Introduction. Liver transplantation (LT) remains the best treatment option for hepatocellular carcinoma (HCC). Patient selection is crucial and debated ever since the emerging of the Milan criteria in 1996. As live-donor LT is being more routinely performed worldwide, numerous new and/or expansions of the original criteria have been suggested to allow more patients to benefit from this superior treatment modality. This study aims to contribute to the ever-growing data in search for better coverage of patients with acceptable outcomes. Methods. Medical recordings of 187 adult patients who underwent LT for HCC in a 6-year period were retrospectively collected. Patients were classified by Milan and University of California, San Francisco, criteria. Survival times as well as tumor, liver disease, and recurrence-related data were recorded for each patient and the outcomes were statistically analyzed. Results. Factors significantly affecting recurrence and survival were histologic differentiation, number and the size of the tumor, and the presence of vascular invasion. Serum alpha-fetoprotein levels did not significantly affect outcomes. Among the patients exceeding both of the criteria, having a total tumor size of less than 160 mm was significantly associated with better outcomes (P = .007). Conclusion. HCC patients having tumors with vascular invasion, poor differentiation, exceeding 6 in number and 160 mm in total diameter demonstrate higher recurrence rates and worse outcomes.

Mucormycosis is a rare lethal complication of organ transplantation that progresses rapidly, and the prognosis is dismal if diagnosed late. We present a surviving liver transplant recipient in whom severe rhino-orbita-maxillary mucormycosis developed 1 month after liver transplantation. Prompt diagnosis with tissue biopsy, local control of the underlying condition with aggressive surgical debridement, and appropriate administration of systemic antifungal therapies are essential to improve prognosis and survival.

Large cell neuroendocrine carcinoma in the gynaecological organs affects the uterine cervix and ovary.Large cell neuroendocrine carcinoma of the ovary is extremely rare, and prognosis is quite poor even when diagnosed at an early stage.These tumours respond poorly to standard chemotherapy regimens.The clinical observation of skin metastasis in patients with epithelial ovarian cancer is relatively uncommon, occurring in only 3.5% of patients.These lesions are observed mostly in skin of the abdominal wall adjacent to the primary ovarian tumours.Metastatic skin lesions on extremities are much more rare; it is reported that only 12% of epithelial ovarian carcinoma skin metastases occur on the limbs.Skin metastasis due to large cell neuroendocrine carcinoma of the ovary has not been previously reported.We report the case of a large cell neuroendocrine tumour of the ovary with skin metastases on extremities appearing two months after surgery in a 68-year old woman.

Abstract Primary lung tumors mimicking the salivary gland–type neoplasms are extremely rare. These types of tumors originate from submucosal bronchial glands. Epithelial-myoepithelial carcinoma is an uncommon tumor in this group, and only 7 cases have been reported. It is considered to be a low-grade malignant neoplasm. We report a case of epithelial-myoepithelial carcinoma of bronchial gland origin in a 73-year-old man who presented with coughing and dyspnea. The bronchus of the left lower lobe contained a tumor mass that had a polypoid growth pattern. The tumor also extended into the pulmonary parenchyma, forming a well-circumscribed mass with a pushing margin. The tumor consisted of epithelial and myoepithelial cells. The epithelial cells were positive for cytokeratins and epithelial membrane antigen, while the myoepithelial cells were positive for S100 protein and muscle-specific actin. According to these findings, we diagnosed epithelial-myoepithelial carcinoma. After undergoing pneumonectomy, the patient has been disease free for 34 months.

We present the case of a patient with advanced endometriosis who presented with chronic pelvic pain, bilateral unruptured ovarian endometrioma, massive peritoneal implants and extremely elevated CA 125, and also elevated CA 15-3 levels. Laparoscopy revealed bilateral unruptured ovarian endometrioma and diffuse peritoneal endometriotic implants. Increased association of elevated levels of CA 125 and CA 15-3 is not so common in advanced endometriosis. The case was successfully treated with laparoscopy and combined low-dose oral contraceptive with one year of follow-up. To the best of our knowledge among the reported cases this is the highest CA 15-3 level ever reported with an extremely elevated CA 125 level.

We aimed to investigate the questionable effect of linear polarized polychromatic light on burn wound healing in rats. Two deep second-degree burn wounds on the backside of each of 21 Sprague-Dawley rats were created with a standard burning procedure by applying a heated plaque. Burned regions located right dorsolaterally and classified as group I lesions were treated with linear polarized polychromatic light + open dressing + antibacterial pomade, whereas group II lesions were located left dorsolaterally and treated with only open dressing + antibacterial pomade. Macroscopic evaluation was performed for determination of the completed wound closure rate, measurement of burn wound area, and investigation of macroscopic edema, hyperemia, and epithelialization. Histopathological evaluation included monitoring of epithelialization, vascularization, origination of granulation tissue, inflammatory cell response, and total histopathological score on days 7, 14, and 21 after burn creation. Macroscopic evaluation revealed more obvious epithelialization in group I lesions between days 6 and 15. The number of completely closed wounds was higher in group I than in group II on days 16 and 21. The average area of burn wounds was lower from day 5, hyperemia was less on days 2 to 17, and edema was less from day 4 to day 13 in group I lesions. Histopathological evaluation revealed a higher rate of epithelialization on day 7 and higher vascularization occurrence on day 21 in group I lesions. Linear polarized polychromatic light seems to be effective in the treatment of burn wounds and in the promotion of healing. This may be related to linear polarized polychromatic light stimulation of epithelialization and vascularization.

Chest wall hamartomas are extremely rare. Frequently mesenchymal hamartomas are presented as a single mass and contain some primitive mesenchymal elements such as chondroid and trabecular bone structures. A 60-year-old man presented to hospital with chest pain. Thirteen years earlier, his CXR and thoracic CT showed three masses on the right and two masses on the left, but he had not received any treatment thereafter. His CT showed the same masses present 13 years earlier, but they were bigger and right thoracotomy was undertaken. At thoracotomy, two sections of the mass in the right posterior mediastinum and one section of the mass in the right apex were excised. They had an occasional bloody appearance and contained small cystic areas, and some areas were extremely hard. Microscopic examination showed that the lesions consisted of mature adipose tissue, a large number of veins of different diameters and collagen tissue. Besides, primitive mesenchymal elements, lymphoid cell accumulations and trabecular bone structures were seen focally. Bilateral chest wall hamartomas are extremely rare and may be confused with malignancy.

Ionizing radiation is known to generate reactive oxygen species (ROS) that can be removed by antioxidants. L-carnitine, a natural component of mammalian tissue, is a necessary factor in the utilization of long-chain fatty acids to produce energy. Furthermore it has been shown that L-carnitine is an antioxidant which has a scavenger effect on ROS and a stabilizing effect on damaged cell membranes. The aim of the study was to evaluate the potential protective effect of L-carnitine on radiation-induced free radicals in hamsters. L-carnitine was given by gavage at a dose of 50 mg/kg for 15 consecutive days before irradiation with a single dose of 8 Gy. 24 h after radiation exposure, the hamsters were sacrificed and samples were taken from blood and tissues, and the biochemical and histopatological determinations were carried out. In the irradiated group, there were significant increases in plasma and liver malondialdehyde (MDA) with marked reduction in glutathione (GSH) levels in the liver, compared with controls. In red blood cells, superoxide dismutase (SOD) and catalase activities were also reduced. All these effects were reversed by L-carnitine. In conclusion, L-carnitine with its antioxidant and free radical scavenging properties could play a modulatory role against the cellular damage produced by free radicals induced by ionizing radiation.

L-carnitine is a quaternary amine that is essential for the normal oxidation of long-chain fatty acids by mitochondria. It is known that L-carnitine and its derivatives prevent the formation of reactive oxygen species, scavenge free radicals and protect cells from peroxidative stress. Oxygen-derived free radicals and lipid peroxidation products play a critical role in the pathogenesis of ethanol-induced gastric mucosal injury. The aim of the present study was to determine the effect of L-carnitine on lipid peroxidation induced by ethanol in the rat stomach. In our study, gastric mucosal injury was induced by the intragastric administration of 1 ml of absolute ethanol. Test compounds were given to rats by gavage 30 min before the ethanol administration. The animals were killed 60 min after the administration of ethanol. The stomach of each animal was removed. Mucosal damage was evaluated by macroscopic examination, histological analysis and by measurement of lipid peroxidation and glutathione activity. The intragastric administration of ethanol induced hyperemia and hemorrhagic erosions in the rat stomachs. L-carnitine significantly prevented gastric ulcerogenesis induced by ethanol and decreased the ulcer index. Plasma and gastric lipid peroxidation that was increased significantly by ethanol was decreased after treatment with L-carnitine. Ethanol treatment decreased significantly the gastric glutathione levels, and pretreatment with L-carnitine increased them significantly. Based on these data, the beneficial effects of L-carnitine on ethanol-induced gastric mucosal injury may be attributed to its antiperoxidative effects.

The thyroid gland is an endocrine organ composed of stable cells. It is well known that regenerative capacity of the thyroid tissue is minimal. Various degrees of morphologic alterations do occur in chronic lymphocytic thyroiditis (CLT), including Hashimoto's thyroiditis. Eighty-five CLT cases were analyzed for these morphologic alterations. Small, irregular, atrophic or hyperplastic thyroid follicles were seen adjacent to the lymphocytic infiltration. There was nuclear enlargement, loss of nuclear polarity in thyrocytes and intrafollicular thyrocyte proliferation in these follicles. We thought that the morphologic alterations in involved follicles could be due to regenerative hyperplasia with increased proliferative activity and basement membrane abnormalities. To examine this hypothesis we investigated Ki-67 and laminin immunoreactivity in the involved follicles adjacent to lymphocytic infiltration areas. The uninvolved follicles were used as controls. Immunopositivity of Ki-67 in involved follicles was significantly higher than that in uninvolved follicles (2.97% +/- 2.16 versus 0.83% +/- 1.63, P < 0.001). Laminin immunostaining indicated the destruction or irregular distribution of basement membrane in involved follicles. We conclude that the increased cell proliferation activity and basement membrane abnormalities in the follicles with morphologic changes adjacent to CLT occur in conjunction with regenerative hyperplasia.

OBJECTIVE(S):This experimental study investigates the dose-related effects of cyclophosphamide (Cy) on primordial follicular reserve in young mice, and examines whether the concomitant administration of a gonadotropin-releasing hormone agonist (GnRHa) may protect gonadal reserve, even at different doses of Cy.METHODS:Forty sexually mature virginal Balb/c mice aged five to six weeks were administered different doses (0, 50, 75,100 mg/kg) of Cy. Another 40 animals were treated with increasing doses (0, 50, 75, 100 mg/kg) of Cy in combination with GnRHa. GnRHa treatment was initiated one week prior to chemotherapy and also continued after chemotherapy for one week. The ovaries were removed seven days after Cy administration and the total number of primordial follicles in both ovaries was counted.RESULTS:Primordial follicular destruction occurred at all levels of Cy exposure. There was a positive correlation between increasing doses of Cy and higher proportion of follicular loss (p < 0.0001). GnRHa was not able to protect against the chemotherapy-induced negative effect on primordial follicular count at low doses (50 mg/kg and 75 mg/kg). Mean +/- SD primordial follicle count in the 100 mg/kg Cy-treated group was significantly lower than in the 100 mg/kg Cy + GnRHa treatment group (73.9 +/- 33.1 vs 89 +/- 17.9, p = 0.047).CONCLUSION:Our data suggest a possible ovarian protective effect of GnRHa cotreatment only at high doses of Cy treatment. However, in spite of co-administration of GnRHa, loss of primordial follicular reserve occurred at all doses of Cy in mice.

Lymphoepithelioma-like carcinoma (LELC) of the urinary bladder is very rare. It is mandatory to make differential diagnosis among lymphoma, chronic cystitis and LELC because of different therapeutic approach. A bladder tumor was found in a 90-year-old patient suffering from hematuria. After transurethral resection, undifferentiated tumor with prominent lymphoid infiltration was seen on light microscopy. Immunohistochemical examination demonstrated positive staining of tumor cells with cytokeratin (CK), epithelial membrane antigen and CK-20. We presented the case because of its rarity and related literature was reviewed.

Purpose: The aim of this study is to determine the cardioprotective efficacy of amifostine. The study consists of researching the relationship between plasma brain natriuretic peptide levels and the electrical and morphologic changes in irradiated rats with or without amifostine.Methods and Materials: Sixty Wistar albino rats were divided into 4 groups, and their hearts were given 15 Gy/fraction with Co-60. In Groups I and II, the rats were killed after 24 hours to detect early effects; in Groups III and IV, the rats were killed 100 days after irradiation to detect late effects. Before irradiation, Groups I and III received 0.9% saline solution, whereas Groups II and IV received amifostine (200 mg/kg). Twenty rats were used as a control group.Results: On the 100th day, mild myocardial degeneration was detected in 5 rats (33%) from Group III (no amifostine). This percentage was statistically different from that of Group IV (treated with amifostine) and the controls (p = 0.042). There was no statistically significant difference between the mean plasma brain natriuretic peptide values of the groups (p > 0.05). There was no significant difference in electrocardiographies between the groups. There was no correlation between continuous variables.Conclusion: In the amifostine group (IV) on the 100th day, there was no myocardial degeneration, suggesting that amifostine has a cardioprotective effect. (C) 2004 Elsevier Inc.

An experimental study was designed to assess the viability and revascularization of intramuscularly injected fat autografts. For the study, 18 rabbits were divided into two groups. In the first group, fat was injected intramuscularly (12 rabbits). Autologous fat was obtained from the inguinal area and subsequently injected into the thigh muscle. In the second group, physiologic saline was injected intramuscularly to determine the effects of cannulation and pressure on muscle tissue (6 rabbits). Fat autografts were performed on the right side of the animal, and the left side was used as the control. Scintigraphic imaging and histopathologic examination of the limbs were performed after injection of adipose tissue on days 15, 30, 45, 60, 90, and 120. On the technetium-99m ((99m)Tc) hexamethylpropylene amine oxime scintigraphy, whereas similar activity distribution was observed between the left and right thigh on days 15, 30, and 45, there was increased uptake at the right thigh on days 60, 90, and 120. This increased uptake indicates that there is viable fat tissue in this region. Histopathologic evaluation showed that microcysts resulting from degeneration of some adipocytes and inflammatory changes on day 15 additionally increased vascularity and fibrosis in some animals on day 30, as well as fibrosis, microcysties, and focal calcification areas in adipose tissue on day 45 and later. It was observed that adipose tissue survived in more than 50% of the graft area in all the animals. These findings show that fat autografts can survive in muscle tissue with less than 50% fibrotic change.

Purpose : The aim of this study was to evaluate the relationship between 201 Tl tumor uptake, chemotherapeutic response, metastasis, p53 status and survival in non-small cell lung cancer (NSCLC). Methods : A total of 23 patients underwent 201 Tl SPECT. In 9 patients, 2nd 201 Tl SPECT study were performed 1 week after the 3rd cycle of chemotherapy (ChT), and early (ER) and delayed (DR) tumor/normal lung ratios and retention indices (RI) were obtained. In 15 patients p53 status was assayed with immuno-histochemical staining. The patients were divided into subgroups after the 3rd cycle of ChT; responders [R(+) (n=10)] and non-responders [R(−) (n=13)], distant metastasis [(M 1 ) n=11] and [(M 0 ) n=12], and mutant p53 status [p(+) n=7, p53(−) n=8]. Results : The differences for ER, DR and RI values between all of the subgroups were not statistically significant. ER and DR of responders decreased significantly after ChT; from to 2.46 to 1.36 (p=0.04) and 2.29 to 1.53 (p=0.04), respectively. In the non-responder group, both ER and DR slightly increased after ChT (p>0.05). Conclusion : Our results suggest that in NSCLC, there was a weak correlation between higher 201 Tl ratios and positive response to chemotherapy, absence of distant metastasis, and p53(−) status. Significant 201 Tl uptake decrease after chemotherapy indicates that delayed 201 Tl uptake can be used in evaluating the chemotherapeutic response.

OBJECTIVES:Progression of the cell cycle is regulated by the interactions of cyclins, cyclin dependent kinases (CDKs) and CDK inhibitors (CDKIs). p27 is a member of the universal cyclin-dependent kinase inhibitor family. The level of p27 protein expression decreases during tumor development and progression in some epithelial, lymphoid and endocrine tissues. It has been suggested that p27 is an independent prognostic factor in various human cancers. The prognostic value of p27 protein expression is not completely understood in bladder cancer yet.AIMS:To investigate the immunohistochemical expression of p27 in transitional cell bladder cancers and its relationship with clinicopathological data, proliferating cell nuclear antigen (PCNA) and p53 oncoprotein immunoreactivity.METHODS:The expression of p27 protein was immunohistochemically analyzed in paraffin-embedded specimens of 75 patients with transitional cell carcinoma of the bladder. p27 expression was compared with tumor grade, stage, growth pattern, disease-free survival, progression, PCNA and p53 immunoreactivity.RESULTS:Expression of p27 was not significantly related to clinicopathologic parameters, disease-free survival, progression, PCNA and p53 immunoreactivity.CONCLUSION:The results indicate that p27 is not a good predictor for outcome of transitional cell carcinoma of the bladder.