Iranian Journal Of Pathology
Volume:16 Issue: 3, Summer 2021

The aim of this study was to measure serum pentraxin 3 (PTX3) in patients with acute myocardial infarction (MI) and compare it with the control group.

In this case-control study, 60 patients with MI (±ST-segment elevation) were included in the case group , and those with symptoms suspicious for coronary artery disease (CAD) and with no abnormal findings in angiography and troponin I level less than 99th percentile of normal population were included as a control group (N=30). Serum PTX3 and troponin I were measured.

In this study, 60 patients including 34 men and 26 women were included in the case group (mean age: 61.4±8.86 years in non–ST-segment elevation myocardial infarction [NSTEMI] subgroup and mean age: 57.9±9.49 years in ST-segment elevation myocardial infarction [STEMI] subgroup), as well as 13 men and 17 women as the control group (mean age: 55.47±10.09 years). PTX3 level was higher in MI cases (1128.4±1205 pg/mL) compared to controls (394.5±170.40 pg/mL) (P=0.001). There was no relationship between ejection fraction (EF) and PTX3 level in the MI group. The area under the ROC curve (AUC) of PTX3 in MI was presented by 0.828 (AUC=0.828) (P>0.001). We defined three different cutoffs for PTX in this study, in which the cutoff ≥400 pg/mL had the highest sensitivity (92%), and the cutoff ≥700 pg/mL had the highest specificity (97%).

According to the results of this study, PTX3 as an inflammatory marker showed higher level in patients with MI, especially in STEMI cases. Therefore, combined evaluation of troponin I and PTX3 levels would be associated with more accuracy in diagnosis of MI.

Early detection of malignancies in the serous fluids has been remained an issue. A classic diagnostic tool for the ascites and pleural effusions is cytologic study (morphology) with approximately 98% specificity for the detection of cancer cells. This study aimed to evaluate the diagnostic value of three complementary markers in the serosal fluids of patients with malignant cytology and suspected cases.

Seventy two patients with serosal effusion treated in three teaching hospitals were studied. The cases underwent a diagnostic workup to determine the pleural effusion malignancy and etiologies. Complementary markers, including CEA, CA15-3, and CA125 were measured in serosal fluids of three categories of benign, suspicious, and malignant. The study was carried out by Chemiluminescence immunoalayzer. The morphologies were re-evaluated by a consulting Cytopathologist.

Of 72 serosal fluid specimens, 41 (56.9%) were related to pleural effusion and 31 (43.1%) were related to ascites. The sensitivity of CEA, CA125, and CA15-3 biomarkers were 64, 84, and 68%, respectively, and the specificity of each test was 100, 86, and 96%, respectively. This was statistically achieved for the combination of the area of markers below the curve (AUC), 0.93 and 90% sensitivity and 91% specificity.

The results suggest that complementary CA125, CA15-3, and CEA markers assayed with well-developed immunoassay method might be useful in the differentiation between malignant and benign effusions while combined with conventional cytology. CA125 yielded a significant correlation between cytomorphology and biomarkers based on the correlation coefficient analysis.

Pancreatobiliary system disorders commonly include inflammatory diseases and tumors. Diagnosis of pancreatic cancer is challenging and is mostly achieved when the disease has extensively progressed, and metastasis has occurred. Therefore, this study was performed to evaluate cytopathology in the diagnosis of Pancreatobiliary malignancies, which can improve diagnostic adequacy and accuracy.

A total of 116 cytopathologic results of the Pancreatobiliary system, performed in the Pathology Department of Taleghani Hospital, Tehran, Iran during 2017-2018 were selected and examined in this observational study. The frequency of different results was determined and compared with other variables.

The most common location of the lesions was the pancreas (47%). The lesions were categorized as malignant, benign, negative, suspicious for malignancy (SFM), and atypical in 28%, 10%, 24%, 14%, and 9% of the cases, respectively. In other cases, lesions were considered non-diagnostic. Rapid on-site evaluation (ROSE) was conducted in 25% of patients. Compatibility of the initial and final diagnoses was 100%, 50%, and 60% in cases with “malignant”, “benign”, and “negative” diagnoses, respectively. The sensitivity, specificity, as well as positive and negative predictive values of cytopathology in the diagnosis of Pancreatobiliary lesions were 75.8%, 92.3%, 95.9%, and 61.5%, respectively.

Our findings indicated that half of the lesions of the Pancreatobiliary system were positive, SFM, and atypical. Fine-needle aspiration (FNA) and endoscopic ultrasound-guided FNA (EUS-FNA) were effective modalities in diagnosing Pancreatobiliary malignancies. The most important point in our experience is the increase in diagnostic sensitivity in the presence of ROSE. Therefore, the simultaneous use of ROSE and EUS-FNA can reduce the need for re-sampling.

Currently, neoadjuvant chemoradiotherapy, followed by surgery, is the standard treatment for locally advanced rectal cancer. The use of induction chemotherapy for this tumor is controversial. In this study, the benefits and side effects of induction chemotherapy in locally advanced rectal cancer are evaluated.

Twenty-nine patients with locally advanced rectal cancer in 2018-2019 were enrolled in this study. Initially, they underwent induction chemotherapy (oxaliplatin 130 mg/m2 every 3 weeks and capecitabine 1000 mg/m2 twice a day for 14 days every 3 weeks for 2 courses). Then, neoadjuvant chemoradiotherapy (radiotherapy 50.4 Gy/28 for 5 days a week concomitant with weekly oxaliplatin 50 mg/m2, as well as capecitabine 825 mg/m2/bid on the days of radiotherapy) was administered. After 4 weeks, computed tomography (CT) scan of thorax, pelvis, and abdomen with and without contrast was performed. Total mesorectal surgery was performed 6-8 weeks after the end of radiotherapy. Four courses of adjuvant chemotherapy were applied. Pathologic complete response (pCR), margin, sphincter preservation, and adverse effects were assessed.

 In this study, pCR was present in 6 (20.7%) patients. R0 resection was done in 96.05%. Sphincter was preserved in 44.4% of lower rectal tumors. Two patients (6.9%) did not complete adjuvant treatment. Grade 3 adverse effects were documented in 13.7% of cases during induction chemotherapy and 17.2% of cases during neoadjuvant chemoradiation. Mortality was not reported.

Induction chemotherapy, followed by neoadjuvant chemoradiotherapy and surgery, would be an effective and safe modality in locally advanced rectal cancer.

Pathologists as medical professionals involved in the diagnosis and planning of therapies in many diseases are exposed to occupational hazards in workplaces. Hence, we aimed to determine the occupational health problems among Iranian pathologists in this cross-sectional study.

This cross-sectional study was conducted among the Iranian pathologists. The data required for this study was collected through a self-reported questionnaire containing 48 questions about major occupational health problems, including musculoskeletal problems, visual disorders, workplace characteristics, health behavior, and other medical conditions.

Among the study participants (N=350), 87.4% presented with musculoskeletal disorders in the past year, with the neck as the most common location of pain (71%). Musculoskeletal pain was significantly higher in those working with the computer for more than 5 hours per day (P=0.007). Furthermore, 273 (78%) participants reported visual refractive errors, and myopia was the most common error (53%). Acute injuries were reported in 263 (75%) participants, and the cutting injury had the highest frequency (56.6%). Depression was reported in 54 (15.4%) of the participants, followed by burnout (10.3%) and hypertension (4%). Intolerance reactions to formalin were reported by 222 (63.6%) and were significantly more frequent among the residents (p <0.001). The residents were more prone to musculoskeletal pain (P=0.002) and injury (P=0.026).

We observed a noticeable prevalence of health risks, including musculoskeletal problems, visual disturbances, injuries, and ergonomic problems among the Iranian pathologists. Solving these problems demands thorough prevention and personal protection, as well as educational programs with more attention toward optimization of ergonomics in the workplace and awareness about chemical and biological hazards.

This study examined the potential of human epididymis protein 4 (HE4) as a marker in early diagnosis or as a prognostic factor for breast cancer (BC) patients.

A total of 31 patients diagnosed with BC were enrolled in the study between 2008 and 2018. The mRNA and protein expression levels of HE4 were analyzed by immunohistochemistry (IHC) and real-time polymerase chain reaction (PCR) in the BC tissue and the non-tumoral adjacent tissue. Using ELISA technique, HE4 plasma levels were also measured in 43 BC patients compared to 43 healthy individuals. The correlation between HE4 expression and clinicopathological features was then investigated.

An increase in HE4 expression was observed at mRNA and protein levels in the BC group compared to the control group (p <0.01, p <0.0001, respectively). In addition, the relative expression of HE4 mRNA in BC patients showed a significant correlation with the differentiation grade of cancer cells (p <0.001). Plasma levels of HE4 was also associated with grade (p <0.0001), stage, and tumor size in BC patients (for both p <0.01). Patients with metastatic BC (p <0.01), lymphatic invasion, and lymph node involvement (for both p <0.05) showed significantly higher plasma levels of HE4 expression than patients without metastasis.

According to our findings, upregulation of HE4 is probably related to invasive BC phenotype, and measuring plasma levels of HE4 could be useful as a screening test in early diagnosis of BC.

Urothelial carcinoma is the seventh most common cancer in the world. The histological classification of papillary carcinoma is one of the most important determinants for its prognosis. Sometimes there is an overlap in the extent of the tumor, and the accurate microscopic diagnosis of the tumor is not always easy. The aim of this study was to evaluate P53 and CK20 immunohistochemical markers in comparison with morphologic findings in low- and high-grade urothelial carcinomas.

For this descriptive study, urinary bladder samples were collected from 50 cancer patients who had undergone biopsy and surgery in Shohaday-e Tajrish Hospital of Tehran, Iran, during the years 2015-2016. P53 and CK20 were studied, and the demographic and histopathological characteristics of the tumor were also analysed.

The mean age of patients enrolled in this study (48 males and 2 females) was 65.8±11.9. Twenty-five cases presented with low-grade and 25 cases presented with high-grade papillary urothelial carcinomas. Sensitivity, specificity, and positive and negative predictive values for P53 were 48%, 80%, 70.5%, and 60.6%, respectively, while the same values for CK20 were 44%, 92%, 84.6%, and 62.2%, respectively. Immunohistochemical results were also positively correlated with the extent of the tumor.

Based on the results, P53 and CK20 may serve as specific markers for diagnosis of low- and high-grade papillary urothelial carcinoma but not sensitive. P53 and ck20 staining have also a high specificity as 80% and 92% and low sensitivity compared to the low and high morphology of papillary carcinoma, thus their positive and their staining intensity are valuable for diagnosis, but their negative results are not determinant.

Coronavirus is an enveloped RNA virus that mainly causes respiratory infection. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test of nasopharyngeal and oropharyngeal swab is the confirmatory diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection. The relationship between SARS-COV-2 and body fluid parameters is still not known. There have been few studies regarding the correlation between urine biochemical parameters and SARS-COV-2 infection. The aim of the study is to determine the importance of urinary biochemical parameters in SARS-COV-2 infection and whether these parameters can be used to predict the severity of the infection.

This was a retrospective observational study consisting of total of 285 patients diagnosed with SARS-COV-2 infection. The patients were divided into three groups according to the severity of infection as mild (120 cases), moderate (110 cases) and severe (55 cases). During the study period 72 healthy persons were enrolled as controls. Analysis was done to find any relationship between various urine biochemical parameters and the severity of SARS-COV-2 infection.

Urinary occult blood (U. Blood) and Urinary protein (U. Pro) have higher positive rates in SARS-COV-2 patients as compared with healthy controls. Among the severities of SARS-COV-2 infection (mild, moderate and severe), both these parameters were significantly higher. Glucose (Glu) and Ketone (Ket) positivity rate was more in moderate cases of SARS-COV-2 than mild cases.

Urinary biochemical parameters are very useful in identification of SARS-COV-2 infection and also have the advantage in evaluating the progression in patients infected with SARS-COV-2. Among the different parameters, Urinary Occult Blood and Urinary protein are significant in the differentiation of SARS-COV-2 severity.

There is currently inadequate information about the expression of immunohistochemical markers in pediatric tumors. Paired box genes 2 and 8 (PAX2 and PAX8) genes have an essential role in kidney organogenesis. This study aimed to investigate the IHC expression of PAX2 and PAX8 in Wilms tumor. Such study would be helpful in diagnosis and possibly in differentiation of this tumor from other mimics, especially in those of poorly differentiated type in small needle biopsy specimens.

We performed a cross-sectional study on 45 Wilms tumor cases referred to Bahrami pediatric hospital between 2005 and 2015. Demographic data were collected from medical documents. Sections from related paraffin blocks were provided by the tissue microarray method, and immunohistochemical (IHC) staining was done for PAX8 and PAX2.

The mean tumor size was 9.98±4.95 cm. Favorable histology was seen in 84.4% of samples. PAX2 was expressed in 41 cases (91.1%), and PAX8 in 37 patients (82.2%). PAX2 and PAX8 expression was mostly seen in both blastemal and epithelial components (77.8% and 66.6%), respectively. Tumors with favorable and unfavorable histology did not significantly differ in PAX2 and PAX8 expression (P=0.637). We found a statically significant relationship between PAX8 expression and tumor size (P=0.033).

PAX2 and PAX8 markers might helpful in diagnosis of Wilms tumor and may differentiate it from other histologically similar kidney tumors. PAX8 expression may be associated with larger tumor size. Tumors with favorable and unfavorable histology may not be different in PAX2 and PAX8 expression.

The present study investigated the relationship between invasive front (IF) of tumors and clinicopathological parameters including stage, grade, nodal involvement, lymphocytic host response (LHR), recurrence, overall survival (OS), and disease-free survival (DFS).

A total of 87 oral squamous cell carcinoma (OSCC) biopsies were evaluated. Clinical stage, grading, nodal involvement, time of recurrence, OS, and DFS were assessed. The number of tumor budding cells in the IF was measured by two pathologists with an optic microscope. IF was graded to low risk (<5) and high risk (>5), according to the counting of tumor budding as a single cancer cell or cluster cells. Also, LHR was reported in the IF as mild, moderate, and severe.

IF was reported in 43.7% of patients as a low-risk group and 49.4% as a high-risk group. LHR was also mild in 31%, moderate in 25.3%, and severe in 43.7% of the patients. Most of the patients were in stage IV (31%) and grade 1 (60.9%). The high risk IF group had a significant statistical relationship with stage (P=0.001), grade (P=0.039), five years OS (P=0.03), five years DSF (P=0.01), and lymph node involvement (P=0.007). The relation between LHR and stage of disease was significant (P=0.034).

Considering the important role of histopathological reports in the treatment plan of patients and the relationship between IF and clinical parameters, IF evaluation in routine histopathological examinations, especially in the early stages of OSCC, seems to be necessary.

Microsatellite instability is common in familial colorectal cancers. It can be tested by the molecular and immunohistochemical methods. There are very few studies which address comparing the clinicopathological characteristics of microsatellite stable (MSS) and microsatellite unstable (MSI) colorectal cancers from Iran. n this study, we aimed to evaluate the clinicopathological and immunohistochemical findings of MSS and MSI colorectal cancers in our Center as the largest Center of gastrointestinal surgery and oncology in the South of Iran. We also compared the immunohistochemical method vs. molecular study using DNA sequencing.

For 5 years (2015-2019), 34 patients who underwent operation in the affiliated Hospitals of Shiraz University of Medical Sciences were clinically suspected to microsatellite instability (MSI). The molecular diagnostic tests with DNA sequencing were performed. Clinicopathological and immunohistochemical findings of MSI colorectal cancers were compared with those who were stable.

In the South of Iran, MSI colorectal cancers were more common in males. These tumors were more common in the right side with more tendencies to produce mucin with lymphocytic infiltration.

It was concluded that immunohistochemistry is a specific method for the diagnosis of MSI colorectal cancers, but false negative rate is high, and sensitivity is low. Therefore, we recommend performing molecular studies by DNA sequencing in colon cancer with clinical suspicion to MSI and negative immunohistochemistry

Hereditary deficiency of plasma prekallikrein (PPK) is a rare autosomal recessive disease. The affected patients are often asymptomatic and diagnosed incidentally during preoperative investigations or during hospitalization by isolated prolongation of activated partial thromboplastin time (aPTT). In this article, we report, a 46-year-old woman who was candidate for two invasive procedures (thyroid FNA and hysterectomy) and underwent preoperative evaluation.  Due to prolonged aPTT with normal PT she was referred to the IBTO reference coagulation laboratory for specific coagulation assays. Ultimately, the examinations revealed severe PPK deficiency (<1%) with partial deficiency of factor XII level (25%).

Cardiac tumors range from benign to high grade malignancies. The incidence of cardiac involvement either by primary, or secondary tumors during autopsy is reported to be extremely low. Extranodal NK/T-cell lymphoma (ENKTL), nasal type is an unusual type of lymphoma. The skin is the second most common site of involvement after the respiratory tract. We present a case of a 63-year-old male, who was recently diagnosed with ENKTL, nasal type, who received chemotherapy, and died without any evident cause. The corpse was referred for routine medicolegal examination. Macroscopical determination of the cause of death was not feasible and subsequent histopathological examination revealed heart infiltration by ENKTL that was found in vivo in cutaneous lesions. Similar infiltrations existed in the pancreatic tissue. To the best of our knowledge, myocardial infiltration of ENKTL, inducing severe myocardial lesions that eventually caused death, is rare, with limited cases reported in the literature.

This approach to learning is in accordance with the first of six strategies of Harden SPICES model for curriculum development: student-centered against teacher-centered approach (S) (7,8). In total, the results from medical students and the Knowles’ Andragogical Model as a theoretical lens, is expected to help medical education experts with emphasizing student center approach in the medical education curriculum to prepare future physician for meeting unexpected healthcare crisis demands.

Human papillomavirus infection is one of the most common genital infections. More than 100 types of the virus have been identified, most of which can infect the genital mucosa. The virus is associated with cancerous and precancerous lesions of the cervix. Some types, such as human papillomavirus 16 and 18, are highly carcinogenic; some other types, such as human papillomavirus 6 and 11, are mildly carcinogenic, with HPV 31.33 in between. This study describes the relationship between different types of HPV infection and the findings of a Pap smear. In this prospective study, 1,500 samples from patients who admitted to a private Pathology Laboratory in Isfahan were collected during the years 2019-2020. Two samples were collected from each patient, one for Pap smear study and the other for polymerase chain reaction (PCR) test to detect different types of human papillomavirus (HPV) infection. In a study of 1,500 samples, 236 were positive for Papillomavirus (HPV) infection in Pap smear. By examining the genotype of positive examples, it was found that 14.8% of the samples were infected with type 16, and 1.7% were infected with type 82. HPV infection is common in Iran and is almost similar to European countries such as Germany and Spain. We also found that using a polymerase chain reaction (PCR) method to detect HPV viruses in vaginal secretions could be very useful. Our findings also show which disease is most associated with each type of HPV.