Iranian Journal of Pathology最新文献

Extracellular vesicles (EVs) are cell-derived vesicles that play a critical role in host-pathogen interactions, facilitating intercellular communication and transporting both pathogen- and host-derived molecules during infection spread. To regulate their environment, for instance, by modulating innate and adaptive inflammatory immune responses, pathogens may alter the composition of EVs produced by infected cells. Gastric cancer is one of the leading causes of cancer-related deaths worldwide, and Helicobacter pylori infection is considered a significant risk factor for its development. This cancer is characterized by significant inflammation mediated by EVs generated from infected host cells. H. pylori contributes substantially to inflammation, promoting disease progression. Moreover, H. pylori produces and releases vesicles known as outer membrane vesicles (H. pylori-OMVs), which contribute to the shrinkage and cellular transformation of the gastric epithelium. Although the vacuolating cytotoxin A (VacA) plays a critical role in pathogenesis, its association with EVs in H. pylori has not been previously addressed. Understanding the roles of extracellular vesicles and VacA during H. pylori infection-whether they benefit the host or the pathogen-could pave the way for new treatment approaches. This review briefly discusses the role of VacA and extracellular vesicles in the growth and pathogenesis of H. pylori.

Background & objective: Human papillomavirus (HPV) is a major cause of cervical cancer and mortality, particularly in low-income countries. Late diagnosis of cervical cancer often leads to advanced-stage disease, resulting in poorer prognosis and higher mortality, which underscores the critical need for effective early screening methods. Pap smears, colposcopy, and HPV testing are essential for early detection. This study addresses a gap in the literature by comparing the effectiveness of different diagnostic methods specifically in women with multiple high-risk HPV (hrHPV) infections-a population for which limited comparative data exist.

Methods: This prospective cross-sectional study, approved by the Ethical Committee of Qazvin University (IR.QUMS.REC.1400.143), was conducted at Kowsar Hospital from 2022 to 2023 and included 608 patients infected with multiple hrHPV subtypes. Inclusion criteria required hrHPV confirmation by PCR genotyping and excluded patients without colposcopy and biopsy or with a history of cervical dysplasia. Participants underwent Pap smear cytology, colposcopy, and biopsy, with the biopsy specimens examined by a gynecologic pathologist. Statistical analyses included chi-square tests for qualitative variables and t-tests or ANOVA for quantitative variables, with a significance level set at P<0.05.

Results: The average age of the patients was 38.54 years, with the majority aged 30-39 years (43.6%). Common symptoms included vaginal discharge (36.5%) and postcoital bleeding (34.9%). Pap smear results showed ASCUS in 43.6% of cases and LSIL in 39.1%. Colposcopy revealed acetowhite lesions in 45.6% and abnormal vascular patterns in 25.5%. Histopathology indicated that 72.4% of patients had CIN I. Smoking was significantly correlated with colposcopic findings (P=0.044). Colposcopy demonstrated the highest sensitivity (69.1%) for detecting cervical lesions, while cytology had the highest specificity (63.1%).

Conclusion: Pap smear findings provide adequate diagnostic accuracy for hrHPV patients, but colposcopy offers superior sensitivity for detecting cervical lesions. Combining both methods is recommended to improve diagnosis.

Background & objective: Limited literature describes the accuracy of endoscopic ultrasonography-fine needle aspiration (EUS-FNA) cytology in various types of pancreatic epithelial tumors, and this underscores the usefulness of cell blocks, and highlights potential diagnostic pitfalls.

Methods: This study included 108 patients who underwent EUS-FNA pancreatobiliary cytology followed by surgery. Age, gender, tumor location, tumor size, presence or absence of a cell block, cytologic and pathologic diagnoses, and histologic tumor grade were recorded. Cytologic and pathologic slides were examined, and the cytologic accuracy was determined by comparing cytologic with the histopathologic results as the gold standard. Additionally, the impact of cell block on the cytologic accuracy was assessed.

Results: EUS-FNA cytology showed an overall accuracy of 80%, a sensitivity of 90%, and a false-positive rate below 1%. Pancreatic ductal adenocarcinomas (PDAs) accounted for 65% of cases, followed by neuroendocrine tumors (NETs), solid pseudopapillary neoplasms (SPNs), mucinous cystic neoplasms (MCNs), and chronic pancreatitis. Diagnostic accuracy was higher for PDA and SPN than for NET and MCN and significantly improved to 100% in cases with a cell block.

Conclusion: Combining pancreatobiliary cytology with a cell block significantly enhances diagnostic accuracy, reaching 100%. Moreover, poorly differentiated PDAs and well-differentiated organoid-type tumors, such as NETs and SPNs, demonstrate higher diagnostic accuracy.

Background & objective: Phyllodes tumor (PT) is a rare fibroepithelial tumor of the breast exhibiting varied clinicopathologic behavior, ranging from benign to borderline to frankly malignant, based on the presence of infiltrative margins, stromal overgrowth, stromal atypia, cellularity, and mitotic activity. In this study, a detailed cytomorphological study of cases of PT with the clinical and histological correlation was performed.

Methods: A cytomorphological study of 17 cases of histologically proven PT diagnosed between Jan 2014 and July 2021 was done retrospectively. Relevant data including age at the time of diagnosis, the duration of illness, presenting symptoms, personal and family history, tumor size, tumor localization, and surgical procedure were obtained. A detailed cytomorphological assessment of stromal and epithelial components was performed, and further histological correlation was obtained for each case.

Results: Age of the patients ranged from 25 to 65 years old. The chief complaint was a palpable breast mass in all patients. The mean size of the lump was 11.86 cm. A complete cytohistological concordance was achieved among malignant cases. Stromal metaplasia was observed in only one case of benign phyllodes tumor, which was chondroid differentiation, and malignant heterologous component as fibrosarcomatous differentiation in one of the malignant PTs. Each of the benign and malignant phyllode tumors ductal carcinoma in situ (DCIS) of its epithelial component was seen in one case.

Conclusion: Phyllodes should be considered in differential diagnosing of any rapidly growing breast lump. Breast imaging has limited role in diagnosis of phyllode tumors. FNAC or trucut biopsy is mandatory in preoperative diagnosis. An extended follow-up is needed in all cases.

Ewing sarcoma (ES) of the head and Neck is a rare entity. The most common location for ES is long bones accounting for 58%, with head and neck accounting only for 3% of all the sites. Here we highlight a unique presentation of ES involving the maxillary region in a 21-year-old male. Patient presented with right maxillary swelling for the last 2 months. Imaging studies reveal osteolytic lesion involving the right maxilla. Ewing's sarcoma rarely affects the head and neck region, posing diagnostic challenges as it mimics many common lesions. Accurate diagnosis requires a multidisciplinary approach involving clinical, radiological, histopathological, and molecular evaluations.

Background & objective: The resistance genes encoding aminoglycoside-modifying enzymes (AMEs) are now widely prevalent in different populations of Staphylococcus aureus. The study aimed to determine the frequency of AMEs-encoding genes in clinical isolates of S. aureus.

Methods: A total of 105 S. aureus isolates were obtained from the different clinical samples; and then were identified by conventional biochemical tests. The antibiotic resistance patterns of the isolates were characterized by the agar disk diffusion method. The distribution of the AMEs and femA genes was determined by conventional and multiplex PCR.

Results: The aminoglycoside resistance rates of kanamycin, tobramycin, gentamicin, amikacin, and netilmicin were 47.6%, 46.6%, 45.7%, 45.7%, and 26.6%, respectively. 16.1% and 1.9% of isolates were MDR and XDR phenotypes, respectively. 21.9% of S. aureus isolates harbored the femA gene and were determined as methicillin-resistant S. aureus (MRSA) clones. The aac(6')/aph(2'') was the most prevalent (47.8%) AME-encoding gene in aminoglycoside-resistant S. aureus, followed by ant(4')-Ia (30.4%) and aph(3')-IIIa (21.7%).

Conclusion: Our study demonstrated that the coexistence of several AMEs and the spread of the resistance determinants like femA in S. aureus clinical isolates are alarming and may contribute to the broadening of aminoglycoside resistance spectra and limit treatment options for staphylococcal infections.

Background & objective: Even with improvements of colorectal cancer (CRC) treatment strategies, this cancer still has an unfavorable outcome. The primary cause of CRC development and recurrence is chemoresistance. CD10 and Notch1 are among cancer stem cell regulators, and they have roles in cancer progression and chemoresistance. This research aims to evaluate the expression of Notch1 and CD10 in CRC and their relationship with different clinicopathological parameters using immunohistochemistry.

Methods: This retrospective study included 100 cases of colorectal carcinoma that were immunohistochemically stained using Notch1 and CD10 antibodies. Expression of Notch1 and CD10 was evaluated and compared with different clinicopathological parameters.

Results: Notch1 expression was detected in the tumor and stromal cells in 92% of the cases, while CD10 expression was seen in 31% of tumor cells 79% of stromal cells of the included cases. Their expressions in tumor cells were significantly associated with higher grade (P=0.029 and 0.001), deeper invasion (P=0.01 and 0.002), advanced stage (P=0.012 and 0.001), and distant metastasis (P=0.001 and 0.02). Notch1 expression was positively correlated with CD10 expression (P=0.018). Both Notch1 expression and high CD10 expression in the stromal cells were associated with short overall survival (P=0.003 and 0.01).

Conclusion: CD10 and Notch1 may have roles in colorectal carcinoma progression via induction of tumor invasion, metastasis and impairment of tumor response to therapy. CD10 and Notch1 could be used as biomarkers for aggressive CRC and may be considered for future target therapy.

Background & objective: The regulator of chromosome condensation 2 (RCC2) and RAS-related C3 botulinum toxin substrate 1 (Rac1) have been implicated in the promotion of breast cancer cell proliferation and migration. The signaling pathway involving p53/RCC2/Rac1 has been proposed to contribute to the regulation of colon cancer metastasis. However, until now, this pathway has not been thoroughly investigated in breast cancer. This study seeks to explore the influence of immunohistochemical expression and the correlation among RCC2, Rac1, and p53 in breast infiltrating ductal carcinoma (IDC).

Methods: Immunostaining was performed on 120 breast IDC specimens using RCC2, Rac1, and p53 antibodies. Statistical analyses were conducted to examine the correlations between these antibodies.

Results: A Positive expression of RCC2, Rac1, and p53 was observed in 116 (96.7%), 120 (100%), and 33 (27.5%) of the breast cancer cases, respectively. RCC2, Rac1, and p53 demonstrated association with poor prognostic parameters such as frequent mitoses, high Ki-67 status, positive lymphovascular invasion (LVI), and advanced tumor stage. A highly significant direct correlation was found between each immunohistochemical marker and the other two markers. Shorter overall survival was linked to multifocal tumors (P=0.017), advanced tumor stage (T3) (P=0.010), Luminal B subtype (P=0.015), progressive disease (P=0.003), positive Her2neu status (P=0.008), and metastasis to distant organs (P<0.001). However, RCC2, Rac1, and p53 did not exhibit a significant association with overall survival.

Conclusion: The high expression levels of RCC2, Rac1, and p53 in breast IDC suggest their potential role in tumor behavior. The association of RCC2 and Rac1 with poor prognostic parameters may serve as predictive indicators for aggressive tumors, thus implying that targeted therapy could be beneficial in the treatment of breast cancer.

Background & objective: Antigen Ki-67 (histone-based nuclear protein) is a static marker of tumor cell proliferation and growth and is commonly measured to indicate the effect of treatment in breast cancer patients. This single-arm trial study aimed to evaluate the effect of short-term endocrine therapy (letrozole) on Ki-67 levels in menopausal women with early hormone-positive breast cancer who were referred to two university hospitals.

Methods: Patients with a pre-treatment Ki67 of 5% or less were excluded from the study. Participants (n=25) received oral letrozole (2.5 mg daily) seven days before surgery. Ki-67% on both biopsies and the surgical specimens were measured and compared.

Results and conclusion: The mean age of patients was 62±9.4 (48-83 years). Our result indicated that pre-surgery consumption of letrozole for hormone-positive breast cancer can significantly decrease the of Ki-67 labeling index (23.24±9.74 vs. 16.92±9.55, P=0.001 by paired t-test), with no drug-related adverse events.