Iranian Journal Of Pathology
Volume:9 Issue: 3, Summer 2014

Plasmapheresis, which is defined as the removal of plasma, can be either “adjusted plasma” or “exchange of plasma”. The former is defined as selective withdrawal of certain (un)-pathological plasma components in different ways such as perfusion and then returning the remained donor plasma to him, the latter is non-selective removal of all components of plasma to provide blood products for injection into patients or to be used as the input of blood transfusion refinery or to remove the pathogen contained plasma before compensating for the volume losses with an equal volume of plasma or more commonly, replacing plasma with a substitute fluid (colloid or crystalloid) such as albumin. Plasmapheresis was divided generally into two groups: 1- Plasma products by donor plasmapheresis 2- Therapeutic plasmapheresis Therapeutic plasma exchange or TPE are often attributed to plasma that exit from the body of patient then compensated by any kind of replacement fluid volumes to support neurmolemic situation of patients. Plasmapheresis is currently used as a therapeutic modality in a wide array of conditions. Generally, plasmapheresis is used when a substance in the plasma, such as immunoglobulin, is acutely toxic and can be efficiently removed. Myriad conditions fall under this category, including neurologic, hematologic, metabolic, dermatologic, rheumatologic, and renal diseases, as well as intoxications, that can be treated with plasmapheresis.

Respiratory, central nervous system, and skin complications of mustard gas toxicity have previously been studied; however, the liver and kidney side effects due to this intoxication have not been fully noted. We aimed to evaluate the frequency of liver, kidney and lung lesions in mustard gas-exposed Iranian veterans who had been exposed to the toxin almost 2 decades before. A total of 100 veteran bodies underwent autopsy by at least two forensic medicine specialists. The liver, kidney and lung specimens were sent for pathological examination and their lesions, severity of the lesions, and the relation between the type/severity of the lesions and the time elapsed since their appearance were studied. A total of 83%, 63%, and 62% of the veterans had lung, liver, and kidney pathologies. The most common pathologies included liver steatosis, interstitial fibrosis of the kidney, and lung atelectasis. Liver and kidney pathologies are far more common than what is considered in the mustard gas-exposed veterans. These pathologies are often accompanied by very severe lung complications.

Hepatitis B is one of the major health problems in the world. Health care workers (HCWs) are at high risk of acquiring hepatitis B virus. The aim of this study was to evaluate the prevalence of HBV infection and the immune response to HBV vaccine among the HCWs in Babol, northern Iran. This study was accomplished on 527 HCWs and administrative staff working at Rohani Hospital, Babol, northern Iran from 2011 to 2012. HBs- Ag, HBc- Ab and HBs- Ab were measured by ELISA method. All susceptible staff vaccinated with recombinant hepatitis B vaccine (Pasteur Institute of Iran) and HBs - Ab titer was evaluated 3 months after the last dose. Anti-HBc was positive in 32 (6.1%) and HBs-Ag in 4 (0.75%) of the participants. The HBV exposure in HCWs was four times greater than the administrative staff (6.65% vs. 1.63%). There was significant association between HBV exposure and occupation and also educational level (P < 0.001), however, this association was not found with age and gender. Seroconversion was seen in 211 (91.7%) of 230 participants who received three-dose series of hepatitis B vaccine. The seroconversion is significantly decreasing by the increase of age (P < 0.001), however, no significant association was seen with age and gender. Considering high HBV infection exposure in HCWs, it is mandatory to ensure vaccination program and postvaccination evaluation along with education and safe work environment preparation.

Fine needle aspiration cytology (FNAC) is well accepted as a useful diagnostic technique in the management of adult patients with head and neck lumps. But, until recently, very few reports have been obtained regarding the role of FNAC in nonthyroidal neck masses in children. Hence, the objective of our study was to determine the diagnostic value of fine needle aspiration cytology in the diagnosis of paediatric nonthyroidalneck masses. This descriptive study was conducted at the Department of Pathology,Dr.BCRoyPGIPSKolkata from January2012 to December 2012. Hundred patients with non-thyroidal neck masses fulfilling theinclusion criteria were included in the study. Fine needle aspirations were performed by Leishman-Giemsa staining. The most common nonneoplastic neck swelling seen in children were an enlarged lymph node due to inflammation 38(42.2%),i.e., reactive lymphadenitis. Others were TB lymphadenitis25(27.8%), nonTB granulomatous lymphadenitis 2(2.22%), chronic sialadenitis 2(2.22%), branchial cyst 4(4.44%) and epidermal cyst 3(3.33%) cases. Overall sensitivity, specificity, positive predictive value and negative predictive value of FNAC in our cases are 93.06%, 72.22%, 93.06% and 72.22%. FNA is a valuable diagnostic tool in the management of children with the clinical presentation of a suspicious neck mass. The technique reduces the need for more invasive and costly procedures like open biopsy.

Extended-spectrum-B-lactamase (ESBL)-producing strains of Klebsiella Pneumonia are an important cause of many serious infections in hospitalized and nonhospitalized patients and delayed treatment of these infections in crease chance of death in patients. This study was performed to determine the prevalence of ESBL-producing K. Pneumonia and to evaluate the frequency of TEM and SHV genes among the clinical samples. One hundred and thirty isolates of K. Pneumonia were collected at Imam Reza Hospital in Mashhad (Iran) from May 2011 to July 2012. ESBL production was determined by the double disk diffusion (DDs) test. PCR method was used to detect TEM and SHV genes. Of 130 patients with K. pneumonia infection 28 were out-patients and 102 hospitalized patients. The most specimens was urine samples (n=25 in out-patients, n=39 in hospitalized patients, totally 49.2%) followed by wound samples (n=3 in out-patients, n=21 in hospitalized patients, totally 21.5%), blood samples (n=19 in hospitalized, 14.6%). The prevalence of ESBL producing K. pnemoniae was estimated 43% (n=56) including three of ESBLs positive isolates from out-patients and 53 from hospitalized patients. Of 56 ESBLs positive isolates, 44(87.54%) TEM, 39(69.64%) SHV and in 27 cases (48.21%) both TEM and SHV were detected. A high prevalence of ESBL-producing K. Pneumonia among the hospital isolates obtained of urinary followed by blood and wound samples were documented. The majority of them carried both TEM and SHV genes. Results of this study alarm for the physicians because treatment and control nosocomial infections for them were difficult.

Tuberculosis is still a major health problem, involving about 1/3 of the world´s population. Diagnosis is difficult when we only use Ziehl-Neelson staining. Many cases may be missed. A more rapid and sensitive diagnostic method is necessary. PCR may be helpful. The aim of this study is to compare PCR, Zieh-Neelsen staining and histopathologic findings in diagnosis of tuberculosis on formalin-fixed paraffin-embedded tissues. Paraffin blocks of the submitted specimens of the patients clinically suspicious for tuberculosis or containing granuloma were selected. Ziehl-Neelsen Staining & TB-PCR (IS6110 element) were carried out. The results of the tests were compared by using the McNemar test. Statistical significance was accepted when the P value was less than 0.05. Forty five specimens were included in the study, 35 had granulomas (19 with caseous necrosis). Acid-fast bacilli were identified in 17 specimens (37.8%). TB-PCR was positive in 16specimens (84%) with caseating granulomas, 11 specimens (68.8%) with non-caseating granulomas & 6 specimens (60%) without granulomas. (P value = 0.59). TB-PCR on paraffin–embedded tissue is a potentially useful approach for early, rapid and sensitive diagnosis of tuberculosis. It is especially useful when granuloma is seen in tissue section, while acid-fast stain is negative. If there was no facilities for PCR, histopathological diagnosis with clinical correlation is more reliable in comparison to AFB results.

Although gastrointestinal involvement by metastatic malignant melanoma is common but primary gastrointestinal (GI) melanoma has been reported in rare cases. In this study we report two cases of primary gastrointestinal malignant melanoma that one of them is a known case of neurofibromatosis type 1(NF1). Both cases showed no evidence of any lesions in skin and eye. Malignant melanoma of GI tract in patient with neurofibroma is reported with hypothesis of a possible relation between two pathologies. Both primary GI melanoma and combination of NF1 with primary GI melanoma are rare entities discussed in this article.

Heterotopic pancreas is an uncommon developmental anomaly of upper gastrointestinal tract. Heterotopic pancreas tissue is very rarely found in ileum. Intussusception in children is usually idiopathic, but definitive aetiology can be established in 90% of adult cases. We are reporting a case of pancreatic heterotopia presenting as a lead point of ileo-ileal intussusception in a 1year 3month year old boy.

Lipomais a most common benign neoplasm of mature adipose tissue in trunk and extremities. The oral cavity rarely affected by this neoplasm(1-4%) and more occurs in buccal mucosa. Floor of the mouth is rarely affected. Usually its size is less than 3 cm. The present report shows an unusual case of large lipoma (5.5 cm in greatest dimension) in the floor of the mouth of a 68- year- old male and review of the literature.

Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer after papillary carcinoma. It usually grows slowly and is clinically indolent; but rarely, its aggressive forms with distant metastases can occur. We report here an uncommon case of bilateral orbital metastasis of FTC. A 70-year-old woman presented with bilateral exophtalmus and past medical history of thyroid nodule surgery 15 years ago. Radiologic evaluation showed massive bilateral orbital mass with extension to calvarium. Tumor decompressed and removed with the suction and curettage and the patient was treated with chemoradiotherapy after operation. Pathologic examination showed metastatic follicular thyroid carcinoma. Although orbital metastasis of follicular thyroid carcinoma is uncommon, FTC should be considered as a potential primary neoplasm in a patient with orbital mass.