Turkish Journal of Pathology - 2007; 23(3)

Mast cells and angiogenesis in primary and recurrent pterygia

Fatma H�sniye D�LEK, Faruk �ZT�RK, Fatma AKTEPE, Samet ERM��, Fatih Mehmet MUTLU — 2007-09-01

Pterygium is a common benign lesion of limbus but the pathogenesis are not completely understood. Pterygia have a chronic inflammatory cellular infiltrate and a rich vasculature. Mast cells are a heterogeneous group of multifunctional tissue-resident cells. It has been suggested that mast cells and their products may be responsible for the formation of new blood vessels. We investigated the number and phenotype of mast cells and neovascularization in pterygia specimens and compared with those in normal conjunctival specimens Pterygia tissues were obtained during excisional surgery from 32 eyes of 32 consecutive patients. Seventeen of all cases were recurrent pterygia. Superior bulbar conjunctival tissue from the same eye was also sampled as control tissues. The tissue sections were stained with routine hematoxyline-eosin and toluidine blue stain for mast cells. For immunohistochemical studies anti-factor VIII-related antigen, monoclonal anti human mast cell tryptase and chymase were used as an endothelial and mast cell marker. The mean number of mast cells in pterygia was significantly higher than that in the normal conjunctival tissue and microvessel counts was significantly higher than the counts of the controls in both primary and recurrent pterygia. There was no correlation between microvessel numbers and mast cell numbers. There was no phenotypic difference between the mast cells in the ptergyia and those in the normal conjunctival tissues. This study confirms that mast cells are prominent in pterygia and our results suggest that mast cells and angiogenesis are independent factors in the genesis and progress of ptergyium.

The correlation of the histopathological findings by increasing the sample size in cholecystectomies

Filiz BOLAT, Fazilet KAYASEL�UK, Tar�k Zafer NURSAL, Nebil BAL, �lhan TUNCER — 2007-09-01

The chronic cholecystitis and cholelithiasis are the most common pathologies seen in gallbladder disease, accompanying hyperplastic and dysplastic lesions. Generally three samples are taken from the cholecystectomized materials in routine pathology laboratories. We investigate whether there would be an increase in the frequency of hyperplasia, metaplasia and dysplasia diagnosis by increasing, the sample size. We also looked into the relation between intestinal metaplasia and dysplasia. In this study 75 cholecystectomized materials were examined and checked for the premalignant epithelial changes. Seventy five cholecystectomized patients with history of chronic cholecystitis and cholelithiasis were put into three groups of equal size-25 each. A single sample when taken from each neck-corpus and fundus of the gallbladder in the first group, two samples were taken from each site in the second group. In the last group the gallbladder was mapped and examined as a whole. Hematoxylineosin (HE), neutral mucin (to signify mucin profile histochemically), PAS-Alcian blue (pH 2.5) and High-Iron- Diamine (HID) (pH 2.5) were used in all biopsy samples. In all samples we looked into the existence and type of pseudopyloric gland metaplasia, intestinal metaplasia, dysplasia, hyperplasia and inflammation. By increasing the sample size in gallbladder we saw an increase in the rate of metaplasia (p<0.001), dysplasia (p<0.001), epithelial hyperplasia (p=0.003), and inflammation (p=0.003) statistically. As the inflammation increases the incidence of metaplasia (p<0.001) and epithelial hyperplasia (p=0.002) were also increasing. There was no significance association between metaplasia and dysplasia. Given these findings, increasing the sample size in cholecystectomy materials- being the most common specimens in daily pathology routines will increase the diagnosis rates of metaplasia, dysplasia and early carcinoma significantly.

Secondary ovarian tumors: Evaluation of 44 cases

Sevgiye KA�AR �ZKARA, Deniz F�L�NTE — 2007-09-01

Secondary ovarian tumors compose 3-8% of all, and 10-30% of malignant ovarian tumors. Histopathological features of SOT diagnosed in our department in 10-year period are discussed. Macroscopical, microscopical, immunohistochemical and cytopathological features of secondary ovarian tumors diagnosed between 1997- 2006 were re-evaluated. Additional histochemical and immunohistochemical studies were applied to find the primaries. Data was statistically evaluated. Totally, 44 secondary ovarian tumors had been diagnosed within this period. The mean age of the patients was 52.9 years; the mean tumor diameter was 103.7 mm. The primary was gastrointestinal system in 50% of the cases. Ten of them (22.7%) were metastases of signet ring cell carcinoma of stomach (Kruckenberg tumor) while 9 cases (20.5%) were from colorectal and three (6.8%) were from appendiceal adenocarcinomas. 27.3% of our cases were originated from genital tract. Synchronous endometrioid adenocarcinomas of corpus uteri and ovary were seen in six cases (13.6%). Ovarian involvement of serous carcinomas of corpus uteri was seen in five (11.4%) cases. Ovarian metastases of breast carcinoma in four cases (9.1%) were seen while the ovarian involvement of adrenal cortical and tubal carcinomas was observed in one case, each. The primary was peritoneal surface in five (11.4%) of the cases. Tumors were bilateral in 65.9% of the cases, and there was statistically significant correlation between the bilaterality rate of the tumors and the primary (p=0.015). The more precise diagnosis of secondary ovarian tumors could be reached by evaluation of clinical, surgical, macroscopical, microscopical, cytopathological and immunohistochemical findings together.

Ovarian tumors in childhood and adolescence: Histopathological evaluation of 44 cases

Sevgiye KA�AR �ZKARA, Deniz F�L�NTE — 2007-09-01

Ovarian tumors of childhood and adolescence constitute the most frequent and special group of gynaecologic tumors due to clinical and histopathological peculiarities and age specific therapeutic implications related to physically, hormonally and immunologically immature host. Pathologic features of ovarian tumors of children and adolescents diagnosed in our department in ten-year period, constitute the perspective of this report. Macroscopical, microscopical, immunohistochemical, and cytopathological features of ovarian tumors under 21-years-of age, and diagnosed in 1997-2006 are re-evaluated. Fourty-two cases (9.7%) belong to the young patients among 391 primary ovarian tumors diagnosed in tenyears. Germ-cell tumors were the most frequent (54.8%) while epithelial tumors were 38.1% and sexcord- stromal tumors was 7.1%. Malignancy rate was 28.6% among all subtypes while epithelial malignancy were 4.8%. Malignancy under 16 years was 31.3% while it was 26.9% in adolescence. Epithelial tumors in childhood was 18.8% while it was 50% over 16 years; the difference was significant (p=0.043). In our series, 60.9% of germ cell tumors were mature cystic teratomas. Malignancy rate within this group was 39.1%. There were four pure dysgerminomas, three mixed germ cell tumors and two immature teratomas within the malignant germ cell tumors. The mean tumor diameter was 92.1 mm. in benign tumors while it was 172.9 mm. in malignant tumors, and the difference was significant (p=0.001). Most of the solid tumors were malignant (p=0.002). As the malignancy potential among the young was considerably high, a detailed clinical and pathological evaluation is mandatory for abdominopelvic masses.

Primary renal myxoma: A case report

Filiz BOLAT, Tahsin TURUN�, Fazilet KAYASEL�UK, �erife ULUSAN, Nebil BAL — 2007-09-01

Myxomas are uncommon soft-tissue neoplasms, which are extremely rare in the kidney with ten cases reported in the literature. A 27-year-old woman was admitted to our hospital with epigastric pain and pelvic mass. Magnetic resonance imaging (MRI) of the abdomen showed a well defined 15x14x7 cm tumoral mass in the left kidney. The patient underwent a left-sided nephrectomy. On microscopic examination, the tumor consisted of large amounts of myxoid material containing a few uniformly scattered spindle cells. Immunohistochemically, tumor cells stained positive for vimentin, but not for S-100 protein, epithelial membrane antigen, pancytokeratin and smooth- muscle actin. With these histopathological and immunohistochemical findings, the case was diagnosed as ‘renal myxoma’. In this report, the clinical and histopathological findings, differential diagnosis and possible histogenesis of a case of myxoma that was originated from the left kidney of a 27 year-old female patient is presented.

Mucinous cystadenoma in an ovarian remnant

P�nar UYAR G��N — 2007-09-01

The ovarian remnant syndrome, a complication of bilateral salpingo-oophorectomy, has progressively received more attention in gynecological surgery literature, in recent years. The syndrome is manifested by pelvic pain, and a palpable or sonographic pelvic mass. In rare cases, patients may present with large masses. Cystic masses or carcinomas are reported to develop in some of the ovarian remnant syndromes after surgery. We hereby present a 69-year-old white female, complaining of abdominal pain, an enlarging abdominal mass, pollakuria, and urinary incontinence with duration of 1 year, 25 years after bilateral salpingo-oopherectomy. Clinical and radiological evidence of a mesenteric cyst was discovered. The final pathological diagnosis was mucinous cystadenoma in an ovarian remnant. Curiously, this patient had no history of endometriosis, previous pelvic or abdominal surgery excl. hysterectomy, pelvic inflammatory disease, inflammatory bowel disease, dense pelvic adhesions, or difficulty encountered during the previous hysterectomy. This tumor is the largest among all other ovarian remnants published in the international literature. Women with complaints of abdominal or pelvic mass and /or pain with a history of total abdominal hysterectomy- bilateral salpingo-oophorectomy must be searched carefully and it must be kept in mind that ovarian remnant syndrome can develop without predisposing potential risk factors.

Pseudomelanoma developing after shave excision of melanocytic nevus: Case report and review of literature

Beyhan DEM�RHAN, A. T�lin G�LE�, Banu B�LEZ�K��, B�lent CELASUN — 2007-09-01

Pseudomelanoma is a pigmented lesion of the skin which follows incomplete excision of a benign nevus and imitates a superficial spreading malignant melanoma both histopathologically and dermatoscopically. Recognition of the features of pseudomelanoma can help preventing unnecessary treatment. Here we report a case of pseudomelanoma occuring two months after a shave excision on the abdomen of a 22 year-old-woman. The original material had not been examined histopathologically. The recurrent lesion had a high score for malignancy under dermatoscopical examination. Some of the histopathological findings resembled in part to malignant melanoma. The patient's history of previous incomplete excision, the presence of remnants of mature melanocytic nevus cell nests and the lack of epidermal invasion were among the helpful findings which helped us diagnose the lesion as pseudomelanoma. In this article, the differential diagnosis of pseudomelanoma from malignant melanoma has been discussed and the importance of recognition of entity is stressed.

Bizarre atypia of the cervical epithelium due to chemotherapy with busulfan and cyclophosphamide

�zg�r EK�NC�, I��lay Bilge YILMAZ, �m�r ATAO�LU — 2007-09-01

We present a 20 year-old female patient with highly atypical epithelial changes in the uterine cervix discovered on cervical smear and biopsy specimens. She had recently been diagnosed with acute lymphoblastic lymphoma and received alkylating agent chemotherapy. We thought that the epithelial atypia was related to chemotherapy in the light of the reports in the literature which are discussed in the present text along with a brief review of related histopathological and cytological criteria.

Prostatic melanosis

Kemal DEN�Z, Olgun KONTA�, Hac� Ali KAHYA — 2007-09-01

Prostatic melanosis is a rare lesion that is characterized by melanin-containing spindle cells mainly located in the stroma of the prostate gland. This lesion is certainly benign and not a precursor of malignant melanoma. However, differential diagnosis of melanosis with primary and metastatic malignant melanoma is extremely important because of the different biological nature and clinical behavior of these two entities. Recognition of the spectrum of pigmented lesions in the prostate gland is essential to take into consideration of the diagnosis of melanocytic lesions. In this paper, a case of melanosis of the prostate in a 65- years old man is described and differential diagnosis of the melanocytic lesions is discussed.

Uncommon soft tissue tumors with controversial histogenesis

Misten DEM�RYONT — 2007-09-01

In this report, five uncommon soft tissue tumors with controversial histogenesis were reviewed. These were the low grade fibromyxoid sarcoma, acral myxoinflammatory fibroblastic sarcoma, pleomorphic hyalinizing angiectatic tumor, ossifying tumor of soft tissue and angiomatoid fibrous histiocytoma. These uncommon tumors often had been diagnosed incorrect, so their therapy delayed. All these tumors had an indistinct biological potential and unknown histogenesis