Iranian Journal Of Pathology
Volume:9 Issue: 4, Autumn 2014

In patients with malignancy، the common etiologies of granuloma formation are tumor related sarcoid reaction، sarcoidosis، tuberculosis and other granulomatous diseases. Often، the finding of granulomas in malignant patients may obscure the primary malignancy or may mislead towards treatment of infectious and other etiologies. Hence، their proper recognition and necessary follow up is needed to establish the cause of granulomatous lesions and for proper management of patients.

CD10 is a cell surface enzyme with metalloendopeptidase activity, also known as Common Acute Lymphoblastic Leukaemia Antigen, which mainly serves as a marker for acute lymphoblastic leukemia (ALL). To date and to the best of our knowledge, only few comparative immunohistochemical studies have assessed CD10 expression in cutaneous epithelial neoplasms. Our goal was to determine whether CD10 can be used in pathologic distinction of cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). This study included 27 BCC and 17 SCC cases immunohistochemically stained for CD10. Cytoplasmic +/- cell membrane staining was considered as positive. Each slide was studied by two pathologists and scored semi- quantitatively as follows: negative (<10%); 1+ (10-50% positive cells); and 2+ (>50% positive cells). The rate of CD10 expression in tumor cells was significantly higher in BCCs in comparison to SCCs. (20/27 vs., 2/17; P <0.0001). Our findings suggest CD10 as a useful adjunct marker in distinguishing cutaneous BCC and SCC.

Accurate differentiation of eczema and psoriasis can be difficult, especially in areas of palm and sole. This study was designed to evaluate histopathological features and identify statistically significant parameters in distinguishing palmoplantar psoriasis from eczema of these regions in patients referring to Razi Skin Hospital, Tehran, Iran. In a cross-sectional study, the patients referring to Razi Skin Hospital were subjected. Biopsies of 36 patients with palmoplantar psoriasis and 16 patients with eczema of these regions were collected from archive of pathology. All of the biopsies were examined blind to the clinical diagnosis by four dermatopathologists separately and data collection forms were completed. Then obtained data were analyzed by SPSS software. The females were more affected than males. There was no difference on involving palm and sole between psoriasis and eczema. Hypogranulosis (P<0.0001), Monro’s microabscess (P<0.0001), tortuous blood vessels in papillary dermis (P<0.0001), suprapapillary plate thinning (P=0.020), confluent parakeratosis (P=0.044) and spongiform pustule (P=0.047) were found to be statistically significant contributors to the clinicopathological concordance in cases of psoriasis. Plasma mounds (P=0.022) were significantly associated with diagnosis of eczema. Psoriasis was more common than eczema in the palms. Histopathologic finding like hypogranulosis, Monro’s microabscess, tortuous blood vessels in papillary dermis, suprapapillary plate thinning, confluent parakeratosis and spongiform pustule had significant relationship with psoriasis and might be useful for its diagnosis.

Methicillin resistance Staphylococcus aureus (MRSA) is one of the most important pathogens that causes several nosocomial and community infections. Adhesion to surfaces and biofilm formation is considered main step in staphylococcal infection. The aims of this study were to determine presence of icaABCD genes and relation to the biofilm formation in of MRSA isolates. Of the 63 MRSA clinical isolates collected from selected hospitals in Tehran, Iran,quantitative biofilm formation was determined by microtiter tissue culture plates (Mtp). All MRSA isolates were examined for determination the icaABCD genes by using PCR method. twenty nine (46%) of the isolates were strong produced biofilm on Mtp. All of the MRSA isolates carried icaD and icaC genes, whereas, the prevalence of icaA and icaB was 60.3% and 51% respectively. S. aureus clinical isolates have different capacity to production biofilm and adhesion. This may be caused by a different in the expression of biofilm genes and hetrogenicity in genetic origins.

Tumor diathesis (TD) is defined as granular proteinaceous precipitates on slide surface of cytologic smears. It is found in the background of smears of invasive carcinoma but not in all cases. The aim of present study was to determine the prevalence of TD in cervicovaginal smears from patients with uterine cervix carcinoma. Cytological smears and histological slides from the Department of Pathology, Women Hospital, Tehran, Iran, of forty six patients histologically confirmed carcinoma of uterine cervix from 1995 to 2003 were reviewed for presence of TD, red blood cells, and neutrophils on cytological smears as well as depth of invasion, histologic types and grade of differentiation of tumor. TD was detected in 28 of the 46 smears (60.9%); in 18 patients with squamous cell carcinoma (62.1%), 7 adenocarcinoma (58.3%), 2 adenosquamous carcinoma (66.7%) and one endometrial carcinoma which involved uterine cervix. TD was seen in 4 (33.3%) uterine cervix carcinoma with 5mm depth of invasion and 17 (65.4%) uterine cervix carcinoma with ≥ 5mm depth of invasion. There was a positive correlation between the presence of TD and the depth of invasion. Although an important criterion of malignancy, TD, was absent in some cases of carcinoma, particularly those that had < 5mm depth of invasion. Increasing in depth of invasion and decreasing in differentiation of the tumor were associated with increasing in frequency of TD in cytological smears. A definite distinction between an intraepithelial lesion and a shallow invasive cancer may not be possible on cervicovaginal smears.

Although breast tuberculosis still remains rare, but in endemic countries should be in differential diagnosis of breast cancer and abscess. Imaging modalities cannot distinguish between cancer and tuberculosis. Acid fast bacilli stain; culture and PCR are helpful diagnostic methods but unfortunately are not very sensitive. Negative results do not rule out this diagnosis, so it seems definite diagnosis can be made by open biopsy and histologic evidence (granuloma tissues). In this case, a 33 years old woman was referred to the Infectious Ward in Imam Reza Hospital, Medical University of Kermanshah, western Iran in 2011; complaining of one lump in her left breast which did not response to usual therapy (painkillers and antibiotics). Fine needle aspiration for histologic and cytologic evaluations were negative but open biopsy showed granulomatous tissues, anti-tuberculosis chemotherapy was begun and response was significant then PCR was reported positive. We think in endemic area, empirical treatment can be started based on histological evidence and proper clinical manifestation.

Myeloid Sarcoma (MS) is a tumor mass consisting of myeloblast with or without maturation occurring at an anatomical site other than the bone marrow. Incidence of MS ranges from 1-9% and is most commonly misdiagnosed as Non Hodgkins Lymphoma or poorly differentiated carcinoma. MS can occur in various sites but nasal cavity involvement is rare. Here we report a case of MS presenting as nasal polyp since 2 weeks in a 30 year old male patient who presented to Otolaryngology department of Father Muller Medical College Hospital, India in 2012. Patient was eventually found to have Acute Myeloid Leukemia (AML). This case highlights the importance of hematological and histological correlation coupled with Immunohistochemistry which is mandatory for the accurate diagnosis of this rare entity.

Rhinosporidiosis is a granulomatous disorder caused by Rhinosporidium seeberi, an aquatic parasite. It spreads through contaminated water and soil. It frequently involves the nasal cavity and nasopharynx. Disseminated or systemic lesions are rare. A 56 year old man presented with multiple tumor like lesions all over the body in our cancer institute in April 2012. Fine needle aspiration cytology (FNAC) from the skin lesions revealed many sporangia and spores of R. seeberi. He had history of nasal mass being removed by excision and was immunocompetent. Histopathological examination and periodic acid Schiff (PAS) stain confirmed it to be disseminated rhinosporidiosis. His accessible lesions were excised with cautery and he was put on oral dapsone therapy. He did not show recurrence till six months of therapy. A common lesion with an uncommon presentation should not be missed which can increase the morbidity and even mortality in such a case.

Eosinophilic cholecystitis (EC) is a rare entity that presents in a manner comparable to acute cholecystitis. The diagnosis is based on classical symptoms of cholecystitis with the presence of eosinophils (>90%) within the gallbladder. EC has been reported alone (idiopathic EC) or in combination with manifestations such as eosinophilic cholangitis, hypereosinophilic syndromes, and parasitic infestations. Papillary hyperplasia of gallbladder occurs in the setting of cholelithiasis, inflammatory lesion of gallbladder, primary sclerosing cholangitis or ulcerative colitis. To the best of our knowledge of the literature reviewed, papillary hyperplasia has never been reported in a setting of eosinophilic cholecystitis. We report a case of 30 years old female presenting with idiopathic eosinophilic cholecystitis associated with papillary hyperplasia of gallbladder in the year 2011 at PGIMS Rohtak (India). Hereby we report coexistence of these two entities never described together.

Primary ovarian carcinoid tumors of the ovary are rare and represent less than 0.1% of ovarian malignancy. One of its subtypes is the strumal carcinoid in which the thyroid tissue is seen in intimate association with carcinoid tumor. We here report a 47-year-old woman with strumal carcinoid of the right ovary presented with cessation of menstrual periods in the past 3 months and was referred due to a possible menopause-related symptom. A firm pelvic mass was found in physical examination and a large mass (20 × 15 × 8 cm) in the right ovary was reported in ultrasound evaluation. The spiral CT scan reported masses in both ovaries. The patient underwent total abdominal hysterectomy plus bilateral salpingo-oophorectomy. The pathological evaluation revealed strumal carcinoid tumor with thyroid tissue in right ovary and benign cystic teratoma in left ovary. Our case was alive at 8 years after the operation with no disease recurrence.