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    Mine Hekimgil

    Ege University, Pathology, Faculty Member
    It is a rare phenomenon to detect the second malignancy in the course of malignant disease. The risk of secondary malignancy in CLL patients is significantly higher than normal population. Also, CLL can be detected as secondary malignancy... more
    It is a rare phenomenon to detect the second malignancy in the course of malignant disease. The risk of secondary malignancy in CLL patients is significantly higher than normal population. Also, CLL can be detected as secondary malignancy in the course of other ...
    Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct lymphoma with specific clinical and pathological features that occurs in diverse anatomic locations. We conducted this retrospective study... more
    Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct lymphoma with specific clinical and pathological features that occurs in diverse anatomic locations. We conducted this retrospective study to demonstrate our experience in patients with MALT lymphomas and compare our results with the literature. We studied 23 patients with histologically confirmed diagnosis of MALT lymphomas (12 with gastric, 11 with non-gastric localization) treated during the past 13 years. The female/male ratio of patients was 15/8 with a median age at presentation of 56 years (range 27-88 years). 16 patients (70%) with stage I and II, 7 patients (30%) with stage III and IV were admitted. At presentation 93% of patients had good performance status (ECOG<2) and 5 (22%) had B-symptoms. There was no difference between gastric and non-gastric MALT lymphomas when compared with sex, age, ECOG performance status, stage of the disease. Patients were treated with differen...
    Langerhans cell histiocytosis syndromes have been described as encompassing a range of disorders, such as eosinophilic granuloma, Letterer-Siwe syndrome and Hand-Schüller-Christian disease. These disorders have been mainly diagnosed at... more
    Langerhans cell histiocytosis syndromes have been described as encompassing a range of disorders, such as eosinophilic granuloma, Letterer-Siwe syndrome and Hand-Schüller-Christian disease. These disorders have been mainly diagnosed at early ages of life and are relatively rare entities in adult age groups. In this study, we aimed to retrospectively evaluate the patients with Langerhans cell histiocytosis followed-up in our hospital. Seven patients were treated between 1995 and 2005. Median age of patients was 27.5 (18-40) years. Main complaints were classified as bone pain in multiple sites (100%), polydipsia (28%), lung infiltration (14%), oral mucosal infiltration (14%), and cranial nerve infiltration (14%). Two patients were diagnosed as Hand-Schüller-Christian disease, and the others were accepted as eosinophilic granuloma. There was no bone marrow or any other organ infiltration except lung infiltration in one patient. Bone infiltration was the prominent sign in all patients w...
    To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At day 30 (Group 1, n=6) and day 60... more
    To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At day 30 (Group 1, n=6) and day 60 (Group 2, n=7) after operation, the testes were removed for histopathological examination. The controls (n=8) were sham operated and were sacrificed at day 60. Germ cell apoptosis was assessed by means of the TUNEL method. Spermatogenesis was arrested and the testicular and seminiferous tubular diameters were significantly reduced In the unilateral undescended testes (UUTs) compared with the contralateral descended testes (CDTs) and the control rats. However, atrophic changes, pathological calcification, necrosis of seminiferous tubule, and absence or sloughing of germ cells were not found in all the animals. The spermatocytes were the main type of germ cells undergoing apoptosis in all the groups. In the UUTs, there was a significant and time-dependent increase in the mean apoptotic index. By 60 days after surgery, increased apoptosis in germ cells was also observed in the CDTs. Apoptosis is the predominant mechanism of germ cell death rather than atrophy and necrosis in cryptorchidism.
    ABSTRACT Increased cyclooxygenase-2 (COX-2) expression has been associated with poor prognosis in multiple myeloma (MM).
    Relation between Epstein-Barr virus (EBV) and nasopharyngeal carsinoma,... more
    Relation between Epstein-Barr virus (EBV) and nasopharyngeal carsinoma, Burkitt's lymphoma, and lymphomas in immunosupressed patients have been shown previously in different studies. The same relationship was also shown in Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) by some researchers. The aim of this study was to demonstrate EBV nucleic acids in tissue sections of adult patients with lymphoma. The presence of EBV encoded RNA (EBER) were investigated with in situ hybridization and EBV-DNA with PCR method in 29 formalin-fixed paraffin-embedded tissue sections (19 lymph nodes, the others being gastric, orbital, skin, salivary gland, testicle, small intestinal, tongue root, bone marrow and gingival tissues) of 8 patients with HL and 21 patients with NHL who were followed-up in Haematology Clinics of our university hospital. EBER and EBV-DNA positivity rates were found as follows respectively; 50% (n: 4) and 37.5% (n: 3) of 8 HL patients, and 23.8% (n: 5) and 47.6% (n: 10) of 21 NHL patients. In total evaluation EBER and/or EBV-DNA were positive in 5 of 8 (62.5%) HL, and 12 of 21 (57.1%) NHL tissue sections. There was no significant difference in EBER and EBV-DNA positivity between HL and NHL groups. As a result, our study emphasize a possible EBV related aetiology in HL and NHL.
    Ocular adnexal lymphoma (OAL) is a rare manifestation of non-Hodgkin lymphoma consisting of the tissues and structures surrounding the eye that include the conjunctiva, eyelids, lacrimal gland, and orbital soft tissues. OAL comprise 1% to... more
    Ocular adnexal lymphoma (OAL) is a rare manifestation of non-Hodgkin lymphoma consisting of the tissues and structures surrounding the eye that include the conjunctiva, eyelids, lacrimal gland, and orbital soft tissues. OAL comprise 1% to 2% of all non-Hodgkin lymphomas and about 8% of the extranodal lymphomas; however, the incidence of OAL has increased by approximately 6% annually in last 2 decades, and OAL now represents the majority of orbital malignancies. There are no uniform treatment guidelines for OAL. Because of high local and extraorbital recurrence rates, appropriate local, systemic, or combined treatment must be applied.
    Relation between Epstein-Barr virus (EBV) and nasopharyngeal carsinoma, Burkitt's lymphoma, and lymphomas in immunosupressed patients have been shown previously in different studies. The same relationship was also shown in Hodgkin... more
    Relation between Epstein-Barr virus (EBV) and nasopharyngeal carsinoma, Burkitt's lymphoma, and lymphomas in immunosupressed patients have been shown previously in different studies. The same relationship was also shown in Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) by some researchers. The aim of this study was to demonstrate EBV nucleic acids in tissue sections of adult patients with lymphoma. The presence of EBV encoded RNA (EBER) were investigated with in situ hybridization and EBV-DNA with PCR method in 29 formalin-fixed paraffin-embedded tissue sections (19 lymph nodes, the others being gastric, orbital, skin, salivary gland, testicle, small intestinal, tongue root, bone marrow and gingival tissues) of 8 patients with HL and 21 patients with NHL who were followed-up in Haematology Clinics of our university hospital. EBER and EBV-DNA positivity rates were found as follows respectively; 50% (n: 4) and 37.5% (n: 3) of 8 HL patients, and 23.8% (n: 5) and 47.6% (n: 10)...
    To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At day 30 (Group 1, n=6) and day 60... more
    To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At day 30 (Group 1, n=6) and day 60 (Group 2, n=7) after operation, the testes were removed for histopathological examination. The controls (n=8) were sham operated and were sacrificed at day 60. Germ cell apoptosis was assessed by means of the TUNEL method. Spermatogenesis was arrested and the testicular and seminiferous tubular diameters were significantly reduced In the unilateral undescended testes (UUTs) compared with the contralateral descended testes (CDTs) and the control rats. However, atrophic changes, pathological calcification, necrosis of seminiferous tubule, and absence or sloughing of germ cells were not found in all the animals. The spermatocytes were the main type of germ cells undergoing apoptosis in all the groups. In the UUTs, there was a significant and time-depend...
    Multiple myeloma (MM) is a malignant disease resulting from an uncontrolled proliferation of a neoplastic plasma cell clone in the bone marrow, which might also be induced by the loss of control on apoptosis. Fas ligand (Fas-L), a member... more
    Multiple myeloma (MM) is a malignant disease resulting from an uncontrolled proliferation of a neoplastic plasma cell clone in the bone marrow, which might also be induced by the loss of control on apoptosis. Fas ligand (Fas-L), a member of the tumor necrosis factor family, induces apoptosis mediated via its transmembrane death receptor Fas (Apo-1/CD95) antigen. In the present study, immunostaining was performed on the initial diagnostic bone marrow biopsies of 36 MM patients (1 stage I, 5 stage II, 30 stage III), to evaluate the distribution of Fas receptor and Fas-L on malignant plasma cells. Both Fas and Fas-L were positive in 13 cases and negative in 3, whereas 10 cases were Fas-negative, Fas-L-positive and 10 were Fas-positive, Fas-L-negative. Although no association was found between the expression of Fas receptor or Fas-L and overall survival, Fas-L positivity was significantly associated with a shorter event-free survival (p = 0.0335). In this study, it has been shown that the expression of Fas-L, in malignant plasma cells of myeloma patients significantly shortens the event-free survival, indicating that the defect in apoptosis might be associated with disease progression in MM.
    Interferon-γ receptor-1 (IFNγR1) deficiency is caused by mutations in the IFNγR1 gene and is characterized mainly by susceptibility to mycobacterial disease. Herein, we report an 8-month-old boy with complete recessive IFNγR1 deficiency,... more
    Interferon-γ receptor-1 (IFNγR1) deficiency is caused by mutations in the IFNγR1 gene and is characterized mainly by susceptibility to mycobacterial disease. Herein, we report an 8-month-old boy with complete recessive IFNγR1 deficiency, afflicted by recurrent mycobacterial diseases with Mycobacterium bovis, Mycobacterium tuberculosis, Mycobacterium avium intracellulare and Mycobacterium fortuitum. Genetic analysis showed a homozygous mutation (106insT) in the IFNγR1 gene leading to complete IFNγR1 deficiency. In addition, he had atypical mycobacterial skin lesions caused by M. avium intracellulare and developed scrotal and lower limb lymphedema secondary to compression of large and fixed inguinal lymphadenopathies. Hematopoietic stem cell transplantation was performed from a matched unrelated donor at 5 years of age; however, he died at 9 months post-transplant. To our knowledge, the patient is the first case with IL-12/IFN-γ pathway defect and severe lymphedema. We have also revie...
    ... Türkiye Klinikleri Dermatoloji Dergisi; İLGEN ERTAM,IŞIL KILINÇ KARAARSLAN,MİNE HEKİMGİL,H. EZGİ ERÇAL,TANER AKALIN,İDİL ÜNAL; Yazışma Adresi/Correspondence: Dr. İlgen ERTAM Ege Üniversitesi Tıp Fakültesi, Dermatoloji AD, İZMİR; ÖZET:... more
    ... Türkiye Klinikleri Dermatoloji Dergisi; İLGEN ERTAM,IŞIL KILINÇ KARAARSLAN,MİNE HEKİMGİL,H. EZGİ ERÇAL,TANER AKALIN,İDİL ÜNAL; Yazışma Adresi/Correspondence: Dr. İlgen ERTAM Ege Üniversitesi Tıp Fakültesi, Dermatoloji AD, İZMİR; ÖZET: ...
    ... 2854–2858. View Record in Scopus | Cited By in Scopus (64). [4] R. Osman and JW Morrow, Reticulum cell sarcoma with primary manifestation in the testicle: three case reports, J Urol 102 (1969), pp. 230–232. View Record in Scopus |... more
    ... 2854–2858. View Record in Scopus | Cited By in Scopus (64). [4] R. Osman and JW Morrow, Reticulum cell sarcoma with primary manifestation in the testicle: three case reports, J Urol 102 (1969), pp. 230–232. View Record in Scopus | Cited By in Scopus (2). ...
    ... Sait Şen*, Mine Hekimgil*, Soner Duman**, Ercan Ok**, Mehmet Özkahya**, Aysın Zeytinoğlu***, Cüneyt Hoşcoşkun**** ... Hücreler kıvrımlı veya büklümlü nükleer kontürlü,ince kromatinli dar sitoplazmalı lenfoid hücre görünümdeydi. ...
    In the course of investigating 30 monoclonal antibodies (MAbs) for their potential reactivity with 25 lung tumors of different histologic types, we found that three MAbs commonly used for their specificities for lymphoid markers were... more
    In the course of investigating 30 monoclonal antibodies (MAbs) for their potential reactivity with 25 lung tumors of different histologic types, we found that three MAbs commonly used for their specificities for lymphoid markers were highly reactive with non-small-cell carcinomas (NSCLC) and totally nonreactive with small-cell carcinomas (SCLC). Immunostaining was performed by the standard streptavidin-biotin-peroxidase method after microwave antigen retrieval on formalin-fixed, paraffin-embedded tissue sections. LN2 (CD74), LN3 (HLA-DR), and BLA-36, which are commonly used for the identification of B-lymphocytes, strongly immunostained 19 of 25 squamous and adenocarcinomas and none of 34 small-cell carcinomas and carcinoids. Moreover, in combined tumors, these MAbs selectively stained the adenocarcinoma cells but not the adjacent small-cell carcinoma cells. A cocktail mixture of LN2, LN3, and BLA-36 assayed on 24 additional lung tumors produced similar results with even stronger and sharper stainings. Other lymphoid MAbs showed some selective staining but to a lesser degree. Among nonlymphoid MAbs, the results were as expected, with MAbs for cytokeratin (B72.3) and epithelial membrane antigen staining NSCLC but also some SCLC. The MAbs for chromogranin and neuron-specific enolase were not entirely specific, whereas some nerve-cell adhesion molecule MAbs showed good specificity for SCLC. In a field with few specific MAbs, the newly discovered ability of these lymphoid MAbs to discriminate between SCLC and NSCLC may prove useful in the immunohistochemical diagnosis of lung tumors.
    In the 2008 WHO lymphoma classification,... more
    In the 2008 WHO lymphoma classification, 'EBV-positive diffuse large B cell lymphoma (DLBCL) of the elderly is included as a new provisional entity. We aimed to evaluate the morphological, immunophenotypic, and clinical characteristics of the cases diagnosed as 'EBV-positive DLBCL of the elderly' in our center and compared them with the 'EBV-negative DLBCL' patients older than 50 years of age. EBV status was detected by Epstein-Barr early RNA (EBER) in situ hybridization analysis. By immunohistochemistry, a panel of antibodies for CD10, Bcl-2, Bcl-6, IRF4/MUM1, CD30, and Ki67 was performed. Out of 149 DLBCL patients older than 50 years, without any known history of immunodeficiency or prior lymphoma, eight patients who fulfill the criteria were re-evaluated. Five patients were male and three were female, with a median age of 67.6 years. Four patients presented with nodal involvement; others presented with bone and soft tissue, bone marrow, and spleen infiltrations. Five cases revealed predominantly monomorphic morphology, one also contained focal areas consistent with polymorphous subtype; and three patients revealed a polymorphous infiltrate. When classified according to 'Hans criteria', five were non-GCB, and three were of the GCB cell phenotype. All cases with polymorphous morphology were revealed to be of the non-GCB cell phenotype, and all expressed IRF4/MUM1. Two patients died with disease, four patients are alive and in complete remission following R-CHOP therapy, and two patients have just recently been diagnosed. When compared with the EBV-negative group, there are no reliable morphological and immunohistochemical features indicating EBV positivity. Therefore, EBER in situ hybridization analysis is necessary to identify 'EBV-positive DLBCL of the elderly'. Further studies are needed to fully understand the details of this disease, which can lead to new treatment modalities.
    Periodontal disease is one of the major oral problems encountered in patients with diabetes mellitus (DM). Vascular changes, neutrophil dysfunction, altered collagen synthesis, and genetic predisposition observed in DM may contribute to... more
    Periodontal disease is one of the major oral problems encountered in patients with diabetes mellitus (DM). Vascular changes, neutrophil dysfunction, altered collagen synthesis, and genetic predisposition observed in DM may contribute to periodontitis; and the vascular alterations observed in such patients may depend on vascular endothelial growth factor (VEGF) actions. Few reports are available about the mechanism of neovascularization and the angiogenic factors that contribute to the periodontal pathology and the role of VEGF in periodontal diseases. The aim of this study is to compare VEGF expression in healthy and periodontally diseased tissues with gingival crevice fluid (GCF) of healthy persons and diabetic patients. Gingival tissue and GCF samples were collected from sites of periodontitis in 10 healthy subjects and in 10 type 2 diabetic patients, and from the sites of healthy gingiva within the same groups. Therefore, each patient became his/her own control. Additionally, 10 people without any systemic or periodontal diseases were enrolled, forming a negative control group. Thus, a total of 50 tissue and 50 GCF samples were provided. No VEGF staining was observed in the negative control group or in the systemically healthy people's healthy tissue samples, whereas four samples of diabetic patients showed positive staining (P < 0.05). However, VEGF was revealed in two tissue samples of periodontal sites of systemically healthy people and in six samples of the diabetic patients (P > 0.05). In all test groups, GCF VEGF levels were higher in periodontal sites (P < 0.05) than in healthy sites. The results of this study showed that VEGF is increased in all periodontal tissues of both groups and in the healthy sites of diabetic patients. Additionally, GCF VEGF values increased in periodontal sites of all test groups.
    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... more
    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 lymphocytosis. 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 t...
    Tumor stage, histological pattern, cell type, diameter and cell ploidy are the factor that have been proposed for predicting the prognosis of renal cell carcinoma (RCC). There is a wide variation in the reported incidence of p53 mutation... more
    Tumor stage, histological pattern, cell type, diameter and cell ploidy are the factor that have been proposed for predicting the prognosis of renal cell carcinoma (RCC). There is a wide variation in the reported incidence of p53 mutation in RCC, and its prognostic significance for this tumor is unknown. We investigated the prognostic value of p53 mutations among other prognostic factors. We evaluated the stages, tumor diameters, histological grades, cellular patterns and the presence of mutant p53 protein in 50 cases of RCC. The survival function of each parameter was estimated by Kaplan-Meier and log-rank tests, and the significance of each parameter on survival was evaluated by logistic regression analysis. The p53 mutation incidence was 20% in the RCC cases included in the study (n = 50). The survival rates of stages pT(2), pT(3) and pT(2-3)N+ were 87.8, 61.0 and 0%, respectively (p = 0.0462). The survival analysis of grade 1-2 and grade 3-4 tumors revealed 92.3 and 51.5% surviva...
    A 31-year-old man with pneumonia and ampiema was treated with antibiotics and drainage. Hemophagocytic syndrome, characterized with pancytopenia was arised during this treatment. Nosocomial infection due to pancytopenia was treated with... more
    A 31-year-old man with pneumonia and ampiema was treated with antibiotics and drainage. Hemophagocytic syndrome, characterized with pancytopenia was arised during this treatment. Nosocomial infection due to pancytopenia was treated with antibiotics. Hemophagocytic syndrome was recovered spontaneously after the treatment of this nosocomial infection. Such a severe hemophagocytic syndrome due to infection is a rare condition.
    Chronic myelogenous leukemia (CML) is a clonal stem cell disorder characterized by clonal expansion of hematopoietic stem cells possessing a reciprocal translocation between chromosome 9 and 22. The disease is characterized by the... more
    Chronic myelogenous leukemia (CML) is a clonal stem cell disorder characterized by clonal expansion of hematopoietic stem cells possessing a reciprocal translocation between chromosome 9 and 22. The disease is characterized by the inevitable transition from the chronic phase to the accelerated phase and to blast crisis [1]. Allogeneic bone marrow transplantation or allogeneic peripheral blood stem cell transplantation is

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