Iranian Journal of Pathology最新文献

Background & objective: High-sensitivity cardiac troponin T (hs-cTnT) has emerged as a critical biomarker in cardiovascular diseases, particularly in congestive heart failure (CHF). This systematic review and meta-analysis aimed to assess the association between hs-cTnT levels and clinical outcomes in patients with CHF.

Methods: A comprehensive literature search was performed across multiple databases to identify studies evaluating the relationship between hs-cTnT levels and clinical outcomes in CHF. Eligible studies reported hazard ratios (HRs) or odds ratios (ORs) for all-cause mortality, cardiovascular mortality, or cardiovascular hospitalization.

Results: Elevated hs-cTnT levels were significantly associated with adverse outcomes. The pooled HR and OR for all-cause mortality were 1.70 (95% CI, 1.49-1.94) and 6.19 (95% CI, 3.88-9.86), respectively. For cardiovascular mortality, the pooled HR was 1.59 (95% CI, 1.38-1.83) and the pooled OR was 6.87 (95% CI, 3.93-12.01). For cardiovascular hospitalization, the pooled HR was 1.56 (95% CI, 1.42-1.70) and the pooled OR was 4.32 (95% CI, 2.22-8.39).

Conclusion: Elevated hs-cTnT levels are strongly associated with an increased risk of all-cause mortality, cardiovascular mortality, and cardiovascular hospitalization in patients with CHF. These findings highlight the prognostic value of hs-cTnT in the clinical management of heart failure.

Background & objective: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Fite-Faraco (FF) is the routine staining method used to demonstrate the presence of Mycobacterium leprae in tissue sections. Fluorescent microscopy (FM) can help visualize lepra bacilli better. The present study compares two methodologies, fluorescent microscopy, and Fite-Faraco, in detecting Mycobacterium leprae in tissue sections.

Methods: Histopathology of skin biopsies in 60 cases of Hansen's were evaluated with FF stain. The performance of Auramine- Rhodamine Fluroscencent stain was compared with conventional FF staining in identifying Lepra bacilli.

Results: A total of 60 clinically and histopathologically confirmed cases of Hansen's disease were included in this ambispective study. The cases were sub-classified into various histological categories. Auramine-rhodamine fluorescent staining was performed and examined under a fluorescent microscope with an LED light illuminator. The bacteriological index (BI) was calculated under an oil immersion field for both Fite-Faraco (FF) staining and fluorescent microscopy (FM), graded from zero to six plus according to Ridley's logarithmic scale. Lepra bacilli were identified in 70% of patients on FF staining, while fluorescent microscopy showed positivity in 80%. The mean BI calculated by FM (2.48) was significantly higher than that by the FF method (2.18), and more multibacillary disease was identified by fluorescent staining compared to FF staining.

Conclusion: It is advantageous to use fluorescent microscopy as an adjunct to conventional Fite-Faraco stain especially in cases where the latter fails to detect lepra bacilli and in a clinically suspected multibacillary disease.

Background & objective: Graves' disease (GD) is a common autoimmune thyroid disorder characterized by thyroid hormone hypersecretion and autoantibody formation against the thyrotropin receptor (TRAb). Interleukin-35 (IL-35), a novel immunosuppressive cytokine of the IL-12 family secreted primarily by regulatory T and B cells, has been implicated in the modulation of autoimmune responses. Transforming growth factor β (TGF-β) is a cytokine with immunoregulatory properties that plays a central role in T-regulatory cell differentiation. This study aimed to investigate serum IL-35 and TGF-β levels in Iraqi patients with GD and assess their association with disease severity, clinical manifestations, and response to carbimazole therapy.

Methods: A total of 103 participants were enrolled, including 66 patients with GD (mean age, 41.6 [SD, 13.95] years) and 37 healthy controls (mean age, 37.43 [SD, 10.25] years). Serum IL-35 and TGF-β concentrations were measured using enzyme-linked immunosorbent assay (ELISA).

Results: IL-35 levels were significantly reduced in untreated GD patients compared with healthy controls and partially increased after carbimazole therapy (P < .001). TGF-β levels were highest in untreated patients and declined after treatment (P < .001). IL-35 showed no correlation with FT3, FT4, or TRAb but was elevated in patients with disease duration longer than 5 years (P = .046) and in those with severe exophthalmos (P = .03). TGF-β levels were inversely correlated with FT3, FT4, and TRAb (P < .05) and were higher in carbimazole nonresponders and in patients with severe exophthalmos (P < .05).

Conclusion: IL-35 may serve as a promising biomarker for monitoring disease activity, prognosis, and therapeutic response in patients with GD.

Background & objective: Signal Transducer and Activator of Transcription 4 (STAT4) is a key transcription factor involved in immune signaling pathways and has been implicated in susceptibility to rheumatoid arthritis (RA) across various populations. However, its role in Iraqi Arab cohorts remains largely unexplored.

Methods: A case-control study was conducted including 68 RA patients and 39 age- and sex-matched apparently healthy individuals. The association between the STAT4 (rs7574865) polymorphism, serum STAT4 levels, RA susceptibility, and therapeutic response to methotrexate (MTX), MTX + infliximab, and tofacitinib was investigated using PCR-RFLP and ELISA techniques.

Results: The frequencies of the GT and (GT+TT) genotypes were significantly higher among RA patients than in controls under codominant and dominant models (P = .003 and P < .001, respectively). The T allele was also significantly more frequent in RA patients than in healthy individuals (P = .001). GT and TT genotypes were significantly associated with severe disease (P = .042) and poor response to tofacitinib compared with the GG genotype (P = .042). Serum STAT4 levels were markedly elevated in RA patients compared with controls (P = .01), particularly in those with severe RA (P = .042).

Conclusion: The STAT4 rs7574865 T allele may contribute to increased susceptibility to RA, greater disease severity, and reduced responsiveness to tofacitinib therapy in Iraqi patients.

Background & objective: Obesity is a growing public health problem worldwide. Bariatric surgery is considered the safest and most effective therapeutic option, although it is associated with various metabolic and neurohormonal consequences. This study aims to evaluate the effect of sleeve gastrectomy (SG) on hypothyroidism within one year following surgery.

Methods: In this single-center prospective cross-sectional study, patients with morbid obesity who were candidates for SG were included. Body mass index (BMI), levothyroxine dosage, and thyroid function tests were compared at baseline and 12 months after surgery.

Results & conclusion: Patients' BMI, levothyroxine dosage, TSH, and T4 levels decreased significantly after surgery (P<0.0001). The effect of SG on T3 levels was not statistically significant. The results of this study demonstrate that SG can significantly improve thyroid function tests in patients with morbid obesity and reduce their need for levothyroxine within one year following surgery.

Background & objective: Our study was mainly aimed at identifying the cause, clinical course of the disease, its most dreaded complication pseudomyxoma peritonei and spread to adjacent structures. We have used IHC techniques to know the origin of the tumor where both appendix and ovary were involved.

Case presentation: We have listed out and discussed in detail 5 cases, each of which have a different clinical course and variation in staging, grading and prognosis. One of the cases had mucin deposit in the ovary for which IHC was done to confirm the origin of the tumor. Some of the findings were incidental and in others presence of mucin content in the appendix lumen raised clinical suspicion of spread to peritoneum and adjacent structures. Grading and staging is of prime importance as it determines the prognosis and management of the patient respectively.

Conclusion: A ruptured or perforated appendix must warrant for an immediate suspicion of pseudomyxoma peritonei which when untreated can lead to mucinous neoplasms in adjacent organs like ovary and colon. Pseudomyxoma Peritonei (PMP) with simultaneous appendix and ovarian neoplasm should be treated as primary appendiceal tumour. Grading and staging of mucinous neoplasm of appendix and Pseudomyxoma Peritoneii needs a unified approach for standardized diagnostic reporting.

Background & objective: Whole Slide Imaging (WSI) has emerged as a transformative technology in the fields of clinical diagnostics, medical education, and pathology research. By digitizing entire glass slides into high-resolution images, WSI enables advanced remote collaboration, the integration of artificial intelligence (AI) into diagnostic workflows, and facilitates large-scale data sharing for multi-center research.

Methods: This paper explores the growing applications of WSI, focusing on its impact on diagnostics through telepathology, AI-powered diagnoses and precision medicine, and educational advancements. In this report, we will highlight the profound impact of WSI and address the challenges that must be overcome to enable its broader adoption.

Results & conclusion: Despite its many advantages, challenges such as infrastructure limitations and regulatory issues need to be addressed for broader adoption. The future of WSI lies in its ability to integrate with cloud-based platforms and big data analytics, continuing to drive the digital transformation of pathology.

Background: Sclerosing angiomatoid nodular transformation of the spleen (SANT) is a rare, benign vascular lesion predominantly described in adults. Pediatric cases are exceptionally uncommon and present a diagnostic challenge due to nonspecific clinical presentations and imaging findings.

Case presentation: We report the case of a 12-year-old boy presenting with recurrent abdominal pain localized around the umbilicus, accompanied by intermittent nausea over a three-month period. Physical examination revealed mild tenderness without guarding. Laboratory findings were unremarkable. Abdominal ultrasound demonstrated a hypoechoic splenic lesion, further evaluated by multidetector computed tomography (MDCT), which revealed a heterogeneous hypodense mass in the spleen. The patient underwent partial laparoscopic splenectomy. Histopathological examination showed a nodular architecture with fibrous bands, capillary-like vascular channels lined by endothelial cells, and a lymphoplasmacytic infiltrate. Immunohistochemical staining was positive for CD31, CD34, and CD8, supporting the diagnosis of SANT.

Conclusion: Although benign, SANT can mimic more aggressive splenic pathologies. This case underscores the importance of considering SANT in the differential diagnosis of splenic masses in pediatric patients and highlights the role of histopathology and immunohistochemistry in achieving a definitive diagnosis.

Background & objective: Cholangiocarcinoma (CCA) is a malignancy that accounts for approximately 3% gastrointestinal cancer. The aim of this study was to evaluate and compare the diagnostic value of CD56, SMAD4, CEA, and p53 biomarkers in diagnosing cholangiocarcinoma and its benign mimickers.

Methods: This retrospective cross-sectional study was conducted on 54 CCA specimens and 27 non-cancerous pancreatobiliary tissue samples diagnosed between 2018 and 2022. All specimens were evaluated using immunohistochemistry (IHC) staining for CD56, SMAD4, CEA, and p53 expression. The cut-off value of each marker was obtained from the respective kit instructions and previous studies. The results were analyzed using SPSS version 26. A significance level of less than 0.05 was considered statistically significant.

Results: Of the 81 specimens, the mean age in the case and control groups was 57.33 ± 11.99 and 44.7 ± 16.69 years, respectively, and 51 (63%) samples were obtained from male patients. We found that 39.5% had grade III p53 expression, 13.5% had grade II p53 expression, 41.9% had grade III CEA expression, and 9.8% had grade II CEA expression. Additionally, 17.3% were positive for CD56 expression, and 7.4% showed SMAD4 loss. There were significant associations between the expression of CEA (79.6%) and p53 (74%) in the CCA group (p-value < 0.05). However, SMAD4 loss and CD56 expression were not statistically significant.

Conclusion: Expression of CEA and p53 based on IHC staining is associated with the occurrence of CCA. However, SMAD4 and CD56 were not significantly associated with CCA. Further survival analysis and sensitivity and specificity assessments are needed to obtain more comprehensive results.