Hilal Erinanc

Diagnosing acute cholecystitis (AC) in patients with end-stage renal disease (ESRD) is challenging because chronic systemic inflammation and immune dysregulation may obscure acute inflammatory responses. Conventional inflammatory markers may therefore have limited diagnostic specificity in this population. This study aimed to evaluate the diagnostic utility of systemic inflammatory indices in ESRD patients undergoing cholecystectomy. This retrospective single-center study included 48 ESRD patients who underwent cholecystectomy either for clinically suspected AC (AC group, n = 31) or prophylactically prior to kidney transplantation (RT group, n = 17). Demographic characteristics and laboratory parameters were obtained from preoperative blood tests. Systemic inflammatory indices, including the neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV), were calculated. Histopathological findings were used as the reference standard for confirming acute inflammation. Exploratory receiver operating characteristic curve analysis was performed to evaluate diagnostic performance and determine optimal cutoff values. Histopathological examination demonstrated neutrophilic infiltration consistent with acute inflammation in 30% of patients with clinically suspected AC. Compared with the RT group, patients with histopathologically confirmed acute inflammation had significantly higher neutrophil counts and PIV levels and lower serum albumin levels. In receiver operating characteristic analysis comparing histopathologically confirmed acute cases with RT controls, PIV showed the highest diagnostic accuracy (area under the curve [AUC] = 0.771), followed by C-reactive protein (AUC = 0.733) and SIRI (AUC = 0.732). Within the AC cohort, SIRI demonstrated the best discriminatory ability for differentiating acute from chronic inflammatory changes (AUC = 0.732). Optimal cutoff values differed substantially between analyses, with lower thresholds observed when acute cases were compared with RT controls and higher thresholds required within the AC cohort. Composite inflammatory indices, particularly SIRI and PIV, may provide additional information in identifying histopathologically confirmed acute inflammation in ESRD patients. However, given the limited sample size, these findings should be interpreted as exploratory and require validation in larger prospective studies.

To investigate novel inflammatory indexes including neutrophil‐to‐lymphocyte ratio (NLR), systemic immune inflammation index (SII), systemic immune response index (SIRI), and pan‐immune‐inflammation value (PIV) in the diagnosis of organizing pneumonia (OP) and distinguishing OP from lung cancer (LC). The study included 125 patients with LC and 21 patients with OP. Retrospectively, we compared the values of SII, SIRI, PIV, NLR, and C‐reactive protein (CRP) and evaluated correlations between the patient groups. The CRP levels in patients with OP (median: 45.2 mg/dL) were lower than those in patients with LC (median: 64 mg/dL). However, no differences were observed in systemic inflammatory indexes between the groups. Statistically significant positive correlations were found between neutrophils and NLR ( r = 0.63), SIRI ( r = 0.52), and SII ( r = 0.72). In addition, significant negative correlations were observed between lymphocytes and NLR ( r = −0.67), SIRI ( r = −0.53), SII ( r = −0.27), and PIV ( r = −0.37). Increased CRP levels may indicate lung carcinoma risk and CRP measurements may be predictive in distinguishing between OP and LC. Additionally, high neutrophil counts, thrombocyte counts and/or lymphocytopenia might lead to a poor immune response and are linked to higher systemic inflammatory indices.

While thyroid cancers are usually present one type of cancer in the thyroid gland, rarely different thyroid cancers may found in one or two different lobes of the thyroid gland at the same time. A 70-years-old female patient presented with a long-standing neck swelling, especially on the left side, which was more prominent, recently increasing in size and causing shortness of breath. Due to tracheal compression and diagnosis of multi-nodular goiter, total thyroidectomy was performed. Histopathological examination revealed a thyroid collision tumor with papillary microcarcinoma on the right and hurtle cell adenoma on the left side. Due to its rarity, clinicians encountered difficulties in the diagnosis and treatment of thyroid collision tumors. We believe that to be aware of these rare entities by encouraging clinicians to report such cases enable to more solid conclusions to diagnosis and management of collision tumors.

Ucar Karabulut K, et al. Ann Surg Treat Res. 2022 Nov;103(5):306-311. https://doi.org/10.4174/astr.2022.103.5.306

Aim: Cutaneous bone formation is an uncommon lesion of the skin. It may be primary or secondary. Secondary lesions are mostly associated with melanocytic nevi. Although many different theories have been proposed to explain the etiology, extraskeletal bone formation is complex and poorly understood phenomenon. Here the authors report a series of melanocytic nevi with cutaneous bone formation and the authors described morphologic and clinicopathologic features such as age, sex, location, focus number and size of the lesion. Material and Method: Through a single center, this retrospective study presents total number of 20 patients with melanocytic nevus with or without osseous metaplasia. Histologic and clinicopathologic features such as age, sex, location, focus, and size of lesion were compared. Results: Lesions were identified in 10 female patients. All of the cases were seen in the head and neck region such as face, forehead, eyebrow, lip, and neck and most of them were solitary. The nevi were usually associated with the single focus of ossification. Most of patients (50%) had acne symptoms and treatment anamnesis. Granulomatous dermal inflammation was seen in 2 patients. There was no difference in nevus morphology and the size of the nevi between the osteonevi and the other types of nevi. Conclusion: In conclusion, this study revealed that although it is rare it has distinctive features such as female patients, face location, and acne anamnesis. Therefore it may be speculated that the osteogenic factors may be involved with inflammatory-induced metaplastic ossification and tend to be related female sex.

Primary leiomyosarcomas of vascular origin are rare tumors. They frequently arise within the inferior vena cava; however, the peripheral vein was also affected. To date, only a few hundred cases have been reported in the world literature. Although it is an extremely aggressive tumor, the symptoms may be unspecific, especially in the lower extremities. In this report, we present a case of primary vascular leiomyosarcoma, arising from the short saphenous vein, with symptoms mimicking thrombus in the initial diagnosis. The diagnosis of leiomyosarcomas was confirmed by standard H&E staining and immunohistochemical staining. Recurrence of the tumor has been observed five years after surgical treatment. Due to its rarity, experience in the management of this type of tumor is limited. The mainstay of treatment for these tumors is complete surgical resection. The purpose of the presented case is to discuss the clinicopathological features and management options of this tumor, under the light of the most recent literatures.

We herein report the clinical and pathological findings of a rare case of nodular fasciitis in the breast parenchyma of a 48-year-old female. Because of potentially malignant findings on ultrasonography and during clinical examination, the patient underwent an excisional biopsy. Histologically, the lesion was composed of spindle to round shaped cells arranged in short bundles in a storiform pattern. Immunohistochemically, the cells were positive for vimentin and SMA and negative for desmin, S100, and CD34. Based on these morphological and immunohistochemical features, a diagnosis of nodular fasciitis was made. We emphasize that nodular fasciitis of the breast may show clinical features and imaging findings similar to those of breast cancer. The histopathologic diagnosis of nodular fasciitis can also be challenging. The purpose of this case report is to highlight the characteristics and the differential diagnosis of this rare neoplasm.

Lymphoepithelial carcinoma is a variant of undifferentiated carcinoma with characteristic dense lymphoid stroma in which nasopharynx is site of predilection. Racial and geographic association and Epstein–Barr virus positivity in endemic areas are other characteristics of this rare neoplasm. Lymphoepithelial carcinoma accounts for only 0.4% of malignant salivary gland tumors. The authors present a patient with Epstein–Barr virus positive lymphoepithelial carcinoma of the parotid gland in a nonendemic region. Besides this, synchronous pleomorphic adenoma in the contralateral submandibular gland caused a challenge in making initial therapeutic decision.

Background: : This study aimed to evaluate the association of a disintegrin and metalloproteinase-33 protein (‘ADAM-33’) expression in vocal polyp formation and to determine its correlation with clinical characteristics.Methods: : Medical charts and histological sections of 32 patients diagnosed with vocal polyps who underwent surgery were analysed. Controls were histopathologically normal vocal fold tissues obtained from 36 patients who underwent surgery for laryngeal squamous cell carcinoma. Immunohistochemical staining was performed to detect ADAM-33 expression in epithelial cells, stroma and vessels.Results: : All epithelial, stromal and vascular staining scores were significantly greater in polyp tissue than in controls (p < 0.001). Stromal ADAM-33 staining scores were higher in vocal polyp patients with a symptom duration of less than six months (p < 0.05). Vocal overuse or the presence of reflux symptoms, sinonasal symptoms or allergy did not affect ADAM-33 immunostaining scores (p = 0.05).Conclusion: : In this study, ADAM-33 immunostaining was significantly increased in vocal polyps. Therefore, over-expression of this protein may be associated with vocal polyp pathogenesis.