Iranian Journal Of Pathology
Volume:8 Issue: 4, Autumn 2013

Bacterial bloodstream infections (BSIs) and surgical site infections (SSIs) are among the most common nosocomial infections with high mortality and morbidity. We aimed to evaluate the frequency of various species among BSIs and SSIs at Tehran Heart Center, Tehran, Iran. Patients with localized or systemic infections that became evident 48 hours or more after hospitalization were included. Data were prospectively collected in 4 intensive care units (ICUs), 5 cardiac care units (CCUs), 7 post-CCUs, and 5 surgical wards during two consecutive years in 2008 and 2009. Approximately 18414 coronary angiography and 7393 open-heart surgeries were done within this period. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion method, in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines. Among 212 detected patients with SSI and/or BSI in the year 2008, 138 had hospital acquired infection (HAI) and 74 had non–HAI while these figures for 2009 was 165/270 and 105/270, respectively. Staphylococcus aureus (21.5%) and Entrobacter spp. (16.5%) were two most common pathogens responsible for hospital acquired BSIs while S. aureus (20.6%) and S. epidermidis (20.6%) were corresponding isolates responsible for community acquired BSIs. Staphylococcus aureus (53.3%) and Escherichia coli (11.0%) were the two most common pathogens responsible for hospital acquired SSIs in the year 2008, while S. aureus (49.0%) and S. epidermidis (11.0%) were the most frequently reported hospital acquired SSIs in 2009. Making rational decisions about hospital infection control plans may reduce infection rates for bacteria with antimicrobial resistance.

Thyroid gland because of its superficial location is amenable to direct physical examination. Clinical assessment of thyroid lesions by means of physical examination, thyroid scans and ultrasonography is not completely reliable. Fine needle aspiration cytology (FNAC) is the most cost-effective, safe and an initial diagnostic test in the pre-operative evaluation of thyroid lesions. Many surgeons use intraoperative frozen section biopsies to confirm the diagnosis of FNAC and guide the extent of thyroidectomy. Therefore, the objective of the present study was to assess the diagnostic accuracy of frozen section in comparison with fine needle aspiration cytology and histopathology in thyroid lesions. Fine needle aspiration cytology and frozen section (FS) were evaluated in 59 patients. FNAC was classified as benign, malignant and suspicious, and FS was classified as benign, deferred and malignant. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for both FS and FNAC. Out of 59 patients, 3 were positive for malignancy, 51 were benign, and five were suspicious on FNAC. Over all accuracy of fine needle aspiration cytology was 93%. Five were positive for malignancy, 50 were benign and 4 were “deferred” in frozen section. Over all accuracy of frozen section was 96%. Fine needle aspiration cytology can be used primarily to select patient for surgery and frozen section can be employed to plan the extent of surgery. Frozen section had a good accuracy, sensitivity and negative predictive value compared to fine needle aspiration cytology.

The accurate assessment of the diseased tissue is fundamental to the diagnosis and management of disorders of the central nervous system (CNS). The ‛squash’ or ‛crush’ technique has been universally employed in the intraoperative diagnosis of CNS tumors. The aim of our study was to evaluate the accuracy of squash preparation in diagnosing CNS tumors by comparing with histopathology. This was a descriptive study which included 63 patients with CNS tumors from whom most of the samples were collected by craniotomy. Squash smears were made and stained with H&E, Papanicolaou & May-Grunwald Giemsa stains. Paraffin sections were made from formalin fixed tissue sent separately. Of 63 cases, squash cytology diagnosis correlated with histopathology in 56 cases with a diagnostic accuracy of 88.9%. A 100% accuracy was seen in pilocytic astrocytoma, anaplastic astrocytoma, glioblastoma, ependymoma, anaplastic ependymoma, choroid plexus papilloma, schwannoma, hemangioblastoma, craniopharyngioma, prolactinoma and metastases. Of the 7 cases which did not correlate with histopathology, one was a sampling error, 4 were diagnostic errors and 2 were instances of grading discrepancy. Squash preparations are a highly effective tool in the rapid intraoperative diagnosis of CNS tumors. It is a simple, reliable, cost effective procedure which in most cases can help the operating surgeon to come to a correct decision regarding the further management of the patients.

Cyclooxygenese-2 (COX-2) expression in breast cancer and its correlation with tumor prognosis is unclear. We investigated the incidence of COX-2 expression in patients and assessed interactions between COX-2 and clinical features of cancer and expression of HER2/neu, estrogen receptor (ER), and progesterone receptor (PR). COX-2 expression was investigated by immunohistochemistry in 29 patients’ specimens diagnosed as primary breast cancer between 2006 and 2008 at the Fatemieh Hospital, Semnan, Iran. Relationship between COX-2 expression and age, histological grade, histological type, nodal status, and hormone receptor status were evaluated. We used IHC method although it was not a quantitative study. Its expression depends on quality of antibody, staining and selection of analyzed region. COX-2, HER-2, ER, and PR were detected in 89.7%, 51.7%, 82.8%, and 79.3% of samples, respectively. Elevated COX-2 expression was not associated with size and grade of tumor, while mean numbers of involved lymph nodes was significantly higher in those with elevated expression of COX-2 (P = 0.001). There were no significant correlations between COX-2 expression and HER-2, ER, and PR receptors. Only tumor tissue was analyzed and did not compare to normal tissue. Elevated COX-2 expression can be found in most patients with breast cancer and has a crucial role in tumor differentiation regarding degree of lymph node involvement. It seems that correlation between COX-2 and other oncogens and hormonal receptors might be influenced by geographical and racial factors, so, assessment of these relationships in each patient’s population may be necessary.

Breast cancer is the most common cancer among women worldwide. Fine needle aspiration biopsy (FNAB) is one of the methods of breast biopsy which is fast, easy and cost effective. The aim of this study was to evaluate the concordance rate between pathologic results of sonography or stereotaxy guided FNAB and guided core needle biopsy (CNB) in the evaluation of breast lesions. During December 2010 until March 2011, 36 female patients with 37 breast lesions referred to FNAB and CNB with the guide of sonography in 35 lesions and with the guide of stereotaxy in 2 lesions. The kappa statistic used to calculate the concordance coefficient. The concordance rate between guided – FNAB and guided – CNB was 93% with using kappa coefficient. In 5 patients, subjected to breast surgery, malignancy was reported as well as in guided-FNAB or guided-CNB. Because of high concordance between these two techniques in the assessment of breast lesions, guided FNAB is recommended in the first step. Guided-CNB can be reserved for lesions with insufficient pathology results by guided-FNAB.

Kerman Province, especially city of Bam in the southeast part of Iran, is epidemics for dry type cutaneous leishmaniasis (DTCL). This study was conducted to compare the effect of different treatments on parasite DNA load following therapies using Real-Time PCR method. Fifteen patients were divided into three groups under therapy with intralesional meglumine antimoniate, topical imiquimod and combination of both drugs. After obtaining consent from patients, punch biopsies were taken before and after treatment. To compare the amount of DNA load a relative quantitative Real-Time PCR method was designed and set up using Leishmania tropica ITS (internal transcribed spacer) gene. After doing PCR, the obtained results were analyzed using 2^-ΔΔCt method and relativity of DNA load before and after treatment were calculated. The highest falling of DNA load was for imiquimod (mean 4/7 cases), glucantime (mean 2/2 cases) and combination therapy (mean 2/4). From clinical point of view combination therapy had the best response. On the other hand, the overall IHC findings showed good response based on decreased CD1a epidermal, increased CD1a dermal, decreased CD68 macrophages and increased CD3 and CD20 of dermis. We set up a new method to compare Leishmania DNA load using the stable human gene of beta actin for normalization. We concluded that imiquimod was immune modulator and had synergistic effects on the best parasitocidal drug of glucantime for better response.

Chronicity of lupus nephritis (LN) should be considered for interaction of cell mediated immunity (CMI) and dendritic cells in glomeruli and tubulointerstitial areas. In this study establishment of immunohistopathological changes of dendritic cells and other immune effector cells in lupus nephritis comparing with non-lupus nephritis was performed. Renal needle biopsies of 35 cases of lupus nephritis and 35 cases of other causes of persistent proteinuria were compared for immunohistochemistry for plasmacytoid (CD123), myeloid (CD11c) dendritic cells, macrophages (CD68) and lymphocytes (CD4) markers. Statistical analysis of the data was performed using Spearman and Pearson correlation or ANOVA and t- student test (P < 0.05). Significant difference of glomerular and interstitial spaces for presence of myeloid-plasmacytoid dendritic cells and lymphocytes except macrophages between lupus nephritis and other causes of persistent proteinuria have found (P<0.001). Positive significant correlations were observed between glomerular presentation of myeloid dendritic cells and chronicity index but not with other markers in lupus nephritis (P <0.001). Statistically significant changes between presence of all markers and activity index were not observed (P >0.05). The myeloid dendritic cells might have synergistic role with other immune cells in pathogenesis and progression or chronicity of lupus nephritis.

Pedunculated chorangioma is extremely rare type of chorangioma. To the best of our knowledge, no case has been reported in Indian literature. We report one such rare case in a twenty two year old primi gravida who delivered a full term live female baby by lower section caesarian section (LSCS). Gross examination revealed a nodular mass attached to the placenta by a pedicle. Histopathological examination confirmed it as chorangioma. The clinicopathological and radiological feature of this rare entity is presented with a brief review of literature.

We present unusual retained remnants of hidden conjoined twin of possible abdominal pagus after 21 years who presented with abdomenpain and incidentally have found his forbidden conjoined twin. He presented for many years with a palpable epigastric mass, and recent abdominal pain, early satiety, nausea and vomiting. The mass was a like deformed fetus weighing 815 gr who was anencephalic and deprived of viscera but there was a distinct vascular connection through the right limb. Microscopic examination revealed a normal epidermis with melanocytes overlying dermis with mature adnexa. The fetus plain film after surgery showed a rather complete skeletal system. All above findings were in favor of fetus in fetus, a rare congenital entity in which a nonviable parasitic fetus grows within the body of its twin.

Proliferating pilomatricoma is a distinctive rare variant of pilomatricoma first described in 1997.Very few cases of proliferating pilomatricoma have been reported in the literature until date. This report is a case of 65 years old male presenting with hard nodular lump on the right side of neck slowly increasing in size for the last 8 months. Wide excision of the lump was performed with clear surgical margins. Histopathology revealed a tumor mass composed of lobular proliferation of basaloid cells in association with adjacent focal areas containing cornified material with shadow cells. Variable nuclear atypia and scattered mitotic activity was noted in basaloid cells, so a final diagnosis of proliferating pilomatricoma was rendered. This report herein reviews histopathological features of this rare entity.

Histoid Leprosy (HL) is a rare variant of Lepromatous Leprosy, occurring in long-standing cases, mostly in a background of acquired drug resistance. Patients usually present with sudden onset multiple nodules and plaques, most often involving the skin and subcutaneous tissue of trunk and lower limbs. Here we report an unusual case of de novo (without any history of prior anti-leprotic therapy) HL, arising as multiple nodules in the face. The histopathology of the lesion showed collection of spindled macrophages in the dermis, oriented in a storiform-like pattern. A possibility of HL was considered and the diagnosis was confirmed by performing a modified ZN stain (Wade-Fite stain) on the biopsy material, which revealed the presence of acid-fast bacilli (AFB) with a bacillary index of 6. Then the patient was put on multibacillary multi-drug chemotherapy and was thereby cured.