Background:Subacute granulomatous thyroiditis (SGT) is an inflammatory disease that presents with different clinical and cytological characteristics. Although the diagnosis is generally made clinically, imaging methods and fine-needle aspiration (FNA) may provide assistance, particularly in atypical cases. The objective of this study is to reveal the ultrasonographic (USG) and cytological characteristics of SGT.Materials and Methods:The clinical, USG and cytological findings of 21 cases diagnosed with SGT were reviewed.Results:Ultrasonographic data was available in 20 cases. A hypoechoic thyroid nodule with irregular margins was detected in 12 of the 20 total cases. Of these, 9 cases complained about pain in the thyroid lodge and generally had unilateral lesions, heterogeneous and hypoechoic areas with indistinct margins, rather than nodular lesions, which were seen in 7 cases. Cytologically, the multinuclear giant cells (MNGCs) found in all cases were accompanied by a dirty background containing varying numbers of granulomatous structures, including isolated epithelioid histiocytes, proliferated/regenerated follicle epithelium cells and inflammatory cells and colloid.Conclusion:Though hypoechoic and heterogeneous areas with irregular margins are strongly associated with thyroiditis, SGT may also appear as painful or painless hypoechoic, solid nodules and generate challenges in differential diagnosis. Although the most remarkable characteristic observed in FNA cytology was the presence of multiple MNGCs with cytoplasm, a dirty background accompanied by mild-moderate cellularity, degenerated-proliferated follicular epithelium cells, rare epithelioid granulomas and mixed type inflammatory cells are characteristic for SGT. The assessment of these radiological and cytological findings in conjunction with clinical findings will assist in the achievement of an accurate diagnosis.

Angioleiomyoma of the scrotum is a rare benign lesion which can mimic a paratesticular tumor. Any solid mass within the scrotum is considered malignant until proven otherwise. Here, we present a case of an angioleiomyoma of the scrotum in a 33-year-old male who presented with painful scrotal mass. Scrotal ultrasonography demonstrated a solid mass in the scrotum, and surgical excision was carried out. Pathologic examination revealed that the tumor was angioleiomyoma.

Cystinosis is an autosomal recessive lysosomal storage disease. We present 2 siblings in whom cystinosis was detected by CD68 immunohistochemical analysis of bone marrow biopsies. The older patient was a 6-year-old boy who had been receiving erythrocyte suspension therapy for 5.5 years because of low hemoglobin levels. The patient was admitted to our hospital because of hepatomegaly, anemia, and thrombocytopenia and underwent a trephine bone marrow biopsy based on a preliminary diagnosis of lipid storage disease. Macrophage-like cells were observed in the hematoxylin/eosin-stained sections. These cells were stained for CD68 to confirm that they were macrophages. Some crystalline structures were seen in the cytoplasm of the macrophages after CD68 staining. These structures were thought to be cystine crystals. The diagnosis of cystinosis was confirmed by a clinical assessment. The 1-year-old sibling of the patient was also examined; this sibling exhibited renal disease and had a family history of consanguineous marriage. Cystinosis was also detected in this sibling by clinical assessment and staining of the patient's trephine bone marrow biopsy for CD68. The staining of the bone marrow biopsies for CD68 enabled the patient and his sibling to be diagnosed with cystinosis; these patients were not correctly diagnosed over the previous 6-year period. No similar report was found in the literature regarding this topic.

Ovarian malignant melanomas are extremely rare tumors. Most of them are secondary tumors and disseminated metastases are recognized at the time of diagnosis. Primary tumors are even more rare and usually associated with a teratoma. A 67-year-old female had a pelvic mass that was recognized on ultrasonography (USG) and physical examination. Intraoperative pathological consultation was reported as "pigmented solid ovarian tumor, probably compatible with malignant melanoma". Paraffin sections, and histochemical (Masson Fontana and Prussia blue) and immunohistochemical examination (S-100 and HMB-45) were also consistent with "malignant melanoma". This case was accepted as "Probably primary ovarian malignant melanoma" in lack of any other tumor focus on detailed clinical and radiological investigation, skin biopsies or pigmented lesions in medical history. It is reported for being an extremely rare tumor and its distinctive characteristics for differential diagnosis are emphasized.Key Words: Malignant melanoma, Ovary, Histopathology ÖZOverin malign melanomları son derece nadirdir. Çoğunluğu metastazlardan oluşmakta ve tanı sırasında yaygın tümör varlığı görülmektedir. Primer malign melanom olgularının çok daha nadir olduğu ve çoğunlukla teratom zemininde geliştiği rapor edilmiştir. Ultrasonografi (USG) ve fizik inceleme ile "pelvik kitle" tanısı konularak opere edilen 67 yaşındaki kadın hastada frozen inceleme sırasında "Pigmente solid over tümörü (Büyük olasılıkla malign melanom)" olarak değerlendirilmiştir. Parafin kesitlerde, histokimyasal (Masson Fontana ve Prusya mavisi) ve immünohisto-kimyasal (S-100, HMB45) inceleme sonucunda "malign melanom" olarak rapor edilmiştir. Hastanın daha önce geçirilmiş biyopsi ve melanom öyküsü olmaması, ayrıntılı fizik inceleme ve sistemlerin değerlendirilmesinde başka odak saptanmaması, tümörün tek taraflı olması nedeniyle "Overin olası primer malign melanomu" olarak kabul edilmiştir. Tümörün son derece nadir görülmesi ve ayırıcı tanıda dikkat edilmesi gereken özelliklerin vurgulanması amacıyla sunulmaktadır.

Skuamöz ya da glandüler farklılaşma göstermeyen KHDAK biyopsilerinde ayırıcı tanı için günlük uygulamada kullandığımız İHK antikorların tekli ve ikili boyama yöntemleri ile elde edilen etkinlikleri karşılaştırılmış ve ikili antikor boyamasıyla daha az doku kullanarak gerekirse uygulanacak moleküler testler için doku tasarrufunu sağlamanın mümkün olup olmadığı değerlendirilmiştir. Gereç ve Yöntem: KHDAK tanılı 40 az diferansiye olgu ve kontrol grubu olarak 8 iyi diferansiye olgu çalışma kapsamına alındı. Tüm az diferansiye olgular İHK olarak TTF-1, p63, CK7 ve CK5/6 antikorları ile tekli ve ikili boyama yöntemleriyle boyanarak değerlendirildi. İyi diferansiye olgular ise eş zamanlı olarak ikili boyama yöntemi ile boyandı. Bulgular: Bu antikor paneli ile tekli boyama yöntemi ile olguların %87,5'inde, ikili boyama yöntemi ile olguların ancak %70'inde alt tiplendirme yapılabildi. Ayrıca tekli boyamalar temel alındığında ikili boyama yönteminde çekirdek antikorları (TTF-1, p63) ile yalancı negatiflik oranları, sitoplazmik antikorlar (CK7, CK5/6) ile yalancı pozitiflik oranları yüksek bulundu. İkili boyama ve tekli boyama yöntemleri sonucunda elde edilen tanılar karşılaştırıldığında 14 olguda (%35) tanı değişikliği olduğu izlendi. Sonuç: Çok sayıda antikor kullanımı, tümörlü doku miktarı, laboratuvar kaynaklarının yeterliliği ve moleküler çalışmalar için doku gereksinimine bağlı olarak pratik ve mümkün olmayabilir. İkili veya çoklu boyamalarla doku ve işlem tasarrufu yapılması bakımından bu çalışmada uygulanan yöntemle elde edilen sonuçlar yüz güldürücü değildir. Bizim değerlendirmemiz, tekli antikor işlemlerinde elde edilen sonuçlara göre karşılaştırması yapılmadan uygulamaya konulacak çoklu antikor kullanımının güvenirliğinin tartışmalı olacağını göstermektedir.