دکتر فاطمه ساری اصلانی

Chromogenic insitu hybridization (CISH) and immunohistochemistry analysis for p57 are ancillary studies discriminating partial hydatidiform mole (PHM), complete hydatidiform mole (CHM), and non-molar hydropic abortion (HA).

It aimed to study CISH with a probe to chromosome 17 (CISH17) and chromosome 2 (CISH2) discriminating chromosomal ploidy of PHM, CHM, and HA; in addition, their surrogacy value in the evaluation of triploid and diploid in product of conception specimens (POCs) was evaluated.

44 statistically significant POCs were selected retrospectively. The Kappa agreement coefficients, sensitivity, specificity, and accuracy with 95% confidence interval (95% CI) were reported.

PHM, CHM, and HA were diagnosed to be 23, 17, and 3 cases based on both CISH2 and CISH17 resulting in their complete discrimination between PHM and HA (23 vs. 3). The Kappa agreement coefficient was 95.4% (p < 0.001) when diagnosing the PHM (23), CHM (20), and HA (1). In addition, the accuracy, sensitivity, and specificity were 95.26% (95% CI: 84.25-99.38), 100% (95% CI: 85.18-100), and 95% (95% CI: 76.18-99.88), respectively. The power analysis on CISH2 and CISH17 tests discriminating between triploid and diploid in POCs was estimated to be 100%.

Based on the current finding, CISH2 and CISH17 enjoyed perfect agreement in diagnosing chromosomal ploidy; in addition, their absolute power discriminating between triploid and diploid revealed that they could be used as surrogate markers for ploidy. Prospective studies on fresh specimens are suggested comparing the CISH method's accuracy with flow cytometry karyotyping and fluorescence in situ hybridization.

Primary cutaneous diffuse large B‐cell lymphoma-leg type (PCDLBCL‐LT) is a rare malignant disease seen in older adults, especially women. In this case report, we discuss a 78-year-old man who developed erythematous indurated plaques on his left shin for about three months. The patient did not report pruritus, weight loss, night sweats, fever, or chills. There was no lymphadenopathy, splenomegaly, or hepatomegaly on the physical examination. A local tissue biopsy was taken from the plaques, confirming the diagnosis of PCDLBCL‐LT via immunohistochemistry. The patient was referred to an oncologist to begin additional evaluation and treatment. According to the literature, chemotherapy with or without adjuvant radiotherapy is the first treatment choice for PCDLBCL‐LT. Monotherapy with rituximab could be considered in some patients with this condition, but the disease may relapse in a short period.

The rate of cosmetic tattooing in Iran is increasing as in many other countries, with concomitant rises in tattoo-associated complications, including inflammatory (infectious and noninfectious) and neoplastic reactions. We reviewed clinical and pathology features of a series of 13 cases of adverse reactions to tattoo pigments. The participants included 11 women and 2 men aged between 22 and 58. The histopathologic reaction patterns were seven granulomatous (four sarcoid, with heavy tattoo pigments in the superficial dermis, and three tuberculoid, with scanty tattoo pigments in the superficial dermis), three cases of pseudoepitheliomatous hyperplasia, one cutaneous lupuserythematosus-like reaction, one pseudolymphomatous reaction, and one case of mild superficial perivascular inflammation. More than two-thirds of the reactions were to brown tattoos on the eyebrows. The lag in lesion development after tattooing varied from five days to two years.

Non-melanoma skin cancer (NMSC) is the most common type of cancer in the world. In traditional Persian medicine (TPM), various types of temperament (Mizaj) are considered to diagnose, treat, and prevent a variety of illnesses. The present study aimed to evaluate the temperament of patients with NMSC in comparison with a control group. A case-control study was conducted in 2018 at the Dermatology Clinic of Shahid Faghihi Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). A total of 110 patients, aged ≥20 years with confirmed NMSC (case group), and 181 individuals without NMSC (control group) were enrolled in the study. The temperament of the participants in both groups was evaluated using Mojahedi’s Mizaj questionnaire. The data were analyzed using SPSS software, and P<0.05 was considered statistically significant. The results showed that the odds ratio of developing NMSC was 2.62 (95%CI: 1.42-4.83, P=0.002) times higher in individuals with dry temperament than other types of temperament. Moreover, the odds ratio of patients with a history of chronic skin ulcers and other types of cancer was 35.7 (95%CI: 11.9-107.15, P<0.001) and 5.22 (95%CI: 1.43-19.06, P=0.012) times higher, respectively, than the control group.  Temperament is associated with NMSC, particularly the dry temperament type, and should be considered a risk factor.

Acral melanoma (AM) is a common type of cutaneous melanoma that occurs in the skin of the palms, soles, and nail beds. This malignancy, like other types of cancer, has different genetic alterations. To date, despite decades of research the roles of oncogenic BRAF mutations in the pathogenesis of AM has not been fully clarified. The present study was designed to identify V600E mutation in patients with AM from the south of Iran. 

The samples were collected from the pathology lab archive of Shiraz University of Medical Sciences (2015-2020). A total of 41 patients with primary invasive AM underwent excisional biopsy or amputation were collected to evaluate BRAF V600E mutation using Polymerase Chain Reaction (PCR) and Sanger sequencing.

Total number of 41cases (21 male and 20 female) and age range of 34-87 years were enrolled. The histological subtypes were 24 acral lentiginous melanomas (ALM), 10 cases of nodular melanoma (NM), and 7 cases of superficial spreading melanoma (SSM). In our study, only one case (a 44-year-old male with nail bed AM and the histological subtype of acral lentigenous melanoma) showed BRAF-V600E mutation. 

These findings suggest that the population of our interest showed a very low prevalence of this mutation providing novel insights into the pathobiology of AM and its related treatment.

We conducted the present study to analyze the clinicopathologic features of patients with malignant ovarian germ cell tumor (MOGCT) with recurrence after 2 and 5 years.
In this retrospective and analytical-descriptive study, the obtained data included: age, tumor size, histopathological type, tumor stage, lymph node involvement, laterality of tumor, tumor necrosis, and mitosis. We also evaluated the Cox Regression analysis between these variables with recurrence after 2 and 5 years.
According to our exclusion criteria, we eliminated 81 cases. These cases consisted of the subjects with dysgerminoma (48.1%), immature teratoma (22.2%), yolk sac (16%), mix germ cell (11.1%), non-gestational choriocarcinoma (1.2%), and embryonal carcinoma (1.2%). We did not observe pure polyembryoma or polyembryoma in combination with mixed germ cell. All the patients received the treatment. The patients’ mean age was 23.3±8.4 years. MOGCT reoccurred in 10 patients after 2 years and in 13 patients after 5 years (10 cases in the first 2 years, and 3 new cases in the next 3 years). Most of the cases (64.2%) were diagnosed to be at stage 1. The Cox regression analysis between positive lymph node and the recurrence of MOGCT after 2 years and between stage IV of disease and the recurrence after 2 years were significant. The Cox regression analysis between laterality, mitosis and necrosis in pathologic slides of the recurrence after 2 and 5 years was not significant.
Stages and involvement of lymph nodes are two major factors concerning the recurrence of MOGCT. Most recurrences occur in the first 2 years. Pathologic features (mitosis and necrosis) of MOGCt in the time of diagnosis not correlated with the recurrence of the disease.

Cutaneous pseudolymphoma can histologically and clinically simulate various types of cutaneous lymphoma. We conducted the current study to evaluate the clinicopathological and immunohistochemical (IHC) aspects of cutaneous pseudolymphoma (PSL).

30 cases of cutaneous PSL were selected from the archives of 2013-2017 in Shahid Faghihi Hospital pathology lab, Shiraz University of Medical Sciences. Available clinical data, histopathological features and IHC findings were statistically analyzed.

The female: male ratio was 2:1 and the median age was 47±14.9 years. The lesions were located on the head and neck 26 (86.7%), trunk 2 (6.7%) and extremities 2 (6.7%). 23 (76.7%) cases had nodular pattern, while 7 (23.3%) showed diffuse pattern. The grenz zone was seen in 24 (80%) cases. Sixteen (53.3%) cases showed top heavy infiltration, 11 (36.7%) showed the same distribution of infiltration at the superficial and deep dermis, often involving the subcutaneous fat and 3(10%) showed bottom heavy infiltration. In IHC, 11(36.6%) cases showed the B cell type, 10 (33.3%) T cell type and 9 (30%) mixed type (B and T cells).

None of the cases was suspicious for cutaneous lymphoma, applying IHC staining. Gender distribution, and the site of cutaneous lesions were similar to previous studies. The most common histological subtype was nodular, while the B-cell cutaneous pseudolymphoma was slightly more common compared to the T-cell type.

Cervical conization is a standard diagnostic method for precancerous lesions. However, its results could be negative despite an initially positive punch biopsy. The present study aimed to re-evaluate pathological biopsies with Ki-67 and p16 immunostaining to assess the diagnostic accuracy of punch biopsies.

This retrospective study performed in Motahhari Clinic and Shahid Faghihi Hospital, (Shiraz, Iran). 88 punch and cone biopsy slides from 2007-2016 were re-evaluated by two pathologists, and the results were compared with the original diagnoses. Agreement between the initial diagnoses and re-evaluations and between our pathologists were assessed with the kappa coefficient. Twenty-two negative conization results after positive punch biopsy were re-sectioned and evaluated with Ki-67 and p16 immunostaining.

The overall agreement (kappa) between the primary punch diagnoses by the original pathologists and those made in the present study (by the first and second pathologists) before immunohistochemical (IHC) staining was 0.33 and 0.43, respectively. The kappa coefficient between punch biopsy diagnoses by the first and second pathologists before IHC staining was 0.73, while it increased to one after IHC staining with Ki-67 and p16. Out of the 22 specimens with the positive punch and negative cone biopsies on initial diagnosis, cervical intraepithelial neoplasia (CIN) was not confirmed in 11 specimens by our pathologists after IHC staining with Ki-67 and p16. These cases were reclassified as transitional metaplasia or acute/chronic cervicitis.

Punch biopsy can be misdiagnosed as CIN positive, leading to unnecessary conization. The use of Ki-67 and p16 markers as appropriate ancillary tests are recommended.

Since its recognition, frontal fibrosing alopecia (FFA) has increasingly been studied globally in terms of its diverse aspects. Having found no studies describing this condition in Southern Iran, we examined the different clinicopathological features of patients with FFA who referred to Faghihi Hospital, Southern Iran, between 2013 and 2018. We searched the archives of the Pathology Department of Faghihi Hospital for the cases with a diagnosis of FFA. Due to its similar histopathologic features with lichen planopilaris, the final diagnosis was made using clinical correlations. Twenty-two patients were enrolled; all were female. Fifteen (68.2%) presented with the disease before menopause. Besides frontal and/or temporal hairline involvement in all the patients, eyebrow alopecia, eyelash loss, body hair loss, and facial papules were present in 81.8%, 27.3%, 50%, and 68.2% of them, respectively. Dermoscopic findings included follicular opening loss (100%), honeycombing of the scalp (81.8%), multiple white dots (77.3%), perifollicular erythema (63.6%), and perifollicular scales (59.1%). The histopathologic examination revealed follicular dropout (95.4%), perifollicular lymphocytic infiltration in the infundibulum and isthmus of the follicles (81.8%), perifollicular fibroplasia (77.3%), intact interfollicular epidermis (59.1%), mild perivascular lymphocytic infiltration in the upper dermis (54.5%), and apoptotic keratinocytes in the infundibulum and isthmus (50%). The most common comorbidity was hypothyroidism (40.9%).  Thediagnosis of FFA should be considered in both premenopausal and postmenopausal women. Eyebrow alopecia, eyelash loss, body hair involvement, and facial papules are helpful clues in the diagnosis. The coexistence of hypothyroidism with FFA suggests immunological involvement in the pathogenesis.