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Author: search.filters.author.Ekemen, Suheyla

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    Does it take three to tango? An unsuspected multimorbidity of CD8(+) T cell lymphoproliferative disorder, malaria, and EBV infection
    (BMC, 2018-01-01) Ekemen, Suheyla; Uzay, Ant; Bassullu, Nuray; Dikicioglu-Cetin, Emel; Matsuda, Kyoko; Ince, Umit; Coban, Cevayir
    Background: Malaria is known to cause acute and deadly complications. However, malaria can cause unforeseen pathologies due to its chronicity. It increases the risk of endemic Burkitt Lymphoma development by inducing DNA damage in germinal centre (GC) B cells, and leading higher frequency of Epstein-Barr virus (EBV)-infected cells in GCs. EBV is well known for its tropism for B cells. However, less is known about EBV's interaction with T cells and its association with T cell lymphoma. Case presentation: A 43-year-old Sudanese male admitted to hospital in Istanbul, Turkey, a non-endemic country, with hyperpigmented painful skin rashes on his whole body. A complete blood count and a peripheral blood smear during admission revealed large granular lymphocytes (LGLs) with abnormally higher CD8 T cell numbers. Additional skin biopsy and pathology results were compatible with CD8(+) T cell lymphoproliferative disorder with skin involvement. Patient was treated and discharged. However, a pathologist noticed unusual structures in skin tissue samples. Careful evaluation of skin biopsy samples by polarized microscopy revealed birefringent crystalloid structures resembling malarial haemozoin mainly loaded in macrophages and giant histiocytes. After purification of DNA from the skin biopsy samples, nested PCR was performed for the detection of Plasmodium parasites and Plasmodium falciparum DNA was amplified. Because, the co-presence of EBV infection with malaria is a well-known aetiology of lymphoma, EBV-early RNA (EBER) transcripts were investigated in paraffin-embedded tissue samples and found to be positive in macrophage-like histiocytes. Conclusions: This is a unique case of malaria and EBV infection in a T-LGL lymphoma patient who presented in a non-endemic country. This case emphasizes the clinical importance of EBV monitoring in T-LGL patients with skin involvement. Notably, Plasmodium infection should be examined in patients from malaria endemic regions by pathological and molecular investigations.
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    An Extremely Rare Case of Back and Hip Pain due to the Metastasis of Late Recurrent Myxopapillary Ependymoma to the Inguinal Lymph Node
    (KOREAN SOC PATHOLOGISTS, 2018-01-01) Ekemen, Suheyla; Yapicier, Ozlem; Boler, Hatice Deniz; Ince, Umit
    Myxopapillary ependymomas (ME) are rare and slowly growing gliomas usually with spinal cord localization originating from the ectopic ependymal residues. They are commonly located in the conus medullaris, cauda equina and filum terminale. ME is known to be more aggressive in childhood, but has a good prognosis in adults with a very low metastasis risk.(1,2) If successfully excised, ME are usually cured completely. However, in adults, ME at the sacrococcygeal region metastasizing to organs outside central nervous system has rarely been reported so far.(3-5) Herein, we report an extremely rare case of an inguinal lymph node metastasis developed 19 years after removal of primary ME at the sacrococcygeal region, which presented with unusually severe back and hip pain. Because the metastasis of ME to the lymph node after such a long time is rare, our case may contribute to improving the differential diagnosis of extremely rare metastatic ME cases and identifying their unexpected role in the pain of unknown origin.