Iranian Journal Of Pathology
Volume:9 Issue: 1, winter 2014

Chronic non healing ulcers or scar undergoing malignant transformation is a rare phenomenon with an estimated incidence of 2%. Though, numerous predisposing factors have been identified, still it is rarely diagnosed and commonly mistaken for a benign condition. The objective of this study was to verify the efficacy of the Fine Needle Aspiration Cytology/ Scrape cytology of chronic non healing ulcers, and its use in the early detection of the malignant transformation, thereby facilitating early management. A total of 10 cases of chronic non healing ulcer with malignant transformation were included in the study where the initial diagnosis was made on fine needle aspiration cytology/scrape cytology and later on confirmed on histopathology. Squamous cell carcinoma (7 cases), acantholytic variant of squamous cell carcinoma (1 case), malignant fibrous histiocytoma (1 case) and carcinosarcoma (1 case) was seen. A 100% concordance with histopathology was seen in squamous cell carcinoma cases. Because of the rarity of the case and unusual transformation, high grade pleomorphic spindle cell carcinoma was the cytological diagnosis in case of malignant fibrous histiocytoma. Marjolin ulcer arising out of chronic non healing ulcers can prove to be a precursor of any different kind of malignancies. fine needle aspiration cytology/scrape cytology can be used as a first line diagnostic modality for the early diagnosis as it is a fast and safe method with high rate of accuracy, sensitivity and specificity.

Birth of healthy term infant depends on normal placenta development with its disturbance causing problems like Intrauterine Growth Restriction (IUGR). The aim of this research was to evaluate morphologic and histopathologic changes of placenta in normal and IUGR infants to improve the management of the future pregnancies. This cross-sectional study was conducted on 23 pregnant women with IUGR and 23 normal fetus referred to Imam Reza Hospital between 2007 and 2009. Mother, newborn and placenta data were recorded after delivery. Inclusion criteria were material age of 18-35 yr and gestational period of 32-42w with IUGR or normal embryo. The subjects were matched for age, height, weight, social status. Exclusion criteria were twin pregnancy, gestational age <32w, preeclampsia or chronic hypertension during pregnancy and diabetes. Data were analyzed using SPSS software version 11.5. Infarction rate, thrombosis, tissue ischemia, increased thickness of membranes and intervillus fibrin were significantly higher in IUGR group. Mean placenta weight was lower in IUGR group (440 vs. 585g). Placenta of IUGR newborns were smaller with more microscopic infarction. Fetal placental weight ratio in IUGR group was lower than controls. The gross and microscopic measurements of a placenta are more objective and seem to offer a good way to get proper information about IUGR.

HBV DNA monitoring is important in management of chronic viral hepatitis B infection. HBV DNA measurements are carried out over period of months to years. So the analytical system must be stable and reproducible. The aim of this study was to determine the performance characteristics and to plan a statistical quality control system of a laboratory-developed real-time quantitative PCR assay for HBV DNA quantification. Values of systematic and random error at two clinical decision points;4.2 Log IU/mL (20000 IU/mL) and 3.2 Log IU/mL (2000 IU/mL) were determined. Candidate quality control procedures were selected and performance of the method by application of normalized operational process specification (OPSpecs) charts was determined. The performance of the assay at level of 4.2 Log IU/mL and 3.2 Log IU/mL were excellent and good respectively. Moreover, a13.5S rule with two measurements offered 90% probability of error detection at level of 4.2 Log IU/mL, while no rule offered 90% probability of error detection at level of 3.2 Log IU/mL. Minimizing the formation of primer-dimer and nonspecific products and concentrating the target DNA during the purification process are proposed for accurate quantitative PCR particularly when CT values are high.

An increasing number of tularemia was reported in all over the world. This infection is characterized by different clinical syndromes that can be considered in differential diagnosis of infectious disease. Despite effective antibiotics against Francisella tularensis, this infection is still as one of the agent of mortality and disability among infectious disease. The aim of this study was investigation of seroepidemiological of F. tuleransis among children between 2-18 years old in a risky zone in Iran. This cross-sectional, laboratory-based study in two distinct villages Saragha seyed and Khoye in Chaharmahal va bakhtiari Province involved 183 children, adolescents who had no sign and symptom of disease and were screened for tularemia immunoglobulins G (IgG), using the ELISA-based quantitative assay. In general, from 183 children 11 persons (6%) were seropositive, compared with 172 persons (94%) were seronegative. According to the high prevalence of antibodies against F. tularensis in this study, this infection must be considered as differential diagnosis of infectious disease in suspect patients.

Squamous cell carcinoma of the tongue (SCCOT) is the most common malignant neoplasm in oral cavity. At the time of the diagnosis of SCCOT regional metastases with a high mortality rate are common, which is due to the extensive lymphatic system drainage of the tongue. Although the level of healthcare has significantly improved, the survival rate is still low with an unsatisfactory cure rate. The present study was designed to establish a clinical review on adults with SCCOT and to determine whether the rate of SCCOT has been changed over the 20-year. A cohort of 102 patients was recruited for this retrospective study. The study was carried out by reviewing the medical reports and case notes of patients with histologically confirmed SCCOT. The peak incidence was observed between 60 and 70 years. Stage I disease was found in 24, stage II in 64, stage III in 10 and stage IV in four patients. Seventy-three patients were treated with combined therapy; surgery and radiation, whereas, 29 patients received only surgery. The overall 5-year survival was 60%. Thirty patients developed tumor recurrence including 12 local, 12 nodal, four locoregional, and two distant. Thirty-four patients died during the follow-up period, six with persistent disease, and 62 remained cancer free, giving a mortality and morbidity rate of 39%. This study recommends aggressive early treatment of patients with SCCOT including resection of the primary tumor with a safe margin (1.5cm) in addition to an appropriate neck dissection.

Studies have documented the morhplogical, neurochemical and functional difference between the dorsal and ventral zones of hippocampus. The aim of this study was to assess the effects of chronic diabetes mellitus type1 on ventral and dorsal zones of hippocampus. Experimental diabetes was induced by stereptozotocin at a dose of 60 mg/kg. At the end of 8 weeks the brains were removed and stained by cresyl violet. The number of dark neurons in CA1 and CA3 regions of dorsal and ventral zones of hippocampus was counted by modified stereological method. The number of dead neurons in CA3 ventral showed significant level of difference (P<0.05) in comparison to CA3 dorsal. The number of dead neurons in CA1 ventral and CA1 dorsal showed also significant difference (P<0.05) The results of our study Provide evidence that is indicative of more vulnerability of ventral zone than dorsal zone of hippocampus to diabetes mellitus type 1.

Infection of pleural fluid is a common disease and because of antibiotic administration, the microbiology of this fluid has changed. The aim of this study was to determine the common bacteria and suitable antibiotics for treatment in pleural effusion (PE). In this cross sectional study, 1210 samples with exudative features were cultured for possible growth of microbial pathogens and then examined for antibiotics sensitivity. Samples’ characteristics were then analyzed according to the age and sex difference. Among 1210 exudative pleural effusions, 38.2% were obtained from females and 61.8% from males. Of 142 pleural fluid samples, 11.7% had a positive culture. Aerobic gram negative organism was the most common type among the other samples with a prevalence of 52% followed by aerobic gram positive (25.3%), non- aerobic gram negative (15.7%), non- aerobic gram positive (6.2%) and fungi (0.8%). E. coli, Staphylococcus Aureus and Acinetobacter baumannii were the most common types of organism among adult population. Aerobic gram positive bacteria had the highest prevalence among the pathogens, and cephalosporins, aminopenicillins and β-lactams were the most effective antibiotics for their treatment.

Laboratory errors are one of the major factors that affect the diagnosis, prognosis, treatment and monitoring in patients. The objective of study is to evaluate the frequency and type of errors in different phases of testing at the Pathology Department of the Shalamar Hospital, Lahore and to evaluate the causes of errors. This observational study was carried out in Shalamar Hospital Laboratories Lahore from 1st July 2011 to 31st December 2011. Errors detected and documented on daily basis. A total of 127,500 samples were received and processed during the six months period. Out of the total samples, 1530 (1.2) errors were detected. Among all errors pre-analytical errors were most common, with a frequency of 70.4%, post-analytical 17.5% and analytical 12.1%. Our study demonstrates the types and frequencies of errors. It is very important to monitor the all phases so to reduce the frequency of error for better reporting of lab results, ultimately which ensures the patient well-being.

Laboratory reference values are an important tool for clinical management of patients. Reference values being used in most laboratories in Iran have been provided from the established reference values from developed countries. However, several variables can affect on these laboratory parameters. Therefore, this study was carried out to establish the reference values of hematological parameters in the blood donors of central province of Iran as a general population. Blood samples of 1100 male blood donors were collected consecutively from Blood Transfusion Organization. Complete blood cell (CBC) count in 2012 and differential was performed using an automated hematology analyzer. The median and 95% reference values (2.5th-97.5th) for Hb and platelet counts were 15.5 g/dl (14.1-17.7) and 209 ×109 cells/L (151-322) respectively. The median for total WBC count, neutrophil, lymphocyte, monocyte and eosinophil were 6.7 ×109 cells/L (4.3-11.2), %58 (%50-%70), 40% (30-49%), 0% (0-2) and %1 (0-3%), respectively. The hematological profile of the population in central province of Iran was different from the reports of other countries and also the standards reference ranges described in textbook. So, further nationwide study should be carried out to establish the hematological reference values of the Iranian population as a whole.

Chordomas are low-grade malignant tumors of bone that occur almost exclusively in the axial skeleton. Chordomas are rare in children and adolescents and comprise <5% of all cases and the site of development is at the skull base. These tumors are believed to behave more aggressively than chordomas in adults and may have unusual morphology. We herein present a rare case of chordoma in a 20-year-old male with low back mass, diagnosed on fine needle aspiration cytology.

Myeloid sarcoma is a rare extramedullary tumor of immature myeloid cells. It has been very rarely reported as lateral cervical mass in English literature. Myeloid sarcoma has also been reported with marked eosinophilia. Here we present a 17 year old boy with lateral cervical mass and persistent eosinophilia. The mass was isointense in MRI and homogenously enhanced after contrast injection which were not specific. Then, microscopic findings revealed blastoid cells with positive reaction for CD68 and CD117 which were highly in favor of myeloid sarcoma rather than its great mimicker, high grade lymphoma.

Epithelial myoepithelial carcinoma is a rare biphasic low grade neoplasm of salivary glands; it most commonly occurs in the parotid gland but can also arise in minor salivary glands. Here a case of 58-year-old female presented with left cheek swelling of one-year duration. CT scan revealed a localized submandibular salivary gland tumor mass not involving surrounding tissues. Histological examination showed a mixture of ductal elements; cuboidal cells bordering small lumina surrounded by polygonal clear cells of myoepithelial component without any evidence of nuclear atypia or mitotic figures. Final diagnosis of epithelial myoepithelial carcinoma was made on the basis of characteristic morphological and immunohistochemical features.

We report a case of florid polypoid endometriosis presenting with advanced bulky disease in pelvis with serum CA-125 levels of 7844U/ml. The extent of tumor, CT scan findings, elevated serum CA-125 levels were suggestive of ovarian malignancy. Histopathology demonstrated endometrial glands and stroma. Glands were neither crowded nor complex and were separated by a fibromatous stroma that contained endometrial stromal cells. These features were consistent with diagnosis of polypoid endometriosis, a recently described entity with a clinical presentation completely different from conventional endometriosis. Our case emphasizes the association of high levels of CA-125 with benign gynaecologic conditions.