Ozge Hurdogan

Background: Protein‐losing enteropathy is a rarely reported feature of CD46‐associated disease and may resemble CD55 deficiency with hyperactivation of complement, angiopathic thrombosis, and protein‐losing enteropathy (CHAPLE) syndrome. Associated hypogammaglobulinemia may be mistaken for primary antibody deficiency. Methods: We describe a 23‐year‐old woman with childhood‐onset enteropathy and hypogammaglobulinemia who had received immunoglobulin replacement for presumed common variable immunodeficiency since age 5. Multidisciplinary reassessment incorporated intestinal and renal histopathology, whole‐exome sequencing, family segregation, and longitudinal evaluation of the response to eculizumab. Results: Duodenal biopsy demonstrated intestinal lymphangiectasia, whereas kidney biopsy revealed chronic thrombotic microangiopathy with concurrent PLA2R‐negative membranous nephropathy. Serum C3 and C4 were within reference ranges. Sequencing identified homozygous CD46 c.565T>G (p.Tyr189Asp), with no pathogenic CD55 variant. The diagnostic laboratory reported the CD46 finding as a variant of uncertain significance. Family segregation and published functional evidence supported its clinical relevance, although patient‐specific functional confirmation was unavailable. Eculizumab promptly improved abdominal pain, vomiting, and oral intake. By April 2026, following dose escalation, serum albumin reached 4.3 g/dL and IgG 554 mg/dL, whereas proteinuria decreased from 5.95 to 2.4 g/day. Conclusion: This case supports considering CD46‐associated disease in adults with a CHAPLE‐like phenotype, particularly when enteric protein loss and hypogammaglobulinemia coexist with renal microangiopathy despite normal C3 and C4. The response to complement blockade supports a complement‐mediated disease process. Documented protein loss should prompt reassessment of a presumptive diagnosis of primary antibody deficiency.

Background We aimed to evaluate the prognostic significance of TLR4 expression in bladder cancer, its association with genes related to EMT, and the potential regulatory role of selected microRNAs. Methods and results Tumor and adjacent healthy bladder tissue samples obtained from 25 patients who underwent radical cystectomy for bladder cancer were analysed. The expression levels of TLR4, SPRR2A, SPRR1A, SPRR2B, ZEB2 and CDH1, in addition to miR-200c-3p and miR-146a-5p were measured using the RT-PCR method. Additionally, the expression of the TLR4 protein was assessed using the immunohistochemistry. Gene expression levels were comparatively analysed with regard to their association with the clinicopathological characteristics, and survival. The SPRR2A expression was significantly higher in tumour tissues compared with the levels in normal tissues (p = 0.001). TLR4 expression showed a positive correlation with SPRR1A (r = 0.603,p = 0.001), ZEB2 (r = 0.398, p = 0.049) and CDH1 (r = 0.403, p = 0.046). Notably, TLR4 expression was significantly lower in patients with lymph node metastasis (p = 0.049), while miR-200c-3p expression was considerably lower in patients with a history of smoking (p < 0.0001). Survival analyses revealed an inverse association between overall survival and SPRR2B expression (r = − 0.665,p = 0.013), whereas cancer-related mortality was associated with the decreased expression of SPRR1A (p = 0.008), and SPRR2B (p = 0.005). Conclusions TLR4 expression is associated with the regulation of the genes involved in EMT, as well as with metastasis in bladder cancer. The interaction between TLR4, EMT-associated genes and microRNAs may have prognostic and therapeutic implications. However, these findings require validation in prospective larger, independent cohorts.

Objective: In advanced-stage testicular cancer, postchemotherapy retroperitoneal lymph node dissection (RPLND) is performed to manage residual retroperitoneal masses. This study evaluated the histopathological features and their associations with primary tumor and clinical outcomes. Methods: Postchemotherapy RPLNDs performed between 2000 and 2024 were reviewed and classified as no tumor, teratoma, nonteratomatous germ cell tumor (NTGCT), or somatic malignancy. Corresponding orchiectomy pathology and clinical data were analyzed for primary tumor, treatment, and follow-up. Results: A total of 151 RPLNDs were evaluated. Median age was 26 years (IQR: 24.7–28.4), and mean largest clinical mass diameter was 62.4 ± 38.6 mm. Diagnoses were teratoma in 87 (57.6%), no tumor in 34 (22.5%), NTGCT and teratoma in 11 (7.3%), NTGCT in 11 (7.3%), and somatic-type malignancy in 8 (5.3%). Embryonal carcinoma in orchiectomy was significantly more frequent in patients with malignancy in RPLND (P = .018). Mean number of paraffin blocks was 10.7 ± 6.62, and malignancy was significantly higher in specimens with ≥10 blocks compared to those with <10 (P = .014). Follow-up data were available for 101 (66.9%), with median follow-up of 85.5 months (IQR: 70.7–100.1); 24 (23.8%) patients died. Mortality was significantly higher in patients with malignant tumor in RPLND (50%) compared to those without malignancy (17.3%) (P = .002). In univariate logistic regression analyses, RPLND tumor diameter (odds ratio [OR]: 1.012, 95% CI: 1.004–1.021; P = .005), malignancy in RPLND (OR: 3.787, 95% CI: 1.669–8.594; P = .001), NTGCT in RPLND (OR: 3.451, 95% CI: 1.473–8.083; P = .004), and yolk sac tumor in orchiectomy (OR: 0.220, 95% CI: 0.049–0.985; P = .048) were associated with overall mortality. In multivariate analysis, only RPLND tumor diameter remained an independent predictor (OR: 1.018, 95% CI: 1.000–1.035; P = .045). Conclusion: Postchemotherapy RPLND most frequently revealed teratoma, while larger tumor diameter independently predicted malignant findings and adequate sampling increased malignancy detection. Cite this article as: Hürdoğan Ö, Cantürk Z, Ugar M, et al. Histopathological spectrum of postchemotherapy retroperitoneal lymph node dissection in testicular cancer: the impact of sampling adequacy and viable nonteratomatous germ cell tumor. Cerrahpaşa Med J, 2026, 50, 0037, doi: 10.5152/cjm.2026.26037.

Objective: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare, indolent renal cell carcinoma variant, rarely showing unusual histology and aggressive behavior. We aimed to document histopathological and clinical characteristics and their relation to survival.Materials and Methods: We retrospectively identified 20 cases diagnosed as MTSCC between 2007-2024 and documented the relationship between clinicopathological features and follow-up.Results: There were 9 males and 11 females with a mean age of 54.6±11.1 (range: 28-72). Twelve (60%) underwent radical nephrectomy, 5 (25%) partial nephrectomy, 3 (15%) tru-cut biopsy. Eight (40%) were consultation cases, 12 (60%) were in-house material. The median tumor diameter was 70.4 (IQR: 4.88-9.03) mm. The presence of hemorrhage was observed in 2 (10%), necrosis in 4 (20%), sarcomatous transformation in 2 (10%). Median number of tissue blocks per case was 13 (IQR: 8-17.5) and correlated with the presence of sarcomatous differentiation (r=0.561, p=0.019). Mean follow-up time was 82.9±63.9 months. Four patients succumbed to disease with distant metastasis and two to other causes. One showed local recurrence. Remaining patients showed no recurrence or metastasis. Among four patients who died of disease, two showed sarcomatous transformation. Sarcomatous transformation showed worse prognostic significance in univariate analysis for overall survival (p=0.028), although not validated in multivariate Cox regression model (HR: 0.607, 95% CI: 0.030-12.120, p=0.744). Kaplan-Meier analysis showed that survival probability was lower in patients with sarcomatous transformation (0% vs 88.9%, p=0.008).Conclusion: MTSCC is a distinct renal neoplasm typically with an indolent prognosis, though rarely metastasizes, causing death. Meticulous histopathological assessment and close follow-up is essential.

Background: IgA nephropathy (IgAN) recurrence a"er kidney transplantation (KTx) could cause allogra" loss. New bio markers are needed to assess the risk of IgAN recurrence and allogra" dysfunction following KTx. Methods: Thirty-seven KTx recipients who underwent KTx between 2002-2011 with biopsy-confirmed pre-transplant IgAN were evaluated in this retrospective study. Demographics, pathological and clinical/laboratory findings, and biomarkers, including levels of advanced oxidative protein products (AOPP) and galactose-deficient IgA1 and 4 tag single-nucleotide variants (tSNVs) associated with IgAN, were recorded. The primary outcome was IgAN recurrence. Biopsy-proven allogra" rejection (BPAR) and death-censored gra" failure (DCGF) were secondary outcomes. Results: 72.9% of patients were male. The mean age of KTx recipients was 37.4 ± 9.9 years. 45.9% of them experienced a recurrence of IgAN, during a median of 125 months of follow-up. There were more male donors in the recurrent IgAN group (P = .022). The median levels of UPCR were higher (P = .002) and estimated glomerular filtration rate (eGFR) were lower (P = .007) at the time of sampling in the recurrent group. Donor sex (male) (P = .018, HR: 3.853, 95% CI: 1.256-11.826) and eGFR at sampling (P = .039, HR: 0.967, 95% CI: 0.937-0.998) were predictors of IgAN recurrence in Cox regression analysis. Advanced oxidative protein products (median 78.4 vs 67.35 (#mol/L)) and Gd-IgA1 (median 5390.3 vs 4732.5 ng/#L) levels were insignificantly elevated in the patients with IgAN recurrence. Statistical di$erences were not present in terms of sec ondary outcomes between the patients with and without IgAN recurrence. Single-nucleotide variants were not statistically associated with the recurrence of IgAN. Conclusions: Prospective biomarker/genetic marker studies, including large patient cohorts, are required to evaluate the risk of IgAN recurrence and allogra" function a"er KTx. Cite this article as: Dirim AB, Mirioglu S, Oto OA, et!al. Prediction of recurrence and gra" outcomes in kidney transplant recipients with IgA nephropathy: role of genetic and oxidative stress markers. Turk J Nephrol. 2025;34(2):124-133.

Malignant neoplasms of the penis are uncommon, the most common being squamous cell carcinoma. Non-Hodgkin's lymphoma occurs in extranodal sites in half of patients, but is extremely rare in the penis. Here, a 24 years old case of a penile mass is reported as non-Hodgkin lymphoma. On physical examination and imaging, two-centimeter lesion was detected on the left distal corpus cavernosum of the penis and extending to the proximal corpus cavernosum. Excisional biopsy from distal left corpus cavernosum performed under general anesthesia. Histopathological examination of the excision material revealed diffuse large B-cell lymphoma with a post-germinal center cell phenotype. Although it is rare in patients presenting with a penile mass, the possibility of lymphoma involvement should be kept in mind. It can mimic Peyronie's disease or corpus cavernosum thrombosis.

Background: Homozygosity for LIMS1 rs893403-GG genotype is linked to an increased risk of allograft rejection after kidney transplantation. Ischemia-reperfusion of the kidney allograft leads to long term infiltration of activated and effector-memory T lymphocytes and resulting in rejection and long-term fibrosis. However, the genotype, LIMS1 expression under ischemic conditions and the long-term histopathological relationships remain ill-defined. Methods: We examined the impact of the recipient’s LIMS1-rs893403 genotype with transplant kidney histopathology. The association of the LIMS1-rs893403 genotype and LIMS1 and GCC2 mRNA expression in ischemic donor kidneys were also examined. Recipients who underwent transplant kidney biopsy were genotyped for the LIMS1-rs893403 variant and associated deletion. Histopathological findings were compared between recipients with LIMS1 risk and non-risk genotypes. Real-time PCR and immunofluorescence staining for LIMS1 and GCC2 expression were performed in non-utilized donor kidneys. Results: Demographic, clinical, and treatment characteristics and the histopathological diagnosis were similar between recipients with rs893403 GG and AA/AG genotype. The Banff tubulitis score was higher in GG recipients (n = 24) compared to AA/AG (n = 86) recipients (1.42 ± 0.65 vs. 1.12 ± 0.66, p = 0.03). Ischemic kidneys with GG showed higher LIMS1 and GCC2 mRNA expression than kidneys with AG. Kidneys with rs893403-GG had higher tubular LIMS1 and GCC2 immunohistochemical staining compared to kidneys with rs893403-AG. Conclusions: Our data supports the role of the LIMS1 locus in kidney transplant rejection, particularly in lymphocyte infiltration into the internal aspect of the tubular basement membranes. Increased LIMS1 and GCC2 expression in ischemic donor kidneys with the GG genotype require further studies.