Breast Pathology
KUMARGURU B N; RAMASWAMY A S; ARATHI C A; SWATHI D
Abstract
Background & Objective: Invasive breast carcinoma (IBC) is the most commonly diagnosed cancer among women in India. The conventional visual method of evaluation of Tumor-Stroma Ratio (TSR) and Stromal Tumor-Infiltrating Lymphocytes (sTIL) appears to be subjective. The present study aims to evaluate ...
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Background & Objective: Invasive breast carcinoma (IBC) is the most commonly diagnosed cancer among women in India. The conventional visual method of evaluation of Tumor-Stroma Ratio (TSR) and Stromal Tumor-Infiltrating Lymphocytes (sTIL) appears to be subjective. The present study aims to evaluate the utility of the indigenously designed square grid method for the evaluation of tumor-stroma ratio and stromal tumor-infiltrating lymphocytes in invasive breast carcinoma by assessing the inter-observer variability.
Methods: This was a retrospective study conducted at a rural tertiary care referral institute from July 2018 to June 2020. In each case, microphotographs were taken from 10 representative fields in H&E-stained sections for evaluating TSR in low-power and sTIL in high-power. Both the parameters were evaluated employing an indigenously designed square grid applied onto microphotographs in the power-point slides by making use of principles of the Pythagorean theorem. Both parameters were separately evaluated by two pathologists. Cohen kappa statistics was the statistical tool used to analyze inter-observer variability.
Results: Thirty cases were analyzed. Invasive breast carcinoma of no special type (IBC-NST) was the most common histopathological type (26 cases (86.67%)). For TRS evaluation, a Kappa value of 0.78 suggested substantial agreement with an agreement of 91.67%. For sTIL evaluation, a Kappa value of 0.51 suggested moderate agreement with an agreement of 88.33%. The P-values were statistically highly significant (P<0.001).
Conclusion: Square grid method is a novel technique for evaluating TSR and sTIL in invasive breast carcinoma. It can be considered an example of the application of Pythagoras’ theorem in Pathology.
Infectious Diseases
Sedigheh Hantoushzadeh; Roya Saeednejad; Mamak Shariat; Raheleh Moradi
Abstract
Background & Objective: It was declared that COVID-19 might be more severe in symptomatic pregnant patients. This study was conducted to examine the pathological indices of the placenta in pregnant women who were diagnosed with COVID-19.Methods: A total of 20 COVID-19–positive mothers were ...
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Background & Objective: It was declared that COVID-19 might be more severe in symptomatic pregnant patients. This study was conducted to examine the pathological indices of the placenta in pregnant women who were diagnosed with COVID-19.Methods: A total of 20 COVID-19–positive mothers were enrolled in this study. Detailed placental pathology findings were compared between subjects based on the history of abortion or occurrence of preterm delivery, hypertension, and diabetes.Results and Conclusion: Intervillositis was the most frequent abnormality of the placenta. There was also a significant association between abortion history and maternal vascular malperfusion (MVM; P=0.02). The placental abnormalities were found to be increased in women with COVID-19, regardless of maternal comorbidities. Further studies are needed to compare the placental pathology between COVID-19–positive women and healthy women.
Microbiology
Seyed Esmaeil Azimi Khatibani; Shima Tabatabai
Abstract
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 ...
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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.
Diagnostic Pathology
Alireza Abdollahi; Ali Labbaf; Mahboobeh Mafinejad; Maryam Sotoodeh-Anvari; Farid Azmoodeh-Ardalan
Abstract
Background & Objective: The world is facing COVID-19 pandemic, and medical education system and consequently the evaluation of students at different levels have been overshadowed. Residency students are among those affected. In the present study, we aim to share our experiences regarding holding ...
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Background & Objective: The world is facing COVID-19 pandemic, and medical education system and consequently the evaluation of students at different levels have been overshadowed. Residency students are among those affected. In the present study, we aim to share our experiences regarding holding exams for pathology residents before and during the pandemic.Methods: This cross-sectional study was carried out in Tehran University of Medical Sciences. The online exam, which consisted of 30 multiple-choice questions, was designed and held in April 2020 to evaluate pathology residents. To assess the quality of the exam, indices such as the number of questions, highest and lowest scores, the average score, the standard deviation, the variance, Cronbach’s alpha reliability coefficient, standard error of measurement, discrimination index, difficulty index, number/percentage of questions on three difficulty levels of easy, normal, hard were reviewed and analyzed.Results and Discussion: The average score of the participants in the January exam which was held in the university’s exam center was 16.23 (±5.03), while the average score in the online exam which was held after the onset of the pandemic was 20.86 (±5.18). The average discrimination indices in the first and second exams were 0.36 and 0.38, respectively, and the average difficulty indices in the first and second exams were 0.54 and 0.70, respectively. We found the administration of this online examination would be a positive experience. By sharing it, we hope to pave the way for similar ventures in the other departments.
Cytology
Fatemeh Samiee Rad; mehdi Ghaebi; Simin Zarabadipour; Arezoo Bajelan; fatemeh Pashazade; Mehri Kalhor; Amane Barikani
Abstract
Background & Objective: Premalignant lesions of cervix have increased dramatically in recent years. Early diagnosis and management of abnormalities have an effective role in preventing the invasion of the disease and also in timely treatment. This study aimed to compare diagnostic methods in the ...
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Background & Objective: Premalignant lesions of cervix have increased dramatically in recent years. Early diagnosis and management of abnormalities have an effective role in preventing the invasion of the disease and also in timely treatment. This study aimed to compare diagnostic methods in the detection of squamous cell abnormalities with abnormal Pap smear test. Methods: This cross-sectional study was performed on 1000 women with abnormal Pap smears in 2007-2018. Sampling was performed with simple method. All samples were subjected to an immediate assessment of colposcopy and histopathology if suspected. The checklist included demographic information as well as symptoms, cytopathology, colposcopy and histopathology findings. Data analysis was performed using descriptive and statistical analysis (P<0.05). Result: A significant relationship between histopathology and Pap smear findings was found (P=0.009), also there was a significant correlation between histopathology and colposcopy findings (P=0.001). However, there was no significant relationship between clinical symptoms and histopathology findings (p=0.8). Sensitivity , specificity , positive and negative predictive value of Pap smear were 43%, 65.9%, 75.4%, 32.2% and of colposcopy were 74.7%, 39.5%, 75%, 39.1%, and of clinical symptoms were 72.6%, 28.1%, 71.1%, 29.7%, respectively. Conclusion: Pap smear findings have the appropriate diagnostic accuracy in comparison with colposcopy and histopathology findings for screening and diagnosis of squamous intra-epithelial lesions. Also, there was higher sensitivity of colposcopy compared with Pap smear to detect cervical lesions. Therefore, it is advisable to use these methods simultaneously.
GI, Liver & Pancreas Pathology
Zeinab Kishani farahani; Mahsa Ahadi; Behrang Kazeminejad; Tahmineh Mollasharifi; Malihe Saber Afsharian; Amir Sadeghi; Farahnaz Bidari zerehpoosh; Elena Jamali; Niki Hasanzadeh; Abolfazl Movafagh; Arash Dehghan; Arsham Moradi; Afshin Moradi
Abstract
Background & Objective: Liver biopsy is the main method for grading and staging liver disorders, but the effects of clinical information and optimal biopsy specimen size on interpretation remain contentious. The aim of the study was to evaluate the impact of clinical information and quality of liver ...
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Background & Objective: Liver biopsy is the main method for grading and staging liver disorders, but the effects of clinical information and optimal biopsy specimen size on interpretation remain contentious. The aim of the study was to evaluate the impact of clinical information and quality of liver specimen on inter-observer agreement for liver disease. Methods: A total of 289 consecutive biopsy specimens from 2010 to 2017 were re-evaluated by five pathologists using the modified Ishak and non-alcoholic fatty liver diseases (NAFLD) activity score (NAS) systems. Detailed clinical information was extracted from medical records of patients and the size of all liver biopsy samples was recorded. Results: Full agreement between primary diagnosis and final diagnosis was obtained in 214 cases (74%). The remaining cases, namely 22 (7.6%) and 53 (18.3%) biopsies had minor and major diagnostic discrepancies, respectively. The results showed that the overall agreement was significantly higher in cases with complete clinical information than patients without any clinical information and even with partial clinical information (P<0.001). Interestingly, no significant difference in inter-observer agreement was achieved with a length over 20 mm (P=0.181). However, the inter-observer variation significantly decreased when the number of portal tract was more than 10 (P=0.001). Conclusion: This study identified the impact of clinical information and the number of portal tracts as the key factors to diagnosis. Therefore, request forms for liver biopsies should always be accompanied with the clinical history. Moreover, adequacy of biopsy specimens is very useful for accurate evaluation of samples by pathologists.
Uropathology
Iraj Khosrovpanah; Sadeq Rostami; Zhoobin Heidari bateni; Mojtaba Teimoori; Darya Khosrovpanah
Volume 13, Issue 3 , July 2018, , Pages 333-339
Abstract
Background and Objective: Prostate cancer is considered as one of the most common malignancies in males. Despite the decreasing trend during the past decade, the incidence continues to rise in adolescents worldwide. Recently, new emerging technologies beside TRUS-guided prostate biopsy were introduced ...
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Background and Objective: Prostate cancer is considered as one of the most common malignancies in males. Despite the decreasing trend during the past decade, the incidence continues to rise in adolescents worldwide. Recently, new emerging technologies beside TRUS-guided prostate biopsy were introduced and showed high potential in the diagnosis of prostate cancer. The current study aimed at investigating the role of blood cell count and its prognostic value on pathologic findings.Methods:The current prospective analysis was conducted on patients with abnormality from January 2013 to January 2015. A total of 168 CBC tests including absolute Neutrophil and lymphocyte counts were performed on males at the Department of Urology, Razi University Hospital (Guilan, Iran). Of these, all males had both CBCs and free:total (F/T) prostate-specific antigen (PSA) ratio.Results: Average age of patients was 63.5±7. It was observed that Neutrophil count and Neutrophil percentage was not significantly different among the groups with different pathologies. In comparison to biopsy findings none of the cell count had suitable specificity and sensitivity. In the multivariate analysis to predict malignancy, only age (B=0.1, S.E=0.04, EXP [B]) =1.1 and sig=0.00) and PSA level (B=0.1, S.E=0.04, EXP [B]) =1.1 and sig=0.00) were significant.Conclusions: In comparison to biopsy findings, none of the cell counts (absolute or percent) had suitable specificity and sensitivity, and the cell count and percentage before biopsy were not different among the groups with different pathologies. Powerful and long-term studies are required to evaluate prognostic values of cell count on adenocarcinoma.
Moeinadin Safavi; Jahanbanoo Shahryari; Mohammadmehdi Moeini Aghtaei; Hossein Nikpour
Volume 11, Issue 3 , July 2016, , Pages 255-260
Abstract
Desmoplastic small round cell tumor (DSCRT) is a rare variant of sarcoma with a highly aggressive behavior. It usually affects abdominal cavity and has a male predominance. Its correct diagnosis and treatment is sophisticated and requires an experienced multidisciplinary team. Hereby we present a 25 ...
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Desmoplastic small round cell tumor (DSCRT) is a rare variant of sarcoma with a highly aggressive behavior. It usually affects abdominal cavity and has a male predominance. Its correct diagnosis and treatment is sophisticated and requires an experienced multidisciplinary team. Hereby we present a 25 yrold man from Kerman Province in 2013 with abdominal mass and ascites who underwent sonograghy guided percutaneous needle biopsy which was misleading and inconclusive for diagnosis. Thus an open biopsy was fulfilled which revealed solid nests of small round cells with hyperchromatic nuclei and clear cytoplasm surrounded by a desmoplastic stroma suggestive for DSCRT. The diagnosis was confirmed by positive immunohitochemical reaction for cytokeratin, desmin and neuron specific enolase(NSE).Ultimately the patient underwent chemotherapy on the basis of P6 protocol without surgical debulking.Diagnosis and treatment of DSCRT could be a dilemma due to its rarity, various clinicopathologic mimickers and lack of a consensus about its management.
Oral Pathology
Fariba Binesh; Mohammad Hossein Dadgarnia; Yasaman Khaksar; Abbas Mirvakili
Abstract
Paragangliomas are neoplasms of neural crest origin. In the head and neck, they uncommonly involve the larynx. The distinction between paragangliomas and other neuroendocrine tumors can be difficult. Precise diagnosis is important in order to optimize patient treatment. Diagnosis relies mostly on histopathologic ...
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Paragangliomas are neoplasms of neural crest origin. In the head and neck, they uncommonly involve the larynx. The distinction between paragangliomas and other neuroendocrine tumors can be difficult. Precise diagnosis is important in order to optimize patient treatment. Diagnosis relies mostly on histopathologic examination followed by immunohistochemistry. Here we report a 77-year-old woman with laryngeal paraganglioma that initially misdiagnosed as laryngeal carcinoid tumor.
Nahid Kazemzadeh; Alireza Kadkhodaei; Babak Soltani; Siamak Soltani; Sahar Rismantab Sani
Volume 9, Issue 3 , July 2014, , Pages 181-186
Abstract
Background & Objectives: Respiratory, central nervous system, and skin complications of mustard gas toxicity have previously been studied; however, the liver and kidney side effects due to this intoxication have not been fully noted. We aimed to evaluate the frequency of liver, kidney and lung lesions ...
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Background & Objectives: Respiratory, central nervous system, and skin complications of mustard gas toxicity have previously been studied; however, the liver and kidney side effects due to this intoxication have not been fully noted. We aimed to evaluate the frequency of liver, kidney and lung lesions in mustard gas-exposed Iranian veterans who had been exposed to the toxin almost 2 decades before.
Methods: A total of 100 veteran bodies underwent autopsy by at least two forensic medicine specialists. The liver, kidney and lung specimens were sent for pathological examination and their lesions, severity of the lesions, and the relation between the type/severity of the lesions and the time elapsed since their appearance were studied.
Results: A total of 83%, 63%, and 62% of the veterans had lung, liver, and kidney pathologies. The most common pathologies included liver steatosis, interstitial fibrosis of the kidney, and lung atelectasis.
Conclusion: Liver and kidney pathologies are far more common than what is considered in the mustard gas-exposed veterans. These pathologies are often accompanied by very severe lung complications.
Sedigheh Khazaei; Babak Izadi; Zhaleh Zandieh; Azadeh Alvandimanesh; Siavash Vaziri
Volume 9, Issue 3 , July 2014, , Pages 206-212
Abstract
Background and Objective: Tuberculosis is still a major health problem, involving about 1/3 of the world´s population. Diagnosis is difficult when we only use Ziehl-Neelson staining. Many cases may be missed. A more rapid and sensitive diagnostic method is necessary. PCR may be helpful. The aim ...
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Background and Objective: Tuberculosis is still a major health problem, involving about 1/3 of the world´s population. Diagnosis is difficult when we only use Ziehl-Neelson staining. Many cases may be missed. A more rapid and sensitive diagnostic method is necessary. PCR may be helpful. The aim of this study was to compare PCR, Zieh-Neelsen staining and histopathologic findings in diagnosis of tuberculosis on formalin-fixed paraffin-embedded tissues. Methods: Paraffin blocks of the submitted specimens of the patients clinically suspicious for tuberculosis or containing granuloma were selected. Ziehl-Neelsen Staining & TB-PCR (IS6110 element) was carried out. The results of the tests were compared by using the McNemar test. Statistical significance was accepted when the P value was less than 0.05. Results: Forty five specimens were included in the study, 35 had granulomas (19 with caseous necrosis). Acid-fast bacilli were identified in 17 specimens (37.8%). TB-PCR was positive in 16specimens (84%) with caseating granulomatous, 11 specimens (68.8%) with non-caseating granulomas & 6 specimens (60%) without granulomas. (P value = 0.59). Conclusions: TB-PCR on paraffin–embedded tissue is a potentially useful approach for early, rapid and sensitive diagnosis of tuberculosis. It is especially useful when granuloma is seen in tissue section, while acid-fast stain is negative. If there was no facilities for PCR, histopathological diagnosis with clinical correlation are more reliable in comparison to AFB results.
Jawahar Ramasamy; Renu G’Boy Varghese
Volume 8, Issue 4 , October 2013, , Pages 263-266
Abstract
Pedunculated chorangioma is extremely rare type of chorangioma. To the best of our knowledge, no case has been reported in Indian literature. We report one such rare case in a twenty two year old primi gravida who delivered a full term live female baby by lower section caesarian section (LSCS). Gross ...
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Pedunculated chorangioma is extremely rare type of chorangioma. To the best of our knowledge, no case has been reported in Indian literature. We report one such rare case in a twenty two year old primi gravida who delivered a full term live female baby by lower section caesarian section (LSCS). Gross examination revealed a nodular mass attached to the placenta by a pedicle. Histopathological examination confirmed it as chorangioma. The clinicopathological and radiological feature of this rare entity is presented with a brief review of literature.
Nalini Gupta
Volume 8, Issue 4 , October 2013, , Pages 273-276
Abstract
Proliferating pilomatricoma is a distinctive rare variant of pilomatricoma first described in 1997.Very few cases of proliferating pilomatricoma have been reported in the literature until date. This report is a case of 65 years old male presenting with hard nodular lump on the right side of neck slowly ...
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Proliferating pilomatricoma is a distinctive rare variant of pilomatricoma first described in 1997.Very few cases of proliferating pilomatricoma have been reported in the literature until date. This report is a case of 65 years old male presenting with hard nodular lump on the right side of neck slowly increasing in size for the last 8 months. Wide excision of the lump was performed with clear surgical margins. Histopathology revealed a tumor mass composed of lobular proliferation of basaloid cells in association with adjacent focal areas containing cornified material with shadow cells. Variable nuclear atypia and scattered mitotic activity was noted in basaloid cells, so a final diagnosis of proliferating pilomatricoma was rendered. This report herein reviews histopathological features of this rare entity.
Elahe Keyhani
Volume 7, Issue 2 , April 2012, , Pages 63-69
Abstract
Muscle biopsy has been used for a long time for diagnosis of muscular, nerurogenic and systemic disorders with muscle involvement, because only very few of these disorders show sufficient specific clinical features for definite diagnosis. Since the presence of difficulties in the screening of numerous ...
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Muscle biopsy has been used for a long time for diagnosis of muscular, nerurogenic and systemic disorders with muscle involvement, because only very few of these disorders show sufficient specific clinical features for definite diagnosis. Since the presence of difficulties in the screening of numerous genes, muscle biopsy could be a time and cost effective procedure for solving the diagnostic problems. The aim of this article is to mention the importance of muscle tissue in the evaluation of primary and secondary muscle diseases, special consideration of how to biopsy, handling the specimen and performing the special staining, and the microscopic findings in order to have better interpretation results.
Fatemeh Mahjoub; Farrokh Tirgari; Afshin Abdi Rad; Mahmoud Mohammadi; Nargess Tabarzan; Omid Emadian
Volume 3, Issue 2 , March 2008, , Pages 95-99
Abstract
Background and Objective: Male breast carcinoma (MBC) is an unusual form of neoplasia, representing 0.7 to 1 percent of all breast cancer cases. Usually, the carcinoma affects patients after the sixth decade. The aim of this study was to evaluate the status of estrogen and progesterone receptors (ER ...
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Background and Objective: Male breast carcinoma (MBC) is an unusual form of neoplasia, representing 0.7 to 1 percent of all breast cancer cases. Usually, the carcinoma affects patients after the sixth decade. The aim of this study was to evaluate the status of estrogen and progesterone receptors (ER and PR) and prognostic factors (p53 and Her-2/neu) in a series of male patients with breast cancer and correlate them with tumor grade and stage. Materials and Methods: Fifty cases of breast carcinoma in male patients, retrieved from the files of the Cancer Institute from 1996 until 2005 was included in this study. Results: Most of the cases were categorized as grade 2 (65.3%), grade 1 cases comprised 20.4% and grade 3 was 14.3%. Stage IIb was the largest group (32%). Estrogen receptor was detected in 90% of cases and progesterone receptor in 68% of cases and no significant correlation was found between estrogen and progesterone receptor positivity and tumor grade or stage. In addition, p53 and Her-2/ neu staining revealed positivity in 11 cases (27.5% ) and 13 cases (26%) respectively with strong positivity in only 6 cases and no significant correlation was found between tumor grade and stage and p53 expression. It is clear from our data that Her-2/neu positivity in MBC is lower than in female breast carcinoma. Conclusion: This study, which comprises rather large series of MBC in Iran during a 10-year period, shows that most patients refer in rather late stages and prognostic factors such as p53 and Her-2/neu has no significant correlation with tumor grade and stage at presentation in our patients.
