Myoepithelial differentiation in breast carcinoma

BACKGROUND: The aim of presenting this work is to describe a matrix producing carcinoma with anaplastic myoepithelial cell foci, with the coexistence of in situ myoepithelial carcinoma which originated from a sclerosing adenosis. CASE REPORT: A 51-year-old perimenopausal woman presented with a hard irregular lump in her left breast. After histological confirmation of malignancy, the patient underwent a modified radical mastectomy. The tumor was composed of a sclerosed fibroadenoma and preexisting sclerosing adenosis with poorly differentiated overt carcinoma within the cartilaginous matrix. There were foci of ordinary, intermediate-grade carcinoma in situ and myoepithelial carcinoma in situ. RESULTS: We performed immunohistochemistry by the streptavidin-biotin horseradish peroxidase method. Estrogen receptor and progesterone receptor were negative, and so was c-erbB-2. Both the invasive and the in situ components were positive for CK7, CK19, CK14, vimentin, smooth muscle actin, nerve growth factor receptor, and epidermal growth factor receptor. By contrast, CK5/6 immunoexpression was found only in the in situ component. Negativity was found for p63 and CD10 within the tumor. While cytoplasmic bcl-2 immunoexpression was detected in some of the tumor cells of the invasive component, intranuclear p53 expression was found to be positive not only in the invasive component but also in the in situ component of the tumor. CONCLUSION: The histopathological findings and the immunohistochemistry results support the derivation of the tumor from myoepithelial cells.     

FDG PET/CT and Conventional Imaging Methods in Cancer of Unknown Primary: an Approach to Overscanning

Purpose

To compare the performance of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) with conventional imaging methods (CIM), including computed tomography (CT), magnetic resonance imaging (MRI), and mammography (MMG) in cancer of unknown primary (CUP).

Methods

A total of 36 patients with CUP, who referred to our clinic for a FDG PET/CT scan, were enrolled in this study. Thirty of the patients were also examined through either diagnostic CT/MRI and/or MMG. The diagnostic performance of both methods for the primary cancer location was analyzed. The results of FDG PET/CT and CIM were compared based on the standard reference of the histopathology and/or clinical and laboratory follow-up.

Results

The primary cancer locations were detected in 24 patients (66.6%, 24/36) by FDG PET/CT, whereas CIM identified the locations in 16 patients (53.3%, 16/30). Sensitivity, specificity, PPV, NPV, and accuracy rates of the detection of the primary tumor localizations were as follows: 83, 70, 89, 58, and 79% for FDG PET/CT; 70, 62, 84, 42, and 68% for CIM, respectively. There was no statistical significance between modalities regarding any of the categories in 30 patients.

Conclusion

FDG PET/CT detected the primary tumors of the patients with CUP more than CIM did. However, the difference between them was not found to be statistically significant. It may be considered that FDG PET/CT scan can be performed as a first-line tool in the initial diagnosis of the patients with CUP and to add radiodiagnostic imaging in selective cases. We conclude that if the first-line examination of a CUP patient has been already performed by a CIM and the result was negative or inconclusive, FDG PET/CT can be considered to avoid unnecessary imaging procedures.

     

Evaluation of laryngeal findings in users of inhaled steroids

The objective of the prospective study is to examine the laryngeal changes by laryngeal videostroboscopy and electromyography (EMG) regarding new-onset dysphonia in asthmatic patients taking inhaled corticosteroids (ICS). Laryngeal changes and electrophysiological status of the laryngeal muscles were evaluated by these methods in 12 patients both at the time of presentation of dysphonia and after cessation of therapy. Laryngeal changes of our patients were mucosal edema, erythema, thickening, adduction deficit, nodule and irregularity in videostroboscopy. Significant correlations were found between laryngeal pathology and dosage and duration of ICS therapy. We detected myopathy by EMG in most of the patients. Also, EMG revealed that cricothyroid muscle was much more affected than thyroarytenoid muscle. In conclusion, we consider that steroid myopathy or mucosal inflammatory theory alone is not sufficient to explain the etiopathogenesis of dysphonia in asthmatic patients taking ICS. The laryngeal mucosal changes were detected by laryngeal videostroboscopic examination in some asthmatic patients, with dysphonia using ICS, and/or laryngeal myopathy was found by laryngeal EMG in some of them in this study. Thus, various factors may have role simultaneously in the occurrence of dysphonia.     

The microstructural and functional changes in the macula of heavy habitual smokers

To investigate whether heavy habitual smoking affects microstructures and functions of the macula, 45 age- (20–39 years old) and sex-matched adult smokers (≥1 box/day for ≥5 years) and 45 nonsmokers (controls) were enrolled in this case–control study. Central macular thickness (CMT), macular autofluorescent pigment density (MAPD), macular electroretinogram (ERG), and photostress recovery time (PRT) measurements were performed. The mean age of smokers and nonsmokers was 32.9 ± 3.9 and 33.1 ± 4.1 years, respectively (p = 0.43), and smoking duration was 11 ± 5.6 years. CMT in smokers (220 ± 28 μm) and nonsmokers (217.2 ± 31 μm; p = 0.57) was similar. Smokers had lower MAPD values (124.6) than nonsmokers (138.2) (p = 0.010). Multifocal ERG parameters in the central (6°) hexagon were similar in both groups (p > 0.05 for latency and amplitudes of P1 and N1). PRT in smokers and nonsmokers was similar (7.2 ± 1.2 and 7.4 ± 1.9 min, respectively; p = 0.33); however, foveal threshold value (FTV) at the first minute after photostress was statistically higher in smokers (36.1 ± 1.04 dB) than nonsmokers (34.8 ± 1.05 dB) (p = 0.011). We conclude that decreased MAPD and altered response to photostress may be indicative of early nicotine toxicity in microstructurally sound macula of adult chronic smokers.     

Treatment with oxytocin antagonists before embryo transfer may increase implantation rates after IVF

This report aimed to examine the effects of atosiban on pregnancy outcome after IVF–embryo transfer. A prospective, randomized, placebo-controlled clinical study was performed. A total of 180 women undergoing intracytoplasmic sperm injection who had top-quality embryos were randomly allocated into treatment and control groups. All the patients had infertility due to tubal factor, hormonal-anovulatory disorders, male factor or unexplained reasons. The treatment group received intravenous administration of atosiban before embryo transfer with a total administered dose of 37.5 mg. In the control group, the same number of cycles was performed with placebo medication. The clinical pregnancy rate (PR) per cycle and implantation rate (IR) per transfer were 46.7% and 20.4% in the atosiban-treated group, which were significantly higher than in the control group (28.9% and 12.6%, respectively, P = 0.01). The miscarriage rates of groups 1 and 2 were 16.7% and 24.4%, respectively (P = 0.01). These results have indicated that atosiban increases the IR and PR after IVF–embryo transfer. These results suggest that atosiban treatment before embryo transfer is effective in priming of the uterus for implantation. This is the first study to investigate the possible contributions of atosiban for improving the PR after IVF–embryo transfer.     

Muscle involvement in two Behçet cases: magnetic resonance imaging and histology findings

Behçet’s disease (BD) is a systemic vasculitis with a classic trio of symptoms of oral aphthous ulcers, genital ulcers, and ocular lesions that present in a relapsing fashion. Despite these most frequently encountered symptoms of the disease, other systems such as vascular, gastrointestinal, and neurological involvements can also occur. Muscular involvement is rare, and there are only a few cases in the literature, which were reported mainly in a pediatric population. In this two-adult case report, muscular involvement of BD with an emphasis on magnetic resonance imaging and histology findings will be presented.     

Male patients with Beh?et's syndrome have stronger pathergy reactions

The effects of patient's sex and age at onset on the pathergy reaction (cutaneous hypersensitivity to a needle prick) and its correlation with disease activity in Behcet's syndrome was investigated by two independent observers in a blind protocol. Among 92 male patients the pathergy reaction was more strongly positive (p less than 0.025) than among 67 female patients of similar age and disease duration. The age at onset did not affect the severity of the pathergy reaction, although, the early onset females (age at onset 24 years or less) had the lowest prevalence of pathergy positivity (52%), compared to early onset males and late onset (age at onset 25 years or more) males and females (73-75%). As previously reported the disease was more severe among males and among those with early onset of either gender. On the other hand, no correlation between the strength of the pathergy reaction and clinical severity could be discerned.     

Efficacy of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis

 To assess the efficacy of intra-articular hyaluronic acid in patients with knee osteoarthritis, sixty female patients with knee osteoarthritis were randomised to three weekly intra-articular injections of 30 mg sodium hyaluronate (Na HA) with a high molecular weight (1.0 to 2.9 million Da) or 40 mg 6-methylprednisolone acetate (6-MPA). The clinical assessments included pain at rest, at weight-bearing and on walking, Lequesne Index and active range of knee flexion. Assessments were done at baseline, at week 4, and at months 3 and 6. A significant decrease in VAS scores for pain at rest, at weight-bearing and pain on walking, and in Lequesne index was found in both groups at week 4 when compared to baseline and there was no significant differences between the two groups. However, at 3^rd month improvement in all pain scores and Lequesne index was found in favour of hyaluronic acid. At 6^th, no significant difference was found between the treatment groups. Improvement in pain was accompanied by an increase in joint flexion at week 4 and at month 3 in both groups. Both treatments were well-tolerated. The results showed that both intra-articular hyaluronic acid and 6-MPA treatments provide clinically significant improvement and demonstrated that Na HA has a long-term beneficial effect in patients with knee osteoarthritis. Received: 13 May 2002 / Accepted: 21 November 2002