Breast Pathology
Amirhossein Jafarian; Mohaddeseh Shahraki; Samaneh Sajjadi; Behrooz Daneshmand
Abstract
Background: Breast sarcoma is a rare, but aggressive tumor. There are few case reports in the literature and several aspects of this disease are still not completely comprehended. Therefore, reporting new cases can help to enrich the literature.Case Presentation: We report a case with a breast mass and ...
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Background: Breast sarcoma is a rare, but aggressive tumor. There are few case reports in the literature and several aspects of this disease are still not completely comprehended. Therefore, reporting new cases can help to enrich the literature.Case Presentation: We report a case with a breast mass and pus secretion from her right breast, misdiagnosed as having an abscess and mistreated by antibiotics. The patient was referred for an ultrasound examination and mammography, and a needle biopsy was performed that suggested an aggressive tumor. By the pathologist’s suggestion, a total mastectomy of the right breast was performed with the excision of sentinel nodes. A pathological examination revealed high-grade undifferentiated pleomorphic sarcoma (UPS) without vascular or lymph node invasion as the final diagnosis. The patient underwent postoperative chemotherapy and is currently in good condition.Conclusion: This case emphasizes considering this rare tumor when approaching a breast mass. Performing surgery with adequate resection margin can improve the patient’s prognosis. Some cases reporting lung and brain metastasis suggest breast UPS is a more aggressive tumor than other breast sarcomas. Total mastectomy with negative margins and free-of-tumor lymph nodes may be the key to improved prognosis in such patients.
Hematopathology
Amir Hossein Jafarian; Melika Kooshki forooshani; Hossein Reisi; Nema Mohamadian roshan
Abstract
Background & Objective: Matrix metalloproteinases-9 (MMP-9) is one of the most important enzymes to breakdown extracellular matrix which plays a major role in tumor invasion and metastasis. This study aimed to determine tumor MMP-9 expression in non-small-cell lung carcinoma (NSCLC) and ...
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Background & Objective: Matrix metalloproteinases-9 (MMP-9) is one of the most important enzymes to breakdown extracellular matrix which plays a major role in tumor invasion and metastasis. This study aimed to determine tumor MMP-9 expression in non-small-cell lung carcinoma (NSCLC) and whether it is associated with histopathologic factors and has prognostic value to affect overall survival (OS). Methods: The specimens of 92 patients with NSCLC diagnosis were included. Tumor sections were stained by immunohistochemistry method. Using scores for the percentage of cells positively stained and the intensity of staining, MMP-9 expression total score was classified as low-score (scores of 0 to 2), moderate-score (scores of 3 to 5), or high-score (scores of 6 or 7). OS was defined as the time interval since the diagnosis of NSCLC to the status at the last follow-up (dead or alive). The follow up period was up to 70 months. Results: About 74% of undifferentiated specimens (grade III tumors) showed high scores for MMP-9 expression which was significantly higher than moderately differentiated tumors (25% had high scores for MMP-9 expression) and well differentiated ones which did not have high scores (p <0.001). A total of 74 patients (80.4%) died during the follow-up period. Of this, 36% had high scores for MMP-9 expression. In contrast, none of the patients who were alive at the last follow-up had high scores for MMP-9 expression (p <0.001). Median OS was significantly lower in high score group (6 months) compared to moderate score (9 months) and high score group (15 months) (p <0.001). Conclusion: MMP-9 expression may serve as a significant prognostic factor for mortality and overall survival in NSCLC. Undifferentiated tumors significantly express higher MMP-9 immunohistochemically.
Molecular Pathology
Amir Hossein Jafarian; Nema Mohammadian Roshan; Hossein Ayatollahi; Abbas Ali Omidi; Masoumeh Ghaznavi; Masoumeh Gharib
Abstract
Background & Objective:Idiopathic pulmonary fibrosis (IPF) is a chronic and uniformly fatal interstitial lung disease with incompletely understood pathogenesis. Several studies have given the evidence for and against viral cofactors in the pathogenesis of Idiopathic pulmonary fibrosis. In this study ...
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Background & Objective:Idiopathic pulmonary fibrosis (IPF) is a chronic and uniformly fatal interstitial lung disease with incompletely understood pathogenesis. Several studies have given the evidence for and against viral cofactors in the pathogenesis of Idiopathic pulmonary fibrosis. In this study Epstein-Bar Virus (EBV) and Human Herpesvirus 8 (HHV-8) have been studied for a possible role in the pathogenesis of IPF.Methods:Polymerase chain reaction (PCR) was employed for the detection of EBV and HHV-8 in 58 formalin-fixed paraffin-embedded lung tissue specimens (29 controls and 29 IPF specimens).Results:EBV DNA was present in the lung tissue of 6 out of 29 (20.7%) IPF specimens compared with 1 out of 29 (3.4%) controls (P=0.102). The HHV-8 gene was identified in 3 out of 29 (10.3%) cases of IPF specimens. The control group showed no evidence of HHV-8 gene (P=0.227).Conclusion:Although multiple studies are strongly suggestive of a role for EBV and HHV-8 in the development of IPF, there was no statistically significant difference in the prevalence of EBV and HHV-8 DNA in the IPF specimens and controls in this study.
Molecular Pathology
Amir Hossein Jafarian; Melika Kooshki forooshani; Farzane Farzad; Nema Mohamadian Roshan
Abstract
Background & Objective: In Triple-Negative Breast Cancers (TNBCs), estrogen receptor (ER), progesterone receptor (PR) and HER2/neu genes are not expressed. Fibroblastic Growth Factor Receptor-1 (FGFR1) gene product is a protein that acts as a receptor of thyrosin kinase. It plays a role in the proliferation, ...
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Background & Objective: In Triple-Negative Breast Cancers (TNBCs), estrogen receptor (ER), progesterone receptor (PR) and HER2/neu genes are not expressed. Fibroblastic Growth Factor Receptor-1 (FGFR1) gene product is a protein that acts as a receptor of thyrosin kinase. It plays a role in the proliferation, differentiation, and migration of malignant cells. The objective was to evaluate the possible relation between FGFR1 over-expression and amplification in TNBCs and other clinicopathological variables. Methods: In this cross sectional study, purposive sampling was used to collect eighty-four TNBC specimens from mastectomy specimens collected between 2013 and 2017. Tissue microarrays were evaluated for FGFR1 over-expression and amplification respectively by immunohistochemistry (IHC) staining and real time Polymerase Chain Reaction (PCR). The needed clinical and paraclinical information were obtained from patients’ files. To analyze the correlation among prognostic factors, we used a wide range of different statistic methods, namely Chi-square test, independent t-test, Fisher's exact test, and ANOVA. Result: FGFR1 over-expression was found in 15 of the 84 samples (17.9%). FGFR1 gene amplification was observed in 33.3% (28 of 84) of the samples. We found no association between FGFR1 and clinicopathological parameters, including tumor grade, stage, and patient survival (P>0.005). Conclusion: FGFR1 over-expression and amplification may not be related to clinicopathological parameters, namely age, stage, and grade of the cancer not to mention TNBC survival. Using FGFR1 as a prognostic factor in TNBCs requires further study.
Breast Pathology
Amir Hosein Jafarian; Melika Kooshkiforooshani; Abdolshakor Rasoliostadi; Nema Mohamadian Roshan
Abstract
Background & Objective: In vascular (vasculogenic) mimicry (VM), tumoral cells mimic the endothelial cells and form the extracellular matrix-rich tubular networks. It has been proposed that VM is more extensive in aggressive tumors. This study was designed to investigate the rate of VM expression ...
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Background & Objective: In vascular (vasculogenic) mimicry (VM), tumoral cells mimic the endothelial cells and form the extracellular matrix-rich tubular networks. It has been proposed that VM is more extensive in aggressive tumors. This study was designed to investigate the rate of VM expression in the stromal cells of invasive ductal carcinoma (IDC) and to find its relationship with other clinicopathological factors. Methods: In this cross-sectional study, 120 patients with histopathologic diagnosis of IDC who received mastectomy were included. The VM expression was determined by immunohistochemistry (IHC). The clinicopathologic data including age, tumor size, histological grade, clinical stage, axillary lymph node metastasis, hormonal receptors, and survival were documented. Results: The mean (±SD) age of the patients was 51 (±13.83) years old. The stromal VM expression was detected in 16 of 120 patients (13.3%). Twelve specimens (75%) of positive VM expression group had grade 3 which was higher than negative VM expression group (9 cases, 8.65%; P<0.001). The VM expression showed statistically significant relationship with higher histologic grade higher clinical stage (stage 3) of the tumor (62.5% vs. 87%; P=0.003), the presence of axillary lymph node metastasis (95.6% vs. 55.8%; P<0.001), and positive HER-2 (100% vs. 31.1%; P<0.001); but not estrogen receptor (ER) or progesterone receptor (PR). However, age, tumor size and mortality rate were not significantly different among the patients with and without VM expression. Conclusion: The stromal VM expression showed significant relationship with higher stage and grade of the tumor and the presence of nodal metastasis. The VM expression in IDC can be used as a marker for tumor aggressiveness.
Molecular Pathology
Amir Hossein Jafarian; Nema Mohammadian Roshan; Masoumeh Gharib; Vahid Moshirahmadi; Aida Tasbandi; Amir Ali Ayatollahi; Hossein Ayatollahi
Abstract
Background and Objective: The primary goal of this study is to develop a rigorous understanding ofthe correlation between COX-2 expression and malignant melanoma prognostic factors. Material and Methods: In this cross-sectional study, we analyzed 60 cases of cutaneous malignant melanoma. The related ...
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Background and Objective: The primary goal of this study is to develop a rigorous understanding ofthe correlation between COX-2 expression and malignant melanoma prognostic factors. Material and Methods: In this cross-sectional study, we analyzed 60 cases of cutaneous malignant melanoma. The related stained slides were reviewed by two pathologists. The results were interpreted according to the COX2 staining index (SI), tumor thickness (Breslow, Clark), number of mitoses per 10 hpf, and melanoma types. Gender, lymph node involvement, metastasis, and survival were considered as evaluation factors as well. Results: The expression of the COX-2 protein was evident in 98.4% of cases. A strong Staining Index(SI) was reported in 60% of all melanomas, moderate staining was detected in 20.8% and weak staining in 10%; 1.6% of studied cases showed no staining. Benign nevus specimens showed no staining for the COX-2 enzyme. Conclusion: We have demonstrated that COX-2 is strongly expressed in the majority of malignant melanomas and that the SI score of COX-2 is related to the number of mitoses, tumor thickness (based on Clark level and Breslow), melanoma sub-type, lymph node involvement, and metastases; No association was noted between the anatomic site, gender, and survival. COX-2 can be applied as a prognostic factor in malignant melanoma and a promising candidate for future target therapies.
Diagnostic Pathology
Amir Hossein Jafarian; Khatoone Mirshekar; Sare Etemad; Masoumeh Jafaripour; Mansoore Darijani; Maryam Sheikhi; Hossein Ayatollahi; Sepideh Shakeri; Seyyede Fatemeh Shams; Saeed Davari
Volume 13, Issue 4 , October 2018, , Pages 415-421
Abstract
Background and Objective: BRAF mutations were studied in various populations for prostate carcinoma (PC); however, mutations in BRAF gene are unusual compared to KRAS. Oncogenic activating of BRAF mutations were studied lately in almost 0%-10% of prostate cancer cases. Methods: In this retrospective ...
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Background and Objective: BRAF mutations were studied in various populations for prostate carcinoma (PC); however, mutations in BRAF gene are unusual compared to KRAS. Oncogenic activating of BRAF mutations were studied lately in almost 0%-10% of prostate cancer cases. Methods: In this retrospective study, we gathered 100 formalin-fixed paraffin-embedded samples of prostate adenocarcinoma. A hundred archived samples of adjacent benign prostatic hyperplasia were chosen as normal control. This study was done in pathology laboratory of Qaem Hospital during 2013-2015.Results: Total number of 200 PC and normal cases was investigated for BRAF V600E mutation. The BRAF V600E mutation was found in only 4 patients but it was not detected in normal cases. There were no significant differences between patient and control groups for this mutation (P>0.99). The frequency of BRAF V600E mutation was not significant in different age groups (P>0.285); the most frequency was related to the age range of 71-80. No significant difference was observed between tumor grade and BRAF mutation (P=0.21).Conclusion: According to our findings, BRAF gene mutations did not play essential role in PC. Therefore, anti-BRAF (V600E) could not be considered as a proper target for therapy.
Biology & Genetic
Hossein Ayatollahi; Alireza Tavassoli; Amir Hossein Jafarian; Amin Alavi; Sepideh Shakeri; Seyyede Fatemeh Shams; Maryam Sheikhi; Neda Motamedi Rad; Mohammadhadi Sadeghian; Afsane Bahrami
Abstract
Background & objective: KRAS mutations are reported in many types of cancers including pancreas, lung, colon, breast, and gastric (GC). High frequency of KRAS mutation is observed in the pancreas, colon, and lung cancers; they commonly arise in codon 12 and 13 of exon 2. Due to the lack of information ...
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Background & objective: KRAS mutations are reported in many types of cancers including pancreas, lung, colon, breast, and gastric (GC). High frequency of KRAS mutation is observed in the pancreas, colon, and lung cancers; they commonly arise in codon 12 and 13 of exon 2. Due to the lack of information about the frequency of KRAS mutations in the Northeast of Iran, the current study aimed at evaluating KRAS frequency in cases with GC in this region. Methods: A total of120 formalin-fixed, paraffin-embedded blocks of patients with GC were assessed. The assays to detect KRAS in codon 12 and 13 were obtained through the peptide nucleic acid (PNA)-clamp. Results: Totally 87 male and 33 female patients were analyzed in the current study. The mean age of the subjects was 55 years. The most common tumoral fragment was located on the body with 48 cases (40%) and the less frequent was related to fondues with six cases (5%). Of the 120 GC samples, 16 (13.3%) cases had codon 12 KRAS mutation, and 16.7% had codon 13 mutations. There were no significant relationships between gender, age, and KRAS mutations in the studied specimens. Conclusion: In conclusion, the overall frequency of KRAS codon 12 and 13 mutations in GC was 30% in the current study population. Frequency of KRAS codon 12 and 13 mutations had significant correlation with tumors location. Different pathogenic mechanisms are suggested for GC according to tumor location. The current study results may be an important diagnostic tool for physicians managing atrophic gastritis.
Amir Hossein Jafarian; Masoumeh Gharib; Nema Mohammadian Roshan; Samaneh Sherafatnia; Abbas Ali Omidi; Sahar Bagheri
Abstract
Background & objective: The histologic distinction of small cell from non-small cell lung carcinoma and correct identification of all subtypes of lung carcinoma are very important in treatment management. The main method for histologic classification of lung tumors is based on morphology. However, ...
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Background & objective: The histologic distinction of small cell from non-small cell lung carcinoma and correct identification of all subtypes of lung carcinoma are very important in treatment management. The main method for histologic classification of lung tumors is based on morphology. However, in small bronchoscopic biopsies in particular, distinction is very difficult upon morphology alone. The current study aimed at evaluating the utility of a panel of antibodies, consisting of thyroid transcription factor (TTF-1), P63, high molecular weight keratin [HMWK (34βE12)], cytokeratin (CK7), and cluster of differentiation (CD56) for accurate distinction of bronchogenic carcinomas. Methods: Bronchoscopic biopsies of 60 lung carcinoma cases including 20 small cell carcinomas, 20 adenocarcinomas, and 20 squamous cell carcinomas (SCCs) with typical morphologic features were selected. All these cases were immunohistochemically stained for TTF-1, P63, HMWK (34βE12), CK7, and CD56. All immunostained slides were scored as either positive or negative. Results: The mean age of the patients was 60 years; ranged from 35 to 81. Sixteen patients were female and 44 were male. All adenocarcinomas were positive for CK7 and most of them (18/20; 90%) were positive for TTF-1. Most of small cell lung carcinomas were positive for TTF-1 (17/20; 85%), and CD56 (18/20; 90%). All squamous cell carcinomas (SCCs) were negative for TTF-1, but most of them were positive for HMWK (34βE12) and P63. Conclusion: The obtained data showed that TTF-1, P63, CK7, CD56 and/or 34βE12 represent a useful panel of antibodies to identify lung carcinoma subtypes in small bronchoscopic biopsies.
Amir Hosein Jafarian; Amin Rahpeyma; Saeedeh khajehahmadi
Abstract
The glandular odontogenic cyst (GOC) is a rare lesion with odontogenic origin. It shows a propensity for recurrence revealed in 30% of all case. This investigation reports a case of recurrent GOC in a 35-year-old female in the anterior region of the maxilla, which is uncommon and discusses about IHC ...
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The glandular odontogenic cyst (GOC) is a rare lesion with odontogenic origin. It shows a propensity for recurrence revealed in 30% of all case. This investigation reports a case of recurrent GOC in a 35-year-old female in the anterior region of the maxilla, which is uncommon and discusses about IHC finding, surgical methods, and differential diagnosis. Under general anesthesia, peripheral bone ostectomy via large round bur for removal of remaining epithelium of the cyst wall was done. Finally liquid nitrogen was used to remaining bone. This article recommends that soft tissue adjacent to the cortical bone perforation should be excised, as well as peripheral bone ostectomy by large round bur for removal of remaining epithelium of the cyst and liquid nitrogen application to the bony cavity. Because of high recurrence rate of the lesion close follow up of the patients is needed.
Amir Hossein Jafarian; Abbas Ali Omidi; Ali Shamsa; Saeedeh Khajeh Ahmadi
Volume 8, Issue 2 , April 2013, , Pages 123-126
Abstract
Primitive neuroectodermal tumor (PENETs) is an uncommon malignancy of bone and soft tissue witch rarely occurs in the kidney. In more than 90% of the cases, the tumor cells relieves a balanced translocation (11; 22) (q24; q12). Immunohistochemical staining may be required for diagnosis of PENET. The ...
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Primitive neuroectodermal tumor (PENETs) is an uncommon malignancy of bone and soft tissue witch rarely occurs in the kidney. In more than 90% of the cases, the tumor cells relieves a balanced translocation (11; 22) (q24; q12). Immunohistochemical staining may be required for diagnosis of PENET. The cells of tumor express CD99, vimentin, NSE, FL1 but do not express Ck, LCA, myogenin, and WT1. We present a 36-year –old female with left –side tender abdominal swelling, and history of trauma to abdominal. CT imaging confirmed a huge solid mass of kidney, also extending into renal pelvis. Histological section of the lesion showed a malignant proliferation of small round cells in rosette-like pattern with foci of necrosis area. Tumor cells expressed high level of CD 99 antigen. The diagnosis of the lesion was primitive neuroectodermal tumors (PNET). Following-up after 6 months showed no recurrence.
Amir Hossein Jafarian; Jahanshah Salehinejad; Bahareh Joushan; Abbas Ali Omidi
Volume 6, Issue 2 , April 2011, , Pages 86-92
Abstract
Background and Objectives: Adenoid cystic carcinoma (ACC), the most common malignant tumor of submandibular and minor salivary glands, is characterized by a high rate of local recurrence and distant hematogenous metastasis and tendency to invade peripheral nerves. In spite of radiotherapy and ...
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Background and Objectives: Adenoid cystic carcinoma (ACC), the most common malignant tumor of submandibular and minor salivary glands, is characterized by a high rate of local recurrence and distant hematogenous metastasis and tendency to invade peripheral nerves. In spite of radiotherapy and surgical treatment, the long-term prognosis is dismal. Today, many studies are being conducted using the immunohistochemical markers to help in the evaluation of ACC prognosis. The present investigation was performed to survey immunohistochemically HER2/neu over expression in adenoid cystic carcinoma of salivary glands. Materials and Methods: The 24 existing samples of formalin-fixed paraffin embedded specimen were stained with HER2/neu markers. Tumors with moderate (2+) to strong (3+) complete membrane staining in at least 10% of the tumor cells were scored as positive for over expression. Results: The overall frequency of over expression for HER2/neu was 45.8% and 11 specimen were positive for HER2/neu expression. A significant relationship was found between HER2/neu over expression and grade of ACC. No significant relationship was detected between immunostaining of HER2/neu and histologic pattern. Conclusion: HER2/neu immunostaining might be reliable and useful for evaluation of ACC prognosis.
Abasali Omidi; Amir Hossein Jafarian; Minoo Erfanian; Mohammad Javad Yazdanpanah; Masoud Sharifian
Volume 4, Issue 3 , June 2009, , Pages 133-136
Abstract
Human brucellosis is common in developing countries and is a multi-system disease with a broad spectrum of clinical manifestations. Cutaneous lesions associated with brucellosis have been rarely reported in the literature. Here we present a case of a 32-year-old man with history of consumption ...
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Human brucellosis is common in developing countries and is a multi-system disease with a broad spectrum of clinical manifestations. Cutaneous lesions associated with brucellosis have been rarely reported in the literature. Here we present a case of a 32-year-old man with history of consumption of cheese made from raw milk seen with occurrence of pancytopenia and diffuse maculopapular rash during the course of Brucella infection. Physical examination showed fever, splenomegaly, mild hepatomegaly and pruritic maculopapular exanthema over the trunk, arms and legs. Laboratory tests revealed pancytopenia. Parasitic examinations and serologic tests for syphilis, salmonellosis, rickettsiasis, toxoplasmosis, Epstein-Barr virus, human immunodeficiency virus, and hepatitis B and C viruses were negative. There was no history of drug consumption.The Brucella agglutination test titer was 1/1280 and histological examination of skin biopsy showed lymphohistiocytic perivascular infiltrates in the upper dermis.Lesions were interpreted as Brucellar dermatitis , The patient was subsequently treated with oral doxycycline and rifampin and was discharged in good health. If there is suspicion of exposure to infected food products, brucellosis should be included in the differential diagnosis of pancytopenia in Brucella-endemic areas; there may be skin lesions other than purpura that can accompany thrombocytopenia.
