Iranian Journal of Pathology

Online ISSN: 1735-5303
Publications
Article
Background: In cancers of prostate, breast, oropharynx, lung, hypopharynx and skin, human tissue kallikreins has been demonstrated as a main role in these problems. There are many research works in which some human tissue kallikreins are expressed in salivary glands. In the present study, the main goal was to determine expression of human tissue kallikreins 4, 8, 10, 11 and 13 in pleomorphic adenomas and mucoepidermoid carcinomas. Methods: Sixty-six specimens (45 cases of pleomorphic adenomas and 21 cases mucoepidermoid carcinomas) were selected for final analysis by immunohistochemistry. For doing association test, clinical parameters obtained from the patients' medical charts, which included age, gender were used and the nonparametric tests employed for statistical analyses. Results: The expression of human kallikreins 4, 8, 11 and 13 was more prominent in benign and malignant tumors compared to that in normal tissues and the difference was significant. In addition, the expression of human kallikreins 4, 8, 10 and 11 in malignant tumors was more than that in benign tumors, with statistically significant differences. Conclusion: The differences in the levels of human kallikreins 4, 8, 11 and 13 suggest that kallikreins may benefit in determining tumor behavior of salivary gland tumors.
 
Irregularly thick walled hyalinized blood vessels are noted. (Hematoxylin and Eosin, 400X) 
There is perivascular cuff which is a consequence of prominent perivascular meningothelial cell proliferation. (Hematoxylin and Eosin, 400X) 
Calcified blood vessels are seen in the periphery of the lesion (Hematoxylin and Eosin, 400X) 
Article
Meningioangiomatosis is regarded as a rare benign hamartomatous condition mostly involving the cerebral cortex and overlying leptomeninges. A strong association of MA with neurofibromatosis type 2 has been documented in published articles. Herein we report a case of an otherwise healthy 13-year-old boy with no family history or stigmata of neurofibromatosis who presented with intractable seizures. MRI revealed a 2×2 cm mass lesion in the frontal lobe. The patient underwent complete surgical resection of the lesion. Although the primary radiologic impression of the lesion was glioma, pathological evaluation of the resected specimen showed mainly proliferation of meningothelial cells and fibroblast-like cells with many thickened blood vessels, which are typical for diagnosis of meningioangiomatosis. After surgical removal of the lesion, the patient is free of seizures.
 
Photomicrograph showing Langerhans' histiocytes with nuclear grooves (Arrow) with eosinophils and a neutrophil. Inset shows a multinucleated histiocyte ( MGG stain; × 400 magnification)
Article
Eosinophilic granuloma is benign end of the spectrum of the Langerhans cell histiocytosis (LCH) which is characterized by solitary or multiple lesions in bones, skin, lung, lymph node etc. Here, we present a case of a 13-year old boy with pain and swelling in the right parietal region of skull with no other complaint. A computerized tomography (CT) scan and subsequent fine needle aspiration cytology (FNAC) revealed solitary eosinophilic granuloma which was subsequently confirmed by histopathology. Minimally invasive procedures like imaging and FNAC usually suffice for diagnosing and following up of patients with this rare disease.
 
(a,b,c):MRI image revealing an intraabdominal_ heterogenous, solid as well as cystic mass arising from left ovary 
(a): Bosselated external surface of ovarian tumor. (b): Cut surface shows solid grey white, variegated and cystic appearance at places 
(3a): Photomicrograph showing immature epithelial elements arranged in nests and glands. (H&E; x100). (3b): Photomicrograph showing immature mesenchymal elements. (H&E; x100).(3c): Photomicrograph showing immature mesenchymal elements with attempted cartilage formation and areas of necrosis. (H&E; x100).(3d): Photomicrograph showing sheets of tumor cells with large polygonal nuclei and prominent nucleoli; (Embryonal component) (H&E; x400) 
4a: Photomicrograph revealing cells forming sheets and poorly formed glands. Nuclei are pleomorphic and show prominent nucleoli; (Embryonal component) (H&E; x400). (4b): Photomicrograph of embryonal component revealing positive immunostaining for CD30 (x400), (Dako, 1:100). (4c): Photomicrograph of embryonal component revealing positive immunostaining for PLAP (x400), (Dako, 1:100). (4d):Photomicrograph of embryonal component revealing negative immunostaining for CD117 (x400), (Dako, 1:100) 
Article
Malignant mixed germ cell tumors,though rare overall, are the most common type of malignant ovarian neoplasms in young and adolescent girls. These tumors are rapidly growing and can metastasize. We report a case of 13-yr-old girl who presented at SHKM GMC, Nalhar, Mewat, Haryana, India in December 2013 with huge abdominal lump of a malignant mixed germ cell tumor comprising both immature teratoma and embryonal carcinoma. This report illustrates the aggressiveness of this tumor and emphasises the need of early diagnosis and treatment.
 
Article
Background & Objective: Cervical cancer is the second most common cancer in the world among women. Human papilloma virus (HPV) plays a major role in its development. The aim of this study was to determine the frequency of HPV type 16 and 18 in cervical discharge by polymerase chain reaction (PCR) method in women with atypical biopsy or Pap smear. Materials and Methods: This case- control study was performed on women in Yahyanejad Hospital, Babol University of Medical Sciences, Babol, Iran during 2008-2009. Sixty women with normal Pap smear (group1) and 30 with atypical Pap smear or biopsy (group 2) were enrolled in the study and their cervical discharge was assessed for HPV type 16 and 18. Data were analyzed with SPSS, Chi-Square, Fisher's Exact test and t-test and P<0.05 was considered significant. Results: HPV type 16 was found in 10% women of group 2 but not seen in group1. HPV 18 was not detected. All women had one partner and none of them had alcohol consumption. Conclusion: In comparison with other studies, the frequency of HPV infection was lower in our study. We considered this is strongly related to our culture and religious beliefs.
 
Article
Background: This research was accomplished to evaluate the IHC expression of p16 (ink4a) and CK17 in low grade cervical intraepithelial lesions (LSIL), high grade cervical intraepithelial lesions (HSIL) and invasive cervical carcinomas and to assess their correlation to HPV (16E6+18E6). Methods: The study included (127) formalin-fixed paraffin-embedded cervical biopsies; of which 22 cases were chronic cervicitis, 24 cases were LSIL, 28 cases were HSIL and 53 cases were invasive cervical carcinomas. Sections were immunohistochemically stained for p16 (ink4a), CK17 and HPV (16E6+18E6). Results: The study established a highly significant increase in IHC of expression of p16 (ink4a), CK17 and HPV (16E6+18E6) from LSIL through HSIL to invasive carcinomas (P-value˂0.001). There was non-significant association between IHC expression of all makers with age of patients; types, grade and stage of cervical carcinomas (P-value˃0.05). HPV (16E6+18E6) revealed a significantly positive correlation with p16 (ink4a) (P-value˂0.05) and a non- significant correlation with CK17 (P-value˃0.05); in LSIL, HSIL and invasive carcinoma cases. Conclusion: p16 (ink4a) expression directly reflects infection with high risk HPV in cervical lesions and can add a significant diagnostic accuracy in the evaluation of CIN. CK 17 is a good marker of malignant transformation, with increasing in its expression according to the severity of cervical lesions; however, it is not related to HPV infection. Both markers are not related to prognostic variables of patients with cervical carcinoma.
 
The presence of TA systems detection by PCR in Brucella. Lanes 1-6 respectively contains: 50 bp DNA ladder, 1: positive control 16S rRNA gene (134 bp), 2: negative control, 3: RelE (208 bp), 4: Fic (111bp), 5: Brn T (106 bp) ,6: CogT (122 bp).
Article
Background & objective: Persister cells are defined as a subpopulation of bacteria that are capable of reducing their metabolism and switching to dormancy in stress conditions. Persister cells formation has been attributed to numerous mechanisms, including stringent response and Toxin-Antitoxin (TA) systems. This study aimed to investigate the hypothetical role of TA systems in persister cells formation of Brucella strains by evaluating toxins of type II TA systems (RelE, Fic, BrnT, cogT) expression. Methods: Brucella strains treated with a lethal dose of gentamicin and ampicillin and to determine the number of surviving cells, bacterial colonies were counted at different time intervals. The role of TA systems in persister cell formation was then determined by toxin expression levels using qRT- PCR method. Results: Our results showed the viability of persister cells after 7 h. The results of relative qRT- PCR showed higher levels of toxin gene expression due to stress conditions, suggesting the possible role of TA systems in persister cells formation and antibiotics tolerance. Conclusion: The results of this study showed that considering the importance of persistence and the tolerance to antibiotics, further studies on persister cells formation and related genes such as the TA system genes in Brucella strains might help us to identify the precise mechanisms leading to persister cells formation.
 
The primer sequences used in this study 
Antibiotic susceptibility testing results 
Article
Background & objective Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important nosocomial pathogen which is associated with significant morbidity and mortality, particularly in high-risk populations. Aminoglycoside-modifying enzymes (AMEs) and 16S ribosomal RNA (16S rRNA) methylation are two important mechanisms of resistance to aminoglycosides. The aim of this study was to determine the prevalence of 16S rRNA methylase (armA, rmtA, rmtB, rmtC, and rmtD), and the AME genes [aac(6′)-Ib, aac(3)-I, ant(3′′)-I, aph(3′)-I and aac(6')-Id], among clinical isolates of A. baumannii in Tehran, Iran. Methods Between November 2015 to July 2016, a total of 110 clinical strains of A. baumannii were isolated from patients in two teaching hospitals in Tehran, Iran. Antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standards Institute guidelines. The presence of genes encoding the AMEs and 16S rRNA methylases responsible for resistance was investigated by multiplex polymerase chain reaction. Results The results showed that colistin was an effective antibiotic and could be used as a last-resort treatment of infections caused by MDR-AB. The resistance rate to aminoglycosides were 100%, 96.36% and 90.9% for tobramycin, gentamicin and amikacin, respectively. In this study, AME genes of aac(6′)-Ib, aac(3)-I and ant(3′′)-I were most prevalent among the isolated strains. Conclusion Markedly high resistance to tobramycin, gentamicin and amikacin was noted in current study. Our results suggested that modifying enzyme genes in conjunction with methylation of 16S rRNA might contribute to aminoglycoside resistance induced in vivo in A. baumannii. Further studies are required to determine the prevalence of the aminoglycoside resistance genes in other hospitals of Iran.
 
Article
Background & Objective: The presence of E. coli in fish intended for human consumption may constitute a potential danger, not only on causing disease, but also because of the possible transfer of antibiotic resistance from aquatic bacteria to those infecting humans. The objective of this study was to develop an improved PCR method based on species - specific 16 S rRNA gene primers (FES, RES) for detection of E. coli from agar plates and fish tissues. Materials and Methods: For the rapid detection of E. coli from fish, a set of primers (FES, RES), targeting 16S rRNA gene sequences of the specific microorganism was designed, and fifty two rainbow trout were obtained. Then 1mL of bacterial concentration of 10 6 CFU/ml was injected into intraperitoneal cavity. Samples were collected from liver and kidney after 48h injection. The PCR reaction conditions were optimized to permit detection of organism from agar plates and fish tissue in a day. Results: All tissue samples were positive for microbiological and PCR identification. DNA was successfully extracted by a boiled - extraction method or by phenol - chloroform - isoamyl alcohol. The BLAST analysis from sequencing of 4 amplicons randomly selected showed similar results, with the match being E.coli with a 100% similarity. Conclusion: This method is fast, specific and sensitive to detect E. coli in infected and asymptomatic animals, fish product, and may have a positive impact on public and environmental health.
 
(a) Right ovarian tumor which is mainly cystic and partly solid at the periphery. (b) Left ovarian tumor which is partly solid and partly cystic; Both cystic walls are lined by old hemorrhagic areas. 
H & E stain (a) Clear cell carcinoma with papillary configuration lined by pleomorphic hobnail cells (X200); (b) Clear cell carcinoma showed large cells with clear abundant cytoplasm and some of the cytoplasm of the cell containing eosinophilic hyaline bodies (X400); (c) Foci of endometriosis in close proximity with clear cell carcinoma of right ovary (X100). 
Article
Clear cell carcinoma of ovary is uncommon ovarian tumour that arises from surface epithelium of ovary. It has well-known association with ovarian endometriosis. We report here the first case of bilateral clear cell carcinoma of ovaries in a 40-year-old woman with a 17-year history of bilateral ovarian endometriosis. In addition, during the longstanding duration of the endometriosis, the patient was treated with hormonal therapy, including oestrogen. It represents the first report of such bilateral involvement in the background of ovarian endometriosis. This should prompt clinicians to be aware that prolonged hormonal treatment of endometriosis may precipitate bilateral malignancy of the ovary.
 
Gene fold expression differences in groups without axillary lymph node invasion and groups with axillary lymph node invasion
Article
Background & objective: Recent studies from gene profiling have revealed some genes that are overexpressed in the epithelial-mesenchymal transition (EMT) process and are responsible for its initiation and activation resulting in tumor progression and metastasis. The present study aimed to assess the role of genes involved in the EMT process and the association of these genes with axillary lymph node and vascular invasion in breast cancer (BC) patients. Methods: In this case-control study, the tumor samples were initially extracted from 33 BC patients. The samples of 15 BC tissues without vascular and axillary invasion were also prepared from the biobank as a control group. RNAs from both tumor and control samples were extracted and stabilized. For assessing overexpression in tumor tissues of selected 18 genes, the real time technique was employed. Results: There was a significant increase in MMP-2 gene fold expression in tumor cells with vascular invasion regardless of axillary involvement compared to the control group (P=0.0008) and also in the comparison of the control group with those with vascular invasion and not axillary lymph node involvement (P=0.003). In addition, gene fold expression of tissue inhibitors of metalloproteinase-1(TIMP-1) was decreased in axillary involving tumor cells compared to control group (P=0.045), and also in comparison with all samples that did not present any axillary lymph node involvements including the control group and the group with isolated vascular invasion (P=0.012). Conclusion: Overexpression of MMP-2 and under-expression of TIMP-1 were associated with more invasive behavior in breast tumor cells.
 
Clinical characteristics of patients with different graft function
Article
Background: Delayed graft function is a main complication after deceased donor kidney transplantation that adversely affects graft outcome. Difficulties in prediction and early detection of delayed graft function have hindered the ability to perform proper therapeutic interventions. We investigated whether measuring urinary interleukin 18 and neutrophil gelatinase-associated lipocalin as markers of ischemia reperfusion injury could predict delayed graft function in deceased donor kidney transplant patients. Methods: We studied 69 patients undergoing kidney transplantation from deceased donor during early October 2013 to December 2014 at the Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Serial urine samples at 2, 24, and 48 h after transplantation were analyzed for interleukin 18 and neutrophil gelatinase-associated lipocalin levels. Results: Thirteen patients (18.9%) developed delayed graft function. Urine interleukin 18 to urine creatinine ratio was significantly higher in patients with delayed graft function compared to those with non-delayed graft function, at 2 (P=0.003), 24 (P
 
Article
Background: Automatic Cell Counter devises make the CBC differential very easy and delivering the results in few second. However, the problem with this device is facing a flag requires a time-consuming microscopic review of the specimen which causes unacceptable wait times for patient as well as costs for laboratories. In this study, we calculated the validity of WBC diff flags in Sysmex XT-1800i. In addition, we verified the correlation between manual and automated samples. Methods: Overall, 1095 flagged samples were selected in the period of 6 weeks (Imam Hospital complex, Tehran Iran, 2014). The results of both automated and manual counting of the samples were carefully studied and compared. Totally, 624 NRBC flags, 450 Blast flags, 155 abnormal WBC Scatter gram flags, 140 Eosinophilia flags and 468 Monocytosis flags were identified. Results: Considering NRBC and blast flags there was a significant difference between our manual counted and automated counted NRBCs and blasts (P<0.05). There was no significant difference between automated and manual counting of flags for WBC Scatter gram. A significant difference between automated and manual counting data in flags, eosinophilia and monocytosis was foun (P<0.05). Conclusion: We propose the NRBC flags to be ignored and report negative except for the neonatal ward, and the Blasts flags to be ignored and report negative in all the cases. The WBC Scatter gram should be report positive. For eosinophilia and monocytosis flags, we propose, the Sysmex results should be considered correct and the manual checking would not be necessary.
 
Article
Background & objective: Pathology education conventional methods have been disrupted by the Corona-Virus Disease 2019 (COVID-19) outbreak, compelling a re-evaluation of the means of educational interactions from the undergraduate to the postgraduate level. This commentary explores how the COVID-19 outbreak has challenged pathology education. Methods: We reviewed the current challenges and determined the potential implications of virtual technologies on modern pathology education for the future of pathology competency learning and assessment. Results & conclusion: The challenges are partly due to transferring from in-person teaching to a virtual education. Other reasons are shifting away from discipline-based teaching to organ-system based in medical curriculum and additional pressures on pathology faculties, such as increased demand for pathology services, lack of time, and learning resources. Keeping the national standards in pathology education even in the constant disruptions from pandemic outbreaks are current challenges. Pathology expertise will need to use emergent technologies in providing educational material to ensure quality pathology education. However, virtualization of pathology education produces a value of digital pathology and web-based pathology training materials. Medical students could review clinical cases remotely with their supervisors and gain the pathology competencies necessary for clinical practice. We need new innovative strategies, and we suggested the following steps to take advantage of the current opportunity to meet the challenges: evaluating the available digital training materials for formal pathology education, investing in the virtual infrastructure for competency-based pathology education, expanding student/residents exposure to pathology educational cases through virtual platforms; applying digital pathology solutions for virtual pathology education.
 
Article
Background & objective: COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) has been a reference test for diagnosing a disease since the very beginning of the pandemic. COVID-19 serology tests have also been developed and used to estimate the prevalence of individuals who have already been infected. We aimed to evaluate the performance of serology tests for the diagnosis of patients who had been referred to medical centers with acute symptoms. Methods: In this cross-sectional study, 80 individuals suspected of COVID-19 who had been referred to Imam Khomeini Hospital Complex, Tehran, Iran, were examined. Upper respiratory tract specimens for RT-PCR and blood samples for COVID-19 IgM and IgG antibody level tests were collected and the results were compared. Results: The overall proportion in agreement, the agreement between positive results, and the agreement between negative results when comparing RT-PCR and IgM serology test were 40% (kappa = -0.006, P = 0.9), 32%, and 66.6%, respectively, and when comparing RT-PCR and IgG serology test were 46% (kappa = -0.006, P = 0.94), 43.5%, and 55.5%, respectively. Conclusion: The absence of a gold standard method for the diagnosis of COVID-19 makes it very challenging to determine the true sensitivity and specificity of different methods. The study results revealed no agreement between the two methods; so the RT-PCR test for upper respiratory tract specimen cannot be replaced with COVID-19 serology test for the diagnosis of patients with acute symptoms.
 
Article
Coronaviruses are considered to be one of the most significant human and animal pathogens. In late 2019, a new species of coronavirus was recognized as the cause of some pneumonia cases in Wuhan, China. The disease spread rapidly and made an epidemic in China and subsequently in almost all countries in the world. In February 2020, the World Health Organization (WHO) named it as COVID-19 standing for Coronavirus 2019 (1). Due to being a pandemic issue, it is needed to discuss various aspects of this viral disease. Recently, Yan Zhang et al. reported a case of coagulopathy and antiphospholipid antibodies in the patient with severe COVID-19 infection (2). Thus, one of the serious complications of COVID-19 that should be taken into consideration is coagulopathy with possible anti-phospholipid antibodies syndrome in these patients. In this regard, some studies also claimed that COVID-19 could cause venous and arterial thromboembolism because of excessive inflammation, hypoxia, immobility, and diffuse intravascular coagulation (3). Antiphospholipid syndrome is a systemic autoimmune disease with vascular and hematologic complications as venous and arterial thrombosis or pregnancy morbidity (4). It is well known that infectious agents are one of the major stimulators of the antiphospholipid antibodies in vivo (5), thus, COVID-19 can be a possible cause of this phenomenon within its infection period and consequently, positive results of antiphospholipid antibodies detection are not unexpected.
 
Chief complaint of the patients suspected for COVID-19
Nasopharyngeal and oropharyngeal swabs collected for the diagnosis of COVID-19 using rRT-PCR by the lab technician and patients
Comparative results of novel coronavirus detected in lab technician-and patient-collected naso-and oropharyngeal swabs
Article
Background & objective: A simple approach to prevent close contact in healthcare settings during the COVID-19 outbreak is to train patients to collect their own nasopharyngeal and oropharyngeal swabs and deliver them to medical laboratories to have them processed. The aim of our study was to compare lab technician- with patient- collected oropharyngeal and nasopharyngeal samples for detection of the coronavirus disease 2019 (COVID 19) using rapid real-time polymerase chain reaction (rRT-PCR). Methods: Fifty adult patients with flu-like symptoms and radiologic findings compatible with atypical pneumonia who were admitted to the infectious diseases ward of Imam Khomeini Hospital Complex, Tehran, Iran, with a clinical diagnosis of COVID-19 from February 28 to April 27 of 2020 were randomly selected and entered in our study. Two sets of naso- and oropharyngeal swabs were collected, one set by a lab technician and the other by the patients, and the COVID-19 rRT-PCR test was performed. Results: Of 50 selected cases, in seven patients all collected naso- and oropharyngeal swabs tested positive, and in 22 patients all samples tested negative for COVID-19 in rRT-PCR. Discrepancies between rRT-PCR results of lab technician- and patient-collected swabs were observed in 12 nasopharyngeal and 13 oropharyngeal specimens. Positive lab technician-collected and negative patient-collected samples were observed in 10 and 5 nasopharyngeal and oropharyngeal specimens, respectively. Negative lab technician-collected and positive patient-collected samples were observed in two and seven nasopharyngeal and oropharyngeal specimens, respectively. The overall percentage of agreement among both nasopharyngeal and oropharyngeal swabs taken by a lab technician and patients was 76% with a kappa value of 0.49 (P=0.001). Conclusion: Based on our findings, lab technician-collected naso- and oropharyngeal swabs cannot be replaced by patient-collected ones with regard to COVID-19 rRT-PCR.
 
Article
Background & Objectives: Tumor diathesis (TD) is defined as granular proteinaceous precipitates on slide surface of cytologic smears. It is found in the background of smears of invasive carcinoma but not in all cases. The aim of present study was to determine the prevalence of TD in cervicovaginal smears from patients with uterine cervix carcinoma. Methods: Cytological smears and histological slides from the Department of Pathology, Women Hospital, Tehran, Iran, of forty six patients histologically confirmed carcinoma of uterine cervix from 1995 to 2003 were reviewed for presence of TD, red blood cells, and neutrophils on cytological smears as well as depth of invasion, histologic types and grade of differentiation of tumor. Results: TD was detected in 28 of the 46 smears (60.9%); in 18 patients with squamous cell carcinoma (62.1%), 7 adenocarcinoma (58.3%), 2 adenosquamous carcinoma (66.7%) and one endometrial carcinoma which involved uterine cervix. TD was seen in 4 (33.3%) uterine cervix carcinoma with 5mm depth of invasion and 17 (65.4%) uterine cervix carcinoma with ≥ 5mm depth of invasion. There was a positive correlation between the presence of TD and the depth of invasion. Although an important criterion of malignancy, TD, was absent in some cases of carcinoma, particularly those that had < 5mm depth of invasion. Conclusion: Increasing in depth of invasion and decreasing in differentiation of the tumor were associated with increasing in frequency of TD in cytological smears. A definite distinction between an intraepithelial lesion and a shallow invasive cancer may not be possible on cervicovaginal smears.
 
Article
Background: Nowadays, the immune response to hepatitis C (HCV) treatment has become a crucial issue mostly due to the interleukin 28B (IL-28B) polymorphism effects in chronic HCV patients. The aim of this study was to detect the polymorphism of IL-28B gene (rs12979860) in HCV genotype 1 patients treated with pegylated Interferon and Ribavirin. Methods: From the 2010 to 2012, a total of 115 peripheral blood mononuclear cells (PBMCs) of HCV patients who presented to Gastrointestinal & Liver Disease Research Center (GILDRC), Firoozgar Hospital, Tehran, Iran were enrolled in this retrospective cross sectional study. Samples were then categorized based on the presence of sustained virologic response (SVR and no-SVR). Variables including age, gender, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels of the two groups were investigated based on different IL-28B genotypes. Results: Analysis by the variables of age and gender showed a mean age ± SD of 42.1±14.0 and gender variability of 44 females (38.2%) and 71 males (61.8%). Adding up these results, the analysis of ALT levels revealed that there was between 293 and 14 mg/ml; AST levels ranged between 217 and 17 mg/ml; the viral load (HCV RNA) ranged between 7,822,000 and 50 IU/ml; the prevalence of CC, CT and TT genotypes were 90.9%, 54% and 25.0%. Conclusion: IL-28B polymorphism has an effective impact on the therapeutic response to ribavirin and peginterferon combination therapy in chronic HCV patients infected by different genotypes. This polymorphism is crucial in natural clearance.
 
Antibiotic Resistance Patterns of Different Bacteria 
Article
Background & Objective Neonatal sepsis is one of the leading causes of mortality in neonatology wards. The aim of this study was to assess sepsis pathogens and antibacterial resistance patterns in a teaching hospital during seven years in Tehran, Iran. Methods In this retrospective study, all neonates suspected to sepsis and fulfilling the sepsis criteria admitted to NICU ward of Mustafa Khomeini Hospital, Tehran, Iran during 2007 to 2014 were included. Demographic information, blood test results, blood culture results of neonates and antibiogram findings were extracted from their documents. Data was analyzed using SPSS 15. Results Ninety neonates with positive culture test were included. Fifty-three were male (58.9%). Thirty neonates were delivered vaginally (33.3%) and 60 caesarean section (66.7%). Most bacterial growths in culture were Staphylococcus aureus and E. coli. The rates of resistance for antibiotics like ceftriaxone, cefotaxim and gentamycin were 5%, 30% and 15%, correspondingly. There were 15 cases (16.7%) with resistance to imipenem. Conclusion Antibacterial resistance patterns vary in different parts of the world and even within a country, therefore assessing resistance patterns in a region is of great importance for proper management and treatment. Our findings might help physicians for proper selection of antibiotics for treatment of neonatal sepsis.
 
-Demographic Characteristics of the Patients 
-The Relationship between Grade of the Tumors and Their Location 
Article
Background and Objectives Gliomas are the most prevalent subgroup of primary brain tumors with a relatively high mortality. However, oligodendrogliomas have a better prognosis compared to other subtypes due to their sensitivity to chemotherapy. Considering the low incidence and the resulting lack of information about oligodendrogliomas, particularly in Iran, this study aimed at assessing their basic characteristics. Methods In this descriptive retrospective study, patients with definite diagnosis of oligodendroglioma were identified by reviewing the archives of pathology reports at the department of pathology of Shohada-e Tajrish Hospital during years 2008 to 2014. Age, gender, location, and the grade of the tumor were extracted and entered to the SPSS statistical software for analysis. Results A total of 182 patients, including 115 males (63.2%) and 67 females (36.8%), were included with a mean age of 38.5±13.36 years. Frontal lobe was involved in 53 patients (29.1%), parietal lobe in 31 (17.0%), temporal lobe in 22 (12.1%), frontoparietal area in 15 (8.2%), parieto-occipital area in 11 (6.0%), temporoparietal and frontotemporal areas each in 9 subjects (4.9%), occipital lobe in 5 (2.7%), and the brainstem in 4 (2.2%). Furthermore, 108 cases (59.3%) had grade-2 and the remaining74 patients (40.7%) had grade-3 anaplastic oligodendrogliomas. The mean age of subjects with brainstem oligodendrogliomas was significantly lower than the other patients (p=0.025). Conclusion Oligodendrogliomas commonly effects the frontal lobe, followed by the parietal and temporal lobes. The mean age of subjects with brainstem lesions was significantly lower than other patients. Age, gender or location of the tumor did not independently predict a higher grade lesion.
 
a) A case of IDC with intermediate Ki 67:15-20% be for neoadjuvant chemotherapy. b) High Ki 67 >30% be for neoadjuvant chemotherapy c) Low Ki 67 <15 % after neoadjuvant chemotherapy 
Article
Background and objective Breast cancer is the most common malignancy among women. The Neoadjuvant chemotherapy is the treatment of choice for non-operable tumors. The Ki67 is a proliferation marker that can be used to predict the therapeutic response to chemotherapy and the patients' prognosis. Methods This retrospective study was carried out on 55 consecutive patients with breast cancer referred to a Training Tertiary Healthcare Center in Kerman, Iran since 2009 to 2014. After diagnostic approval, the tissue samples of patients were examined for estrogen and progesterone receptors, ki67 and HER2-neu markers by using immunohistochemical staining. Then the patients were treated with 6 cycles of Neoadjuvant chemotherapy regimens by Doxorubicin and Taxans or 4 chemotherapy cycles, containing Anthracycline and Cyclophosphamide and 4 cycles of Paclitaxel. After mastectomy, their samples were reexamined for ki67 again and classified into three groups (low: ki67<15%), medium (Ki67 = 16-30%) and high (Ki67> 30%). Results Before chemotherapy, 54.5% of the patients had high expression of Ki67. But after chemotherapy, 52.7 of the patients had complete therapeutic response showing that the Ki67 level was reduced significantly (P=0.003). Conclusion Before and after Neoadjuvant chemotherapy, Ki67 measurements may be used as a predictive marker of therapeutic response.
 
Article
Background: Cryptosporidium is known as an opportunist disease-causing agent in man in recent decades. It causes diarrhea and intestinal disorders in the immune deficit and immune competent individuals. This study was aimed to investigate the clinical characteristics of HIV/AIDS patients with cryptosporidiosis infection. Methods: This cross-sectional descriptive study was performed on 53 HIV/AIDS patients referred to the Behavior Disease Consultation Center of Imam Khomeini Hospital in Tehran, Iran in 2013. First, the patients were studied clinically and the context data were recorded in a questionnaire for parasitological examination and referred to the laboratory for eosinophil count, and CD4 count per ml of blood. Results: Cryptosporidiosis was observed in 4 (7.6%) of the total 53 HIV/AIDS patients. The highest prevalence of infection was observed in the age range of 30-39 yr. It was observed in different sexes as 5.7% of male and 1.9% of female, but statistically was insignificant (P=0.163).75% of patients had no intestinal symptom, 11.4% with acute diarrhea and 3.8% with chronic diarrhea. Cryptosporidiosis cases were observed in 5.7% of patients without intestinal symptom. Conclusion: Practitioners in the clinical examination for the detection of the opportunistic intestinal protozoan infection should use clinical and paraclinical characteristics of the HIV/AIDS patients for the diagnostic of Cryptosporidium and other opportunistic parasitic diseases.
 
Probe sequences used in ISH experiments
Mir-21 significant overexpression in Wilms' tumor in 4 samples compared to the normal kidney tissues (P-value=0.0021)
Article
Background and Objective Wilms’ tumor (WT) is the most common genitourinary tract tumor in children. MicroRNAs (miRNAs) are small non-coding RNAs; their role in the pathogenesis of many types of human cancers has been identified. We aimed to evaluate the expression of miR-21, a well-known oncomir, in WT tissue samples which is a very common urinary tract malignancy in children. Methods We performed chromogenic in situ hybridization (CISH) to detect the sub-cellular localization of miR-21 in 25 formalin-fixed, paraffin-embedded (FFPE) samples of WT. We also evaluated miR-21 expression in 24 of these blocks and 6 normal kidneys as controls using quantitative real-time PCR technique. Results While our real-time PCR analysis showed miR-21 significant overexpression in 4 tumors compared to the normal kidney samples, we could not detect significant ISH signal in any of these samples. Conclusion Low expression of miR-21 in WT might pinpoint the weak involvement of this miRNA in the pathogenesis of this cancer.
 
Agarose gel electrophoresis of PCR products. A: amplification of fragment of β-globin: M: 100 bp DNA marker, lanes 1-7: positive samples, lanes 8-10: negative samples, lane 11; positive control, lane 12; Negative control. B: amplification of fragment of EBV EBNA-1 gene: M: 100 bp DNA marker, lanes 1-7: positive samples, lane 8: positive control, lane 9: negative control.
Patients' pathological-related parameters
Article
Background & objective: The role of Epstein-Barr Virus in development of breast cancer is frequently studied. In this regard, miRNAs are among the contributing elements in the molecular pathophysiology of EBV-related diseases. In addition, a growing number of host miRNAs are believed to be implicated in pathogenesis of breast cancer. MiR-218 is a tumor suppressive miRNA that is subjected to dysregulation in various EBV-associated cancers. We aimed to investigate the frequency of EBV and its relationship with expression status of tumor suppressive miR-218 in breast cancer and adjacent normal tissue. Methods: A total number of 51 fresh malignant breast cancer tissues (cases) and their adjacent normal tissues (controls) were collected. Nested-PCR and RT-qPCR were set to identify EBV frequency and miR-218 expression in cases and controls, respectively. Results: Out of all samples, 6.8% (7/102) comprising 11.6% (6/51) in malignant tissues and 1.9% (1/51) in normal control tissues were positive for EBV (P<0.05). Quantitative data showed that miR-218 was significantly downregulated in malignant tissues compared to control tissues (P<0.0001). In addition, reduced expression of miR-218 was associated with adverse clinical outcomes, metastasis, and higher grades of malignancy. Given the presence of EBV, lower expression of miR-218 was observed in breast cancer group in comparison with normal group (P<0.05). Conclusion: Our results raise the possibility of the relation between EBV infection and miR-218 downregulation in breast cancer and propose further investigations in this regard.
 
Peripheral Blood Findings 
Article
Background & objective Introduction: First detection of any solid tumour as metastatic deposits in bone marrow directs clinicians to start searching for the primary tumour. Detection of bone marrow metastasis determines the stage of the malignancy, prognosis, mode of treatment, chemotherapeutic response and follow-up in case of relapse. The aim of the current study was to analyse the clinico-haematological presentation and morphological pattern of infiltration of solid tumours detected first as metastatic deposits on bone marrow examination. Methods Three-year retrospective analysis of MGG-stained bone marrow aspiration smears and touch imprints of the bone marrow biopsy and Hematoxylin and Eosin (H&E) stained histopathological sections of biopsies was performed at the Department of Pathology at a tertiary care institute (January 2014 to December 2016). The morphological pattern of metastatic deposits and haematological profiles of the patients were analysed. Exclusion criterion was the presence of hematolymphoid malignancies. Results In 22 cases, bone marrow was the first site of detection of metastasis. The age of the patients ranged from 3 years and 10 months to 82 years, with equal gender predilection. Overall, 16 cases had cytopenias, 9 cases each had leucocytosis and leukoerythroblastic presentation. The metastasis was from Ewing’s sarcoma, prostate carcinoma, gastric adenocarcinoma invasive duct carcinoma breast, gallbladder carcinoma, lacrimal duct carcinoma and invasive papillary urothelial carcinoma. Conclusions Bone marrow examination is a cheap and reliable investigation to detect metastasis in an unsuspecting case. Bilateral trephine biopsies are recommended to increase the efficacy of detecting bone marrow metastasis.
 
Primers Sequences and PCR Conditions in the Current Study
Gel electrophoresis of multiplex PCR products of bla OXA-23 and bla OXA-24/40 ; Line 1: marker, molecular weight 50-1500 bp; Line 2: positive control; Line 3: negative control; Lines 4, 6-13, 15, 16: negative samples for bla OXA-23 and bla OXA-24/40 , Line 17: positive samples for bla OXA-24/40 (246 bp length); Lines 5, 14, 17: positive samples for bla OXA-23 (501 bp length)
The Source of Pseudomonas aeruginosa in Hospitals
Source of Pseudomonas aeruginosa in Clinical Samples
Article
Background and Objective Pseudomonas aeruginosa (P. aeruginosa) cause serious nosocomial and non-nosocomial infections. The blaOxacillinases (OXA)-23 and blaOXA24/40 induce resistance to carbapenems. The current study aimed at detecting blaOXA-23 and blaOXA-24/40 in P. aeruginosa strains isolated from patients with nosocomial and non-nosocomial infections. carbapenems. The current study aimed at detecting blaOXA-23 and blaOXA-24/40 in P. aeruginosa strains isolated from patients with nosocomial and non-nosocomial infections. Methods The current descriptive cross sectional study was conducted in Sanandaj, Iran (Kurdistan Province) from December 2015 to August 2017, on 146 strains of Pseudomonas spp. isolated from patients’ specimens. Microbiological methods and polymerase chain reaction (PCR) for gyrB were applied to detect P. aeruginosa. Imipenem (IMP)-disk diffusion method and OXA-23-/OXA-24/40-multiplex PCR were used to identify resistant strains. Stata 12 using Fisher exact test and logistic regression were employed to analyze the data (P ≤0.05). Results The gyrB-PCR results showed that 91.78% of isolates were P. aeruginosa. Nosocomial infection caused by P. aeruginosa was observed in 41.79% of the studied patients; however, 27.61% of P. aeruginosa strains were resistant to IMP; blaOXA-23 and blaOXA24/40 were detected in 11.19% and 2.24% of the strains, respectively; a co-existence of blaOXA-23 and blaOXA24/40 was also observed in 2.23% of P. aeruginosa strains. There were no significant relationships between antibiotic resistance and harboring resistance genes; in addition, between IMP resistance and age, gender, place of residence, inpatient/outpatient, and type of specimen no association was found (P≥ 0.05). Conclusion Resistance to IMP and the detection of resistant genes in the current study were observed in the clinical samples. Antibiotics should be prescribed more cautiously in order to prevent antibiotic resistance in pathogens.
 
Article
Papillary thyroid carcinoma (PTC) is considered as a relatively common type of malignancy showing a wide morphologic spectrum. Different variants of this tumor have been reported. Among PTC variants, PTC with nodular fasciitis-like stroma (PTCFLS) is rare. This variant consists of stromal components rich in spindle cells and accounts for 60-80% of tumors. In addition, there are small foci of epithelial components in PTCFLS though its features are similar to conventional PTC. In this case study, we present a new case with PTCFLS. The case is a 28-year-old female who was referred to the ENT clinic due to a painless mass on the anterior part of her neck. The mass showed a gradual increase in size over the 6 months prior to her referral. Thyroid test results were normal. Ultrasound imaging demonstrated an 84 × 36 mm heterogeneous nodule in the right thyroid lobe without calcifications but increased vascularity. There were also some reactive lymph nodes in both sub-mandibular areas. An ultrasound-guided fine-needle aspiration (FNA) biopsy of the right thyroid lobe nodule revealed a benign thyroid adenomatoid nodule. Following right thyroid lobectomy, final pathologic studies confirmed a diagnosis of PTC with exuberant fibromatosis-like stroma. In the 20-day post-surgery visit, the patient was found asymptomatic. Re-evaluation of the left thyroid lobe and follow-up were recommended. In this study, a diagnosis of a rare variant of PTC, i.e., PTC-FLS, was made through a combination of ultrasonography, fine needle aspiration cytology, and histological examination.
 
Article
Background and objective: The aim of this study was to compare the cytotoxiceffects of local probiotic bacteria, including Lactobacillus paracasei, Lactobacillus brevis, while isolated from "Tarkhine" food and the induction of apoptosis in the HT-29 human colon adenocarcinoma cell line and normal fibroblasts. Methods: HT-29 and L-929 cell lines were treated with cell-bound exopolysaccharide extract (cb-EPS) from L. paracasei and L. brevis. The MTT assay was used to analyze cell viability. Cellular apoptosis was examined by flow cytometry and DNA fragmentation assay. Results: The cb-EPS from both probiotic bacteria prevented the proliferation of HT-29 colon cancer cells. In addi- tion, the cytotoxic and anti-proliferative effects of the exopolysaccharide extract from both bacteria in L-929 fibro- blasts were much lower than HT-29 cells. The induction of apoptosis in HT-29 cells was observed at 48h compared with 72h. It seems that the exopolysaccharides extracted from both bacteria have a greater effect on the induction of apoptosis at 48h. The cb-EPS of L. brevis showed more potent anti-proliferative and apoptotic properties than the cb- EPS of L. paracasei. The ladder pattern of DNA fragmentation confirmed the induction of apoptosis in cancer cells. Conclusion: The results of the MTT assay and apoptosis indicate that the induction of apoptosis by the exopolysac- charide from bacteria depends on the dose, time, and strain of bacteria. Further studies may contribute toward the understanding of using these probiotic bacteria as biological products to treat and prevent cancers.
 
&2 diffuse proliferation of polygonal and spindled tumor cells with round or ovoid nuclei between blood vessels that showing thèstaghorn'' shape. H&E stain, ×200 
IHC study revealed positivity tumor cells with CD 34 marker. ×200 
IHC study revealed negative tumor cells with EMA marker. ×200 
Article
Intracranial hemangiopericytomas (HPC) are rare vascular tumors. They account for 0.4% of primary central nervous system tumors. HPC is more commonly located supratentorially and tends to occur in a younger age group, with average age at presentation of 38–42 years. The tumor was found throughout the entire CNS, usually superficially and closely related to the meninges. Moreover, they have a strong tendency for local recurrence and extracranial metastasis. Given the clinical, pathological and imaging similarities between Hemangiopericytoma and angioblastic/anaplastic meningioma and the necessity of differentiating these two (choosing the proper treatment and prognosis), we present a report of meningeal Hemangiopericytoma tumor in a 33-year-old female. Our study suggests that in addition to routine histopathological examination, immunohistochemical study is essential to differentiate it from other differential diagnosis.
 
Article
Background & objectives: One of the important infectious factors in pregnant mothers and newborns is Group B Streptococcus (GBS). There is no perfect report about prevalence of GBS in Iran and in the case of preterm rupture of amniotic membrane or preterm labor all patients are treated by antibiotics without culture so this has led to adverse taking antibiotics and drug resistance. The present study is intended to determine the frequency of colonization of GBS in the pregnant mother (35-37 weeks), referred to medical centers of Shahed University. Methods: Overall, 210 pregnant women (35-37 weeks), referred to medical center of Shahed University, Tehran, Iran were selected as sample group and after filling out the questionnaires about demographic data and midwifery status and the related information of post- partum, the rectovaginal culture was done for them. Results: Among 210 samples, 7 (3.3%) included positive culture in terms of GBS colonization while all these cases were sensitive to penicillin, ampicillin, cephalothin, nitrofurantoin, and all of the samples were resistant against tetracycline and contrimoxazole. There was no relationship among age, job, education, number of pregnancy, blood pressure background, diabetes and preterm childbirth with positive culture. Similarly, because of limited number of positive cases it was not possible to examine the relationship among GBS colonization and infection in mother and newborn. Conclusion: There was a low frequency in GBS colonization in the studied hospitals and the study inside the country also confirms this finding.
 
Article
Bronchogenic cyst is a result of abnormal development of the ventral foregut presents as a discrete mass. Most commonly, it is appeared in the middle mediastinum and rarely is seen in adults. We report a 35-year-old woman who was asymptomatic and incidentally was found with a mass in chest radiograph.
 
Article
Background & objective: Acral melanoma (AM) is a common type of cutaneous melanoma that occurs in the skin of the palms, soles, and nail beds. This malignancy, like other types of cancer, has different genetic alterations. To date, despite decades of research the roles of oncogenic BRAF mutations in the pathogenesis of AM has not been fully clarified. The present study was designed to identify V600E mutation in patients with AM from the south of Iran. Methods: The samples were collected from the pathology lab archive of Shiraz University of Medical Sciences (2015-2020). A total of 41 patients with primary invasive AM underwent excisional biopsy or amputation were collected to evaluate BRAF V600E mutation using Polymerase Chain Reaction (PCR) and Sanger sequencing. Results: Total number of 41cases (21 male and 20 female) and age range of 34-87 years were enrolled. The histological subtypes were 24 acral lentiginous melanomas (ALM), 10 cases of nodular melanoma (NM), and 7 cases of superficial spreading melanoma (SSM). In our study, only one case (a 44-year-old male with nail bed AM and the histological subtype of acral lentigenous melanoma) showed BRAF-V600E mutation. Conclusion: These findings suggest that the population of our interest showed a very low prevalence of this mutation providing novel insights into the pathobiology of AM and its related treatment.
 
Flow cytometric results of treated and nontreated cell groups. A. Control group, B. Scramble, C. treated with 50 nM of miR-506, D. treated with 100 nM of miR-506
The position of viable, apoptotic and necrotic cells in the flow cytometry quadrant according to the type of absorbent stain
Article
Background & objective: Acute lymphoblastic leukemia (ALL) is a malignant disease that arises from various mutations in B or T-lymphoid progenitors. MicroRNAs (miRNAs) regulate gene expression by binding to the 3' untranslated region of protein-coding genes. Dysregulation of miRNA expression may result in the development of cancerous phenotypes. Therefore, for the first time in this field, the present study aims to investigate the effect of overexpression of miR-506 in Jurkat (acute T cell leukemia) cell line. Methods: In this study, Jurkat cell lines were cultured in RPMI-1640 medium. Next, miR-506 was transfected with concentrations of 50 and 100 nM with Lipofectamine 2000. The accuracy of the transfection was confirmed by the transfection of siRNA conjugated with FITC. 48 h after transfection, the cells were prepared for other tests (flow cytometry, MTT assay, and RNA extraction). The expression level of miR-506 in the cells was analyzed using the quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). Finally, SPSS 21 software was used for the data analysis. Results: According to our results, the viability of cells in concentrations of 50 and 100 nM was significantly higher than the control group. By overexpression of miR-506, the expressions of pro-apoptotic genes (p53, p21) and anti-apoptotic gene B-cell lymphoma-2 (BCL-2) are decreased and increased, respectively. Conclusion: This study showed that miR-506 may function as an oncogenic miRNA in the T- ALL cell line. In conclusion, overexpression of miR-506 leads to an increase in viable cancer cells.
 
Article
Background and Objectives: To compare pathologic complete response (PCR) in patients with advanced rectal cancer receiving neoadjuvant chemoradiotherapy (NACT) by 5-FU or Xeloda (capecitabine) with and without Eloxatin (oxaloplatin injection). Materials and Methods: Seventy-five consecutive patients with the diagnosis of advanced rectal adenocarcinoma were included. Two basic chemotherapy regimens were used: one drug (5-FU or Xeloda) or two-drug (5-U or Xeloda with Eloxatin). Endpoints were PCR and preservation of sphincter during surgery through low anterior resection (LAR). All analyses were done using SPSS software version 17.0 (SPSS Inc., Chicago, IL). Results: There were no significant differences between the group of patients who received one-drug regimen with those who received two-drug regimen regarding the pCR (four cases (23.5%) versus 25 vases (43.1%)) state or the type of surgery performed [nine cases (52.9%) versus 36 cases (62.1%)]. Conclusion: Adding Eloxatin to the standard treatment of rectal adenocarcinoma (5-FU based) did not yield in a higher PCR or a higher chance to preserve the anal sphincter.
 
Distribution of Cases of CIN According to Histopathological Grade
Article
Background and Objective The currentstudy aimed at investigating the histomorphological spectrum of cervical intraepithelial and invasive lesions assessing the diagnostic significance of P16/INK4a and Ki-67 in such lesions, andcorrelatingP16/ INK4a and Ki-67 immunoexpression with histologic type and grade. Methods A total of 60 cases were selectedcomprising 10 cases withchronic cervicitis, 29 cases withcervical intraepithelial neoplasia(CIN), and 21 cases withsquamous cell carcinoma. These cases were evaluated morphologically and immunohistochemically with P16 and Ki-67. Results There was no expression of P16 and Ki-67 in 10 (100%) cases withchronic cervicitis while in CIN, it was expressed in 25 (86.20%) cases and in carcinoma it was expressed in 20 (95.23%) cases. Ki-67 was expressed in 28 (96.55%) cases withCIN and in 100% of cases withcarcinoma. Conclusion Cervical carcinoma is a significant contributor to cancer-related morbidity and mortality worldwide. Identification of bio-markers in cervical neoplasia is necessary to distinguish CIN from other non-neoplastic cervical lesions to prevent under treatmentor overtreatment as the histomorphological features alone are not sufficient.Significant upregulation of P16, cyclin dependent kinase inhibitor, and Ki-67, a nuclear non-histone protein, was observed in carcinoma cervix and with the increasing severity of CINs. Correlation between grades of P16 and Ki-67 among cervical pre-neoplasia and neoplasia showed an increasing P16 expression with consistently increasing Ki-67 labelling index in the groups with theincreasing severity.
 
Correlation Between Tumor Size, Fuhrman Grade, Pathological Tumor Stage, Ki-67 and Nuclear Morphometry
IHC of Ki-67 in clear cell RCC (x200) a) IHC of Ki-67 (%) in Fuhrman grade1 of Clear cell RCC(x200) b) IHC of Ki-67 (%) in Fuhrman grade2 of Clear cell RCC(x200) c) IHC of Ki-67 (%) in Fuhrman grade3 of Clear cell RCC(x200) d) IHC of Ki-67 (%) in Fuhrman grade 4 of Clear cell RCC(x200) 
Article
Background and objective Clear Cell Renal Cell Carcinoma (CCRCC) is the most common adult renal neoplasm. Staging and grading of RCC are important predictors of survival. Fuhrman nuclear grading is widely used for CCRCC, the subjective nature of which has prompted more objective methods to evaluate nuclear features. Furthermore, Ki-67, a reliable marker of cellular proliferation may provide another variable for assessment of the biological behavior of RCC. The aim of this research was to study nuclear morphometry and Fuhrman nuclear grading of clear cell RCC, and to assess their relationship with the Ki-67 index. Methods Hematoxylin and eosin slides of forty cases of CCRCC were retrieved and studied for pathologic variables, including Fuhrman nuclear grade, pathological tumor and node stage. Nuclear morphometric analysis was performed using computer-assisted image analysis. The relationship between Fuhrman nuclear grading, pathologic stage, tumor size, nuclear morphometry and proliferative index were analyzed. Results According to Fuhrman grading, four (10%) cases were grade I, 23 (57.5%) were grade II, 12 (30%) were grade III, and one (2.5%) was grade IV. Moderate to high correlation was seen between Fuhrman nuclear grade and mean nuclear area, perimeter, diameter, length, nuclear roundness factor and Ki -67, with a P value of < 0.05. Conclusion The CCRCC is an extremely heterogenous disease and clinical outcome is unpredictable despite several validated prognostic factors. The widely used Fuhrman nuclear grading is subjective, while nuclear morphometry, using computer assisted image analysis, can ensure more objective assessment. The Ki-67 index could provide reliable information and compliment the other prognostic parameters.
 
Article
Wilson disease is a metabolic disorder with an autosomal recessive genetic pattern and occurs in 1-4 of every 100000 individuals. Inactivation of the ATP7B gene leads to accumulation of the toxic copper to liver and brain causing hepatic and neurological complication. Therefore, most patients suffer from chronic hepatic inflammation and central nervous system disorder. Nowadays, up to 500 mutations were found in the ATP7B gene that weaken or fully disrupt the function of the gene product. Recurrent mutations were found in different population. We found a homozygous pathogenic missense mutation at codon 778 (R778W) in an individual from southwest Iran. This mutation has been reported in previous studies in the continents America and Europe. The present study is the first report from Wilson disease that has been diagnosed in southwest Iran. This mutation has been shown in previous studies in patients from continents America and Europe.
 
Article
Background and objective: S100A8/A9 is a heterodimer calcium-binding protein which is involved in tumor cell proliferation, adhesion and invasion, and is proposed as a biomarker for better diagnosis and prognosis in many cancers. The aim of this study was to evaluate the simultaneous serum-based level of S100A8/A9 and CA15-3 as well-illustrated cancer biomarkers, as well as their prognostic value in breast cancer patients and healthy matched controls. Material and methods: Thirty breast cancer patients at different stages of disease and healthy matched controls with no history of inflammatory, autoimmune diseases, or cancer, were enrolled in the study. The levels of S100A8/A9 and CA15-3 were assessed serologically using the Enzyme-linked immunosorbent assay (ELISA) method, and the relevance of these markers with patients' clinicopathological features were subsequently assessed. Results: Based on our data, the serum levels of both S100A8/A9 and CA15-3 were significantly higher in patients compared to the healthy controls, and thus positively correlated with tumor size. Also, statistical analysis shows that the serum level of S100A8/A9 has 100% specificity and sensitivity (AUC = 1.00, 95% CI) for the diagnosis of breast cancer patients. Conclusion: According to our data as well as other observations, the S100A8/A9 heterodimer can be considered as a potential biomarker for the proper diagnosis and prognosis of breast cancer.
 
Congenital rhabdomyosarcoma: large globular mass arising from left flank of abdomen 
Congenital rhabdomyosarcoma: abdominal X-ray revealed a homogeneously dense mass (arrows) involving left flank of abdomen (A); MRI confirmed the mass to be arising from parietal abdominal wall constituents (B & C) 
Anaplastic rhabdomyosarcoma: histologically, few pleomorphic, bizarre rhabdomyoblasts (arrows) interspersed between classical ERMS morphology [H&E stain, 100x; inset: H&E stain, 400x] 
Article
Rhabdomyosarcoma encompasses a group of malignant myogenic neoplasms expressing a multitude of clinical and pathological diversities. It is the commonest soft tissue sarcoma of childhood but neonates are rarely affected. Embryonal subtype is the most frequent. Head-neck and genitourinary tracts are predominant sites, while trunk is considered among the unusual sites of rhabdomyosarcoma. Herein we report a case of anaplastic rhabdomyosarcoma in a newborn girl presenting, at the Pediatric Surgery Outpatient Department of North Bengal Medical College and Hospital, India in 2013 with a large tumor mass in the left flank region, arising from abdominal wall muscles.
 
Article
Although the majority of mesenchymal lesions of the gastrointestinal tract are neoplastic in nature, but nonneoplastic reactive processes may also involve the gastrointestinal tract and mesentery. Some more aggressive neoplasms located in same area, such as fibromatosis or gastrointestinal stromal tumors may be cause of diagnostic confusion. Reactive nodular fibrous pseudo tumor (RNFP) of the gastrointestinal tract and mesentery is a recently recognized entity. Here we present one such lesion in 71 years-old- man with a history of abdominal surgery. The tumor was firm, tan– white colored, ranged in size 19.5 cm in greatest dimension, and was grossly well circumscribed. Histologically it is composed of spindle-shaped cells resembling fibroblasts arranged haphazardly or in intersecting fascicles, embedded in a collagen-rich stroma with sparse intralesional lymphoid cells frequently arranged in aggregates. We present a case of this entity have largest tumor and also due to the rarity.
 
Article
Background & Objective: Abdominal cutaneous and subcutaneous nodules are uncommon lesions which may be benign or malignant. Majority of the malignant nodules are metastatic in origin and may be the initial presentation of primary malignancy, hence an early diagnosis is important. Our aim was to find out the spectrum of lesions (both non-neoplastic and neoplastic) that present as cutaneous and subcutaneous abdominal wall nodules and to assess the efficacy of fine needle aspiration cytology (FNAC) in early diagnosis of all such lesions so that need for histopathology can be minimized. Material and Methods: The study was conducted on 46 patients of all age groups, presenting with various palpable cutaneous and subcutaneous abdominal wall nodules. FNAC was performed, smears stained with May Grunwald- Giemsa stain and Pap stains. Special stains were applied wherever required. Cytological diagnosis was subsequently correlated with histopathological diagnosis. Results: Out of 46 FNAC cases; there were 13 non-neoplastic lesions, 15 benign neoplasms and 17 malignant lesions. One case was inadequate for opinion that on histopathology turned out to be metastatic deposits from renal cell carcinoma. The rate of unsatisfactory FNAC was 2.2% and the sensitivity was 89.47%. The specificity and positive predictive value was 100%. Conclusion: FNAC is a simple, minimally invasive, highly accurate and cost effective technique for quick diagnosis of malignant metastatic abdominal wall nodules, thus minimising the need for histopathology and for deciding mode of treatment.
 
Article
Hepatoid variant of yolk sac tumor of ovary is an unusual tumor with an aggressive behavior. It is usually observed in young females, presents with abdominal complaints and is associated with raised α-fetoprotein (AFP) levels. It should be differentiated from other hepatoid tumors involving the ovary. A complete patient evaluation with gross, microscopy, and immunohistochemistry can identify the site of origin to administer appropriate treatment. The current study reported the case of a 30-year-old married parous female presenting with abdominal distention and pain of two months duration. She had regular menstrual cycles. Based on lab investigations her serum AFP level was markedly raised to 34,244 ng/mL (normal range: 0-9 ng/mL). Computerized tomography (CT) scan showed large lobulated heterogeneous mass in both ovaries and omental, gall bladder, and lung metastasis. A CT guided biopsy of the ovarian mass was done. On histopathology, a differential diagnosis of hepatoid variant of yolk sac tumor, hepatoid carcinoma of ovary and hepatoid tumor arising from gall bladder metastasizing to the ovary were observed. Patient underwent surgery. Per operatively gross ascites with bilateral ovarian mass, extensive omental, pelvic, and gall bladder deposits were observed. Bilateral salpingo-oophorectomy with omental deposit biopsy was conducted. Histopathology along with immunohistochemistry confirmed a diagnosis of hepatoid variant of yolk sac tumor in both ovaries with widespread intra-abdominal metastasis.
 
Microphotograph showing (A) Aspirate of metastatic adenocarcinoma in liver (L-G stain, 400X); (B) Cell block showing well-defined malignant glands (H & E stain, 400 X); (C)Aspirate from hepatocellular carcinoma (L-G stain, 400X);inset showing a closer view of malignant hepatocytes; (D) Cell block of the same case as (C) showing well defined trabecular arrangement of malignant hepatocytes (H & E stain, 400 X);inset showing a closer view of the same (H & E stain, 400X).
(A) Cell block preparation of a case of the Wilms tumor highlighting spindle cell component(H & E stain, 100X); (B) Tubular structures of the same case as (A)(H & E stain, 100X); (C) Aspirate showing pleomorphic sarcoma (L-G stain, 400X); (D) Cell block of the same case as (C) showing features suggestive of leiomyosarcoma (H & E stain; 400X)
Article
Background & objective Fine needle aspiration cytology (FNAC) is an easy, rapid, and less hazardous tool to diagnose the intra-abdominal lesions with various imaging modalities adding to its sensitivity and accuracy. However, sometimes it does not yield adequate information for precise diagnosis and the risk of false-negative and indeterminate diagnosis is always present. Cellblock preparations may be particularly helpful in such problematic cases. The current study aimed atevaluating and comparing the cytological as well as histopathological features of different intra-abdominal mass lesions. Methods Image-guided FNAC followed by cell block were performed on 167 patients from June 2012 to May 2013. Histologically correlated 111 cases were evaluated. Results of conventional smear, cell block, and combination of FNAC with cell block were compared with histopathological findings regarding diagnostic sensitivity, specificity, and accuracy of diagnosis. Results Cell block was more specific to diagnose these lesions than FNAC (95.49% versus 90.09%). Combined application of cell block with FNAC was more specific (96.39%) than cell block alone with 100% diagnostic accuracy. Conclusion Application of a combination of cell block with FNAC was more useful to diagnose intra-abdominal mass lesions.
 
Article
Background & objective: Modified Ultra-fast Papanicolaou (MUFP) stain has been developed from Papanicolaou stain (PAP) with the goal to improve staining quality, minimize staining time for obtaining immediate cytological diagnosis and to check specimen adequacy during Ultrasound guided Fine needle Aspiration Cytology (US guided FNAC). The aim of this research was to study the cytomorphological features of intra-abdominal lesions with help of US guided FNAC and to assess the diagnostic utility of Modified Ultrafast Papanicolaou stain in cytological diagnosis. Methods: This cross-sectional study enrolled consecutive 100 subjects in N.K.P Salve Institute of Medical Sciences and Research Centre, Nagpur, which is a tertiary teaching hospital in India, from July 2015 to June 2017 who underwent US guided FNAC for Intra-abdominal lesions. Fine needle aspiration was done under ultrasound guidance and the smears were divided into two groups. Wet smears were fixed in 95% ethyl alcohol for conventional PAP staining and air dried for MUFP. After staining, results were evaluated on basis of the cytological features. Scores were given according to four parameters namely background of smears, staining pattern, cell morphology and nuclear staining. Quality index was calculated from the ratio of score achieved to the possible maximum score. Results: The most common organs involved were ovaries (46 %) followed by liver (11%) and most common lesions were malignant (68 %). The cytological characteristic showed significant difference in all four parameters (P<0.05) when MUFP stain smears were compared with PAP stain smears. There was also statistically significant difference when cumulative score and Quality Index were compared (P<0.001) between the two stains. Conclusion: The US guided Fine needle aspiration (FNA) is simple, safe, rapid and inexpensive technique useful in cytological diagnosis. MUFP stain is fast, reliable and has better diagnostic utility for cytological diagnosis when compared to PAP stain.
 
Article
Dear Editor, erythrocyte sedimentation rate (ESR) is a useful basic clinical pathology laboratory investigation. It can be helpful in diagnosis and follow-up of several diseases. At present, a new automated method with proven reliability is available for ESR test (1). Here, the authors report on observation on a laboratory experiment to test the effect of zinc nanoparticles on ESR results. The total of 100 blood samples was used in the experiment. Each sample was divided into two parts. One part was directly measured for ESR and the other part was added by 1 droplet of zinc nanoparticles solution then exposed to ESR measurement. All ESR measurements were done using the same automated ESR analyzer; MicroSed SR-system, in the same ISO15189 accredited clinical laboratory at the same time, place and condition. The ESR results showed a difference in ESR values between two groups. The ESR values for the groups with and without zinc nanoparticles were equal to 25.6 + 7.2 and 10.7 + 3.4 mm/hr, respectively. Therefore, zinc nanoparticles can interrupt the ESR test conducted by automated analyzer. This observation was similar to the recent report which showed nanoparticles can alter the result of lipid profile test (2). Therefore, due to the widely use of nanoparticle substances, practitioners must consider the effect of nanoparticles interference in the interpretation of ESR results.
 
Article
Background and Objective: Failure to thrive (FTT) is a sign that describes a particular problem rather than a diagnosis and explain growth failure or more advanced failure to gain weight appropriately. The aim of this study was to determine the prevalence and type of chromosomal abnormalities in patients presented with FTT. Materials and Method: One hundred FTT cases with clinical impression of having chromosomal abnormality referred for cytogenetic study during a period of 5 years (2007-2011) with age range from 5 month to 15 years. Chromosomal analysis was carried out for them. The standard protocol for peripheral blood lymphocyte culture was followed by metaphase chromosome preparation and conventional analysis of G-banded chromosomes. All analyses were performed using the SPSS soft ware package, version 18. Result: Fifteen cases showed karyotypic abnormality. The most common karyotype abnormality was aneuploidy resulted from monosomy of the chromosome X in girls. Conclusion: Turner syndrome with various forms of chromosomal complement is the most common chromosomal abnormality causing growth failure in girls.
 
Top-cited authors
Alireza Abdollahi
  • Tehran University of Medical Sciences
Abdolmajid Ghasemian
  • Fasa University of Medical Sciences
Amitis Ramezani
  • Institut Pasteur International Network
Arezoo Aghakhani
  • Institut Pasteur International Network
Horieh Saderi
  • Shahed University