Gynecologic Pathology
Savita Agarwal; Megha Ralli; Pinki Pandey; Shruti Singh
Abstract
Ovarian small cell carcinoma is a rare and highly malignant tumor with poor prognosis. It usually presents in younger females with features of hypercalcemia. The exact histogenesis of the tumor is unclear and it may present as an undifferentiated tumor. In such cases, immunohistochemistry (IHC) plays ...
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Ovarian small cell carcinoma is a rare and highly malignant tumor with poor prognosis. It usually presents in younger females with features of hypercalcemia. The exact histogenesis of the tumor is unclear and it may present as an undifferentiated tumor. In such cases, immunohistochemistry (IHC) plays an important role to confirm the diagnosis. Limited treatment options are available and mainly include radical surgery followed by adjuvant therapy in advanced stages. The current report was a rare case of small cell carcinoma of ovary presenting no symptoms of hypercalcemia diagnosed on histopathological examination and IHC findings.
Shahram Sabeti; Sara Zahedifard; Hussein Soleimantabar; Manijeh Zarghampour; Mihan Pourabdollah Toutkaboni
Abstract
Pericardial hemangioma is very rare and their coincidence with other visceral hemamgiomas is exceptional. We are reporting a 72-year-old man with an incidentally discovered pericardial hemangioma during coronary artery bypass graft (CABG) and mitral valve replacement surgery and a prior history of multiple ...
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Pericardial hemangioma is very rare and their coincidence with other visceral hemamgiomas is exceptional. We are reporting a 72-year-old man with an incidentally discovered pericardial hemangioma during coronary artery bypass graft (CABG) and mitral valve replacement surgery and a prior history of multiple hepatic cavernous hemangiomas. This case has been reported due to its extreme rarity. To the best of our knowledge, this is the second case of this kind reported till date.
Hematopathology
Bushra Siddiqui; Shahbaz Habib Faridi; Veena Maheshwari; Mohammad Aslam; Kafil Akhtar
Volume 11, Issue 2 , April 2016, , Pages 171-175
Abstract
Granulomatous response in association with breast cancer and within the cancer draining lymph nodes is an extremely rare phenomenon. Granulomatous inflammation is an immune response commonly seen against infectious agents and certain non-neoplastic conditions. The etiopathogenesis of granulomas associated ...
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Granulomatous response in association with breast cancer and within the cancer draining lymph nodes is an extremely rare phenomenon. Granulomatous inflammation is an immune response commonly seen against infectious agents and certain non-neoplastic conditions. The etiopathogenesis of granulomas associated with malignancies is not clear but it may be because of an immunologic reaction to tumour antigens. We hereby report a 50-yr-old postmenopausal female presented to Surgical Outpatient Department, Aligarh Muslim University, India, with complaints of lump and pain in her left breast for 6 months. We have also discussed about its etiopathogenesis, final diagnosis, treatment & patient outcome.
Mohammad Salehi; Abdolmajid Ghasemian; Seyyed Khalil Shokouhi Mostafavi; Somayyeh Najafi; Hassan Rajabi Vardanjani
Abstract
Backgrounds & Objective: The Helicobacter pylori prevalence has continuously decreased during recent years in Iran. The current study aimed at determining H. pylori prevalence in Neyshabur city, Northeast Iran, during 2010-2015. Methods: The current epidemiologic survey was conducted in Neyshabur ...
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Backgrounds & Objective: The Helicobacter pylori prevalence has continuously decreased during recent years in Iran. The current study aimed at determining H. pylori prevalence in Neyshabur city, Northeast Iran, during 2010-2015. Methods: The current epidemiologic survey was conducted in Neyshabur from 2010 to 2015 to determine the prevalence of H. pylori infection. A total of 11596 participants (3681 male with the mean age of 31.7±6.2 years and 7915 female with mean age of 68.3±4.7 years) were included. The enzyme-linked immunosorbent assay kits for the detection of H. pylori and Stat Fax 3200® Microplate Reader (USA) with a sensitivity of 95% and specificity of 98% were used. Titers above 12 units were considered positive for IgG, IgA, and IgM (negative <8, equivocal 8 to 12, and positive >12 U). The Chi-square t test and F test were used to analyze data. Results: The overall IgA, IgG, and IgM seropositive samples among the study participants were 852 (7.2%), 9000 (72.8%), and 1256 (5.2%), respectively. The IgA seropositivity was significantly high among the age group above 51 years, compared with the other age groups. Moreover, the IgG and IgM seropositivity were significantly high among the age groups 41 to 50 and 31 to 40 years respectively, compared with the other age groups. There was no significant difference between male and female cases regarding IgA and IgG seropositive samples, but IgM level was significantly higher among females, compared with that of the male cases. Furthermore, there was no significant alteration in IgA, IgG, and IgM seropositivity during 2010-2014 in Neyshabur. Conclusion: The prevalence of H. pylori in Neyshabur was high in the healthy population. Furthermore, the H. pylori prevalence did not change from 2010 to 2014 in the studied city. Effective approaches to improve health, educational, and socioeconomic status should be implemented to minimize and control H. pylori infection.
Hematopathology
Beuy Joob; Viroj Wiwanitkit
Abstract
Dear Editor, Dengue is an important arbovirus infection. This infection can result in an acute febrile illness. The important hematological abnormalities included hemoconcentration and thrombocytopenia (1). Due to the decreased platelet count, the patient might develop petechiae and hemorrhagic complication. ...
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Dear Editor, Dengue is an important arbovirus infection. This infection can result in an acute febrile illness. The important hematological abnormalities included hemoconcentration and thrombocytopenia (1). Due to the decreased platelet count, the patient might develop petechiae and hemorrhagic complication. In endemic area, the presumptive diagnosis of dengue is usually derived by the clinical findings (1). Sometimes, the atypical clinical presentation of dengue can be seen. The dengue without thrombocytopenia is possible and might be difficult for diagnosis (2). Here, the authors present an interesting case of dengue with platelet count and no hemocon-centration. The automated hematogram can help explain the aberrant complete blood count finding. The patient was a 13 years old female patient. The chief complaint was high fever for 4 days and petechiae for 1 day. The tourniquet test was positive. The complete blood count was done and the hemoglobin level was 12.4 g/dL and platelet count was 276,000/mm3. In the present case, there was no thrombocytopenia and no hemo-concentration. However, the autoamted hematogram (Figure 1) showed flag that platelet interpretation was possible. From history taking, the patient was a known case of beta-thalassemia/hemoglobin E disorder. The additional dengue NS1 Ag test was positive. The patient was diagnosed to have dengue and received the standard fluid replacement therapy. She got full recovery within 1 week. In the present case, the unexpected normal platelet count despite overt petechiae might be explainable by the automated hematogram. The patient had the underlying hemoglobin disorder problem that results in anisopoikilocytosis and microcytic anemia. With the underlying abnormal hematological parameter, anemia, no hemoconcentration can be explained. Regarding the platelet count, the microcytosis, anisocytosis and poikilocytosis can interfere with the platelet count in autoamted hematology analytical process. Nevertheless, the automated hematogram and flag can help explain and assist the physician in charge for further use of definitive diagnosis test for dengue.
GI, Liver & Pancreas Pathology
Mohammad Shafiei; Mahdi Alemrajabi; Ali Najafi; Amirhomayoon Keihan; Masoudreza Sohrabi
Abstract
Background and Objective: Colorectal Cancer (CRC) is the third most common cancer after prostate (breast in women) and lung cancer; it is also the third cause of cancer deaths reported in both men and women in 2020. Currently, the most commonly used diagnostic tools for CRC are colonoscopy, serological ...
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Background and Objective: Colorectal Cancer (CRC) is the third most common cancer after prostate (breast in women) and lung cancer; it is also the third cause of cancer deaths reported in both men and women in 2020. Currently, the most commonly used diagnostic tools for CRC are colonoscopy, serological methods, and other imaging techniques. Despite the benefits and abilities of these methods, each of them has disadvantages that reduce its functionality and acceptance. The aim of this study was identifying specific and non-invasive genetic biomarkers to diagnose colorectal cancer. Methods & Material: In this study, changes in the expression of HLTF and SEPT9 genes were evaluated by Real Time PCR in blood and tissue samples of CRC patients. A total of 100 samples (50 Blood and 50 Tissue samples) were evaluated with a definite diagnosis of CRC in Firoozgar Hspital, Tehran, Iran, in 2018. The QPCR method was used to compare the expression of candidate genes between the patients group and control group in both samples. Sensitivity and specificity of the test were examined using ROC curve analysis. Results: The results showed a significant down-regulation in the expression of both selected genes in tissue and peripheral blood in the various stages of the CRC. The sensitivity and specifity of both genes was about 80%. Conclusion: The findings showed that the two candidate genes can be suggested as specific biomarkers for diagnosis of CRC using the peripheral blood as a non-invasive method. For a definite conclusion, more research is needed.
Ali Zare-Mirzaie; Behrang Kazeminezhad; Mona Akbari Ghouchani
Abstract
Background& Objective: Increase in intra- and extracellular glucose levels can cause oxidative stress, and the prolonged imbalance between prooxidants and antioxidantscan lead to cell damage and the associated complications in patients with diabetes. Vitamin D acts as a strong antioxidant in ...
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Background& Objective: Increase in intra- and extracellular glucose levels can cause oxidative stress, and the prolonged imbalance between prooxidants and antioxidantscan lead to cell damage and the associated complications in patients with diabetes. Vitamin D acts as a strong antioxidant in the body and several studies emphasized on its important role to prevent oxidative stress in prediabetic and diabetic subjects. The current study aimed at determining and comparing the total antioxidant capacity (TAC) in individuals with hemoglobin A1c (HbA1c) below and above 6.5%, and its correlation with vitamin D levels. Methods: The current cross sectional study was conducted on a total of 107 patients with diabetes (HbA1c >6.5%) and 107 non-diabetic subjects (HbA1c <6.5%) referred to Rassool Akram Hospital, Tehran, Iran from 2015 to 2016, as the sample population. The two groups were compared regarding their TAC and vitamin D serum levels and the association between vitamin D concentration and TAC was evaluated. Results: Age and body mass index (BMI)were significantly higher in patients with diabetes, compared with the serum levels of vitamin D and TAC (P P=0.003). In multivariate regression model, the duration of diabetes was also significantly associated with TAC level (beta coefficient=-0.82, P <0.001). Conclusion: The low serum levels of TAC and vitamin D in patients with diabetes could be indicative of oxidative stress in the presence of high blood glucose levels. Supplementation of vitamin D in patients with diabetes might be effective to control the negative impacts of the disease and decrease cells’ exposure to oxidative environment in prediabetes.
Gynecologic Pathology
Arshia Yazdani; Mohammad Ranaee; Sara Babazadeh; Fatemeh Shafizadeh
Abstract
Placental mesenchymal dysplasia (PMD) is an uncommon placental lesion, which may mimic molar pregnancy at gross and microscopic examination. PMD can be associated with fetal growth restriction, Beckwith-Wiedemann syndrome, intrauterine fetal death, and preterm delivery. Nonetheless, it may also be associated ...
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Placental mesenchymal dysplasia (PMD) is an uncommon placental lesion, which may mimic molar pregnancy at gross and microscopic examination. PMD can be associated with fetal growth restriction, Beckwith-Wiedemann syndrome, intrauterine fetal death, and preterm delivery. Nonetheless, it may also be associated with a normal appearing fetus.Objective: We aimed to emphasize that clinicians, radiologists, and pathologists should be aware of PMD as one of the etiologies of intrauterine growth restriction (IUGR).We presented the case of a 27-year-old gravida 1, para 1 woman who was admitted to Ayatollah Rouhani hospital, in Babol, Iran, at 30 weeks of gestation due to severe IUGR and fetal tachycardia. Ultrasound examination showed uteroplacental insufficiency and increased resistive index (RI) of umbilical artery. At last, a normal female fetus (1320 g) with no definitive anomalies was delivered by cesarean section. Pathological examination revealed cystically dilated stem villi with peripherally located thick-walled muscular stem vessels, and also stromal fibroblasts overgrowth in some stem villi. None of the examined sections revealed trophoblastic proliferation or stromal trophoblastic inclusion. The findings confirmed the diagnosis of PMD.Careful radiological and pathological examination should be performed in the case of IUGR for ruling out the rare placental abnormalities, including PMD.
Breast Pathology
Akbar Safaei; Ahmad Monabati; Maral Mokhtari; Mehdi Montazer
Abstract
The most widely used guideline for the breast cancer biomarker assessment and reporting (the 2013 ASCO/CAP guideline) does not state the unusual occurrence of cytoplasmic Her2/neu staining (1, 2).
We recently encountered a T2N1Mx ductal adeno-carcinoma which consisted of two dissimilar tumor cell populations. ...
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The most widely used guideline for the breast cancer biomarker assessment and reporting (the 2013 ASCO/CAP guideline) does not state the unusual occurrence of cytoplasmic Her2/neu staining (1, 2).
We recently encountered a T2N1Mx ductal adeno-carcinoma which consisted of two dissimilar tumor cell populations. The more prominent population (75% of tumor cells) was made up of sheets of neuroendocrine-like cells (NEL) and the other tumor cell population had a usual adenocarcinomatous histomorphology (UAC) (Fig. 1A). The NEL was ER+ (clone 073), PgR-(clone 636), 40% ki67 with distinct dot-like cytoplasmic Her2 staining (clone CB11) which is considered as negative regarding the current guidelines. The UAC was ER+, PgR+, 20% ki67, and Her2 negative (Fig. 1A-C). Moreover, NEL did not react with either chromogranin or synaptophysin, but it expressed neuron-specific enolase (NSE). Dual color Her2/neu chromogenic in situ hybridization probes (chromogenic ISH) established that both components were not amplified for this oncoprotein gene (Fig. 1D).
Alireza Abdollahi; Reyhaneh Abdollahpouri; Seyed-Mohammad Tavangar
Volume 11, Issue 3 , July 2016, , Pages 281-285
Abstract
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 ...
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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. How to cite this article: Abdollahi A, Abdollahpouri R,Tavangar SM. Meningeal Hemangiopericytoma in a 33-yr-Old Female; a Case Report. Iran J Pathol. 2016; 11(3):281-5.
Oral Pathology
Ivonne A. Montes-Mojarro; Javier Baquera-Heredia; Juan Felipe Sanchez-Marle; Carlos Ortiz-Hidalgo
Abstract
The solitary fibrous tumors (SFT) are rare tumors in the head and neck region and there have been only 5 cases reported in the literature in the soft palate. The current paper presents a unique case of a 62-year-old male with TFS arising in the soft palate. The tumor was highly cellular, composed of ...
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The solitary fibrous tumors (SFT) are rare tumors in the head and neck region and there have been only 5 cases reported in the literature in the soft palate. The current paper presents a unique case of a 62-year-old male with TFS arising in the soft palate. The tumor was highly cellular, composed of bland looking haphazardly arranged spindle cells. The signal transducer and activator of transcription (STAT)-6 and nuclear β-catenin were reactive by immunohistochemistry (IHC). The current case highlights the importance of the STAT-6 and the β-catenin as IHC markers to make a differential diagnosis with other entities. In summary, the paper presents the first reported case of a SFT of the soft palate in a male patient with nuclear expression of STAT-6 and β-catenin.
Beuy Joob; Viroj Wiwanitkit
Abstract
Dear Editor-in-Chief
The present global consideration is on the recent outbreak of 2014 Western Ebola virus in West Africa (1 – 3). This viral hemorrhagic fever wide spreads to several countries in West Africa and remote countries (1 - 3). With high death rate, the disease is presently on the ...
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Dear Editor-in-Chief
The present global consideration is on the recent outbreak of 2014 Western Ebola virus in West Africa (1 – 3). This viral hemorrhagic fever wide spreads to several countries in West Africa and remote countries (1 - 3). With high death rate, the disease is presently on the list of public health threatens. The main problem for management of the infection is the limited knowledge on its clinical presentation.
An interesting concern is on the gastroenterology presentation of this new disease. In fact, some new viral diseases such as atypical influenza virus infection can have an important clinical presentation as diarrhea (4). Here, the authors try to summarize on the magnitude of diarrhea in clinical presentation of this new disease. From information reported from 15 confirmed cases from Guinea (1 – 3, 5), 73.3% of the cases primarily present with diarrhea. This rate is considerable high comparing to those observed in other viral hemorrhagic disease such as dengue (rate of diarrhea at presentation < 5% (6).
This calls for the attention that it is necessary to think about new Ebola disease in any febrile illness patient with diarrhea who has history of visiting to outbreak area.
Nephropathology
Hedieh Moradi Tabriz; Arezoo Eftekhar-Javadi; Atiieh Zandnejadi
Abstract
Thyroid gland metastatic tumors are rare in clinical practice. Clear cell RCC is one of common metastatic tumors to thyroid. We here reported a case of incidentally found clear cell renal carcinoma metastasis to the thyroid gland 3 years after nephrectomy, in the thyroidectomy procedure performed for ...
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Thyroid gland metastatic tumors are rare in clinical practice. Clear cell RCC is one of common metastatic tumors to thyroid. We here reported a case of incidentally found clear cell renal carcinoma metastasis to the thyroid gland 3 years after nephrectomy, in the thyroidectomy procedure performed for the patient due to the thyroid enlargement caused by multinodular goiter. A 65-year-old Iranian man with a history of multinodular goiter referred to our surgery clinic for thyroidectomy because of compressive effects on the trachea. Patient had a history of nephrectomy due to clear cell RCC 3 years ago. After thyroidectomy, gross and histological examination of thyroid revealed clear cell renal carcinoma metastasis to the thyroid gland in the setting of a multinodular goiter. The diagnosis was confirmed by immunohistochemistry staining. Patients with multinodular goiter are more prone to present with metastasis to thyroid gland if they have a history of malignancy, especially renal cell carcinoma.
Uropathology
Masood Soltanipur; Mohammadreza Jalali Nadoushan; Hossein Yarmohammadi
Abstract
Background & Objective: Prostatic adenocarcinoma (PAC) is one of the most common tumors worldwide. Immunohistochemical expression of cytokeratins has been evaluated in the diagnosis and prognosis of tumors. The aim of the present study is the evaluation of Cytokeratin-7 (Ck-7) and Cytokeratin-19 ...
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Background & Objective: Prostatic adenocarcinoma (PAC) is one of the most common tumors worldwide. Immunohistochemical expression of cytokeratins has been evaluated in the diagnosis and prognosis of tumors. The aim of the present study is the evaluation of Cytokeratin-7 (Ck-7) and Cytokeratin-19 (Ck-19) expression and its relationship with Gleason score in patients with PAC.Methods: In this cross-sectional study, 78 samples from 78 patients with PAC referred to Mostafa Khomeini Hospital were gathered. Samples were immunohistochemically stained by Ck-7 and Ck-19 markers. The percentage of each marker in tumor cells was determined, and its relationship with Gleason scores and Gleason grade groups was analysed by SPSS version 24.Results: The expression of Ck-7 and Ck-19 were seen in 37.2% and 82.1% of samples, respectively. The mean of Ck-7 expression in tumor cells was 4.98%±7.19 (ranged 0 to 26%), while the mean of Ck-19 expression was 41.02%±23.36 (ranged 0 to 78%). There was no relationship between Ck-7 expression with Gleason scores and Gleason grade groups. However, Ck-19 expression was increased in higher Gleason scores and Gleason grade groups (P<0.001). No relationship was found between age and Ck-7 (P=0.309) and Ck-19 (P=0.375).Conclusion: The Ck-7 expression in PAC samples is weak and focal and had no relationship with the Gleason scores and Gleason grade groups. However, Ck-19 expression in PAC was high and was associated with tumor dedifferentiation of samples. There was no relationship between the expression of both markers with the patient's age.
Biochemistry
Beuy Joob; Viroj Wiwanitkit
Volume 13, Issue 3 , July 2018, , Pages 379-380
Abstract
Dear Editor An important problem to manage diabetes mellitus is controlling the patients` blood glucose. Fluctuation of blood glucose results in molecular biochemistry change and can result in unwanted diabetic complications (1). In clinical practice, hemoglobin A1C (HbA1C) is a common useful laboratory ...
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Dear Editor An important problem to manage diabetes mellitus is controlling the patients` blood glucose. Fluctuation of blood glucose results in molecular biochemistry change and can result in unwanted diabetic complications (1). In clinical practice, hemoglobin A1C (HbA1C) is a common useful laboratory test to follow-up patients with diabetes (2). Sometimes, an unexpected laboratory result can be observed. Here, the authors presented a case of extremely low hemoglobin A1C level and discussed its clinical importance. The current study was a consultation case of an abnormally low HbA1C level. The patient was a 40-year-old male with the history of cerebral stroke and on control of diabetes mellitus. The patient was firstly diagnosed with diabetes mellitus at the time of diagnosis of stroke. The HbA1C level of this patient at the first time on the first diagnosis of diabetes mellitus was 7.2% (fasting plasma glucose 218 mg/dL). This case was on strict diet control and took oral metformin 2000 mg/day. The HbA1C levels at the 1st, 2nd, 3rd, 4th, 5th, and 6th months after the first diagnosis were 6.4%, 6.4%, 6.1%, 6.1%, 5.9%, and 5.9%, respectively. However, the aberrant result was observed on the 7th month that the HbA1C was 3.2% (the fasting blood glucose level at this time was 92 mg/dL). The laboratory already checked and validated the result. The other laboratory investigations including complete blood count, blood lipid, uric acid, liver function test, and renal function test were within normal limit. Focusing on the performance of HbA1C test, the precision and accuracy of the test, coefficient of variation (CV) was 1.2% and mean bias +0.4 %, which were according to the clinical pathology standards (3). All tests were performed at an ISO15189 certified laboratory. Therefore, the main question is “What is the cause of abnormally low HbA1C in this case?”To confirm the problem, repeated HbA1C test was performed and the fructosamine test was also performed in parallel. The low HbA1C level was still observed (3.3%). The fructosamine test was also performed and the abnormally low fructosamine level was observed. Hence, this case was consulted to a clinical pathologist expert. The expert verified and confirmed the correctness of laboratory analysis. The possible causes of the cases with abnormally low HbA1C are listed as a) extremely diet control of the patient, b) excessive use of antidiabetic drugs, and c) laboratory error. Also, hemolytic anemia or hemorrhage might be a cause of reduced HbA1c. Nevertheless, in the current case, there was no evidence of hemolytic anemia or hemorrhage (the reticulocyte count and serum bilirubin were within normal limits and the blood smear examination showed normal appearance). In the current case, laboratory error was excluded. History taking showed that the patient extremely practiced food restriction and avoided any fruit and sugar products after his onset of stroke. Also, the patient consumed only one-sixths of food amount that he did before the stroke. Under such circumstances, the patient felt fainting in the afternoon every day. He was suggested not to be too much diet restricted and the dosage of antidiabetic drug was reduced to 500 mg daily. After modification, the patient had no problem and the follow-up visits showed the normal HbA1C in the next three months and he never had the problem of extremely high or low HbA1C level to date (24th month after diagnosis of stroke).Laboratory investigation is a tool of family physician to manage primary care for common diseases. The diabetes mellitus is a very common problem. The basic practice is to monitor the glucose control. Of several laboratory tests, hemoglobin A1C is a very good test that can be useful in clinical practice. The abnormally high HbA1C level can be observed in cases with underlying hemoglobinopathy, although there is no problem of poor diabetes control (4). However, there are also some limitations in using due to the possibility of incorrect high result. The aberration of laboratory result can be observed in the area with high prevalence of hemoglobinopathy such as Southeast Asia (5).In general practice, the abnormally high HbA1C level is commonly observed in the patients with diabetes and poor diabetes control. However, the opposite case of the abnormally low HbA1C level is rarely mentioned. In the current case, an abnormally low HBA1C level was observed, which is not common in clinical practice. There are many possible causes as already mentioned, but the important concern is usually the laboratory error. Sometimes, the patients take herbal products with glucose lowering effects that can induce unwanted hypoglycemia. Nevertheless, in the current case, the patient did not take any additional herbal products, but excessively and strictly controlled intake of food. The excessive control can result in low blood glucose accumulation and low HbA1C. In the current case, although there is no clinical problem yet, the problem could exist if there were no detection of the abnormally low HbA1C level.
Dermatopathology
Ruchita Tyagi; Dilpreet Kaur; Gursheen Kaur; Bhavna Garg; Neena Sood; Sunil Gupta
Abstract
Basal cell carcinoma (BCC) commonly affects the elderly and is mostly confined to the head and neck region. Only 10% of all cases occur on the trunk. We presented a case of bullous lesion on the abdomen in a young male, initially diagnosed by clinicians as a vascular nevus. Histopathological examination ...
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Basal cell carcinoma (BCC) commonly affects the elderly and is mostly confined to the head and neck region. Only 10% of all cases occur on the trunk. We presented a case of bullous lesion on the abdomen in a young male, initially diagnosed by clinicians as a vascular nevus. Histopathological examination and immunohistochemistry (IHC) revealed it to be Nodular cystic variant of BCC. This rare variant of BCC morphologically resembles benign skin adnexal tumor of Eccrine syringofibroadenoma. Ber Ep4 positivity on IHC established the correct diagnosis. This case highlights that nodular cystic variant of BCC can be a diagnostic dilemma for clinicians and pathologists.
Gireesha Rawal; Sufian Zaheer; Amit Yadav; Indrani Dhawan
Volume 13, Issue 4 , October 2018, , Pages 474-478
Abstract
Malignant fibrous histiocytoma (MFH) is one of the most common types of soft tissue sarcomas in adults. Distant metastases are developed in 30–40% of patients with MFH, with the most common site being the lung. However, metachronous MFH has not been reported previously in literature. This report ...
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Malignant fibrous histiocytoma (MFH) is one of the most common types of soft tissue sarcomas in adults. Distant metastases are developed in 30–40% of patients with MFH, with the most common site being the lung. However, metachronous MFH has not been reported previously in literature. This report describes a case of a 30-year-old man, who had two metachronous thigh tumors, both of which were confirmed to be MFH on histopathology and immunohistochemistry evaluations. A contemporary multidisciplinary approach to therapy including surgery, radiation and chemotherapy was advocated. Two primary sites of MFH raised the possibility of a genetic abnormality that could predispose such a patient to develop multiple primary sites of the same tumor.
Thin Thin Win; Nik Mohamed Zaki Nik Mahmood; Saung Oo Ma; Mazita Ismail
Volume 11, Issue 5 , October 2016, , Pages 478-482
Abstract
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 ...
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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.
Vijaylaxmi Madalli; Shrinivas M. Basavaraddi; Venkatesh Naikmasur; Krishna Burde; Priya Horatti
Volume 9, Issue 1 , January 2014, , Pages 79-80
Parvin Rajabi; Seyed Mehdi Eftekhari; Elham Rouhani; Omid Mirmosayyeb; Azar Baradaran
Abstract
An ectopic thyroid is a form of thyroid dysgenesis in which an entire or parts of the thyroid gland may be located in another part of the body than what is the usual place. The most frequent location is the base of tongue. Although most cases are asymptomatic, symptoms related to tumor size and its relationship ...
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An ectopic thyroid is a form of thyroid dysgenesis in which an entire or parts of the thyroid gland may be located in another part of the body than what is the usual place. The most frequent location is the base of tongue. Although most cases are asymptomatic, symptoms related to tumor size and its relationship with surrounding tissues, hormonal dysfunction and seldom malignancy may also occur. Any disease affecting the thyroid gland may involve the ectopic thyroid, including malignancy.
Phiza Aggarwal; Deepak Aggarwal
Abstract
Dear Editor-in-Chief We read with interest the study by Khazaei et al. (1) in which the authors have nicely concluded that PCR is more sensitive test than Ziehl-Neelsen staining and histo-pathological examination for the diagnosis of tuberculosis (TB). They have rightly pointed to use PCR, selectively, ...
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Dear Editor-in-Chief We read with interest the study by Khazaei et al. (1) in which the authors have nicely concluded that PCR is more sensitive test than Ziehl-Neelsen staining and histo-pathological examination for the diagnosis of tuberculosis (TB). They have rightly pointed to use PCR, selectively, in acidfast bacilli negative paucibacillary forms of TB. However, we intend to highlight few points regarding PCR which may add to practical applicability of the study. PCR detects mycobacterial DNA in specimens and does not represent disease activity which is important for diagnosis of tuberculosis. Due to inadvertent exposure to the environment, relevance of PCR in pulmonary specimens is debatable. In the study, 12 patients (41%), positive for acid fast bacilli (AFB) by ZiehlNeelsen stain, were negative by PCR (1). This raises serious concern regarding the credibility of the test and needs to be discussed. Culture for tubercle bacillus is the only gold standard investigation for diagnosis of TB. The presence of granuloma on histopathology is quite suggestive for TB. However, it should always be differentiated from other granulomatous pathologies like sarcoidosis which can also present with positive PCR for Mycobacterium tuberculosis(MTB) (2). In the study, 16 subjects had non-caseating granulomas out of which 11 were positive PCR for MTB (1). Now, whether they were really having tuberculosis, is questionable. In the absence of culture, response to anti-tubercular treatment is a good surrogate marker for tuberculosis confirmation. It would be useful if authors mention the treatment response in their subjects and correlate it with PCR to reestablish its diagnostic value. As concluded by authors, PCR is a sensitive test for diagnosis of paucibacillary tuberculosis, but pending limitations, it should always be interpreted in light of relevant and comprehensive picture. Acknowledgements The authors declare that there is no conflict of interests.
Oral Pathology
Tamgadge Avinash; Tamgadge Sandhya; Shashibhushan Dodal; Mayura Chande; Treville Pereira
Volume 11, Issue 2 , April 2016, , Pages 176-180
Abstract
Neurilemmomas are benign tumors of peripheral nerve sheath Schwann cells. One of the variants of neurilemmoma is the ancient type of neurilemmoma characterized by degenerative features such as cystic degeneration, calcification, hemorrhage and hyalinization which could be easily misdiagnosed. Their occurrence ...
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Neurilemmomas are benign tumors of peripheral nerve sheath Schwann cells. One of the variants of neurilemmoma is the ancient type of neurilemmoma characterized by degenerative features such as cystic degeneration, calcification, hemorrhage and hyalinization which could be easily misdiagnosed. Their occurrence in oral cavity is extremely rare and intraosseous type occurring in maxilla is exceedingly rare with very few cases being published in literature. A 38 year old male patient reported with a chief complaint of swelling over the left cheek and left upper back region since 10 months. The case is of recurrent intraosseous ancient neurilemmoma in the maxilla in the patient which is distinctive for the lesion. This unique case presented with distinct histologic architectural pattern of ancient neurilemmoma showing degenerative changes such as cystic degeneration and recurred within a short duration of time.
Nephropathology
Shirin Taraz Jamshidi; Khadijeh Sajjadian; Maryam Emadzadeh; Malihe Saber Afsharian; Mahmoud Reza Kalantari; Anita Alenabi; Abbas Ali Zeraati; Ali Emadzadeh
Abstract
Background & Objectives: Polyomavirus-associated nephropathy (PVAN), mainly caused by the BK virus, is one of the most important infectious complications of kidney transplantation. The leading histopathologic characteristics of PVAN is viral cytopathic effects, such as nucleomegaly with smudged or ...
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Background & Objectives: Polyomavirus-associated nephropathy (PVAN), mainly caused by the BK virus, is one of the most important infectious complications of kidney transplantation. The leading histopathologic characteristics of PVAN is viral cytopathic effects, such as nucleomegaly with smudged or clumped chromatin and intranuclear ground-glass inclusion, mostly in tubular epithelial cells. Moreover, tubular necrosis, tubulitis, interstitial inflammation, atrophy, and fibrosis have been noted. Positive immunohistochemistry (IHC) staining for SV-40 highlights the infected epithelial cells of renal tubules. Methods: A total of 85 core needle biopsies of transplanted kidneys were evaluated histologically and were stained for SV-40 using the IHC method. In addition, a follow-up of graft failure was performed. Results: Our findings revealed that the frequency of polyomavirus infection in kidney transplant patients in the Northeast of Iran is 4.7%. There was no significant correlation between PVAN and graft rejection. Although a higher rate of graft loss was observed in PVAN patients, in comparison with non-PVAN patients (25% vs. 14.8%), the difference was not statistically significant. Moreover, patients with immunohistochemically confirmed PVAN and those with histopathologic features of viral-like cytopathic effects had significantly lower graft survival in the follow-up period (42.5 vs. 196.8 months and 109.4 vs. 205.7 months, respectively). Conclusion: The frequency of polyomavirus infection in kidney transplant patients in the Northeast of Iran is 4.7%. There was no significant correlation between PVAN and graft rejection. Furthermore, we observed that polyomavirus infection accelerates the course of graft loss.
Oral Pathology
Pooja Jaiswal; Mousumi Sharma; Faraz Ahmad; Nausheen Sanaullah Khan; Siddhartha Sinha; Megha Agarwal
Abstract
Background and objective: Fine needle aspiration cytology (FNAC) of salivary gland lesions is an accepted and useful diagnostic tool to differentiate between benign and malignant lesions. Majority of the neoplasms are benign, and specific diagnosis on cytology can be made in most of the cases. However, ...
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Background and objective: Fine needle aspiration cytology (FNAC) of salivary gland lesions is an accepted and useful diagnostic tool to differentiate between benign and malignant lesions. Majority of the neoplasms are benign, and specific diagnosis on cytology can be made in most of the cases. However, the utility is limited by the overlapping and heterogeneous morphological features of benign and malignant neoplasms. The current study aimed at investigating the cytomorphological features of salivary gland lesions with histopathological correlation and performing risk based stratification of these lesions using the recommended Milan system for reporting of salivary gland cytopathology (MSRSGC). Methods: The current study was conducted on 192 retrospective and prospective cases of salivary gland lesions over a period of three years from October 2014 to September 2017. Cytohistopathological correlation was observed in 62 cases. Subsequently, cytomorphological features were further revaluated, classified according to MSRSGC into six groups, and correlated with clinico-histopathological features. Result: Diagnostic sensitivity and specificity of FNAC for salivary gland lesions was 63.16% and 97.62%, respectively. The positive predictive value was 92.31% and negative predictive value was 85.42%. The diagnostic accuracy to differentiate between benign and malignant lesions was 86.88%.The number of cases in each diagnostic category and the risk of malignancy (ROM) were as follows: nondiagnostic – three cases (ROM – 33.33%), nonneoplastic – 14 cases (ROM – 7.14%), atypical – one case (ROM – 100%), benign – 28 cases (ROM – 7.14%), NUMP – one case (ROM – 100%), suspicious – one case (ROM -100%), and malignant – 13 cases (ROM – 92.30%). Conclusion: Risk based stratification scheme as recommended by MSRSGC can provide a standard method to analyse the results and help to plan the management of salivary gland lesions.
Head and Neck Pathology
Shokouh Taghipour Zahir; Fatemeh Derakhshani; Mohammad Reza Vahidy; Mojtaba Meybodian
Abstract
Angiosarcoma is a malignant vascular tumor that occurs mostly in the soft tissues, skin, trunk, and limbs. Angiosarcoma of the parotid gland is a very uncommon and rare tumor.Herein, we presented a case of a 66-year-old man who was referred for a lump in his neck and his initial biopsy reported Castleman ...
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Angiosarcoma is a malignant vascular tumor that occurs mostly in the soft tissues, skin, trunk, and limbs. Angiosarcoma of the parotid gland is a very uncommon and rare tumor.Herein, we presented a case of a 66-year-old man who was referred for a lump in his neck and his initial biopsy reported Castleman disease. After three months during which the mass did not resolve, a re-biopsy was performed. The biopsy revealed vascular neoplasm composed of neoplastic spindle cells arranged in fascicles with red blood cells between them in the lymph node. This metastatic angiosarcoma was confirmed by immunohistochemical staining. Neoplastic cells were positive for vimentin, EMA, and CD31. The patient underwent radiation therapy. Nine months later, MRI (magnetic resonance imaging) showed a tumor in the parotid gland. The microscopic examination revealed a primary angiosarcoma of the parotid.Although primary angiosarcoma of the parotid gland is very rare, it should be considered as a possible origin in metastatic angiosarcoma of the neck. Further research is recommended on the subject.
