Pediatrik Kasık Fıtığı Keselerinde Kompartmana Özgü BCL- 2 İmmünoekspresyonu ve Klinik İlişkileri: Tek Merkezli, Retrospektif, Analitik ve Kesitsel Bir Çalışma

Öz

Amaç: Gonadal inişi sırasında oluşan peritoneal divertikülün persistan açıklığı, pediatrik indirekt inguinal fıtığın temelini oluşturur. Bu süreçte düz kas persistansı ve yetersiz programlı hücre ölümünün rol oynadığı öne sürüldüğünden, hernia kesesinin beş kompartmanında B-hücreli lenfoma 2 (BCL-2) immünekspresyonunu
karakterize ettik ve demografik ile laboratuvar korelasyonlarını değerlendirdik.
Gereç ve Yöntemler: Bu tek merkezli, retrospektif kesitsel çalışmaya, 1 Ocak 2021 ile 21 Kasım 2024 arasında önceden belirlenmiş uygunluk kriterlerini karşılayan tüm pediatrik hastalar dahil edildi. BCL-2 boyanması epitelyal, stromal, müsküler, vasküler ve nöral kompartmanlarda ayrı ayrı derecelendirildi. Kompartmana özgü pozitiflik, Cochran Q testi ve ikili McNemar testleriyle karşılaştırıldı. Cinsiyet, yaş, lateralite ve preoperatif laboratuvar parametreleriyle ilişkiler; kesin testler, Mann-Whitney U testi ve yaş-cinsiyet düzeltmeli Firth penalize lojistik regresyon kullanılarak değerlendirildi; çokluk için Holm veya Benjamini-Hochberg düzeltmesi uygulandı.
Bulgular:  Uygun 155 olgunun (128 erkek, 27 kız) tümü analiz edildi. En az bir kompartmanda BCL-2 pozitifliği 37 olguda (%23,9) saptandı; en sık müsküler (%12,3) ve stromal (%11,0) kompartmanlarda görüldü, epitelyal, vasküler ve nöral kompartmanlarda nadirdi (Cochran Q[4]=43,636, p<0,001). Kız cinsiyet, herhangi bir kompartman pozitifliği (düzeltilmiş olasılık oranı [aOO]=3,24, %95 güven aralığı (GA) 1,34-7,79; Holm-düzeltmeli p=0,019) ve stromal pozitiflikle (aOO=5,38, %95 GA 1,88-15,36; Holm-düzeltmeli p=0,006) daha yüksek olasılıkla ilişkiliydi; müsküler pozitiflikle ilişkili değildi. Düzeltme sonrası hiçbir laboratuvar parametresi anlamlılığını korumadı.
Sonuç: Pediatrik hernia kesesinde BCL-2 immünekspresyonu nadir, çoğunlukla düşük yoğunlukta ve başlıca müsküler ile stromal kompartmanlarla sınırlıydı. Kız cinsiyetin stromal ve genel pozitiflikle ilişkisi hipotez üretici niteliktedir ve az sayıdaki kız olgu (n=27) nedeniyle temkinli yorumlanmalıdır; rutin laboratuvar parametreleri güçlü bağımsız ilişki göstermedi.
 

Anahtar Kelimeler

• Apoptoz
• BCL-2
• İmmünohistokimya
• Kasık Fıtığı
• Pediatri
• Processus Vaginalis

Destekleyen Kurum

Bu çalışma herhangi bir dış finansman almamıştır; araştırma ile ilgili masraflar araştırmacılar tarafından karşılanmıştır.

Etik Beyan

The study was approved by the Ordu University Non-Interventional Clinical Research Ethics Committee (presidency dated 06.12.2024 and numbered 17/201).

Teşekkür

Yoktur.

COMPARTMENT-SPECIFIC BCL-2 IMMUNOEXPRESSION AND ITS CLINICAL CORRELATES IN PEDIATRIC INGUINAL HERNIA SACS: A SINGLE-CENTER RETROSPECTIVE ANALYTICAL CROSS-SECTIONAL STUDY

Öz

Objective: Persistent patency of the peritoneal diverticulum that forms during gonadal descent underlies pediatric indirect inguinal hernia. Because persistence of smooth muscle and inadequate programmed cell death have been implicated in this process, we characterized B-cell lymphoma 2 (BCL-2) immunoexpression across five hernia-sac compartments and evaluated its demographic and laboratory correlates.
Material and Methods: This single-center retrospective cross-sectional study included all pediatric patients meeting prespecified eligibility criteria between January 1, 2021, and November 21, 2024. BCL-2 staining was graded separately in epithelial, stromal, muscular, vascular, and neural compartments. Compartment-specific positivity was compared using Cochran's Q test and pairwise McNemar tests. Associations with sex, age, laterality, and preoperative laboratory parameters were evaluated using exact tests, Mann-Whitney U tests, and age- and sex-adjusted Firth penalized logistic regression, with Holm or Benjamini-Hochberg adjustment for multiplicity
Results: Among 155 eligible cases (128 boys, 27 girls), BCL-2 positivity in at least one compartment was detected in 37 cases (23.9%), most frequently in muscular (12.3%) and stromal (11.0%) compartments, and rarely in epithelial, vascular, and neural compartments (Cochran's Q[4]=43.636, p<0.001). Female sex was associated with higher odds of independently associated with any-compartment positivity (adjusted odds ratio [aOR]=3.24, 95% CI 1.34–7.79; Holm-adjusted p=0.019) and stromal positivity (aOR=5.38, 95% CI 1.88–15.36; Holm-adjusted  p=0.006), but not muscular positivity. No laboratory parameter remained significant after adjustment.
Conclusion: BCL-2 immunoexpression in pediatric hernia sacs was uncommon, predominantly low-intensity, and localized mainly to muscular and stromal compartments. The association of female sex with stromal and any-compartment positivity is hypothesis-generating and warrants cautious interpretation given the small number of female cases (n=27); routine laboratory parameters showed no robust independent associations

Anahtar Kelimeler

• Apoptosis
• BCL-2
• Immunohistochemistry
• Inguinal Hernia
• Pediatrics
• Processus Vaginalis

Destekleyen Kurum

This study received no external funding; research-related costs were covered by the investigators.

Etik Beyan

The study was approved by the Ordu University Non-Interventional Clinical Research Ethics Committee (presidency dated 06.12.2024 and numbered 17/201).

Teşekkür

None.

Kaynakça

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