Iranian Journal Of Pathology
Volume:1 Issue: 3, summer2006

Pregnancy termination and recurrent abortion are one of the common complications during pregnancy and in patients with a bad obstetric history. In this study, a total of 154 individuals including 75 couples four single women from different communities and with various incomes were investigated chromosomal abnormalities using blood culture and chromosomal banding technique. Chromosomal analysis of these patients revealed three abnormal karyotypes (3.8%) in three women and two abnormal karyotypes in conceptions. Two of these couples had consanguineous marriage and the remaining women included one isochromosome for X [46, x,I (xq)], two translocations [45, xx, t (15:21)] and [46, xx, t (7:14)], one trisomy ‘21’ (47, xx, +21), and a ring chromosome (46, xx, r(X). In addition, 27 conceptions had been reported for these five couples. These included 23 abortions with 18 of them within first trimester (78.26%) and four of them had abortions within second trimester (21.74%), one had a normal child, three had abnormal children, and one with stillbirth. It was found out that abnormal karyotype is present in 3.8% of patients with a bad obstetric history. There was also a close relationship between number of deliveries and abortions and this relation was statistically significant (p<0.01). In addition, consanguinity was also related with number of abnormal children (p<0.05). There was also a significant relationship between consanguinity and first trimester abortions (p<0.05). Therefore, in couples with more than three abortions, especially within first trimester, chromosomal evaluation can have a diagnostic value.

This study was designed as a retrospective study on urine samples during three years in Shaheed Mostafa Khomeini Hospital to determine demographic characteristics of patients with urinary tract infection (UTI), microbial etiology, and susceptibility of isolated bacteria to antibiotics. All urines fulfilling the criteria for significant bacteriuria (>104 colonyforming units/ml of urine) were included in the study. Isolation and identification of bacteria was performed by standard method and susceptibility testing was determined by disk diffusion method according to NCCLS guideline. A total of 909 patients with urinary tract infection were enrolled in this study. Mean age of the patients was 53.2 years. In addition, females were affected more often than males (female/male sex ratio was 2.22). Meanwhile, considering all strains, 79.5% were Gram-negative bacilli and 67.7% were Enterobacteriaceae. Furthermore, E.coli and Klebsiella spp represented the most common Gram-negative and Enterococci and S. aureus represented the most frequent Gram-positive isolates. The four most frequently isolated bacteria were E. coli (52.1%), Enterococci (10.5%), klebsiella spp. (10.3%), and pseudomonas spp. (9.4%). In addition, E. coli was significantly more common in females (56.6%) than in males (42.2%) and in outpatients (57.4%) than in inpatients (47.4%). The proportion of pseudomonas spp. was significantly higher in males (17.7%) than in females (5.6%). Enterococci were significantly more common in inpatients (12.5%) than in outpatients (8.4%). Altogether, the rate of susceptibility of all UTI pathogens was very low to ampicillin (6.9%) and high to cefotaxime (83.6%) and ciprofloxacin (78.2%). Urinary pathogens isolated from female patients and outpatients were more susceptible to most of examined antibiotics than those isolated from males and inpatients. It was found out that degrees for antibiotic resistance of urinary pathogens are alarming and show the necessity of keeping up the monitoring of antibiotics susceptibility in UTI isolates and restricting antibiotic consumption in our population.

It is well known that menstrual period and ovarian function are affected by chemotherapy. Although breast cancer is the most common cause of chemotherapy in women and ovarian hormones have very important direct and indirect effects on overall survival, disease-free survival, and life quality of patients, but few studies have addressed the frequency and related factors of ovarian failure in breast cancer patients after receiving conventional regimens of chemotherapy. Therefore, the risk of ovarian failure after conventional chemotherapy regimens for breast cancer (with and without taxans) and the factors that influence ovarian function due to chemotherapy including patient’s age and type and dosage of drugs were investigated in this study. The cross sectional protocol of this study was conducted on 81 premenopausal breast cancer patients with regular menstruation that were candidates for chemotherapy and had not any history of prior hormonal therapy or chemotherapy. Alteration of menstrual cycles and ovarian function were evaluated by measuring blood levels of FSH and LH. Then, the role of patient’s age, type and dosage of drugs were analyzed on ovarian function. Out of a total of 81 patients evaluated, 44 (54.3%) were found to suffer from ovarian failure after chemotherapy. There was also no significant difference for the risk of ovarian failure between two major groups of chemotherapy regimens. In addition, the probability of ovarian failure increased after increasing the dosage of the drug. Meanwhile, patients over 40 years were more sensitive to chemotherapy than younger ones. It is concluded that patient’s age is the most important factor determining the risk of chemical castration. In this respect, addition of taxans to conventional chemotherapy does not increase the risk of chemical castration.

Cervical cancer involves many women annually and Pop smear test has played a significant role in reducing its mortality and for this reason, its improvement is very essential. In this respect, cervex brush is a new tool that has been introduced in many countries. Therefore, this study was conducted to compare Pop smears from cotton swab-spatula and Cervex brush methods with regard to cell number. The clinical trial and randomized protocol of this study was conducted on 400 women as referrals of gynecology clinic of Hazrat Rassoul Akram (s) hospital and the cases with inclusion criteria were further investigated and their data using above-mentioned methods were compared. For statistical analysis, SPSS software and student’s t-test and chi-square tests were used. It was found out that the mean age of cases was 34.13 ± 9.3 years. Meanwhile, there was a significant difference between the groups regarding endocervical cells (p<0.001) and bleeding on sampling (p<0.001). It is concluded that appropriate use of Cervex brush method can prevent the need for re-sampling regarding Pop smear test and in this way it can lower health-related costs.

Wilms’ tumor has been recognized as the most common primary malignancy of kidney at childhood, comprises 5-6% of tumors in this period, and manifests itself with various clinical symptoms. Since there have been no sufficient studies in this field in Iran, therefore, this study was conducted to investigate its histopathology and clinical symptoms. This study was carried out on existing data from 66 children with a diagnosis of Wilms’ tumor at children hospital during the years 1984-1999. In this regard, personal and disease-related characteristics of patients including age, gender, tumor stage, histopathology, and involved kidney were evaluated and SPSS software and Chi-square, t-test, ANOVA, and Mann- Whitney U test were used for data analysis. The most common age of disease incidence was 2-4 years. In this regard, girl/boy ratio was 1.5. Meanwhile, the prevalence of an abdominal mass as the most common symptom was 83.3%. Left kidney was involved in 47% of cases and 55 of patients had a favorable histology. In addition, there was a significant correlation between site of kidney involvement and tumor histology (p<0.005). Considering the achieved advances in the diagnosis and treatment of Wilms’ tumor, prompt identification with regard to clinical symptoms can have a valuable role in its effective management.

This study was undertaken to assess the ability of standard urinalysis (UA) and hemocytometer white blood cell (WBC) counts for the diagnosis of urinary tract infection (UTI) in patients with urinary symptoms. A total of 600 patients with symptoms of urinary tract infection were enrolled in this prospective study. Standard UA, hemocytometer WBC counts, and quantitative urine culture tests were performed on the specimens. The results of UA and hemocytometry were compared with urine culture findings to determine the accuracy of these two methods in the diagnosis of UTI. In this regard, sensitivity, specificity, positive and negative predictive values, accuracy, and likelihood ratios were determined for each of the screening tests. There were 91 positive urine cultures with at least 105 bacteria per milliliter. Sixtyseven patients were female. The results of UA and hemocytometry were as follows: sensitivity 64.8% and 77%; specificity 89% and 90.3%; positive predictive value (PPV) 51.3% and 58.8%; negative predictive value (NPV) 93.4% and 95.6%; and accuracy 85.3% and 88.4% respectively. Although hemocytometer WBC counts have a higher sensitivity, specificity, and positive predictive value than standard UA, the differences are not statistically significant (p>0.05).

Diagnosis of Hirschsprung’s disease (HD) as the most common cause of neonatal intestinal obstruction is based on the presence of aganglionosis from seromuscular or full thickness biopsy. Due to the complication of full thickness or seromuscular rectal biopsy, mucosal-sub mucosal biopsy is more intended. However, interpretation of these biopsies stained with hematoxylin and eosin (H&E) and even using immunohistochemical (IHC) methods such as acetylcholine esterase is often problematic. Although neuron-specific enolase staining (NSE) is an available and easy method to perform for diagnosis of HD, however, our knowledge on its specificity is not adequate. Therefore, this study was aimed to determine the diagnostic value of NSE on the mucosal-sub mucosal rectal biopsy for the diagnosis of HD and the allied disorders deficit. This study was conducted on 65 mucosal-submucosal and 65 seromuscular rectal biopsies (standard) obtained from the patients suspected of HD and allied disorders referred to the Avicena and Shafa hospitals (Sari, Iran) from April 2003 to September 2004. Two biopsies were taken from each patient: the mucosal-submucosal biopsy was stained by NSE and H&E staining was used for seromuscular samples. The prepared slides were observed and evaluated at double blind condition and the results were compared. Sensitivity, specificity, efficiency, positive and negative predictive values in the diagnosis of HD in NSE method were 100%, 84.2%, 89.1%, 81.8%, and 100% respectively (p<0.05). On evaluation of hypoganglionosis, there were one false-negative and nine false-positive. In NSE staining, finding ganglion cell definitely rules out HD, but lack of ganglion cell confirms 81.8% of H.D cases. Thus, NSE staining on mucosal- submucosal specimens is possibly adequate for establishing the presence or absence of ganglion cells.

Microcystic adnexal tumor is a rare sclerosing variant of ductal carcinoma of eccrine sweat glands which is highly invasive. This tumor is often misdiagnosed as other benign or malignant skin lesions and improper treatment is carried on and is associated with high recurrence rate. We reported here in a 59-years old man who underwent incisional biopsy for a ongenital lesion on posterior neck which had grown recently. Microscopic examination exhibited an infiltrative tumor as constituted by small cord-like and angulated tubules with tadpole or comma-like shapes, individually set in abundant fibrous stroma in dermis. So, the diagnosis was syringoma. In the next step, the lesion underwent excisional biopsy. Histologically, a tumor located in dermis with extension to subcutis was noted which contained basaloid keratinocytes with occasional horn cysts and abortive hair follicles. In other areas, ducts and gland-like structures lined by two-cell layers predominated. The tumor extended to skeletal muscle and perineurial structures but no significant atypia or mitosis was identified. Eventually, with respect to mentioned features, the diagnosis was microcystic adnexal tumor. It is concluded that thinking about this rare invasive skin tumor with proper use of Mohs’ surgery and its correct diagnosis is clinically of high significance to reduce its recurrence rate. Meanwhile, this tumor was noticeably set in a congenital lesion in this reported case.

Spinal cord compression due to extramedullary hematopoiesis is a well-described and rare syndrome encountered in several hematological disorders including β-thalassemia. Hereby, a 37-year old pregnant woman with intermediate β -thalassemia with paraparesis and lower limb hypoesthesia was presented. MRI showed soft tissue masses in both sides of thoracic paraspinal area. Histologically, a mixture of all hematopoietic cell lines was present at different stages of maturation. Medical literature is also reviewed in this report.