complaints.

Lichen planus pigmentosus is a rare subtype of lichen planus. Because of its rarity, we present the case of a patient diagnosed as lichen planus pigmentosus-inversus based on clinical and histopatological findings, which clinical appearance did not resemble lichen planus at initial examination.

Malignant transformation of a benign cystic teratoma of the ovary is only rarely seen. A review of the English literature revealed no reports of a malignant melanoma developing from concurrent primary endometrial carcinoma and ovarian cystic teratoma. We report herein a 54-year-old nulliparous woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for a pelvic mass and was diagnosed by histopathological examination to have a malignant melanoma developing from concurrent primary endometrial carcinoma and ovarian cystic teratoma. No foci of primary malignant melanoma except for the ovary were found upon clinical examination. The patient received postoperative interferon alpha 2B and radiotherapy. She was still asymptomatic at 12 months of follow-up.

Background: Sarcoidosis is known as a T helper 1 lymphocyte (Th1-Ly) mediated disease which can imitate or sometimes accompany many primary rheumatic diseases. The purpose of this study is to share the clinical, demographic and laboratory data of patients presenting with rheumatologic manifestations and diagnosed with sarcoidosis. Methods: A total of 42 patients (10 men) were included in the study. The patients were admitted to the rheumatology outpatient clinic for the first time with different rheumatic complaints between November 2011 and May 2013 and were diagnosed with sarcoidosis after relevant tests. Clinical, demographic, laboratory, radiological and histological data of these patients were collected during the 18-month follow-up period and then analyzed. Results Mean patient age was 45.2 years (20–70 years) and mean duration of disease was 3.5 years (1 month–25 years). Evaluation of system and organ involvement revealed that 20 (47.6%) patients had erythema nodosum, 3 (7.1%) had uveitis, 1 (2.3%) had myositis, 1 (2.3%) had neurosarcoidosis, 32 (76.2%) had arthritis and 40 (95.2%) had arthralgia. Of the 32 patients with arthritis, 28 (87.5%) had involvement of the ankle, 3 (9.4%) had involvement of the knee and 1 (3.2%) had involvement of the wrist. No patient had cardiac involvement. Thoracic computed tomography scan showed stage 1, 2, 3 and 4 sarcoidosis in 12 (28.5%), 22 (52.4%), 4 (9.5%) and 4 (9.5%) patients, respectively. Histopathology of sarcoidosis was verified by endobronchial ultrasound, mediastinoscopy and skin and axillary biopsy of lymphadenopathies, which revealed noncaseating granulomas. Laboratory tests showed elevated serum angiotensin-converting enzyme in 15 (35.7%) patients, elevated serum calcium level in 6 (14.2%) patients and elevated serum 1,25-dihydroxyvitamin D concentrations in 2 (4.7%) patients. Serological tests showed antinuclear antibody positivity in 12 (28.5%) patients, rheumatoid factor positivity in 7 (16.6%) patients and anticyclic citrullinated antibody positivity in 2 (4.8%) patients. Conclusion: Sarcoidosis can imitate or accompany many primary rheumatic diseases. Sarcoidosis should be considered not simply as an imitator but as a primary rheumatic pathology mediated by Th1-Ly. New studies are warranted on this subject.

Objective: Both CXCr-4 and COX-2 are biological markers that play a significant role in several neoplastic processes. We explored the differences in expression of these markers in certain subtypes of basal cell carcinoma, and squamous cell carcinomas in general. Material and Method: In this study, we investigated the differences between 38 patients with basal cell carcinoma (nodular, infiltrative and micro-nodular subtypes) and 24 patients with well-differentiated squamous cell carcinomas with respect to their depth of invasion, tumor location, age, and CXCr -4 and COX-2 expression. Results: Statistically, we found no significant difference between squamous cell carcinomas and basal cell carcinoma in terms of CXCr-4 and COX-2 expression; however, the degree of marker expression became stronger with increasing depth of invasion in both tumors. The expression of both markers was also higher in infiltrative type basal cell carcinoma compared to all the other subtypes. The results were statistically significant (p

Bu yazıda 31 yaşındaki bayan hastada fibroadenomun nadir bir formunu su- nuyoruz. Ultrasonda areolaya doğru birleşen multipl, hipoekoik, solid, tubu- ler yapılar saptanmıştır. Histopatolojik tanısı fibroadenomun intraduktal for- mudur. Bildiğimiz kadarıyla literatürde histopatolojik ve radyolojik bulguları içeren kaynak mevcut değildir., In this paper, we present an unusual form of fibroadenoma in a 31-year-old female. Ultrasonography revealed multiple, hypoechoic,solid tubular struc- tures that converged toward the areola. The mass removed totally. Histo- pathological diagnosis was intraductal form of fibroadenoma. To the best of our knowledge, no reference to this histopathologic and radiologic findings has previously been reported in the literature.

To evaluate the efficacy of myo-inositol (MI) pretreatment in OHSS.In this experimental OHSS rat model, 42 immature Wistar albino female rats were divided into 6 groups: (1) the control group, (2) the ovarian stimulation group, (3) the OHSS group, (4) the OHSS + Metformin group, (5) OHSS + MI group, (6) OHSS + Metformin + MI group. OHSS was established after treatment with metformin and myo-inositol for 14 days, in the meanwhile the treatment of metformin and myo-inositol was also continued. All animals were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight and diameter, ovarian VEGF, COX-2 and PEDF expression (immunohistochemistry), serum PEDF and estradiol (E2) levels.Vascular permeability, VEGF and COX-2 expressions were reduced in animals treated with MI and/or metformin. While PEDF expression was increased in the groups taking metformin, there was no difference in PEDF expression in the group taking MI and OHSS group. There was no significant difference in serum PEDF levels between groups. Blood E2 levels were decreased in groups treated with MI or metformin compared to the OHSS group.Our data demonstrate that myo-inositol is effective in preventing OHSS, similar to metformin. Although the two drugs are thought to act through distinct mechanisms, there is no apparent benefit to co-treatment with both drugs in an animal model of OHSS. Administration of myo-inositol prior to IVF treatment may favor the control of ovulation induction. Further studies are necessary to elucidate the mechanism of action and further support our findings.

within the normal limits. Based on genetic examination, the karyotype was normal (46,XY), and no microdeletion was observed on the Y chromosome. The patient, who had a presumed diagnosis of a testicular tumour, underwent radical orchiectomy. Tissues from healthy parts of the testicle were sent to the andrology laboratory, and the observed spermatozoa underwent cryopreservation. Histopathological examinationrevealeda nodular, grey-white lesionof8 mm indiameter that was limited to the testicle and consistent with a classical Sertoli cell tumour without mitosis. Inhibin, vimentin and cytokeratin staining were positive in an immunohistochemical examination. No pregnancy was achieved with intracytoplasmic sperm injection applications using cryotesticular sperm extraction (TESE) in 2006 and 2007. In 2010, a twin pregnancy and twin live birth were achieved with intracytoplasmic sperm injection application using fresh TESE. The patient was tumour free in the 5-year follow-up period. Sertoli cell tumours, in the category of sex cord stromal tumours, account for only 1% of all testicular tumours. In total, 170 cases have beenreportedintheliterature. 4 Thefirstsignisusuallyapainlessmass, and the serum levels of alpha-fetoprotein, b-human chorionic gonadotropin and lactate dehydrogenase are within the normal limits. As for all testicular tumours, the risk of developing a Sertoli cell tumour increases in patients with undescended testicles and those who have beenoperatedonforthiscondition. 5 Sertolicelltumoursareobserved as nodular masses that are easily distinguished from testicular tissue during ultrasound examination. Although organ-sparing treatment is recommended in the form of partial orchiectomy, a significant proportion of these patients undergo radical orchiectomy. Immunohistochemical investigations facilitate the approach to the diagnosis. Malignant transformation occurs in approximately 10% of Sertoli cell tumours. Less than 50 cases have been reported in the literature. The malignancy criteria are as follows: a size of more than 5 cm, pleomorphicnucleiwithnucleoli, threeormoremitosesper10magnification fields and vascular spread. 1 Metastasis has been defined in malignant cases. Only 7% of all cases demonstrate metastasis during follow-up. Metastatic disease does not respond well to radio-chemotherapy, and survival is poor. 6 Sertoli cell tumours may be associated with androgenic deficiency, Peutz–Jeghers syndrome and Carney’s syndrome. 6 None of these

Background Sarcoidosis is a chronic systemic inflammatory condition characterized by the presence of noncaseating granulomas. Often the initial presentation of sarcoidosis is rheumatologic, and clinicians should include it in the differential diagnosis of different arthritic, vasculitic, autoimmune, and myopathic syndromes. Objectives The aim of this study was to determine the clinical, demographic and laboratory data of newly diagnosed patients with sarcoidosis. Methods BetweenNovember 2011-December 2012, 33 patients reffered for the first time to our Rheumatology outpatient clinic with different rheumatic complaints and as result of the investigations were diagnosed with sarcoidosis were included in the study. Within the 13 months follow-up and treatment period, clinical, demographic, laboratory, radiological and histological data were collected and analyzed. Results 33 patients(7men) were included in the study. Mean age was 46.6 year(20-70year), mean disease duration was 4.3 year(1-25year). The first presenting symptoms of the patients were evaluated; 32 patients had arthralgia, 13 patients had arthritis, 8 patients had erythema nodosum(EN), one patient had muscle weakness, 4 patients had cough, 5 patients had exertional dyspnea, one patient had Raynaud’s phenomenon. Systemic organ involvement were evaluated; EN was seen in 15(45.4%), uveitis was seen in 3 (9.09%), myositis was seen in 1(3.03%), neurosarcoidosis was seen in 1(3.03%), arthritis was seen in 26(78.7%) patients. Among 26 patients with arthritis, 22(84.6%) had ankle involvement, 3 (11.5%) had knee involvement, and one patient had involvement of the wrist. There were no patients with cardiac involvement. CT scan of thorax were performed: 11 patients (33.3%) had stage 1, 18 (54.5%) had stage 2, and two (6.06%) had stade 3, and two patients (6.06%) had stage 4 sarcoidosis. Histopathological verification of sarcoidosis with typical non-caseating granulomas were done using endobronchial ultrasound (EBUS) and mediastinoscopic lymph nodes byopsi, as well as skin and axillary lymph node byopsi. Laboratory examinations were performed; increased serum ACE level was seen in 9 (27.3%) patients, increased serum Ca was seen in 3 (9.09%) patient, increased serum D3 was seen in one (3.03%) patient. On serological investigations; nine (27.3%) patients had ANA positivity, 5 (15.1%) patients had RF positivity. Three patients with sarcoidosis overlapping with another rheumatic pathology (Sjogren’s syndrome, scleroderma, ankylosing spondylitis). Conclusions In this study, we have shared clinical and demographic data of 33 newly diagnosed patients with sarcoidosis who were referred with different musculoskeletal complaints. Sarcoidosis can mimic and/or may associated with many primary rheumatic diseases. Recognizing the different rheumatological manifestations of sarcoidosis can lead clinicians to diagnose this condition and start the appropriate therapy. In this regard, further studies are needed. Disclosure of Interest None Declared

Purpose To evaluate the efficacy of myo-inositol (MI) pretreatment in OHSS. Methods In this experimental OHSS rat model, 42 immature Wistar albino female rats were divided into 6 groups: (1) the control group, (2) the ovarian stimulation group, (3) the OHSS group, (4) the OHSS + Metformin group, (5) OHSS + MI group, (6) OHSS + Metformin + MI group. OHSS was established after treatment with metformin and myo-inositol for 14 days, in the meanwhile the treatment of metformin and myo-inositol was also continued. All animals were killed 48 h after hCG administration and were compared in terms of vascular permeability, ovarian weight and diameter, ovarian VEGF, COX-2 and PEDF expression (immunohistochemistry), serum PEDF and estradiol (E2) levels. Results Vascular permeability, VEGF and COX-2 expressions were reduced in animals treated with MI and/or metformin. While PEDF expression was increased in the groups taking metformin, there was no difference in PEDF expression in the group taking MI and OHSS group. There was no significant difference in serum PEDF levels between groups. Blood E2 levels were decreased in groups treated with MI or metformin compared to the OHSS group. Conclusions Our data demonstrate that myo-inositol is effective in preventing OHSS, similar to metformin. Although the two drugs are thought to act through distinct mechanisms, there is no apparent benefit to co-treatment with both drugs in an animal model of OHSS. Administration of myo-inositol prior to IVF treatment may favor the control of ovulation induction. Further studies are necessary to elucidate the mechanism of action and further support our findings.