Evaluation of phosphatase and tensin homologue (PTEN) expression in gastric cancer and its relationship with histopathological findings

INTRODUCTION

Phosphatase and tensin homologue (PTEN) is an important tumour suppressor in multi-step tumorigenesis. To establish the role of PTEN in gastric cancer progression, we examined the PTEN expression degree in gastric cancer tissues. We also explained the connection between PTEN expression and histopathological findings.

MATERIALS AND METHODS

Our study was cross-sectional and made up of 50 patients with known gastric cancer. Immunohistochemical staining for PTEN was done on gastric cancer tissues. Tumour behaviour was estimated by histopathological assessments.

RESULTS

Twenty-seven (54%) of the 50 patients had PTEN staining. The evaluation of the connection between PTEN expression and demographic data and tumour behaviours revealed no meaningful relationship between PTEN expression and patients' age, gender, tumour site and size, tumour type, tumour grade and stage, neural, and lymphovascular invasion (P-value>0.05).

CONCLUSION

PTEN expression level is expected to be a significant molecular event in the progression of gastric cancer and may be a predictive marker for gastric cancer behaviours dependent on society.

Collision tumor of squamous cell carcinoma of the scalp and meningioma: A case report

Finding 2 different histological tumor types at the same site is extremely unusual, especially in patients with no history of radiation exposure or a family history of cancer. We describe a rare case of co-occurrence of meningioma and squamous cell carcinoma at the same site. A 67-year-old woman with a 6-month headache and a verrucous ulcerative mass on her frontoparietal region is the subject of this case study. Her medical history and her family's medical history are both blank. Her bilateral frontoparietal regions were found to have large heterogeneous lesions with areas of necrosis and superficial ulceration on radiological examination. An extensive heterogeneous extra-axial lesion was discovered during further radiological analysis in the left parasagittal region. Histopathologic examination revealed an impinging tumor consisting of a meningioma and squamous cell carcinoma at the same site. It is extremely uncommon to have multiple primary scalp cancers of different cell types present at the same time. To identify these cancers and choose the best treatments, clinicians will benefit from the information in our case reports.

Antibiotic Resistance Pattern in Intensive Care Units in a Large Referral Hospital in Iran

Background & Objective

Antibiotic resistance, especially in the form of multidrug-resistant (MDR), is a big problem, especially in intensive care units (ICUs). This study aimed to evaluate antibiotic resistance and MDR patterns among patients hospitalized in the ICUs in one of the large referral centers in Iran.

Methods

The present study was conducted at Imam Khomeini Hospital in Tehran (a great referral hospital), which admits critically ill patients requiring ICU services. To determine the rate of positive cultures for resistant strains, the patient's blood specimens were sent to the laboratory of the hospital for inoculation on proper culture media within 2 hours of extraction. Antimicrobial susceptibility tests were done using the Bauer-Kirby disk diffusion method.

Results

A total of 1,755 samples were collected from the patients to assess microbial strains and antibiotic resistance. The most common microbial strains detected in the cultures extracted from peripheral blood samples were Klebsiella pneumonia (22.1%), Staphylococcus epidermidis (7.9%) and another coagulase-negative Staphylococcus (15.0%). The antibiogram test showed antibiotic resistance in 1,509 cases, leading to a resistance prevalence rate of 85.9%. The most common antimicrobial resistance observed was against cotrimoxazole (61.7%), ciprofloxacin (51.3%), imipenem (50.0%), and ampicillin (49.6%). The rate of MDR was found to be 96.3%.

Conclusion

In Iran's ICUs, a significantly high level of antibiotic resistance may be seen especially the MDR pattern, which indicates the need to change the pattern of prescribing and managing these drugs in ICU centers.

Effects of nebulized hypertonic saline on inflammatory mediators in patients with severe COVID-19 pneumonia: A double-blinded randomized controlled trial

INTRODUCTION

An exaggerated immune response is considered the most important aspect of COVID-19 pathogenesis. Hypertonic saline (HS) has shown promise in combating inflammation in several respiratory diseases. We investigated the effects of nebulized HS on clinical symptoms and inflammatory status in patients with severe novel coronavirus infection (COVID-19) pneumonia.

MATERIALS AND METHODS

We randomly assigned 60 adults admitted to the intensive care unit (ICU) due to severe COVID-19 pneumonia to the experimental (received nebulized 5% saline) and control (received nebulized distilled water) groups. All interventions were applied 4 times daily for 5 days. The levels of tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), and other clinical factors from venous blood were evaluated before and after intervention application. Mortality rate, intubation rate, and durations of ICU and hospital stay were also compared between groups.

RESULTS

The levels of TNF-α (MD: -21.35 [-32.29, -10.40], P  =  0.000) and IL-6 (-9.94 [-18.86, -1.02], P  =  0.003) were lower in the experimental group compared to the control group after applying the interventions. The levels of white blood cell count, PO2, and serum sodium were also statistically significant differences between groups. However, we did not observe significant differences in terms of hospitalization durations and mortality rates.

CONCLUSION

Nebulization of HS in patients with severe COVID-19 pneumonia appears to be effective in reducing inflammation, but does not appear to affect intubation rates, mortality, hospitalization, or length of stay in ICU.

The value of SOX10 expression in predicting perineural invasion in gastric cancer

BACKGROUND

SRY-related HMG-box 10 (SOX10) protein has a confirmed role in the regulation of neural cell proliferation and differentiation. It is now suggested that the changes in SOX10 expression may be linked to neural invasion by cancer cells. We aimed to assess the value of SOX10 expression in predicting perineural invasion in gastric cancer.

METHODS

A cross-sectional study was performed on 40 patients with gastric cancer. To assess perineural invasion, Hematoxylin & Eosin stained slides were examined. The expression of SOX10 was also examined by immunohistochemistry.

RESULTS

Our study showed higher perineural invasion in those with SOX10 positivity as compared to those without SOX10 expression (64.0% vs. 6.7%, p=0.001). No association was revealed between other baseline variables and SOX10 positivity. The expression of this marker increased the chance of neural invasion up to 17 times as indicated by the multivariable regression modeling. Multivariable regression modeling indicated that the chance of neural invasion increased up to 17 times in cases of SOX10 positivity.

CONCLUSION

Overexpression of SOX10 is closely associated with the risk of perineural invasion in gastric cancer.

Frequency and Underlying Causes of Alloimmunization Against Red Blood Cell Antigens in Patients Referred to the Blood Bank of the Tertiary Referral Hospital of Tehran from 2018 to 2020

BACKGROUND

Alloimmunization against blood group antigens is an important non-infectious complication of blood transfusion, and early detection of these alloantibodies by antibody screening before transfusion is crucial. Identifying which underlying factors will affect the occurrence of alloimmunization will be necessary to manage this event as accurately as possible. We aimed to assess the prevalence rate and main determinants of RBC alloimmunization among patients referred to a large referral blood bank in Iran.

METHODS

This retrospective cross-sectional study was conducted on all patients referred to a blood bank at Imam Khomeini Hospital between October 2018 and September 2020. Information was collected by referring to the archives of the hospital information system as well as the documents recorded at the blood bank ward and reviewed by two pathologists and completed documents.

RESULTS

In total, 39270 cases were cross-matched. Accordingly, the frequency of alloimmunization cases was equal to 220 cases, which indicated a prevalence of 0.56%. The most common alloantibodies were anti-K (43.2%, 95% CI: 36.8‒49.5), anti-E (34%, 95% CI: 27.7‒40.5), and anti-C (16.3%, 95% CI: 11.4‒21.4). Among patients with positive alloimmunization, the most common blood groups were blood group B (34.6%), followed by blood group A (34.1%). Most of these patients were Rh-positive (77.3%). In patients with positive alloimmunization, the frequency of hemoglobinopathy was estimated to be 37.7%. Frequent blood transfusions were found in 42.2%, a history of malignancy in 17.3%, graft history in 11.3%, and a history of pregnancy in 35.0%.

CONCLUSION

Alloimmunization was more prevalent and more predictable among patients with hemoglobinopathies and those receiving recurrent transfusions. Therefore, a history of repeated blood transfusions should be regarded as a risk factor contributing to alloimmunization.

Investigation of Parvovirus B19, Cytomegalovirus, Herpes Simplex Virus Types 1 and 2, Human Papillomavirus Types 16 and 18 in Papillary Thyroid Carcinoma

Background & Objective

Viral infections are associated with the pathogenesis and progression of human malignancies. Several studies have suggested the role of viral infections in papillary thyroid carcinoma (PTC). However, the results are still conflicting, and the potential role of viruses in PTC tumorigenesis remains to be elucidated. In the present study, we aimed to investigate the presence of parvovirus B19, cytomegalovirus (CMV), herpes simplex virus types 1 and 2 (HSV-1/HSV-2), and human papillomavirus (HPV) types 16 and 18 in PTC.

Methods

In this cross-sectional study, paraffin-embedded tissue blocks of 40 patients with PTC were used. Tissue blocks were studied for the presence of the virus genome using real-time polymerase chain reaction (PCR).

Results

Of the 40 patients with PTC, there was 1 positive case of HPV (2.5%), while 6 cases were positive for parvovirus B19. HSV and CMV DNAs were not detected in any cases.

Conclusion

Correlations among HSV, CMV, and PTC are unexpected in our patient population. But parvovirus B19 and, to a lesser extent, HPV DNA genomes were detected in PTC using real-time PCR.

Evaluation of Lymphovascular Invasion by CD31 Expression in Gastric Adenocarcinoma

Background & Objective

Lymphovascular tumoral invasion is a typical histopathological feature of gastric carcinomas and supports the recognition of high-risk patients for the recurrence. We aimed to study CD31 expression in diverse subtypes of gastric carcinomas and to show its association with the histopathologic findings of the carcinoma to assess the prognosis.

Methods

This cross-sectional study was conducted on 40 established patients with gastric adenocarcinoma from radical gastrectomy. The patients were classified according to the pathology assessments. Tumoral tissues were assessed by immunohistochemical staining for CD31 expression. Malignant behavior was estimated by histopathological evaluations.

Results

CD31 positivity was described in 23 (57.5%) of all evaluated patients. In assessment of CD31 expression and tumor features presented, no significant association between the CD31 expression and patients' age, sex, tumor site, size, grade and stage, subtypes of carcinoma, perineural invasion, and also lymphovascular invasion was found. (P>0.05).

Conclusion

Lymphovascular invasion may make valuable additional evidence and may be useful to detect gastric carcinoma patients at high risk for recurrence, who could be candidates for more supplementary therapies. However, in our study, CD31 expression did not show any association with the aggressive histopathologic features of this tumor.

Empyema with an extensive retroperitoneal abscess after the first dose of the COVID-19 vaccine, a case report

INTRODUCTION

The most common side effects were mild pain at the injection site and fever after the COVID-19 vaccination. A retroperitoneal abscess is a rare disorder with a deceptive onset and difficult diagnosis. It has various reasons and is related to a high mortality rate.

CASE PRESENTATION

A 29-year-old man with a recent history of first-dose Covid-19 vaccination, was referred for dyspnea, chest, and abdominal pain. Chest imaging revealed a lung abscess evacuated to pleural space. Left posterolateral thoracotomy surgery was done. Post-operation abdominopelvic imaging revealed increased fat stranding and fluid collection, suggesting retroperitoneal infection and abscess formation and the patient underwent drainage.

CLINICAL DISCUSSION

Common side effects after COVID-19 vaccination were mild and expectable without hospitalization. But in our case, a rare complicated side effect was seen.

CONCLUSION

Uncommon side effects should be observed to recognize whether they are related to the vaccine or not.

The Role of P21 Protein Expression in Predicting Progression and Biological Behaviors of Gastric Adenocarcinomas

Background: P21 protein is a cyclin-dependent kinase inhibitor and has a crucial function as a cell cycle regulator in malignant tissues. Thus, its association with aggressive characteristics of malignant lesions is suggested. Objectives: We evaluated the expression level of P21 in gastric cancers and its association with the histopathological findings of cancer. Methods: This cross-sectional study was performed on gastric adenocarcinomas from radical gastrectomy. The histopathological examination was assessed by Hematoxylin & Eosin. The immunohistochemistry technique was then used to assess the expression of the P21 marker. Results: P21 positivity was revealed in 28 specimens of the cancerous lesions with an overall prevalence of 70.0% in our population. There was no association between P21 positivity and tumor-related characteristics, including tumor location, type, grade and stage, as well as the size of the cancerous lesion. P21 positivity could not be related to perineural or lymphovascular invasion of the tumor (P-value > 0.05). Conclusions: In our population, the expression of P21 may not be prognostic or predict tumor biological behavior among patients with gastric adenocarcinomas.

Symptomatic calcifying odontogenic cyst in the maxilla, a case report with a literature review

INTRODUCTION

Calcifying odontogenic cysts (COC) are rare lesions classified as developmental cysts and occur mostly in the maxillary and mandibular bone. Some of the COCs are related to odontogenic lesions.

CASE PRESENTATION

We report a 60-year-old man with COC of the maxillary bone, presenting after tooth extraction. The patient has a palpable tender mass at the right upper tooth area. Imaging shows a well-defined radiolucency in the 7-3 tooth area of the right upper jaw. The combination of radiologic data and histopathologic findings was in keeping with the calcifying odontogenic cyst. Total enucleation is the chosen treatment for COC. No recurrence is proved by X-ray imaging after 1-year follow-up.

DISCUSSION

COC is a rare entity of odontogenic cysts and needs an exact diagnosis by pathology examination to estimate behavior.

CONCLUSION

Our case report offers significant data that could help clinicians and surgeons as well as pathologists with the diagnosis and management of these lesions.

GATA Binding Protein 3 (GATA-3) expression evaluation as prognostic factor in breast cancer and its relationship with other immunemarkers

Introduction

Breast cancer is the most frequent cancer in which the mortality rate could be decreased by proper management. The GATA3 transcription factor is one of the most frequently mutated genes in breast cancer.

Materials and Methods

We studied the immunohistochemical (IHC) expression of estrogen and progesterone receptor, human epidermal growth factor receptor 2, and GATA-3 in 166 radical/partial mastectomy specimens having different histologic grades and stages of breast carcinoma. All samples were obtained from the pathology department of Sina hospital in Tehran-Iran from 2010 to 2016.

Results

There was a direct relationship between the luminal subtype carcinoma and higher GATA-3 expression (P-value: 0.001) and between triple-negative carcinoma and lower GATA-3 expression (P-value: 0.001). Moreover, there was a direct relationship between the metastasis rate and the tumor's grade with GATA-3 staining (P-value: 0.000 and 0.001, respectively).

Conclusion

GATA-3 expression is related to the histopathologic and prognostic factors. GATA3 can be introduced as an important predictor in breast cancer patients.

COVID‐19‐associated mucormycosis involving the maxilla

It is important to increase the awareness and knowledge of head and neck surgeons about the recent surge of craniofacial mucormycosis in COVID‐19 patients because early diagnosis and appropriate treatment are essential to improve the outcomes. Here, we describe clinical features, treatment protocols, and outcomes of treatment in eight patients with COVID‐19‐associated mucormycosis in the maxilla. Consistent with the findings of previous studies, our experience in the management of these eight patients shows that early administration of amphotericin B and prompt aggressive surgery are essential for optimal control of the disease.

Rare gastrointestinal presentation of systemic mastocytosis, a case report

Introduction

Systemic mastocytosis is a rare disease resulting from infiltration of atypical mast cells in multiple organ systems and present with variety of symptoms. Primary appendiceal and cecal mass with isolated abdominal pain as a presenting feature in systemic mastocytosis have not been reported in literature up to now.

Case report

We described a 69- years-old female with systemic mastocytosis who presented with chronic abdominal pain and recent progression. On imaging of the abdomen and pelvis showed a mass in cecum. The patient underwent surgery and histopathologic evaluation of cecal and appendiceal masses revealed uniform small round cell tumor with eosinophilic cytoplasm admixed with many eosinophils distorting normal colonic mucosal architecture. The neoplastic cells showed positive expression of CD117 and Mast cell tryptase. According to all these considerations systemic mastocytosis was confirmed as the diagnosis.

Conclusion

Isolated abdominal pain and primary large intestinal mass are uncommon features of systemic mastocytosis. This case report informed physicians and pathologists to consider it as one of differential diagnosis.

•

Mastocytosis is an uncommon neoplastic infiltration of mast cells in one or multiple organs.

•

Isolated abdominal pain and primary large intestinal mass are uncommon features of systemic mastocytosis.

•

Mastocytosis reveal common surprising clinical signs that to conclude lead to inadequate treatment. mastocytosis.

Renal Epidermoid Cyst: A Case Report

In contrast to epidermoid cysts of the dermis, epidermoid cysts of the kidneys are exceptional. This report explains an uncommon patient with renal epidermoid cyst who presented with flank pain and previous history of renal stones. Our patient underwent excisional resection. The histopathological evaluation discovered cyst wall covering by squamous epithelium and containing keratinous materials compatible with the epidermoid cyst. Based on pathology findings, the patient didn’t receive any more treatment. Because pathology evaluation is necessary for the diagnosis or rules out the possibility of malignancy, biopsy before surgery is advised.

Retroperitoneal Unicentric Castleman's disease, a case report

Introduction

Castleman's disease (CD) is an unusual nonmalignant lymphoproliferative disorder which presented with enlarged hyperplastic lymphoid tissue and had three subtypes, hyaline-vascular, plasma cell, and mixed form according to histologic findings.

Case report

We report a 31-year-old woman who presented with abdominal pain from 3 months ago. Imaging studies showed a well-defined mass on back of pancreas without any invasion. The histopathological examination revealed lymphoid tissue with prominent vascular proliferation and hyalinization of the vessel walls compatible with Hyaline vascular CD. So, pathological assessment is essential for the diagnosis.

Conclusion

Unicentric CD must be considered as differential diagnosis in a solid solitary abdominal mass. In patients with abdominal mass of an ambiguous nature, surgical resection is necessary as diagnostic tool and the first treatment approach.

•

Castleman's disease is an unusual nonmalignant lymphoproliferative disorder.

•

Unicentric Castleman's disease must be considered as differential diagnosis in a solid solitary abdominal mass.

•

Surgical resection is necessary and adequate for diagnosis and treatment of patients.

IgG4-related cholecystitis misinterpreted as gallbladder cancer, a case report

Introduction

Immunoglobulin G4-related disease (IgG4-RD) is a new defined entity with features that factually have been overlapped with other diseases with distinctly diverse treatments and prognoses.

Case presentation

This report describes a 50-year-old woman who presented with abdominal pain from 3 months ago. The patient underwent open cholecystectomy with Roux-en-Y hepaticojejunostomy due to suspicious of malignancy. The histological examinations revealed acute on chronic cholecystitis with extensive fibrosis and many inflammatory cells infiltration composed of plasmacells and eosinophils without any evidence of malignancy. Pathological and immunohistochemical examination for IgG4 compatible with IgG4-RD. So, pathological assessment is essential for the diagnosis.

Conclusion

IgG4-RD in gastrointestinal tract frequently misinterpret as malignancy before surgery, and surgeon should notice this disease in the differential diagnosis in order to choose the treatment.

•

IgG4-related disease is rare fibroinflammatory condition.

•

Gastrointestinal IgG4-related disease is problematic to establish previous surgery.

•

Malignancy is main differential diagnosis of IgG4-related cholecystitis.

Evaluation of the histopathologic status of rectal adenocarcinoma and its regional lymph nodes after neoadjuvant therapy, and its relation to the duration of disease-free survival

INTRODUCTION

Colorectal cancer is one of the most common malignant tumors and has a relatively poor prognosis. Lymph node involvement is considered the most important prognostic factor.

MATERIALS AND METHODS

During a retrospective cohort study, 132 patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from 2010 to 2015 in Sina hospital were reviewed.

RESULTS

Multivariable analysis was performed and shown the clinical stage was not a representative factor for disease-free survival (P = 0.187), but Dworak Tumor Regression Grading were significantly associated with higher disease-free survival (P = 0.000) in stage II and stage III. The total number of retrieved lymph nodes and involved lymph nodes in the same clinical stage were statistically associated with higher mean disease-free survival in patients (P = 0.000 in both conditions).

CONCLUSION

In the same clinical stage, increasing the Dworak Tumor Regression Grading reduced the risk of rectal cancer recurrence. Increasing total number of retrieved lymph nodes and involved lymph nodes, 2.14 times and 3.87 times increased the risk of recurrence, respectively.

Recurrent Cranial Chondrosarcoma: A Case Report

Chondrosarcoma of the cranium is a rare malignancy. The result of treatment is challenging to assess because the slow-growing rate means that there is a long interval previously discovering the recurrence and last long time to diagnosis of recurrence. This report describes a 38-year-old man who presented with a generalized seizure 2 months before his referral. The patient underwent excisional surgery. The histological examinations revealed a cartilage developing tumor compatible with chondrosarcoma. The radiologic and histologic correlation established the diagnosis. But, the patient had two episodes of recurrence after surgery. We determined that intracranial chondrosarcoma must be comprised in the differential diagnosis of a mass with calcification on cranial imaging. Accurate diagnosis is obligatory for supplementary patient managing, and a recurrence is more common in patients only treated by surgery.

Relationship between phosphatase and tensin homolog (PTEN) expression in high grade glioma and histopathologic findings

Introduction. Malignant glioma is resistant brain tumor to treatment and considered by aggressiveness that fails successful resection. Molecular pathways including PTEN related with tumor behavior. Materials and methods. We studied the immunohistochemical expression of PTEN in 32 brain surgical resection specimens with different histologic grades. All samples were from pathology department of Sina hospital in Tehran-Iran from 2020-2021. Results. From 32 patients, 21 (65.6%) had no PTEN staining. There was significant relationship between high age and no PTEN expression and average age with no PTEN staining was 54.05±14.01 years (P value: 0.044). There was significant relationship between necrosis in histopathologic evaluation with no PTEN staining (P value: 0.016). Also, there was no significant relationship between sex, tumor’s size, Tumor’s site, tumor’s grade, and primary or secondary type of tumor with PTEN staining (P value > 0.05). Conclusion. PTEN expression related to histopathologic features such as necrosis and age. PTEN can be introduced as an important prognostic indicator in high grade.

A Case of Nodular Fasciitis of the Breast Previously Misdiagnosed as Breast Carcinoma; A Case Report

Introduction: Nodular fasciitis is an exceptional benign soft tissue tumor of the breast that clinically and radiologically can simulate invasive duct carcinoma. Case presentation: We report a case of 67-year-old woman who had a palpable right breast mass of 2 months duration. Sonography showed a hypoechoic heterogeneous round nodule with irregular and speculated borders in right breast. Right breast mass core needle biopsy was inconclusive. Right mastectomy was done due to highly suspicious for malignancy on imaging. Pathological and immunohistochemical examination revealed that the tumor composed of a stellate spindle cell tumor with red blood cells extravasation, compatible with nodular fasciitis. Therefore, pathological evaluation of the lesion is crucial in the assembly of the diagnosis. Conclusion: Nodular fasciitis should be considered in the differential diagnosis of any suspicious breast mass.

Strongyloides stercoralis Larvae in Bronchoalveolar Lavage Fluid in the Asthmatic Patient: A Case Report

Strongyloides stercoralis is a common cause of gastrointestinal infection. Symptoms are usually mild, but in the setting of impaired host immunity, severe and disseminated illnesses may occur. The present report describes a male patient with a history of asthma and corticosteroid therapy, now presented with dyspnea and abdominal pain. Examinations show Strongyloides stercoralis larvae in Bronchoalveolar lavage fluid specimens. The patients who have undergone immunosuppressive therapy are highly indicated for Strongyloides stercoralis screening which prevents hyperinflation in endemic areas.

Primary Testis Leiomyosarcoma: A Case Report

Primary leiomyosarcoma in testis is an uncommon tumor with few cases reported. It generally develops after radiotherapy or long-term taking anabolic steroid medication. We report a 53-year-old male patient with primary testis leiomyosarcoma who presented with painless testicular enlargement without any known predisposing factors. Ultrasound revealed a large heterogeneous left testicular solid lesion. Alpha-fetoprotein (AFP) and beta-human chorionic gonadotrophin (beta-HCG) levels in serum were normal. Left radical orchidectomy following with histology assessment established a diagnosis of primary leiomyosarcoma of testis. No data of cancer metastasis was established. The patient didn't receive any adjuvant therapy. There wasn't any evidence of recurrence after 1 year follow-up. Leiomyosarcoma must be one of the differential diagnoses of seronegative tumors in testis. The motivation for this paper is the extreme infrequency of the situation and the differential diagnosis by all expansive inguinoscrotal tumors.

Hematologic Presentations of COVID-19 Can be Misinterpreted as Acute Myeloid Leukemia

Introduction: COVID-19 infection prompts inflammatory responses and acute lung injury in human beings. Complete blood count with differential is essential investigative tool in its managing. However, very few studies revealed the variations of blood cell morphology in this disease.Case report: We reported a 39-years- old female patient complained of respiratory distress one week prior to hospitalization. The patient suffered from cough, fever, and molecular test was reported positive for COVID-19 infection. Laboratory data revealed severe permanent leukopenia and peripheral blood smear examination showed blastoid cells after remission of respiratory signs. Patient underwent bone marrow biopsy for rule out acute myeloid leukemia. But, on bone marrow sample, only viral cytopathic effects were seen. COVID-19 virus stimulates inflammatory cells to produces various inflammatory cytokines and as a result, viral cytopathic effects on white blood cells is seen. Conclusion: We have described how the characteristic peripheral blood findings of COVID‐19 infection can be misinterpret as acute myeloid leukemia.

Evaluation Expression COX-2 in Prostatic Carcinoma by PCR and Immunohistochemistry and Its Relationship with Gleason Score

Introduction: Prostate cancer is among the most common malignancies. Despite the high prevalence and importance of prostate cancer, the molecular mechanisms underlying its development and progression remain poorly understood.Materials and Methods: This cross sectional study was conducted on 50 cases of prostatic carcinoma with different Gleason score referred to Sina hospital in Tehran in Iran in 2016. The gene expression was assessed by using the immunohistochemistry staining and PCR technique. Result: The presence of neoplasia on prostatic biopsy induced strong staining and increased in mRNA level of COX-2 expression when compared to normal tissue (P-Value >0.05). The expression is not well associated with different Gleason grades of prostatic carcinoma. Conclusion: The expression of COX-2 protein by immunohistochemistry staining and PCR technique in our study offers the valuable diagnostic information. Thus, we think this marker might be studied in larger series of patients for its further validation as diagnostic factor in prostate biopsies.

Association between Preoperative Leukocytosis and Pathological Features of Colorectal Cancers

Background: Using hematologic profiles including leukocyte count have been considered as prognostic factor for some cancers. We have been assessed the predictive value of leukocytosis before surgery in colorectal cancers.Methods: This cross-sectional study has been conducted on patients with colorectal cancer who underwent surgery from 2017 to 2019 in Sina hospital, Tehran. The patients were divided in two groups based on high and low leukocyte count before surgery. Results: A total of 84 patients were studied with colorectal cancers including 46 males (55.4%) and 37 females (44.6%) with the average age of 55.2 (± 13.63) years. 36.1% of patients had leukocytosis in laboratory data before surgery. There was a significant association between tumor’s grade and the incidence of leukocytosis before surgery (P <0.001). The existence of leukocytosis is highly associated with poorly differentiated tumor. Also, the relationship between the location of the tumor and leukocytosis was seen which the location was distal, the possibility of leukocytosis decreased significantly (P <0.005). Conclusion: Our findings suggest that the location of the tumor and its degree of tumor differentiation are related with leukocytosis. This current study by considering leukocytosis before surgery aimed to use this variable as a prognostic factor in patients with colorectal cancer alongside with other variables.

Intra-cranial Chondroma: A Case Report and Problematic Diagnosis

Introduction:

Chondroma is a benign cartilaginous tumor. It is found very rarely in the head and neck.

Case presentation:

This report describes a 25-year-old woman who presented with generalized headache from 4 months ago. The patient underwent excisional surgery. The histological examinations revealed benign cartilage forming tumor, compatible with chondroma. The radiologic and histologic correlation confirmed the diagnosis. Based on the diagnosis, the patient received no more treatment.

Conclusion:

We concluded that intracranial chondroma should be included in the differential diagnosis of a calcified mass on skull imaging. Proper diagnosis is necessary for further patient management.

Survivin and Her2 Expressions in Different Grades of Urothelial Neoplasms of Urinary Bladder

Background & Objective:

Urothelial neoplasm (UN) of bladder is a potentially lethal malignancy, particularly in locally advanced or metastatic cases. Development of molecular markers such as HER2 and Survivin may provide useful information on diagnosis and prognosis in UN of bladder.

Methods:

We studied the immunohistochemical (IHC) expression of HER2 and Survivin in 84 radical/partial cystectomy and transurethral resection (TUR) specimens with different histologic grades and stages. All samples were obtained from Pathology Department of Sina Hospital in Tehran, Iran from 2014 to 2018.

Results:

From the total number of 84 UN samples, 10 cases (11.9%) showed papillary neoplasm of low malignant potential, 30 cases (35.7%) presented with low-grade papillary urothelial neoplasm, and 44 cases (52.4%) diagnosed as high-grade papillary urothelial neoplasm. HER2 and Survivin expressions were seen in 44 (52.4%) (P=0.610) and 9 (10.7%) patients (P=0.046), respectively. Survivin expression showed a mild increase in high grade UN.

Conclusion:

Our findings suggest that the IHC expression of Survivin and HER2 are not well associated with histological grades of urothelial neoplasms of bladder. This may be partly due to relatively small sample size and other factors such as patient characteristics or antibody specifications.

Association between Expression of Tissue Inhibitors of Metalloproteinases-1, Matrix Metalloproteinase-2, and Matrix Metalloproteinase-9 Genes and Axillary Lymph Nodes Metastasis in Patients with Breast Cancer

Background

Certain enzymatic biomarkers such as matrix metalloproteinase (MMPs) are instrumental in the breast cancer. Hence, they are viewed as predictive biomarkers in the primary prognosis of this type of cancer. Furthermore, they enjoy a predictive value in the evaluation of the disease, recurrence of tumor, invasion of tumor cells to other areas as well as therapeutic outcomes. The present study aimed to determine the association between the expression of the three tissue inhibitors of metalloproteinases-1 (TIMP1), MMP2, and MMP9 genes and axillary lymph nodes involvement in patients with breast cancer.

Methods

Patients in this study were categorized into two groups, first with axillary lymph nodes involvement (as the case group) and second group without the involvement of axillary lymph nodes (as the control group) referred to Cancer Institute at Imam Khomeini Hospital in Tehran in 2016. The gene expression was assessed using the reverse transcription polymerase-chain reaction technique.

Results

There was no significant difference in the mRNA level of MMP2 and MMP9 genes between the cancer tissues with and without axillary lymph node metastasis in comparison with normal samples. However, the mRNA level of TIMP1 gene was considerably higher in the cancer tissue with axillary lymph node metastasis as compared to the samples without metastasis. In other words, the presence of axillary lymph node metastasis induced a 77.8-fold increase in mRNA expression when compared to condition without metastasis.

Conclusions

The expression of TIMP1 gene is strongly associated with axillary lymph node metastasis in breast cancer patients.

The Emerging Role of Succinate Dehyrogenase Genes (SDHx) in Tumorigenesis

Transformation of a normal cell to cancerous one is dependent on the accumulation of several genetic and epigenetic alterations. One of the candidate driver genetic alterations can happen in succinate dehydrogenases (SDHx) coding gene include SDHA, SDHB, SDHC, SDHD, and SDHAF2.  The most important SDH mutation is in the SDHD gene, which encodes the smallest subunit of mitochondrial complex II (SDH). It has key function both in familial and non-familial hereditary paraganglioma/phaeochromocytoma syndrome (HPGL/PCC). SDHx genes mutations can have resulted in genetic and epigenetic changes like histone hypermethylation. These properties can lead to succinate-mediated inhibition of α-ketoglutarate-dependent dioxygenases. So hypoxic conditions can generate subsequent neoplastic transformation, and in this review, we are presenting the role of SDHx in several malignancies.

The Emerging Role of Succinate Dehyrogenase Genes (SDHx) in Tumorigenesis

Transformation of a normal cell to cancerous one is dependent on the accumulation of several genetic and epigenetic alterations. One of the candidate driver genetic alterations can happen in succinate dehydrogenases (SDHx) coding gene include SDHA, SDHB, SDHC, SDHD, and SDHAF2. The most important SDH mutation is in the SDHD gene, which encodes the smallest subunit of mitochondrial complex II (SDH). It has key function both in familial and non-familial hereditary paraganglioma/phaeochromocytoma syndrome (HPGL/PCC). SDHx genes mutations can have resulted in genetic and epigenetic changes like histone hypermethylation. These properties can lead to succinate-mediated inhibition of α-ketoglutarate-dependent dioxygenases. So hypoxic conditions can generate subsequent neoplastic transformation, and in this review, we are presenting the role of SDHx in several malignancies.