فهرست مطالب mahsa akbari oryani

Disorders of sex development (DSD) result from intrauterine defects in sex discrimination. The clinical phenotype differs based on the disease type. Cases with ambiguous external genitalia are diagnosed at birth. However, diagnosis of cases with normal-appearing external genitalia may be delayed until puberty. Here, we report a patient with a pelvic mass and a small uterus that was diagnosed by abdominal ultrasound, in addition to the history of primary amenorrhea and physical examination suggested Swyer syndrome, confirmed by genetic karyotyping. Pathological examination of the surgically removed mass revealed dysgerminoma. Until the age of 19, the patient did not have any idea about 46, XY karyotype, and assumed to be a female. The development of dysgerminoma (as a result of the simultaneous presence of gonadal dysgenesis and Y-chromosome) was another challenge that the patient had to deal with. The diagnosis of this patient at an earlier age could have prevented the development of gonadoblastoma, by removal of the streak gonads. By the presentation of this case, we intend to increase the physician’s awareness about DSDs; earlier diagnosis may help the patient deal with her disease better and reduce the risk of further complications.

Breast fibroadenoma in the axilla is a rare manifestation that consists of biphasic proliferation of fibromyxoid stroma without atypia or mitosis, with a glandular component consisting of two luminal and myoepithelial layers. In this study, breast fibroadenoma in the left axilla of a 45-year-old woman is presented.

The patient was a 45-year-old woman complaining palpation of a mass in the left axilla that underwent a needle biopsy, but in the ultrasound and mammography examination, both breasts were normal and without mass. In the pathology examination of the needle biopsy specimen of the axillary mass, biphasic proliferation of fibromyxoid stroma without atypia or mitosis, along with a glandular component consisting of two layers of luminal and myoepithelial tuberculosis was observed, and after the pathological examination of the surgical specimen, the diagnosis of fibroadenoma was confirmed. During the one year follow-up, the patient was alive with good general condition.

A careful examination of any swelling in the axilla area of a woman should be considered, because even though the main breast tissue is normal, it may be caused by benign or even malignant neoplasms from the accessory breast.

Pediatric patients rarely develop ovarian tumors, but mainly develop ovarian germ cell tumors. Malignant germ cell tumors are generally rare and dysgerminoma is the most frequent malignant ovarian neoplasm in young and adolescent girls. In this study, a case of ovarian malignant mixed germ cell tumor with combination of dysgerminoma and embryonal carcinoma component is reported.

A 13-year-old girl referred to Omid educational, research and treatment center of Mashhad with abdominal pain and swelling from five months ago and was gradually worsened. In the ultrasound examination, a mass with a cystic nature was reported in the pelvis with dimensions of 269×185mm. The patient underwent salpingo-oophorectomy surgery and tumor removal for pathological study. In the microscopic examination, 95% of malignant germ cell tumor was reported as dysgerminoma and 5% as embryonal carcinoma (CD 30 positive). The patient was discharged in good general condition to continue the treatment and receive chemotherapy.

Any adolescent girl who develops a rapidly growing pelvic mass should be evaluated for malignant mixed germ cell tumors of the ovary, which are highly aggressive. In these patients, prompt surgical intervention with fertility preservation is crucial.

Renal cell carcinoma (RCC) accounts for 2-3% of the malignant tumors in adult patients. The most common sites of metastasis are the lung, bone, liver and brain respectively. Unusual metastatic sites require attention during follow-up of renal cell carcinoma. The duodenum and pancreas are uncommon sites for metastasis from renal cell carcinoma. We describe here a 62-year-old man with metastastic renal cell carcinoma to the duodenum and pancreas. The patient presented with melena and bowel obstruction, 10 years after nephrectomy for renal cell carcinoma, then with initial diagnosis of ampula vater adenocarcinoma undergo an exploratory laparotomy and a mass was found in duodenum, vater ampulla and pancreas, then pancreaticoduodenectomy was performed. histopathological examination of mass showed a metastatic renal cell carcinoma with sarcomatoid component. In conclusion, patients after radical nephrectomy due to renal cell carcinoma require long-term systematic monitoring. Gastrointestinal metastasis from Renal cell carcinoma should be considered in nephrectomized patients with gastrointestinal symptoms.

Coexistence of malignant phyllodes tumor and invasive ductal carcinoma in a breast lesion is a very rare medical condition. In this study, a case of coexistence of invasive ductal carcinoma and malignant phyllodes tumor in a single breast mass was reported.

The patient was a 39-year-old woman with a mass in left breast. On the requested ultrasound, the image of a heterogeneous hypovaco mass with an irregular margin with size of 30 × 17 × 24 mm was seen. The patient was candidate for complete removal of the breast and axillary lymph nodes. In the histologic evaluation, an invasive ductal carcinoma with malignant phyllodes component was diagnosed which was confirmed by immunohistochemistry. In immunohistochemical study, ER, PR, HER2 were negative in carcinomatous component and CK was negative in phyllodes stromal component, also KI67 index was 35%. In the evaluation of axillary lymph nodes, one out of 7 lymph nodes involved by invasive ductal carcinoma. The patient was referred for adjuvant chemotherapy using four cycles of doxorubicin, cyclophosphamide every two weeks, and four cycles of paclitaxel every two weeks and then adjuvant radiotherapy. In 20 month follow-up, she was alive with no evidence of disease recurrence.

Although coexistence of malignant phyllodes and invasive ductal carcinoma of the breast is very rare, but in breast carcinoma with abnormal microscopic findings, due to the diagnostic and therapeutic importance, the concurrent presence of other breast neoplasms such as phyllodes tumor should be considered.

Six pathogen-associated Outer Membrane Iron receptors (OMPs) reside in Uropathogenic strains of E. coli (UPEC): haem-utilization gene (ChuA), Heme acquisition protein (Hma), IrgA homologue adhesin (Iha), Iron-regulated virulence gene (IreA), IroN, and IutA. Cumulative concern over the prevalence of this bacteria in hospital environments, especially in Intensive Care Units (ICUs), highlights the significance of vaccination against this pathogen. In this study, we aimed to develop 3D models of ChuA, Hma, IutA, IreA, Iha, and IroN proteins by invoking various in silico methods and design a chimeric immunogen composed of highly immunogenic regions from these six Escherichia coli antigens as a chimeric vaccine.

In the present study, homology modeling, fold recognition, Ab initio approaches, and their combination were invoked to determine the Three-Dimensional (3D) structures of ChuA, Hma, Iha, IreA, IroN, and IutA. Next, a set of biochemical, immunological, and functional properties were predicted using various bioinformatics tools.

The obtained results indicated that all six modeled proteins fold to a β-barrel structure. The results of biochemical, immunological, and functional analysis determined the regions of each antigen carrying the best immunogenic properties. These regions are employed to construct the final vaccine linked via flexible GGGGS linkers. Intriguingly, re-analyzing the properties of the final vaccine indicated its immunological advantage over individual proteins. 

The strategy of this study to predict the protein 3D structure, followed by epitope prediction, could be adapted to design efficient vaccine candidates. Applying this approach, we designed a vaccine candidate harboring the most promising regions of six OMPs. This approach could lead to better functional, structural, and therapeutic outcomes in the context of vaccine design investigations.

Endothelial progenitor cells (EPCs) are known as putative cells in neovasculogenesis during pathological conditions, which are derived from bone marrow. This study was performed to systematically review the EPCs frequency in patients with non-small cell lung cancer (NSCLC) by evaluating the expression of CD133 and vascular endothelial growth factor (VEGF) markers.
We search the PubMed and Scopus databases for the following keywords; CD133 AND lung AND VEGF. Inclusion criteria were all the articles studied the expression of both CD133 and VEGF markers in patients with NSCLC. No language and date restrictions were imposed to the search strategy. All the articles that studied only one biomarker or those that investigated the markers expression and EPCs count in patients with other types of tumors except NSCLC were excluded from the study.
Totally 51 articles obtained following the primary search of both databases. Only 7 of them had the eligibility to be included in this systematic review. Six articles were case- control and one was a cohort type of investigation. Flowcytometry and immunohistochemistry were the most applied methods for estimating the EPCs count and evaluating the expression of markers in circulating peripheral blood and tumors tissue. The expression of EPCs markers was increased in patients with NSCLC compared to healthy control individuals; however, the frequency of EPCs was low in peripheral blood of patients.
Although it is not clear that circulating EPC numbers are associated with lung cancer patients angiogenesis, EPCs and VEGF levels are elevated in patients with operable NSCLC. The ideal method for evaluating circulating endothelia cells (CECs) or EPCs levels in vivo is still a matter of debate and because of the low number of EPCs in peripheral blood, their detection is technically challenging.

Several methods are available for the diagnosis of autoimmune bullous disease. Since the immunohistochemistry of complement component is easy and more accessible compared to other methods, it is thought that this technique as an efficient method can replace other difficult, and time-consuming procedures. Therefore, in this study we aimed to systematically review the literatures in which the diagnostic value of complement component 3d (C3d) and C4d had been investigated in bullous pemphigoid.
A systematic search was conducted in the PubMed, Google scholar, and Scopus using following search method (((C3d OR C4d OR complement component 3d OR complement component 4d immunohistochemistry)) OR (C3d OR C4d marker OR complement component 3d OR complement component 4d marker)) AND (bullous pemphigoid OR cutaneous pemphigoid) to evaluate the diagnostic value of C3d and/or C4d for early and accurate detection of bullous pemphigoid on November 2015. Subsequently, the extracted data were described.
Total of 28 documents were collected and reviewed based on the purpose of this study. Of the collected articles, 21 documents were excluded in several steps of article selection process and only 7 relevant articles were included for data assessment. The results showed that the deposits of C3d and/or C4d in skin biopsies were found in 125 of 134 patients, indicating that immunohistochemistry is a reliable technique for the diagnosis of inflammatory skin diseases.
The results of this review showed that C3d and/or C4d immunohistochemistry in skin biopsies is a reliable technique for the diagnosis of inflammatory skin diseases, particularly bullous pemphigoid.