Browsing by Author "Ertan, Y"

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    Systemic mastocytosis presenting with a prominent B lymphocyte proliferation in the bone marrow and extensive fibrosis of the spleen
    Nese, N; Cagirgan, S; Ertan, Y; Sönmez, A; Soydan, S; Hekimgil, M
    Systemic mastocytosis is a disease characterized by multifocal mast cell proliferation in the bone marrow or other extracutaneous organs. Because of loosely scattered and hypo-/agranular mast cells, the diagnosis is sometimes very difficult. In the bone marrow, mast cell infiltration may be associated with prominent lymphoid infiltration leading to a misdiagnosis of a low grade non-Hodgkin lymphoma. A 49-year-old woman presented with right arm and leg pain, psychiatric symptoms, and diarrhea for four years. Physical examination and laboratory investigation revealed hepatosplenomegaly, anemia, mild thrombocytosis, mild leucocytosis and lymphacytosis. In the bone marrow biopsy, there was a prominent B lymphocyte proliferation reminiscent of a low grade non-Hodgkin lymphoma/leukemia and there were some spindle cells aggregates in paratrabecular location. The consecutive bone marrow biopsies were similar to the first. The subsequent splenectomy specimen exhibited striking fibrosis. In the lymph node sections, there was marginal zone hyperplasia. Multifocal accumulations of mast cells were strongly positive with mast cell tryptase and CD117 on immunohistochemical staining, though no metachromasia was identified in Giemsa and Toluidine Blue stained aspirates and tissue sections, probably due to hypo-/agranulation of mast cells. The case was presented to emphasize the importance of the antibody to mast cell tryptase in the diagnosis of mastocytosis and to discuss problems of differential diagnosis of systemic mastocytosis.
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    Two challenging cases of pituicytoma
    Ozisik, H; Yurekli, BS; Simsir, IY; Ertan, Y; Eraslan, C; Ozdemir, N; Ozgiray, E; Saygili, F
    Introduction Pituicytoma is a rare tumor of the pituitary gland derived from neurohypophyseal pituicytes. Case 1 A 58-year-old female presented with decreased vision; she was admitted to the neurosurgery department of Ege University after the detection of a pituitary macroadenoma. Magnetic resonance imaging (MRI) showed a 28 * 18 * 17-mm suprasellar mass, and laboratory tests revealed hypopituitarism. Hydrocortisone and L-thyroxine treatment were initiated, and the patient underwent resection through the endoscopic endonasal approach (EEA). The histopathological examination revealed a pituicytoma. The recurrence of tumor was detected during the 1-year follow-up, and the patient is awaiting surgery. Case 2 A 70-year-old woman presented with visual changes; she had a past medical history of hypophyseal macroadenoma and pituicytoma resected through an EEA in 2012 and 2017, respectively. During follow-up, 2 years after the second surgery, MRI showed progression of the pituicytoma then measuring 38 x 23 x 22 mm; it had invaded the cavernous sinus and was causing hydrocephaly and panhypopituitarism. The patient underwent the third resection through the transcranial approach in order to minimize bleeding. After this surgery, the patient developed diabetes insipidus and underwent treatment with desmopressin. Histopathological examination revealed a pituicytoma. At 6-month follow-up, imaging showed a sellar suprasellar mass 37 x 22 x 24 mm invading the cavernous sinus, indicative of recurrence. In the postoperative period, the patient applied to the department of radiation oncology to have fractionated radiotherapy. Discussion Pituicytomas are known to be low-grade tumors; because of their rarity, they are a real challenge. These patients should be followed up closely.
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    The Role of Immunohistochemistry in Differential Diagnosis of Follicular Patterned Lesions of Thyroid
    Yegen, G; Demir, MA; Ertan, Y; Nalbant, OAK; Tunçyürek, M
    Objective: In the present study we aimed to assess the role of galectin3, cytokeratin 19, thyroid peroxidase and CD44v6 in distinguishing benign from malignant follicular lesions. Material and Method: Fifty-four malignant and 50 benign lesions were evaluated and classified according to World Health Organization 2004 histological classification. Galectin-3, cytokeratin 19, thyroid peroxidase and CD44v6 were performed immunohistochemically and the slides were evaluated by two independent investigators. Sensitivity, specificity and diagnostic accuracy were assessed for each antibody tested. Results: Sensitivity, specificity and diagnostic accuracy were as follows respectively: Galectin-3: 59,25%, 84% and 71,15%; Cytokeratin 19: 70%, 82% and 75,4%; Thyroid peroxidase: 61%, 70% and 65,4%; CD44v6: 20,4%, 88% and 52,9%. Conclusion: The negativity for Galectin-3 and Cytokeratin 19 can not exclude malignancy but positivity can be thought as a sign of malignant feature or potential for lesions in which there is strong suspect of malignancy. Thyroid peroxidase immunostaining failed to differantiate benign from malignant oxyphilic tumors but decreased expression can be used as a malignancy marker together with Galectin-3 and/or Cytokeratin19 positivity in suspicious cases. CD44v6 does not seem to be reliable in distinguishing benign from malignant follicular patterned thyroid lesions. In conclusion, our approach is to take as much new samples or serial sections as possible in cases without clear-cut evidence of malignancy but with histological and immunohistochemical suspicion. Follicular variant papillary carcinoma has different criteria for malignancy and it should be always kept in mind while evaluating a benign-looking lesion with immunohistochemical signs that favor malignancy.
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    Central Nervous System Angiosarcoma: A Case Report
    Sari, ÜS; Ak, AK; Ovali, GY; Mavioglu, H; Zeybek, S; Özgiray, E; Sari, MF; Ertan, Y
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    Can CD10 be used as a diagnostic marker in thyroid pathology?
    Yegen, G; Demir, MA; Ertan, Y; Nalbant, OA; Tunçyürek, M
    CD10-common acute lymphoblastic leukemia antigen is a membrane-bound zinc metalloproteinase that is expressed by different hematopoietic cell types at unique stages of lymphoid and myeloid differentiation. It was reported to be expressed in various nonlymphoid cells and tissue, as well as in various types of neoplasms. Recently, it has been found to be useful in the differential diagnosis of benign and malignant follicular-patterned lesions of the thyroid. In the present study, we evaluated the staining pattern of CD10 in various thyroid lesions, including 14 benign and 61 malignant cases, as well as in adjacent thyroid tissue. CD10 was negative in normal thyroid tissue, adenomatous nodules, minimally invasive follicular carcinoma, and well-differentiated carcinoma. It was expressed in nine of 14 (64.2%) conventional papillary carcinomas, four of 24 (16.6%) follicular variant of papillary carcinomas, three of six (50%) papillary microcarcinomas, one of nine (11.1%) widely invasive follicular carcinomas, and three of ten (30%) follicular adenomas. In contrast to results of previous studies, CD10 is not useful in the classification of thyroid follicular lesions as benign or malignant, but it shows strong positivity in conventional papillary carcinoma.
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    Histopathological and Immunohistochemical Features of 32 Cases of Splenic B-Cell Lymphoma and Leukemia
    Döger, FK; Hekimgil, M; Ertan, Y; Sarsik, B; Soydan, S; Nese, N
    Objective: Leukemias and non-Hodgkin lymphomas commonly involve the spleen or originate primarily in the spleen and then spread to other sites. Material and Methods: In this retrospective study, we examined the histopathological and immunohistochemical characteristics of 32 cases of primary or secondary splenic B-cell lymphoma and leukemia, in which the diagnosis was established according to the World Health Organization (WHO) classification. The immunohistochemical panel included ALK-1, BCL-2, BCL-6, CD3, CD5, CD10, CD20, CD21, CD23, CD30, CD43, cyclin D1, Ki-67, and TRAP. Results: There was no other nodal or extranodal disease involvement in the majority of patients diagnosed with lymphoma at the time of presentation, while cases of leukemia had undergone splenectomy for palliative purposes. The diagnoses were as follows: 11 cases of hairy cell leukemia (HCL, 34.4%), 8 cases of splenic marginal zone lymphoma (SMZL, 25%), 8 cases of diffuse large B-cell lymphoma (DLBCL, 25%) including 1 T-cell-rich B-cell lymphoma (TCRBCL), 4 cases of mantle cell lymphoma (MCL, 12.5%), and 1 prolymphocytic leukemia (PLL, 3.1%). Conclusion: Overall assessment of spleen, liver, bone marrow, and lymph node examinations and a detailed correlation of the histopathological and immunohistochemical features with the clinical findings are very helpful and usually lead to the final diagnosis in most cases of primary or secondary splenic B-cell lymphoma and leukemia.