Iranian Journal Of Pathology
Volume:2 Issue: 4, Autumn 2007

This review deals with studies that have used cDNA microarrays and immunohistochemistry to identify a subtype of breast carcinoma recently known as “basal-like” carcinoma. The key breast carcinoma studies are critically discussed to highlight methodological problems in cohort selection, definitions, interpretation of results, and statistical analysis. It concludes that “basal-like” carcinomas do not reflect a single, biologically uniform group of breast cancers and show significant variations in their phenotypes, grades, immunoprofiles, and clinical behavior, just as a wide range of subtypes and behaviors is observed among epithelial/luminal-derived breast carcinomas. Welldesigned studies with comparison of low grade non-basal versus low grade basal and high grade non-basal versus high grade basal carcinomas are necessary before one can be convinced that this subtype represents a distinct clinicopathologic entity.

Pseudomonas aeruginosa has become a frequent cause of nosocomial infections, particularly in intensive care units (ICUs). Many reports have documented high rates of resistance in this species to commonly-used broad-spectrum antibiotics. The aim of this study was to assess the in vitro activity of some antibiotics against Pseudomonas aeruginosa strains to determine the susceptibility patterns of isolates to different antibiotics. A total of 233 Pseudomonas aeruginosa isolates obtained from various clinical specimens of hospitalized children in Ali-Asghar hospital of Tehran (Iran) were considered for susceptibility test. These strains were tested against 12 different antibiotics by a disk diffusion method. Of these isolates, 33.9% were from trachea, 31.8% from urine, 6.9% from eye, 5.2% from blood, 5.1% from ear, 1.3% from cerebrospinal fluid, 1.2% from stool, and 14.6% from other sites. In addition, 48.5% of P. aeruginosa strains were isolated from patients in ICUs. The most active antimicrobials were amikacin and other active compounds were gentamicin, ceftazidime, and ciprofloxacin respectively. Isolates from ICUs were more resistant to amikacin and gentamicin as compared to those from non-ICU wards (p<0.05). Isolates from trachea were more resistant to amikacin, gentamicin, ciprofloxacin and ceftazidime than those from other sites (p<0.05). Our study showed that amikacin was the most active agent against P. aeruginosa followed by gentamycin, ceftazidime, and ciprofloxacin. According to our in vitro study results, active antibiotic susceptibility testing and surveillance should be continued in order to curtail the problem of antibiotic resistance.

Computerized tomography and fluoroscopic computerized tomography are amongst the methods used for guiding needle biopsy processes; however, fluoroscopic computerized tomography demonstrates the images during the process of biopsy. This study aims to compare and contrast the success of biopsy under guide of computerized tomography and fluoroscopic computerized tomography, independently and based on the location of the mass. Computerized tomography and fluoroscopic computerized tomography are amongst the methods used for guiding needle biopsy processes; however, fluoroscopic computerized tomography demonstrates the images during the process of biopsy. This study aims to compare and contrast the success of biopsy under guide of computerized tomography and fluoroscopic computerized tomography, independently and based on the location of the mass. In this study, among 206 subjects, 122 were examined under guide of fluoroscopic tomography and 84 under guide of conventional computerized tomography. In all anatomical locations of the mass except for mediastinum, negative cases of biopsy in conventional computerized tomography were more than fluoroscopic computerized tomography the total rate of success in fluoroscopic computerized tomography group was 86.1% and in conventional computerized tomography it was 76.2%. The results of this study showed that the fluoroscopic computerized tomography in biopsy is more successful than conventional computerized tomography in pelvis, abdomens, bone and liver and this might be the result of the feasibility of watching the biopsy needle during the procedure.

Dyslipidemia has become a common problem in human immunodeficiency virus (HIV) disease, especially in patients on combination antiretroviral therapy. In this study we aimed to determine the prevalence of dyslipidemia and metabolic abnormalities in 2 groups of HIV infected patients receiving highly active antiretroviral therapy (HAART) and antiretroviral-naive patients.Patients and Forty HIV infected patients treated by HAART as a case group (6 females and 34 males) with a mean age of 40.7 ± 10 years and 15 HIV naïve as a control group (2 females and 13 males) with a mean age of 38.40 ± 8.3 enrolled in this study. The two groups were well matched in respect to age, sex and CD4 cell counts. A standardized questionnaire with epidemiological, clinical, and therapeutic data was completed by physicians. Blood samples were obtained for metabolic measurements. CD4 positive cell count was measured by f lowcytometry. Levels of total cholesterol, triglycerides, LDL, HDL, lactate, and FBS were elevated in 24%, 37%, 3.7%, 44.4%, 29.6% and 11% of patients respectively. There was a significant difference regarding mean total cholesterol and LDL between treated group and controls (p<0.05). There was also no significant difference between treated group and controls regarding triglyceride, HDL, lactate and FBS levels. Our study demonstrated that metabolic abnormalities are relatively common in HIV-infected patients receiving HAART. Therefore, it is recommended to screen the HIV infected patients on HAART for metabolic disorders, potential of morbidity, and possible long-term cardiovascular risk factors.

Paraffin-embedded tissue specimens are excellent resources for large-scale molecular epidemiological studies, but the extraction of the high quality nucleic acid may be problematic. The aim of study was identification of the best method for DNA extraction of paraffin-embedded pathological samples.

In order to identify the optimal method for DNA extraction, DNA extraction was optimized by comparing four different tissue digestion buffers and six different protocols (xylene/ethanol method 1, xylene/ethanol method 2, xylene/ethanol method 3, simple boiling method, microwave method, and thermal cycler heating method) for paraffin elimination. To evaluate the quality and stability of the extracted DNA, they were used to amplify a 260bp fragment from the β-globin gene in PCR methods.

Amplification of a 260 bp β-globin gene fragment using tissue digestion protocol 4 was obtained in 22/25 (88%) of samples in xylene/ethanol method 1, 19/25 (76%) in xylene/ethanol method 2, 19/25 (76%) in xylene/ethanol method 3, 20/25 (80%) in simple boiling method, 19/25 (76%) in microwave method, and 0/25 (0%) in thermal cycler heating method. PCR amplification was also done using two-fold serial dilutions of the 10 positive DNA samples and tissue digestion protocol 4. In this part, different deparaffinisation methods (xylene/ethanol different methods, simple boiling, and microwave methods) were compared. Successful amplification of a 260 bp β- globin gene fragment of 1:10 and 1:20 dilutions was obtained for xylene/ethanol (method 1) and microwave method. Multivariate logistic regression statistical test and SAS software were used for statistical analysis.

Based on the results, tissue digestion protocol 4, xylene/ethanol (method 1) and microwave protocols are the best.

Effective clinical prediction of Pneumocystis carinii pneumonia (PCP) is quite critical, especially in high risk groups. Different scoring systems have been reported to help the physicians before patients entering the acute stage. This research study was conducted to evaluate the possibility of grading the disease based on clinical symptoms and laboratory findings of pneumocystosis in a rat model. Twenty female rats (two-month age, a weight of 150-200 g, Sprague- Dawley strain) were stimulated artificially by methyl prednizolone acetate to infect them. Changes of clinical signs and symptoms were followed up for two months. All changes were registered and graded according to defined criteria. Oral swab, broncho-alveolar lavage, and lung homogenate were collected before injection and at weeks 2, 3, 4, 5, 6 and 7 from test and control groups. All specimens were tested by Giemsa and Gomori’s metenamin silver staining and PCR methods. Three stages were determined for infection of PCP on the basis of clinical symptoms and laboratory findings. With regard to the correlation between staining and PCR results and clinical symptoms in the studied groups, those animal models under suppressed immune system are in a healthy condition up to 10 days after injection, but those from days 11-20, 21-30, and over 30 are in phases 1, 2 and 3 respectively.

Vancomycin-resistant enterococci (VRE) are major causative agents of urinary tract infections (UTIs) in hospitalized patients. The aim of this study was to determine prevalence of UTI caused by VRE in an Iranian 1000-bed hospital and to assess the activity of commonly used antibiotics including nitrofurantoin against VRE isolates. This study was carried out between April 2002 and April 2006 in Milad Hospital (Tehran). Only patients who had puria and significant bacteriuria included in our study. All isolates performed identification to species level and susceptibility testing performed by disk diffusion method as recommended by Clinical Laboratory Institute Standards (CLSI). In total, 837 enterococcus species were isolated from UTIs that 668 (79.8%) and 169 (20.2%) isolates were E. faecalis and E. faecium respectively. Analysis of the collected data revealed that 9.43% of vancomycin-resistant strains were resistant to nitrofurantoin as well (6 out of 65), while 84.9% of the isolated enterococci (54 out of 65) were vancomycin-resistant and nitrofurantoinsensitive. The obtained data also showed that both vancomycin- and nitrofurantoin-resistant isolates had higher frequency rate in admitted patients compared with out-patients. It is concluded that susceptibility of approximately 85% of VRE to nitrofurantoin indicates that this antibiotic still is the suitable alternative drug for treatment of urinary tract infections caused by VRE.

Pre-eclampsia is characterized by hypertension, dyslipidemia, and increased systemic inflammatory response and has been associated with an increased maternal risk of cardiovascular disease later in life. Endothelial dysfunction is thought to be a central pathogenic feature in pre-eclampsia on the basis of elevated adhesion molecules. The aim of the present study was to compare the level of soluble intercellular adhesion molecule-1 (sICAM-1) in sera of normal and pre-eclamptic pregnancies. In this cross-sectional study, we studied the serum level of sICAM-1in peripheral blood obtained from normal pregnant women (n = 40), mild pre-eclampsia (n = 37) and severe pre-eclampsia (n = 38). Concentration of soluble adhesion molecule was determined using enzyme-linked immunosorbant assay (ELISA). There was no difference in the mean plasma sICAM-1 between normal pregnant women and mild pre-eclamptic women. Serum concentration of sICAM-1 was significantly higher in severe pre-eclampsia (p<0.05) than normal pregnancy. There was also significant differences in s ICAM- 1 levels between mild and severe pre-eclampsia (p<0.05). These results suggest that soluble intercellular adhesion molecule-1 is increased in severe pre-eclampsia, and sICAM-1 may be useful in predicting the severity of pre-eclampsia.

Viral hepatitis is the most frequent disease as a complication of hemodialysis treatment. Because of the importance of reducing the risk of infection, we decided to study the seroprevalence and possible predisposing factors of hepatitis B and C infections. The prevalence of hepatitis B and C serologic markers and risk factors were assessed in 130 hemodialysis patients in two university-affiliated hospitals in Tehran. Sample population included 52 women and 78 men with the mean age of 52.9 years and the mean duration of hemodialysis of 4.83 years. The seroprevalence of antibodies against the hepatitis C virus (anti-HCV) and hepatitis B surface antigen (HBsAg) were 8.5% and 4.6%. Out of all patients, 55.4% and of vaccinated individuals, 71.3% had positive hepatitis B surface antigen antibody (HBsAb). There was also a significant correlation between anti-HCV positivity and the mean duration of hemodialysis (p=0.00). However, there was no relationship found between the history of transfusion and anti-HCV or HBsAg positivity (p = 0.98, p = 0.71). Among aminotransferases, aspartate transaminase (AST) level had only a relationship with positive HBsAg(p = 0.02). Correlation of duration of hemodialysis with the presence of antibodies against HCV strongly supports that the hemodialysis environment is as a source of transmission of this disease. High prevalence rate of HBsAg positivity in the hemodialysis units needs more restricted rules for immunization with HBV before beginning the hemodialysis program.

In this article, leiomyoma arising from the uterus remnant in a patient with Mayer–Rokitansky– Kuster–Hauser (MRKH) syndrome is reported. The patient was a 41-year–old woman with pelvic mass and a history of Mullerian agenesis and serum level of CA125 = 45 U/ml who had exploratory laparotomy. A 6×8×4 cm³ solid and firm mass with smooth surface arising from the uterine remnant as myoma was confirmed. Uterine myoma can even occur in rudimentary uterus and it is one of the differential diagnosis for pelvic mass in cases with Mayer-Rokitansky-Kuster-Hauser syndrome.

Several types of familial goiter have been defined on the basis of clinical and biochemical data. Those goiters caused by inherited enzyme defects in hormone synthesis are called dyshormonogenetic goiters. Because this form of goiter is commonly associated with pleomorphism, hypercellularity and mitotic activity of the follicular epithelium, one should be particularly strict with the criteria for the correct diagnosis, especially in FNA. We report an 11-year-old boy presented with hypothyroidism and thyroid enlargement. FNA result was malignancy. Total thyroidectomy was performed and the pathology report was dyshormonogenetic goiter.