Iranian Journal of Pathology最新文献

Background & objective: Cervical carcinoma is the fourth most common malignancy among women worldwide, with a disproportionately high incidence and mortality in developing countries, including Iraq, where 320 new cases and 62 deaths were reported in 2023. Although the Papanicolaou (Pap) smear remains the cornerstone of screening, findings across Arab populations have been inconsistent, underscoring the need for region-specific data. This study aimed to determine the prevalence and patterns of cervical epithelial cell abnormalities and assess the diagnostic accuracy of Pap smears in Najaf, Iraq.

Methods: This retrospective, cross-sectional study was conducted over ten years (December 2014-December 2024) and included 3522 cervical Pap smears from women aged 16 to 80 years (mean, 36.97 ± 10.62 years) obtained at a private medical laboratory. Samples were classified according to the 2014 Bethesda System.

Results: Of 3522 samples, epithelial cell abnormalities were identified in 192 (5.45%). Atypical squamous cells of undetermined significance (ASC-US) were the most frequent abnormality (3.78%). The highest prevalence was observed among women aged 40 to 60 years. A strong cytohistopathologic correlation was noted. The Pap test demonstrated a sensitivity of 76.19%, specificity of 80.30%, and overall diagnostic accuracy of 79.31%.

Conclusion: The 5.45% prevalence of epithelial abnormalities, predominantly ASC-US, highlights the ongoing need for active cervical cancer screening programs. The significant concordance between cytologic and histopathologic findings confirms the diagnostic reliability of the Pap smear. Further studies are warranted to characterize local cytologic patterns and identify prevalent HPV genotypes to inform HPV vaccination and targeted prevention strategies.

Background & objective: Real-time PCR is widely used to detect SARS-CoV-2, the virus responsible for COVID-19, but false-negative results can occur even with internal controls. This study aimed to investigate the impact of using alternative internal control materials on the accuracy of SARS-CoV-2 detection kits.

Methods: Between December 2021 and January 2022, 162 respiratory tract samples were collected from patients with suspected COVID-19 at Ghaem Hospital in Mashhad, IR Iran. Samples were initially tested with the Pishtaz Teb kit, which uses DNA internal control, and then negative samples were retested with the Geneova kit, which uses a RNA internal control. Positive and negative controls were consistently used to validate the results.

Results: After retesting with the Geneova kit, only one patient out of 162 negative samples was positive for SARS-CoV-2. The Pishtaz Teb and Geneova controls consistently produced the expected results, but the Geneova internal control matched the Pishtaz Teb control in only 44% of cases. The higher threshold cycle value for Geneova internal control suggested RNA degradation during the experimental period.

Conclusion: Proper quality control measures are crucial for accurate SARS-CoV-2 detection. The study highlights the importance of selecting reliable diagnostic kits with high sensitivity and specificity to reduce false-negative results, particularly in cases with a low viral load or early stages of the disease. The internal RNA control can detect RNA degradation and help identify false-negative diagnoses, leading to better disease control and management. Further research is needed to improve the accuracy of COVID-19 diagnostic tests.

Background & objective: Hepatic porphyria is an autosomal dominant disorder characterized by a deficiency in enzymes involved in hepatic porphyrin metabolism. Disruptions in this metabolic pathway can be precipitated by various factors, including physical exertion, psychological stress, fasting, infections, and drug withdrawal. Clinically, the condition manifests as episodic lower abdominal colic and a range of neuropsychiatric symptoms.

Case presentation: A 74-year-old male farmer presented with a four-month history of intermittent abdominal pain, abdominal distension, generalized weakness, and anorexia. The diagnosis of hepatic porphyria was established through a combination of imaging studies, laboratory investigations, liver biopsy, and genetic testing, which revealed a pathogenic c.587G>T (p.C196F) mutation in the FECH gene. The patient exhibited mild cutaneous lesions along with significant abdominal pain, abdominal distension, accompanied by constipation, nausea, and vomiting.

Conclusion: This case highlights the diagnostic challenges and poor prognosis of hepatic porphyria when specific therapies are unavailable. Early recognition and genetic confirmation are vital for guiding management, and clinicians should suspect porphyria in patients with unexplained abdominal pain and liver dysfunction.

Background & objective: Fine-needle aspiration cytology (FNAC) is a minimally invasive, rapid, and relatively safe diagnostic method for the initial evaluation of lymphadenopathy of unknown origin. In May 2020, the Sydney System was proposed to provide recommendations for diagnostic categorization, FNAC of lymphadenopathy, pathology reporting, and related practices. This study aimed to analyze the applicability of the Sydney System in lymph node FNAC and to evaluate diagnostic accuracy and risk of malignancy (ROM) for each diagnostic category.

Methods: A 2-year retrospective diagnostic study was conducted from January 2019 through December 2020. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy (DA), and ROM were calculated using histopathology as the gold standard.

Results: A total of 632 lymph node FNAC cases were included, with histopathological follow-up available in 45 cases. The median age of patients was 26 years, with a male-to-female ratio of 1.2:1. Cervical lymph nodes were most frequently involved (367 cases, 58.1%). Overall sensitivity, specificity, and diagnostic accuracy were 66.7%, 85.0%, and 76.3%, respectively. ROM by diagnostic category was: nondiagnostic (25%), benign (5.2%), atypia of undetermined significance (AUS) (50%), suspicious (80%), and malignant (88.8%).

Conclusion: FNAC demonstrated high diagnostic efficacy when applied using the proposed Sydney System, supporting the utility of this standardized reporting scheme for lymph node cytology.

Background & objective: Graft-versus-host disease (GVHD) is a major complication following allogeneic bone marrow transplant (BMT), often limiting therapeutic success in leukemia patients. Chemokine receptors, such as those encoded by Duffy (FY) and Kidd (JK) blood group genes, may influence GVHD development by modulating immune cell trafficking. To evaluate the association between donor and recipient Duffy and Kidd genotypes and GVHD incidence in leukemia patients undergoing HLA-identical sibling BMT.

Methods: This retrospective cross-sectional study analyzed 100 DNA samples from 50 donor-recipient pairs (20 with GVHD, 30 without). Genotyping for FY and JK antigens was conducted using PCR-RFLP. Statistical analysis was performed using chi-square and logistic regression tests in SPSS v19, with significance set at P < 0.05.

Results: Kidd and Duffy genotype distributions differed between BMT recipients who developed GVHD and those who did not. However, when gender was included as an additional variable, these associations in recipients were no longer statistically significant for either genotype. In donors, neither the Kidd nor the Duffy genotypes showed a significant association with GVHD status overall. Interestingly, when stratified by gender, a significant difference was observed only for the Kidd genotype in donors of GVHD-positive recipients, but not in donors of GVHD-negative recipients. However, multivariate logistic regression did not confirm any independent association between Kidd or Duffy genotypes and GVHD in recipients (OR = 2.94, 95% CI: 0.494-17.49, P = 0.236) or donors (OR = 2.273, P = 0.323).

Conclusion: Kidd and Duffy blood group phenotypes may influence susceptibility to GVHD. Understanding this relationship can support better donor-recipient matching in BMT.

Background & objective: Spermatogenesis is a temperature-dependent process, and testicular heat stress can cause spermatogenic failure by inducing cell apoptosis and oxidative stress, ultimately leading to male infertility. Adipose-derived mesenchymal stem cells (AMSCs) have been considered an effective therapy for various tissue degenerations, demonstrating the ability to stimulate testicular regeneration and restore spermatogenesis. The current study focuses on the therapeutic potential of AMSCs on semen quality, testicular morphological changes, and oxidative stress parameters in rats exposed to heat stress.

Methods: In this experimental study, 35 adult male rats were randomly assigned to five groups: Group I (control), Group II (vehicle), Group III (heat stress group, temperature-humidity index: 43 °C for 20 minutes), and Groups IV and V (treatment groups receiving 0.5×10⁶ and 1×10⁶ AMSCs, respectively, on the second and fifteenth days after heat stress induction). Sixty days after heat stress exposure, the animals were euthanized; serum testosterone levels and oxidative stress biomarkers were analyzed, and the testes and epididymis were collected for histological and sperm evaluation.

Results: Scrotal heat stress caused deleterious effects on testicular histological structure and function. Testosterone levels and total antioxidant capacity were significantly reduced in the heat stress group. The 1×10⁶ AMSCs-treated group showed moderately preserved testicular tissue morphology. Apoptotic spermatogonia and primary spermatocytes decreased significantly in the AMSCs treatment groups in a dose-dependent manner. Malondialdehyde levels and total antioxidant capacity were also improved. Progressive sperm motility, sperm count, and viability were notably enhanced in the AMSCs-treated groups.

Conclusion: A single dose-dependent injection of AMSCs demonstrated regenerative properties that improved with increasing cell number. Overall, administration of 1×10⁶ AMSCs can alleviate testicular damage and promote the spermatogenesis process in testicular hyperthermia.

Background & objective: There are limited findings regarding histopathological changes in sleeve gastrectomy samples and their relationship with preoperative clinical and histopathological characteristics. The present study aims to assess histopathological findings in sleeve gastrectomy samples and identify the main determinants of these changes.

Methods: This cross-sectional study retrospectively reviewed demographic, preoperative clinical, histological, and endoscopic findings of 258 patients who underwent laparoscopic sleeve gastrectomy surgery. Postoperative pathological findings were also evaluated.

Results: Microscopic examination revealed pathological findings in 212 samples (82.2%). The most common histopathological finding reported in patients was chronic gastritis, present in approximately 67.1% of cases, followed by active gastritis in 13.6%. Additionally, 19.0% of patients tested positive for helicobacter pylori infection. A significant association was found between the history of hyperlipidemia and helicobacter pylori positivity (p = 0.039). Before surgery, 80 patients (41.7%) had normal endoscopic results, while at least one significant abnormal finding was observed in 58.3% of cases. However, there was no significant relationship between preoperative endoscopic findings and histopathological changes after surgery in almost all examined patients.

Conclusion: Histopathological examination of sleeve gastrectomy samples reveals a high prevalence of abnormal findings, including active gastritis, Helicobacter pylori infection, intestinal metaplasia, and dysplasia requiring therapeutic management. However, tracking these changes in biopsy samples obtained from endoscopy before surgery may not be sufficient to predict the histopathological findings after sleeve gastrectomy.

Background & objective: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disorder characterized by dysregulated autoantibody production and diverse clinical manifestations. Despite advances in research, the diagnosis and management of SLE remain challenging. This study evaluated plasma levels of interleukin-1β (IL-1β) and microRNA-146a (miR-146a) in patients with SLE and explored their potential as diagnostic and prognostic biomarkers.

Methods: Blood samples were collected from 100 patients with SLE and 100 healthy controls. Patients with SLE were further classified into newly diagnosed (ND; n=50) and under treatment (UT; n=50) subgroups. Plasma IL-1β levels were quantified using ELISA, and circulating miR-146a expression was assessed by quantitative reverse transcription PCR.

Results: Patients with SLE exhibited significantly higher plasma levels of IL-1β and miR-146a compared with healthy controls. ND patients demonstrated the highest concentrations of both biomarkers. Among patients with SLE, those with lupus nephritis (LN) showed markedly elevated IL-1β levels compared with those without LN. Longitudinal analysis during a 24-week follow-up indicated that higher baseline IL-1β levels were associated with an increased risk of LN development, supporting its potential prognostic relevance.

Conclusion: IL-1β and miR-146a are elevated in patients with SLE, with IL-1β levels correlating with new-onset disease and LN development. These findings suggest that IL-1β and miR-146a may serve as useful biomarkers for diagnosing, monitoring, and predicting disease progression in SLE, although further validation is warranted.