Iranian Journal of Pathology最新文献

Background & objective: Fungal co-infections increase the incidence and mortality of viral respiratory tract infections. This study systematically reviews and conducts a meta-analysis to evaluate the prevalence of COVID-19 patients with fungal coinfections. The aim is to provide a concise overview of the impact of these infections on patient outcomes especially association with risk of mortality, informing future research and optimizing patient management strategies.

Methods: To identify relevant studies on COVID-19 patients, we conducted a systematic search of databases from the beginning of the year until July 2023, including fungal co-infections, mortality, and sequelae. Eligibility criteria were developed using the PICO framework, and data extraction was carried out separately by two authors using standard techniques. Statistical analysis was performed using the correlation model and differences between studies were evaluated using the I2 test. R and RStudio were used for statistical analysis and visualization.

Results: We initially identified 6,764 studies, and after checking for equivalence and consistency, 41 studies were included in the final analysis. The overall COVID-19 odds ratio for people who died from fungal infections was 2.65, indicating that patients infected with both COVID-19 and fungal infections had a higher risk of death compared to patients with COVID-19 alone. Specifically, COVID-19-associated pulmonary aspergillosis (CAPA) has a higher odds ratio of 3.36, while COVID-19-associated candidiasis (CAC) has an odds ratio of 1.84, and both are much more associated with death. However, coinfection of the fungus with other fungal species did not show a significant difference in the risk of mortality.

Conclusion: This study identified CAPA and CAC as the most common infections acquired in healthcare settings. Fungal coinfections may be associated with an increased risk of death in COVID-19 patients.

COVID-19 is known to present with acute respiratory distress syndrome pathological manifestations. Studies have shown that patients with COVID-19 can develop diffuse alveolar damage, acute bronchopneumonia, necrotic bronchiolitis, and viral pneumonia. In this study, we investigated 11 cases. Needle necropsies of 11 patients, hospitalized at Tohid and Kowsar hospitals of Kurdistan University of Medical Sciences, with a positive antemortem SARS-CoV-2 (COVID-19) real-time PCR test, were fixated within 3 hours after death in the negative-pressure isolation morgue. The participants included six men (54%) and five women (46%) with a mean age of 73.82±10.58 (52-86) years old. The average hospitalization was 14.27±15.72 days. The results showed interstitial lymphocytic pneumonitis in most of the cases, varied from mild to moderate and up to severe in some cases. In 7 cases, anthracosis was noted, while one case demonstrated anthracosis with fibrosis. The hyaline membrane was reported in two patients. In one case, severe interstitial lymphocytic pneumonia with intra-alveolar exudate with organization, lithiasis, bronchiolitis pattern (BOOP), intra-alveolar hemorrhage, and mild fibrosis were seen. As a result, it is suggested to keep an eye on these pathologies in management of the severe cases of COVID-19 infection.

Background & objective: Colorectal carcinoma (CRC) is the third leading cause of cancer-caused death worldwide and constitutes about 6.48% of all malignancies in Egypt. Studying the molecular profile of CRC is essential for developing targeted therapies. STAT3 and CTLA4 expression are considered as molecular abnormalities involved in the CRC progression and chemo-resistance. Therefore, they could be used as potential therapeutic targets. This study aimed to evaluate pSTAT3 and CTLA4 expression levels and their possible roles as prognostic and predictive biomarkers in CRC using immunohistochemistry (IHC).

Methods: This retrospective study included 113 CRC patients. Tissue microarrays were constructed, followed by pSTAT3 and CTLA4 antibodies immunostaining. Their expression was assessed and compared with the clinicopathological parameters and survival data.

Results: Both pSTAT3 and CTLA4 overexpression were significantly associated with poor prognostic parameters, such as the presence of distant metastasis (P=0.02 & 0.03), high grade (P<0.001 & 0.03), high mitotic count (P<0.001 & 0.03), high tumor budding group (P=0.008 & 0.04), infiltrating tumor border (P<0.001 & 0.007) respectively, and advanced pathological stage with pSTAT3 (P=0.02). A significant association was found between overexpression of both markers and short overall survival. Correlations between the H-score of pSTAT3 and CTLA4 in CRC showed a significant positive correlation (P<0.001).

Conclusion: STAT3 and CTLA4 positivity may be linked to the development and progression of the CRC, and they may provide potential prognostic indicators and therapeutic targets for CRC patients.

Background & objective: Antibiotic resistance in urinary tract infection (UTI) is increasing nowadays, therefore, the aim of this study was to evaluate the resistance patterns of many pathogens toward several antibiotics that are in common use in our hospitals.

Methods: Subculture and identification of pathogenic bacteria were performed on 1148 hospitals' bacterial primary cultures which were considered positive for UTI. An antibiotic sensitivity test was performed by using the disc diffusion method. The rates of resistance were statistically analyzed and correlated with the types of antibiotics and bacteria.

Results: It was found that 1148 out of 2087 urine samples were UTI positive, the majority of cases (76%) were from females (P<0.0001). Escherichia coli and Klebsiella were the most isolated Gram-negative bacteria, while Staphylococcus spp. was the most isolated Gram-positive pathogen. E. coli showed the highest resistance rate among all bacteria, while Streptococcus spp. was the most sensitive. The highest resistance was noticed to be against gentamicin and ampicillin, while the most effective drugs were imipenem and amikacin. There was a significant difference in resistance rates among the different bacterial categories (P<0.0001), while no significant difference was noticed in resistance rates among antibiotics categories (P>0.05).

Conclusion: Elevated rates of antibiotic resistance were noticed in this study in UTI-causing bacteria; therefore, it is highly important at least to every general hospital to investigate the antibiotic resistance rates occasionally to determine the proper antimicrobial treatment as well as re-evaluate antibiotics which were considered as empirical.

Background & objective: CD24 is a small, highly glycosylated membrane protein whose expression is associated with tumorigenesis and the progression of several types of cancer. Prostate adenocarcinoma is one of the most common cancers in men, and microscopic Gleason grading is an important factor affecting prognosis. This study aims to investigate the relationship between immunohistochemical expression of CD24 and its relationship with benign prostatic hyperplasia (BPH) and Gleason grade in prostate adenocarcinoma.

Methods: This cross-sectional study was conducted on 163 patients, with an average age of 70.63±9.05 years, including 78 (47.9%) patients with prostate adenocarcinoma and 85 (52.1%) patients with benign prostatic hyperplasia., referred to Mostafa Khomeini Hospital in Tehran between 2018 and 2021, who underwent open prostatectomy or Trans Urethral Resection of Prostate (TURP). Immunohistochemical staining was used to evaluate CD24 expression, and Gleason grade was determined in the case of prostate adenocarcinoma. Data were analyzed with SPSS 22 and a P-value<0.05 was considered statistically significant.

Results: The percentage and intensity of CD24 staining in prostate adenocarcinoma patients was significantly higher than in BPH patients (P<0.05). Gleason score strongly correlated with the percentage and intensity of CD24 staining (P<0.05). The immunoreactive score, obtained by multiplying the CD24 expression percentage with staining intensity, was also significantly related to the Gleason score (P<0.05).

Conclusion: CD24 expression can be considered as a factor in differentiating cases of prostate adenocarcinoma from benign prostatic hyperplasia. Also, a high level of this marker can indicate the progress of prostate cancer.

We report a 4.5-year-old girl with recurrent episodes of bilateral lower limb weakness following periods of upper respiratory tract infection since the age of 1.5 years. Nerve conduction velocity and electromyography studies suggested distal motor neuropathy. The whole exome sequencing analysis revealed a homozygous variant, c.955G>A (p.Gly319Ser), of the mitochondrial trifunctional protein α-subunit (HADHA) gene. This variant has already been reported as pathogenic in an Iranian consanguineous family with a probable diagnosis of Charcot-Marie-Tooth disease. In addition, this variant, in compound heterozygosity with another likely pathogenic variant, has been known to be linked with mitochondrial trifunctional protein deficiency.

Wolffian adnexal tumors (FATWOs) originate from the mesonephric duct remnants. FATWOs are extremely rare and 100 incidental FATWOs have been reported in the English literature as of now. Most FATWOs have low potential for malignancy but aggressive behavior including recurrence and metastasis have been described in few cases; There is no standard protocol for optimal treatment of FATWOs. The case described here is a 35-year-old female who presented with a right-side ovarian mass via abdominal ultrasound. She had a history of left salpingo-oophorectomy due to an abdominal mass, which both histopathologic and immunohistochemical study's findings were consistent with Wolffian tumor. Later, she underwent total abdominal hysterectomy with tumor debulking because of the probable malignant behavior of the tumor. FATWO has a heterogeneous histologic pattern which may make its diagnosis challenging. No specific immunohistochemical markers have yet been recognized for FATWO and pathogenesis or molecular alterations are not definitive. Therefore, there is no comprehensive recommendation for optimal clinical management of FATWO or its recurrence.

Background & objective: Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide, which can lead to virus-related cancers. This study aimed to investigate the frequency of HPV genotypes in women with genital warts referred to available laboratories in Tehran by molecular hybridization method.

Methods: This cross-sectional descriptive study was conducted on the genital warts of 67 women aged 20-50, who were referred to the clinics of Afshar, Namad, Mani, and Al-Mohammed in Tehran province. Viral DNA was extracted using Add prep genomic DNA extraction kit, and genotyping was studied using HPV Direct Flow CHIP Kit. Data were analyzed by GraphPad Prism software.

Results: HPV was reported to be positive in all cases. The most common low-risk genotype involved was type 6, with 30 cases (44.77%), and the most common high-risk genotype involved was type 16, with 4 cases (5.97%) in the total population. Among the patients examined, there were 16 cases with multiple infections.

Conclusion: The results of this study showed that low-risk genotypes may be responsible for majority of the genital warts. High-risk genotypes and simultaneous infection with several genotypes could also be common in genital wart samples. Therefore, controlling HPV infection is important, especially in patients with high-risk genotypes. HPV genotyping should be considered in diagnosis and prevention of HPV-related cancers.

Background & objective: Thyroid lymphomas are predominantly secondary to lymphoma at other sites, and primary follicular lymphoma of the thyroid is a very rare entity.

Case presentation: Here, we report a case of a 62-year-old female who presented with swelling in the front of her neck for one month. The clinical diagnosis was a multinodular goiter. Fine needle aspiration cytology was done and reported as nodular colloid goiter with lymphocytic thyroiditis. The system examination was unremarkable. Histopathological assessments of the right hemithyroidectomy specimen revealed the effacement of thyroid architecture by abnormal and extensive lymphoid follicles. Immunohistochemistry revealed CD20, CD10, BCL2, and BCL6 positivity in the lymphoid follicles. FDG-PT CT scan demonstrated no evidence of lymphoma elsewhere. So, a e final diagnosis of follicular lymphoma of the thyroid was made.

Conclusion: Due to the rarity and low prevalence of primary follicular lymphoma of the thyroid and challenging in its differentiation from Hashimoto's thyroiditis with dense lymphoplasmacytic infiltration and formation of lymphoid follicles, histopathologic diagnosis should be confirmed by immunohistochemical studies.

Background & objective: Colorectal cancer is the second reason for cancer-associated death. The prognosis of the malignancy is defined by TNM scoring. However, tumor grading, lymphovascular invasion, perineural invasion, and tumor buddings may affect its prognosis. This study aimed to assess the prognostic and histologic impact of tumor budding in colorectal adenocarcinoma.

Methods: This study is a retrospective cohort of 192 patients with colorectal adenocarcinoma. All four stages of colorectal adenocarcinoma patients were included, but the patients in stages I and II were also analyzed separately. We used pathology reports to extract the histopathologic data. The prognostic values were extracted by calling the patients.

Results: Less than half of the patients were in stages I and II of the disease. According to our analysis, tumor extension and lymphovascular invasion were correlated with tumor budding count in patients in stages I and II, and lymphovascular invasion, tumor grade, tumor stage, lymph node involvement, tumor extension, tumor site, metastasis, and five-year survival were correlated with tumor budding within all stages.

Conclusion: It is recommended that tumor budding count should be assessed and reported in pathology reports of adenocarcinomas due to its high correlation with poor prognosis.