Iranian Journal Of Pathology
Volume:7 Issue: 2, Spring 2012

Nodular lesions of liver are usually neoplastic (primary or metastatic), although inflammatory lesions can occur. The objectives of this paper were to study the cytomorphological changes in various nodular lesions of liver and to correlate the cytomorphological findings with biochemical parameters especially serum alpha-fetoprotein. A cross-sectional study consisting of 40 patients with nodular liver lesions was carried out at Regional Institute of Medical Sciences (RIMS) during the period from August 2008 to July 2010 (2 years). A detailed clinical history and relevant data were collected. Fine needle aspiration cytology (FNAC) findings were correlated with clinical and biochemical parameters especially alpha-fetoprotein (AFP). Statistical analyses of the results were done and discussed. Out of these 40 patients, 28 (70%) were male and 12 (30%) were female with a male female ratio of 2.3:1. Age of the patients ranged from 13 years to 85 years with a mean age of 47.5 yr. Regarding the FNAC diagnosis, 18 cases (45%) were non-neoplastic and 22 cases (55%) were neoplastic. Out of the total 22 malignant lesions, majorities were metastases with 14 cases (63.6%) and 8 cases (36.4%) were hepatocellular carcinoma (HCC). 75% of HCC patients (6 cases) had markedly elevated serum AFP level (> 500 ng/ml). The association of hepatic malignancy with serum alpha-fetoprotein level was found to be statistically significant. This study emphasized on unique cytomorphological patterns of distinctive liver lesions for the diagnosis by FNAC and importance of the interpretation of FNAC results along with serum alpha-fetoprotein level in the cases of malignancy.

Infection with human immunodeficiency virus (HIV) results in dysregulation of the cytokine profile. A switch from a T helper 1 (Th1) to a Th2 cytokine has been proposed as an important factor in progression of HIV infection to AIDS. The aim of the present study was to assess the level of Th1 and Th2 cytokines in HIV infected individuals in order to identify the switch from Th1 to Th2 cytokines. This study was carried out on 140 HIV infected patients (21 treatment naïve and 119 under treatment) and 35 matched healthy controls refereed to Iranian Research Center for HIV/AIDS, Tehran, Iran. The serum samples were checked with enzyme-linked immunosorbent assay (ELISA) for interleukin (IL)-2, IL-4, IL-10 and interferon (IFN)-gamma. The Chi-square and t2-tests were used with the SPSS 16 package program for statistical analysis A total of 140 HIV positive patients with mean age 36.9±9.2 years and 35 matched controls were enrolled in the study. IL-2 level was relatively higher and IL-10, IL-4 and IFN-gamma levels were relatively lower in the treatment naïve group than the under treatment group. Except for IL-2, all of the other cytokines exhibited a negative correlation with the CD4 cell counts and IFN-gamma levels showed the strongest negative correlation. Our observations did not demonstrate switching of the type 1 to type 2 T helper cells cytokine profile in HIV infected patients and suggested more complex changes in Th1 to Th2 cytokine patterns in HIV infection.

In Iran, prenatal Chlamydia and gonorrhea screening of pregnant women and neonatal eye prophylaxis are not routine practice. The present research aimed to identify bacterial agents of neonatal conjunctivitis. A cross sectional study was conducted on all babies born over a period from April 2007 to April 2008 in Hajar Hospital of Shahrekord University of Medical Sciences. Babies presenting clinical signs of erythema and edema of eyelid and purulent eye discharge were considered as clinical conjunctivitis. Specimens were obtained in all cases with conjunctivitis and were performed gram staining and cultures in specific media. A simple ELISA has been performed for measurement the immunoglobin M antibody to C. trachomatis and positive result rechecked by indirect immunoflurescent test. During the period of one year, 223 neonates have revealed bacterial conjunctivitis. The incidence rate of neonatal conjunctivitis was 2.8%. Chlamydia conjunctivitis was identified in 13.6% of cases and gonococcal conjunctivitis was identified in 5.5% of cases. The high incidence rate of Chlamydia and gonococcal conjunctivitis, have revealed that the eye prophylaxis from ophthalmia neonatorum is needed promptly.

The association between metabolic syndrome (MetS) and hyperuricemia has been formerly studied mostly in healthy people in western countries. We tried to examine the relationship between hyperuricemia and MetS in an Iranian population undergoing coronary angiography. From March 2008 to September 2008, we studied 465 patients (260 men, 55.9%) undergoing elective coronary angiography due to symptoms related to coronary artery disease. The MetS was defined according to the adapted Adult Treatment Panel III (ATP-III A), and hyperuricemia was defined as serum uric acid concentrations ≥ 7.0 mg/dl in men and ≥ 6.0 mg/dl in women. For the statistical analysis, the statistical software SPSS version 13.0 and the statistical package SAS version 9.1 were applied The mean age of the study population was 59.66 ± 10.04, ranging from 31 to 85 years. Hyperuricemia was detected in 231 (49.7%) of total population, in 126 (54.5%) of men, and in 105 (45.5%) of women. In the multivariable adjusted model, subjects with MetS and subjects with 5 components of the MetS compared to those without any components of the MetS, had 1.56-fold and 4.19-fold increased odds of hyperuricemia, respectively. Hyperuricemia was significantly associated with elevated BP and low level of HDL-cholesterol but not with other components of MetS. Our study demonstrated that hyperuricemia was strongly associated with the prevalence of MetS according to adapted ATP III guidelines in an Iranian sample of patients undergoing coronary angiography.

Lipoprotein-a potentially represents a useful tool for risk stratification in cardiovascular accidents. The aim of this study was to evaluate the atorvastatin effect on serum lipid profile & lipoprotein A. In 2009, 405 patients with acute coronary syndrome randomly were divided into 2 groups, taking 20 & 40 mg atorvastatin daily for 3 months. Lipid profile & lipoprotein-a serum levels were checked at the beginning of the study and also one and three months later. There was no statistical difference between the two groups in all measurements except in patients with unstable angina. The difference lay in the change of LP-a level after one month (P=0.045) and in apo-a level in all patients in the second and the third measurements compared with the first one (P=0.001 & P=0.002). It appears that the two doses (20mg and 40mg) of atorvastatin have a reduction effect on lipoprotein-A and serum lipid levels, but no difference is seen in the level of reduction. The 40 mg atorvastatin leaves more effects on reduction of apo-a than on the 20 mg after one and three months.

Meningoencephalitis in Iranian children is frequent, but encephalitis is rare. The frequency of HHV-6 and HHV-7 in central nervous system diseases of our children is unclear. The aim of this study was searching the DNA-s of HHV-6 & HHV-7 in CSF samples of children with meningoencephalitis A cross sectional study (2007-2009) was done in Pediatric Ward in Rasoul Hospital, Tehran Iran. Totally, 150 CSF samples obtained from children (1-180 months) with meningoencephalitis. Conventional and BACTEC Ped Plus medium, latex agglutination tests were used for ruling out the bacterial causes. We searched the DNA-s of HHV-6 & HHV-6 quantitatively by Real time - PCR in 150 CSF samples obtained from children with meningoencephalitis. 60.7 % of cases were male. Fever was reported (>38.5) in 74%; irritability in 70%; Convulsion was seen in 53% of cases. Herpes virus was detected in 12% (18/150) of cases. Both HHV-6 & HHV-7 were found in 6% of all cases. HHV-6 DNA was detected in 4.7% (6) and HHV-7 DNA was detected in 2 cases (1.4%) without any correlation to age, sex and clinical signs. HHV-6 was slightly more frequent than HHV-7. Our data indicate that herpes viruses are not uncommon causes in children with meningoencephalitis. The incidence was lower than other references.

To determine the diagnostic accuracy and pitfalls of frozen section in ovarian tumors in one of the largest university affiliated gynecologic oncology centers in Tehran, and determine the cause of discrepancies. We retrospectively analyzed the results of frozen section and permanent diagnoses of ovarian masses by reviewing the reports in the department of Pathology of Imam Hussein Hospital from 1997 to 2009. Among 1498 cases of ovarian lesions, only 187 patients had both frozen and paraffin section diagnoses (age range 10-82 yr). 71.7% of these cases had complete concordance, 26.7% had partial and 1.6% had no concordance. The overall sensitivity and specificity of frozen section diagnosis were 100% and 99.3%, respectively. The sensitivity of frozen section diagnosis for benign, borderline, and malignant lesions was 99.3%, 100% and 94.9%; and the specificities were 100%, 98.9% and 99.3% respectively. Our results show high sensitivity and specificity of frozen section diagnosis in ovarian masses. Pathologist’s misinterpretation was the only cause of discrepancies.

Ovarian borderline serous tumors are uncommon. Combination of borderline serous adenofibromatous tumor and prominent micro papillary architecture is not previously reported. We report a case of borderline papillary serous adenofibromatous tumor (also called serous adenocarcinofibroma) with extensive micropapillary pattern in a 27 year-old married woman. She was infertile and presented with diffuse abdominal pain and dysparonia. Bilateral 5.3 and 4.5 cm solid ovarian masses were detected by sonography. Both masses were ovoid with tan-pink bosselated smooth external surfaces, and solid tan lobular cut surfaces. Microscopically, both tumors showed many papillary structures in a fibrotic stroma and contained multiple psammoma bodies. The papillae had broad hyalinized fibrotic stroma with many micropapillary projections arising from the main papilla, lined by mildly pleomorphic cuboidal cells. Mitotic activity was low with no marked nuclear atypia or stromal invasion. No extraovarian implants or metastases were identified.

Mantle cell lymphoma is an aggressive type of B-cell non-Hodgkin’s lymphoma that originates from small to medium sized lymphocytes located in the mantle zone of the lymph node. The gastrointestinal tract is the predominant site of extranodal involvement in the form of multiple lymphomatous polyposis. Multiple lymphomatous polyposis due to mantle cell lymphoma presenting with intussusception is uncommon and very few cases have been reported. We are reporting a Mantle cell lymphoma with multiple lymphomatous polyposis presenting with intussusception in a 62 years old male.

Nonfunctional adrenocortical carcinoma is an extremely rare malignant tumor in children. Unlike the functional tumor which is detected early due to its hormonal presentation, nonfunctional tumor is detected at a later stage. Here we report a case of a 10 year old girl who presented with abdominal mass and symptoms of short duration. No hypertension and cushingoid features were seen. Serum alpha-fetoprotein, urine vanillyl mandelic acid and homovanillic acid levels were not elevated. CT scan showed multiple pulmonary nodules suggestive of metastatic deposits. With gross and light microscopic findings differential diagnoses of hepatoblastoma, paraganglioma, renal cell carcinoma, adrenal cortical and medullary tumours were made. An array of immunohistochemical markers was done and the final diagnosis given was nonfunctional adrenocortical carcinoma with foci of osseous metaplasia.

Congenital methemoglobinemia is a rare cause of cyanosis. We report a case of a girl, 17 years old with peripheral cyanosis and normal cardio-pulmonary system. She was diagnosed as a case of methemoglobinemia based on findings of polycythemia and HbM band on hemoglobin electrophoresis. We emphasize the importance of this rare entity in the differential diagnosis of cyanosis.