Turkish Journal of Pathology最新文献

Objective: ALK-related superficial soft tissue tumors represent an emerging category of neoplasms in daily pathology practice. We report the case of a 49-year-old Caucasian woman with an ALK-related neoplasm who presented with a 1,5 cm nodule on her left thigh.

Case report: The lesion was excised and histopathologically evaluated. Microscopic examination revealed a well-circumscribed nodule composed of epithelioid and oval-to-spindle cells. Although some morphological features were shared with epithelioid fibrous histiocytoma (EFH), there were no epidermal collarettes. In addition, significant storiform architecture and also foamy histocyte groups were detected in the lesions. ALK positivity was observed in both the immunohistochemical and FISH studies. Superficial ALK-rearranged Myxoid Spindle Cell Neoplasms (SAMS) were first considered in the differential diagnosis due to their prominent storiform structures. The lesion shared both EFH and SAMS morphology. Finally, we reported the case as `EFH with SAMS-like features`. The patient showed no evidence of recurrence during a 10-month follow-up.

Conclusion: This case presents the diagnostic challenges in ALK-positive neoplasms. Superficial soft tissue tumors associated with ALK include a heterogeneous group of lesions that may share similar morphological features. We believe that a generic term, ALK-Rearranged Superficial Mesenchymal Neoplasms (ARSMN), may serve as a more inclusive diagnostic label for these entities in routine pathology practice.

A 28-year-old female patient presenting with complaints of shortness of breath was diagnosed with diffuse pulmonary lymphangiomatosis based on radiological examinations and pathological analyses. This rare disease is characterized by the abnormal proliferation and dilation of lymphatic vessels. Although it is typically observed at younger ages in the literature, it can also be rarely diagnosed in adults. Our case emphasizes the importance of differential diagnosis for diffuse pulmonary lymphangiomatosis. The clinical, radiological, and pathological findings of the disease are discussed in detail.

Objective: Anemia is a common complication in kidney transplant patients, often attributed to viral infections. Our objective was to describe a rare case of severe anemia secondary to Parvovirus B19 infection in a kidney transplant recipient, highlighting diagnostic and therapeutic challenges in the immunosuppressed setting.

Case report: We present a 43-year-old woman with end-stage renal disease secondary to polycystic kidney disease who received a living-kidney transplant from her husband. Seven months after transplantation, she presented with severe anemia, fatigue, and palpitations. Laboratory findings demonstrated severe normocytic, normochromic anemia (Hb: 5.8 g/dL). Parvovirus B19 serology tests were negative twice, while PCR testing revealed a significant viral load (25×10⁶ copies/mL). Bone marrow biopsy findings included giant proerythroblasts with characteristic viral nuclear inclusions. The patient received intravenous immunoglobulin (IVIG, 100 mg/kg/day for 4 days), and mycophenolate mofetil was discontinued. After therapy, hemoglobin levels and viral load improved significantly, leading to successful resolution of anemia.

Conclusion: This case emphasizes the importance of considering Parvovirus B19 in the differential diagnosis of anemia in transplant patients. In immunosuppressed individuals, PCR and bone marrow analysis can be essential for diagnosis, especially when serologic tests are inconclusive. Timely intervention can lead to favorable outcomes.

Echinococcus granulosus, also known as the 10.5146/tjpath.2024.13488dog tapeworm, causes echinococcosis or hydatid disease in humans. It is an anthropozoonotic and non-endemic disease. Hydatid cysts are most commonly found in the liver and lungs, but can occur in any other organ, including the brain, kidneys, bones, and peritoneal cavity. Isolated renal hydatidosis is an extremely rare condition, accounting for only 2-4% of all cases of hydatidosis, with its occurrence in children being even rarer. We are reporting a rare case of isolated renal hydatidosis in a 12-year-old boy.

Bone marrow necrosis, albeit an infrequent finding, is usually associated with highly proliferative malignant disorders, such as leukemia, lymphoma, or sickle cell anemia, solid tumor metastasis, and infections. It is also a typical finding in Caisson disease and in divers that developed decompression illness. Herein we report a case of bone marrow necrosis post deep diving in a bone marrow transplant recipient.

Objective: One of the most difficult areas in a surgical pathology practice is intraoperative consultation. In a previous study, we proposed an algorithm that provides a systematic approach to intraoperative consultation for central nervous system tumors. Our aim was to demonstrate the effectiveness of this algorithm.

Material and methods: 102 cases were selected from intraoperative consultation procedures performed at our institution between 2012 and 2020. The algorithm was tested by five observers. The observers examined the smears and frozen sections without the algorithm, and then with the algorithm.

Results: The percentage change in the rate of correct diagnoses made by the four observers (O) increased after using the algorithm (O2: 8%, O3: 5%, O4: 8% and O5: 13%), but decreased for only one observer (O1) (5%). The most common error made by the four observers was `grading of glial tumors` (O1: 40%; O2: 23%; O4: 40% and O5: 27.5%), and this group of errors was mostly corrected by using the algorithm (O1: 33%; O2: 3.8%; O4: 23% and O5: 10%). For two observers (O2 and O5), a statistically significant change in diagnostic levels was observed after using the algorithm (p=0.024 and p=0.040; respectively). In addition, thanks to the use of the algorithm, a high degree of agreement was found between the observers` diagnoses (77.7%, p < 0.001).

Conclusion: In the intraoperative consultation of central nervous system lesions, algorithms can help to increase the accuracy of the diagnosis and reduce interobserver variability. This study demonstrates that an algorithmic approach is an effective method for pathologists in intraoperative consultation procedures.

Objective: To study and correlate the clinicopathological findings of Solitary Rectal Ulcer Syndrome (SRUS) in 10 pediatric patients.

Material and methods: This study is a retrospective study of patients from January 2017 to June 2024. The clinical records were reviewed for details of the clinical presentation, colonoscopic findings, associated local and systemic diseases, and other investigations.

Results: The mean age of presentation was 10±1 years, and the youngest child was 6 years old. The most common clinical presentation was rectal bleeding and a single ulcer on endoscopy. Histological findings included crypt distortion, crypt branching, and fibromuscular obliteration of the lamina propria. Immunohistochemistry (IHC) for Smooth Muscle Actin (SMA) and special staining with Masson Trichrome (MT) were used to highlight fibromuscular areas whenever in doubt.

Conclusion: The pathogenesis of SRUS is not well understood. It may be associated with chronic mucosal and hypoperfusion-induced ischemic injury to the rectal mucosa due to trauma or increased rectal pressure during straining. Solitary rectal ulcer is a misnomer, as the patient may present with multiple or no ulcers. Endoscopy and histopathology help to diagnose SRUS. Timely and correct diagnosis reduces the morbidity associated with this entity.

Objective: The past ten years have seen an increase in gabapentin (GBP) overuse and abuse in Egypt after pregabalin scheduling. Numerous studies have demonstrated the detrimental effects of pregabalin; nonetheless, GBP`s effects are minimal. The objective of this investigation is to study GBP-induced neurotoxicity in rats and the protective benefits of alpha-tocopherol (vitamin E `Vit E`).

Material and methods: Forty (40) adult male albino rats were randomly split into four groups: (10 rats each): Group I, which was subdivided into group Ia (5 rats), received a regular diet as a negative control; group Ib (5 rats) received corn oil as a positive control; group II received alpha-tocopherol; group III (GBP misuse); and group IV received GBP + alpha-tocopherol. The corresponding medicines were administered to every rat for fifty days. Neurobehavioral tests were performed on the day of scarification. Hippocampal tissues were collected for immunohistochemical and histological analysis.

Results: Weight gain rose considerably by the end of the research in the drug-treated groups. In neurobehavioral tests, controls performed better and had higher locomotor indices. The group that misused GBP showed more deteriorated cells and more negative effects on hippocampal tissues. These histological alterations dramatically decreased with alpha-tocopherol therapy.

Conclusion: GBP in high doses had neurotoxic effects, disrupted hippocampal tissues, and increased the number of degenerated cells. Alpha-tocopherol treatment significantly attenuated the deleterious effects induced by GBP.

Objective: To highlight two cases mixed neuroendocrine non-neuroendocrine tumors (MINEN) of the liver and to review the literature till date. To present two cases of MINEN of the liver diagnosed in our centre with clinical & diagnostic workup, the treatment modalities, and follow up. Extensive review of the literature and compilation of the presentation and treatment modalities used in those cases.

Case reports: Thirty-three cases of MINEN of the liver have been reported till date including ours. Our cases presented as incidental masses in liver during workup for other symptoms. AFP levels were normal in both cases but PIVKA (Protein induced by vitamin K absence) levels were increased. Resection was done in one of the cases while the other patient had to undergo transplantation. A diagnosis of MINEN was made on H&E, and confirmed on IHC. One patient was unfit for systemic chemotherapy whereas the other patient received cisplastin and etoposide based chemotherapy. Both patients developed metastasis on follow up but are still alive after 12-15 months.

Conclusion: MINEN is an uncommon tumor of the liver with a poor prognosis as shown by the few studies available. Recurrence and distant metastases are often described even after complete resection and the course is fatal. The role of adjuvant chemotherapy following surgical resection is not fully elucidated. Mean survival in the cases reported ranged from 1 month to 33 months. However, no significant differences were seen in the clinicopathologic profile of the cases described so far. Further multiinstitutional studies and follow up will help to further characterize this subtype for appropriate treatment.