Turkish Journal of Pathology - 2013; 29(2)

Ba�yaz�

Alp USUB�T�N — 2013-05-01

Editorial

Alp USUB�T�N — 2013-05-01

Relationship Between β -Catenin Expression and Prognostic Parameters of Colorectal Carcinomas

Kemal PEKER, Mahmut BA�O�LU, Nesrin G�RSAN — 2013-05-01

Objective: Colorectal carcinomas are the most frequent tumors of the gastrointestinal tract. β-catenin, which is related to cadherins, is a cytoplasmic protein responsible for intercellular adhesion. It is also an important component in the Wnt signal pathway. Recent studies have shown structural alterations in the APC gene and axin in patients with colorectal carcinoma, along with β-catenin. We aimed to compare β-catenin expression, which is a prognostic factor itself, with other prognostic parameters. Material and Method: A total of 70 patients who had surgical intervention for colorectal malignancies between January 1994 and December 2003 were included in the study. Fift y-nine of the patients (84.3%) were male, 11 of the patients (15.7%) were female; their ages varied between 24 and 82 (mean 60.3 �15.2) years. Paraff in blocks were immunohistochemically stained for β-catenin. The number of stained cell nuclei was assessed according to the stage of disease using the TNM classification, histological grade, lymphatic invasion, vascular invasion and tumor's local invasion. Results: When groups constituted according to tumor histologic grade were compared for prognostic parameters in terms of stain density for β-catenin and number of stained cell nuclei, stain density was mild (+) and the number of stained nuclei was smaller in well-diff erentiated groups while stain density was strong (+++) and the number of stained nuclei was higher in poorly diff erentiated groups. There was a relation between β-catenin expression and diff erentiation grade, lymph node metastasis, stage and tumor size but not with vascular invasion. Conclusion: These data indicate that β- catenin, with functions in cell homeostasis and relations with the APC gene, has a substantial role in colorectal carcinogenesis.

Value of Glut-1 and Koc Markers in the Differential Diagnosis of Reactive Mesothelial Hyperplasia, Malignant Mesothelioma and Pulmonary Adenocarcinoma

�zlem ��ER, Adile Ferda DA�LI, Ahmet KILI�ARSLAN, G�khan ARTA� — 2013-05-01

Objective: Malignant mesothelioma (MM) is a primary malignant tumor developing from mesothelial cells lining the serosal surfaces and particularly the pleura, and has a very poor prognosis. It may display a variety of histological patterns and has a wide spectrum of cytomorphological characteristics, causing problems in its diff erential diagnosis from lung adenocarcinomas and sometimes from benign mesothelial proliferations. Immunohistochemical examination is the most useful method for this distinction. In our study, we aimed to determine the value of glucose transporter isoform-1 (GLUT-1) and K homology domain-containing protein (KOC) markers in the diff erential diagnosis of reactive mesothelial hyperplasia, malignant mesothelioma and lung adenocarcinoma. Material and Method: Our study included 30 samples of malignant mesothelioma, 30 samples of pulmonary adenocarcinoma and 30 samples of reactive mesothelial hyperplasia selected from the archives of the F�rat University Hospital's Pathology Department Laboratory. The samples were applied GLUT-1 and KOC markers by immunohistochemistry and the place of these markers in the diff erential diagnosis was examined. Results: GLUT-1 was found positive in 80% of malignant mesothelioma cases, 83.3% of adenocarcinoma cases and 6.6% of reactive mesothelial hyperplasia cases. KOC was positive in 83.3% of malignant mesothelioma cases, 76.6% of adenocarcinoma cases and 46.6% of reactive mesothelial hyperplasia cases. There was no statistically significant diff erence between malignant mesothelioma and lung adenocarcinoma cases in terms of the diffuseness and intensity of staining with GLUT-1, whereas a significant diff erence was established when these groups were compared with reactive mesothelial hyperplasia cases. However, the KOC staining diffuseness and intensity results were similar to those obtained with GLUT-1. Conclusion: In conclusion, GLUT-1 and KOC markers do not diff erentiate malignant mesotheliomas from pulmonary adenocarcinomas but can be useful in diff erentiating reactive mesothelial hyperplasia from malignant mesothelioma and lung adenocarcinoma.

Cyclin D1 Expression in Odontogenic Cysts

Nasim TAGHAVI, Shirin MODABBERNIA, Alireza AKBARZADEH, Samad SAJJADI — 2013-05-01

Objective: In the present study expression of cyclin D1 in the epithelial lining of odontogenic keratocyst, radicular cyst, dentigerous cyst and glandular odontogenic cyst was investigated to compare proliferative activity in these lesions. Material and Method: Immunohistochemical staining of cyclin D1 on formalin-fixed, paraffin-embedded tissue sections of odontogenic keratocysts (n=23), dentigerous cysts (n=20), radicular cysts (n=20) and glandular odontogenic cysts (n=5) was performed by standard EnVision method. Then, slides were studied to evaluate the following parameters in epithelial lining of cysts: expression, expression pattern, staining intensity and localization of expression. Results: The data analysis showed statistically significant diff erence in cyclin D1 expression in studied groups (p<0.001). Assessment of staining intensity and staining pattern showed more strong intensity and focally pattern in odontogenic keratocysts, but diff erence was not statistically significant among groups respectively (p=0.204, 0.469). Considering expression localization, cyclin D1 positive cells in odontogenic keratocysts and dentigerous cysts were frequently confined in parabasal layer, diff erent from radicular cysts and glandular odontogenic cysts. The difference was statistically significant (p<0.01). Conclusion: Findings showed higher expression of cyclin D1 in parabasal layer of odontogenic keratocyst and the entire cystic epithelium of glandular odontogenic cysts comparing to dentigerous cysts and radicular cysts, implying the possible role of G1-S cell cycle phase disturbances in the aggressiveness of odontogenic keratocyst and glandular odontogenic cyst.

Follicular Mucinosis and Follicular Mycosis Fungoides: Clinicopathological Evaluation of Seven Cases

2013-05-01

Objective: Follicular mucinosis is a disease characterized by follicular degeneration and mucin accumulation. It can be seen in mycosis fungoides, although idiopathic or forms associated with other diseases are also known. Follicular mycosis fungoides is a type of mycosis fungoides with diff erent clinicopathological and prognostic features. Material and Method: Seven cases with follicular centered lesions and multiple biopsies (2-6) were included. Cases were evaluated according to their clinical, histological and immunophenotypical features and follow-up data. Results: All cases were male, and the mean age was 40.3 (range 18-61). Clinical complaints were follicular prominence, erythema and alopecia at head and neck, trunk, and lower limbs. Follicular mucinosis (6/7), and dermal lymphoid infiltration showing minimal-intensive folliculotropism accompanied by eosinophils was seen. Lymphoid infiltration was composed of small-medium sized cells, with scattered hyperchromatic nuclei in six cases. In one case there was only minimal cytological atypia. Intense folliculotropism of atypical lymphocytes and dense dermal infiltration without follicular mucinosis was seen in one case. Local and/or systemic treatments were applied and partial remission was achieved histologically. In three cases new and increasing lesions were seen. Density of infiltration and atypia were increased. Conclusion: The findings supported the opinion that follicular mucinosis is an important finding seen in mycosis fungoides. There can be important diff erences concerning the amount of infiltration and degree of atypia. In cases where the density of infiltration associated with follicular mucinosis is not diagnostic for MF, there can be progression over time. Long-term follow up is necessary in such cases where the diff erential diagnosis is diff icult.

Effects of Contraception on Cervical Cytology: Data from Mardin City

I��k �kbal BARI�, Yeliz ARMAN KARAKAYA — 2013-05-01

Objective: Mardin is an area of low socioeconomic level with low rates of contraceptive method use. Our aim in this study was to evaluate the effects of the contraceptive methods used in the area on epithelial cell abnormalities and vaginal flora changes. Material and Method: Cervical smear samples received at the Pathology Department between 2010 and 2012 of 526 patients who had used a contraceptive method and 112 who had never used one were included in the study. The cases were divided into 3 groups as those using hormonal contraception (107, 20.3%), those using an intrauterine device (343, 65.2%) and those using a barrier method (76, 14.4%). The evaluation was made using the Bethesda 2001 criteria for cervical epithelial abnormalities and specific cervicovaginal infections. Results: There was no significant difference between the groups for epithelial cell abnormalities while bacterial vaginitis (12%, p=0.03) and Trichomonas vaginalis (7.6%) were more common in the IUD users. The Actinomyces rate in RIA users was 1.3%. There was only 1 case of bacterial vaginitis in the barrier group and none of the other patients had a specific infection. Discussion: We did not find a significant cytopathic effect of using a IUD or hormonal contraception in our study. There was a low rate of epithelial abnormality in the barrier method group. IUD was seen to increase the incidence of bacterial vaginitis, Trichomonas vaginalis and Actinomyces. We did not find a significant effect of hormone use on the vaginal flora.

Diagnostic Contribution of Postmortem Needle Biopsies in Neonates

�zg� Suna CEL�LO�LU, Can CEL�LO�LU, Erdal KURNAZ, Ramazan �ZDEM�R, Ahmet KARADA� — 2013-05-01

Objective: We examined the contribution of neonatal postmortem needle biopsy in circumstances of autopsy denial where magnetic resonance imaging cannot be performed. Material and Method: 247 postmortem needle biopsy specimens of 76 neonatal cases who died in the neonatal intensive care ward of a tertiary hospital between 2005 and 2010 and where the family did not give permission for an autopsy were retrospectively evaluated. Results: 90 needle biopsy attempts (36.4%) were unsuccessful among the 247 biopsies. Liver needle biopsies were found to yield the most valuable diagnostic contribution. A total of 53 liver biopsies provided clinical information that contributed to the diagnosis. Conclusion: The postmortem needle biopsy should be applied in all cases in which standard biopsy cannot be performed. Success rates and level of information gained by extrahepatic needle organ biopsies in neonates were found to be quite low whereas needle biopsies of the liver yielded valuable results. We believe it is more appropriate to perform percutaneous postmortem biopsies solely on the liver in neonates.

Is There Any Relationship Between the Clinical, Radiological and Histopathologic Findings in Sinonasal Polyposis?

Ercan AKBAY, T�may �ZG�R, Ya�ar �OKKESER — 2013-05-01

Objective: The aim of this study was to assess the relationship between clinical, radiological and histopathological findings in nasal polyposis. Material and Method: This was a retrospective study of 85 patients with nasal polyposis who were treated by endoscopic sinus surgery between the years of 2005 and 2010. All patients underwent preoperative paranasal sinus Computerized Tomography scan in the coronal plane and these images was evaluated with Lund-Mackay scores. The biopsy materials diagnosed as nasal polyp were identified by archive scanning at the pathology department. The Haematoxylin-Eosin stained preparations of the biopsy materials were re-evaluated. All of the results were analyzed by using the SPSS 13.0 soft ware program. Statistical significance was determined as p-value<0.05. Results: When the patients with (16.4%) and without (83.6%) bronchial asthma were compared regarding the eosinophil, lymphocyte, neutrophil, macrophage, mast cells and goblet cells/ epithelial cell rate, no statistical significance was found (p>0.05). There was a positive relationship between the preoperative complaint durations and the total Lund-Mackay scores (r=0.270, p=0.012). The neutrophil amount (16.53�19.87) on the preparations of the patients with metaplasia was higher than the neutrophil amount (8.71�23.98) on the preparations of the patients without metaplasia (p=0.001). Radiologically, there was a positive correlation between the infiltration of anterior-posterior sinuses by the polyp tissues and the Lund-Mackay score of the nasal cavity. Conclusion: There was a positive correlation between preoperative complaint duration and squamous metaplasia; and there was also a positive correlation between the preoperative complaint duration and the total Lund-Mackay score. There was no histopathological difference between the polypoid infiltration of the front and rear group sinuses.

Signet Ring Lobular Carcinoma in Situ as a Part of the “Rosen Triad” (Tubular Carcinoma, Columnar Cell Hyperplasia, and Lobular Carcinoma in Situ)

Josko BEZIC, Dijana GUGIC — 2013-05-01

Objective: The association of tubular carcinoma, columnar cell lesions and lobular carcinoma in situ, also known as the “Rosen Triad”, may be encountered in breast biopsies performed for evaluation of mammographically detected microcalcifications. Case Report: A case in which tubular carcinoma and columnar cell hyperplasia were associated with a histologically unusual form of signet ring lobular carcinoma in situ is presented. Signet ring non-invasive lobular carcinoma is classified as high-grade lobular carcinoma in situ, but herein is associated with changes that belong to the molecular pathway of low-grade mammary neoplasia. Conclusion: We reported the case of lobular carcinoma in situ associated with columnar cell hyperplasia and tubular carcinoma, in which the lobular carcinoma in situ was presented in a histologically unexpected form comprised predominantly of signet ring cells.

Large Cell Neuroendocrine Carcinoma of Urinary Bladder; Case Presentation

Ay�eg�l SARI, Murat ERMETE, Canan SADULLAHO�LU, Kaan BAL, Ahmet BOL�KBA�I — 2013-05-01

Large cell neuroendocrine tumor of the urinary bladder is very rare. It is a type of neuroendocrine carcinoma that is morphologically different from small cell carcinoma. This manuscript describes a 67-year-old man who presented with hematuria. Ultrasonogrophic and computer tomography revealed a 5 cm mass in right posterolateral wall of the bladder that invaded perivesical tissue and he subsequently underwent transurethral resection. Microscopic examination showed a tumor with a sheet-like and trabecular growth pattern comprising necrotic areas which infiltrated the muscularis propria. Tumoral cells had coarse chromatin, prominent nucleoli, moderate amount of cytoplasm and immunohistochemically stained strongly positive with synaptophysin, chromogranin and CD56. There are only few case reports of large cell neuroendocrine tumor of the urinary bladder so the biological behavior and the treatment protocol of these tumors are still obscure. Appropriate management protocols and prognostic estimation could be achived by the increased number of cases being reported. Therefore in a case of a poorly differentiated tumor in bladder, although rare, it is important to consider large cell neuroendocrine carcinoma in differential diagnosis.

Microfilaria in Association with Adrenal Lymphoma Diagnosed on Cytology: An Extremely Rare Case Report

Sushila JAISWAL, Gyan CHAND, Hira LAL, Mukul VIJ, Rakesh PANDEY — 2013-05-01

Filariasis is a common public health problem in Asian countries. In this report, the authors have described detection of microfilaria in the cytological specimen of adrenal lymphoma. To the best of our knowledge, this is the first reported case in the literature where microfilaria was seen in an adrenal gland involved by lymphoma. The literature is briefly reviewed.

Diffuse Lipid �nfiltration and Squamous Metaplasia Accompanying Amyloid Goiter: Case Report

Remziye EREN, Hamide SAYAR, Harun �IRALIK, Fikret EZBERC� — 2013-05-01

Systemic amyloidosis is one of the serious complications of Familial Mediterranean Fever (FMF). Amyloid accumulation secondary to FMF can cause pressure symptoms in thyroid gland rarely. A 17-year-old male patient with the diagnosis of FMF performed the complaints of dyspnea during his follow-up period. He has demonstrated a rapidly increasing mass localized in front of his neck within the last three months that was diagnosed as a diff use, hyperplasic and pressuring thyroid gland. Total thyroidectomy was performed. Histopathological investigation of the material obtained aft er thyroidectomy revealed diff use lipid infiltration in parenchyma, intense amyloid accumulation around and between the follicles that caused pressure on the follicles, and cystic areas in the tissue. Squamous metaplasia foci in cyst epithelium were detected. Upon these findings the case was diagnosed as amyloid goiter accompanied by metaplastic variations. In conclusion, it can be appropriate to take into account the possibility that metaplastic variations could accompany amyloid goiter in patients with long-term FMF.

Warthin-Like Papillary Carcinoma of the Thyroid: A Case Series and Review of the Literature

2013-05-01

Warthin-like tumor of the thyroid is a recently described rare variant of thyroid papillary carcinoma. The distinguishing histological feature of this variant is papillary foldings lined by oncocytic neoplastic cells with clear nuclei and nuclear pseudoinclusions, accompanied by prominent lymphocytic infiltrate in the papillary stalks. Its prognosis has been reported to be almost similar to conventional papillary carcinoma. In this case series, we report four cases with Warthin-like papillary carcinoma of the thyroid, diagnosed at Dokuz Eylul University Faculty of Medicine Department of Pathology in 2008 and 2009. Three patients were female. The mean patient age was 39 years (range, 20-56) and the mean tumor size was 1.7 cm (range, 0.9-2.0 cm). All of the cases had lymphocytic thyroiditis in the background. None of the tumors showed lymphovascular invasion. The patients are free of any recurrence and/or distant metastasis with a mean follow-up of 25 months. This rare variant of thyroid papillary carcinoma with distinct histopathological features should be indicated in pathology reports. Further studies and long-term follow-up of patients are needed to highlight the biological behavior of this variant.

Eccrine Porocarcinoma of the Scalp

S�meyye EKMEKC�, Banu LEBE — 2013-05-01

Objective: Eccrine porocarcinoma is a rare malignant tumor of eccrine sweat glands. It may arise de novo, but it usually develops in pre-existing eccrine poroma. Here we report a case of eccrine porocarcinoma in the grafted area on the scalp of a male patient who had recurrent basal cell carcinoma of the scalp, with clinical, histopathological and, immunohistochemical features. Case: We report a case of eccrine porocarcinoma in 78-year-old male patient who had recurrent basal cell carcinoma of the scalp. The tumor was polypoid, granular and heterogenous colored. Microscopic examination revealed a tumor composed of basaloid-poroid neoplastic cells in the dermis which showed solid and cystic areas. Focal clear cell change, and atypical and frequent mitoses were also observed. Neoplastic cells were diffusely positive with pankeratin. There was focal positivity with EMA and CEA. Conclusion: Eccrine porocarcinoma is a rare tumor. There are no large series that evaluate the diagnosis, monitoring and treatment of these tumors. In addition, this entity has to be kept in mind in the differential diagnosis of epidermal and skin appendix tumors.

Atypical Teratoid Rhabdoid Tumor: Case Report

2013-05-01

Atypical teratoid rhabdoid tumor is a rare highly malignant embryonal tumor of the central nervous system that is often seen in early childhood. It is very important to distinguish it from other brain tumors because it has a very poor prognosis and there are differences in its treatment. A case of atypical teratoid rhabdoid tumor in a six-week-old male baby is presented. The tumor was located at posterior fossa. Histopathologically, the tumor has rhabdoid tumor cells and mesenchymal components beside the undifferentiated small cells. While EMA, vimentin, synaptophysin and smooth muscle actin have been stained with immunohistochemical staining, desmin, chromogranin, CD 99 and CD 56 have not been stained. The patient died four months after surgery despite the chemotherapy given. In conclusion, morphological characteristics can vary to a large extent that it is difficult to recognize atypical teratoid rhabdoid tumor. Immunohistochemical panel and molecular genetic study will help to establish the correct diagnosis.