Iranian Journal of Pathology最新文献

Background & objective: Conjunctival lesions have a wide range of histological manifestations that are difficult to distinguish clinically. The gold standard for diagnosis of these lesions is the pathological examination, a costly and invasive procedure that may also adversely affect patients. Therefore, clinical researchers seek less invasive, inexpensive, and easier methods to detect conjunctival lesions. This study aims to compare the accuracy of impression cytology with pathology in patients referred to Farshchian Hospital in Iran.

Methods: In this descriptive/cross-sectional study, 64 patients with conjunctival lesions were selected from patients referred to Farshchian Hospital in Hamedan in 2021. A cytology specimen was obtained from the patients and sent to the laboratory. The diagnostic accuracy of this method was compared with pathological results (gold standard). Data were analyzed by SPSS 16 software.

Results: The mean age of patients was 54.47 ±16.94 years; 70.3% were male, and 29.7% were female. In the cytologic and pathologic examination, 28.1% of the specimens showed dysplasia, and 71.9% were non-dysplastic. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the cytologic impression compared to the pathologic methods were 91.30%, 77.78%, 91.30%, 77.78%, and 87.5%, respectively. A positive and significant correlation was observed between pathological and cytological diagnosis scores (r=0.825, P-value<0.001).

Conclusion: In conjunctival lesions, impression cytology may be a relatively accurate and sensitive procedure that can distinguish dysplastic from non-dysplastic conjunctival lesions.

Background & objective: Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by immune dysregulation, autoantibody production, and organ damage, notably in the kidneys. Cytokine imbalances contribute to SLE's diverse clinical presentations. This study investigated the roles of interleukin-8 (IL-8) and its receptor, CD181 (CXCR1), in SLE pathogenesis, specifically focusing on their association with hemolytic anemia, a severe complication.

Methods: This research investigates the role of interleukin-8 (IL-8) and its cognate receptor, CXCR1 (CD181). It was analyzed clinical and demographic data from 250 SLE patients and quantified IL-8 and CD181 mRNA and protein expression in samples from patients with active SLE, inactive SLE, and SLE complicated by hemolytic anemia, comparing them to healthy controls.

Results: Of the 250 samples, 84% were from SLE patients, with 67% in the active disease phase. Significant upregulation of both IL-8 and CD181 mRNA and protein was observed in SLE patients compared to controls. Specifically, mRNA expression was significantly elevated in active SLE (p=0.0001) and inactive SLE (p=0.01). Notably, IL-8 mRNA expression was significantly higher in SLE patients with hemolytic anemia (p<0.0001) compared to those without (p<0.01(.

Conclusion: These findings suggest that the IL-8/CD181 axis plays a crucial role in the inflammatory processes and tissue damage associated with SLE, particularly in the development of hemolytic anemia.

Background & objective: Neonatal cholestasis (NC) occurs in approximately 1 in 2500 live births. Autophagy-related gene 5 (ATG5) is a central component of the autophagy machinery, particularly in autophagosome formation. The autophagic process regulated by ATG5 has been implicated in various physiological and pathological conditions. This study aimed to evaluate the role of ATG5 in NC.

Methods: This retrospective study analyzed liver biopsies from 74 patients with NC. 46 with extrahepatic etiology and 28 with intrahepatic etiology. Immunohistochemical expression of ATG5 was assessed in hepatocytes and biliary epithelium.

Results: A significant association was observed between intrahepatic cholestasis and the intensity of ATG5 expression in zone II hepatocytes (P = .029). Overexpression of ATG5 in hepatocytes was significantly associated with mild portal tract fibrosis (P = .038) and mild lymphocytic infiltrates (P = .005).

Conclusion: ATG5 appears to contribute to the pathogenesis of NC in Egyptian infants. These findings may provide a basis for further research into novel diagnostic and therapeutic strategies.

Background & objective: Programmed death ligand-1 (PD-L1) plays a critical role in tumor immune evasion, particularly in Non-Hodgkin's B-cell lymphomas (NHL). This study aimed to evaluate PD-L1 expression across various NHL immunophenotypes and assess its correlation with clinical and demographic parameters.

Methods: In this cross-sectional, descriptive-analytical study, 71 formalin-fixed, paraffin-embedded tissue blocks diagnosed with Non-Hodgkin's B-cell lymphoma were retrieved from the pathology archives of Alzahra Hospital and Seyed-al Shohada (Omid) Hospital in Isfahan (2019-2020). PD-L1 expression was assessed immunohistochemically using tumor proportion score (TPS), combined proportion score (CPS), and immune cell (IC) score. Statistical analysis was performed using the Mann-Whitney U and Kruskal-Wallis tests, with p < 0.05 considered statistically significant.

Results: Among the 71 patients, 67.6% were male, with a mean age of 52.61 ± 18.43 years. Diffuse large B-cell lymphoma (DLBCL) was the most common subtype, accounting for 52.1% of cases. PD-L1 expression was significantly higher in females (TPS: 18.13 ± 9.73; CPS: 28.22 ± 13.31) compared to males (TPS: 4.42 ± 3.56; CPS: 12.08 ± 10.14) (p = 0.040, p = 0.022). No significant differences in PD-L1 expression were observed across age groups. DLBCL demonstrated significantly higher IC and CPS values compared to other subtypes (p < 0.05), while plasmacytoma and Burkitt lymphoma exhibited the lowest scores (e.g., immune score: 1.11 ± 0.11 for plasmacytoma). No statistically significant differences in TPS were noted among the different immunophenotypes (p = 0.119).

Conclusion: Elevated PD-L1 expression, particularly in immune cell scores, suggests potential utility in PD-1/PD-L1-targeted therapies for NHL. However, the prognostic significance of PD-L1 remains inconclusive, highlighting the need for further investigation into its role as a predictive biomarker in the clinical management of Non-Hodgkin's B-cell lymphomas.

Background & objective: Community-acquired Staphylococcus aureus bacteremia (CA-SAB) is associated with substantial morbidity, mortality, and healthcare costs. This study aimed to identify clinical and laboratory factors associated with in-hospital mortality among patients with CA-SAB.

Methods: This retrospective cross-sectional study was conducted at a tertiary referral hospital in Tehran, Iran. Adult patients with positive blood cultures for S. aureus who met CA-SAB criteria were included. Demographic, clinical, and laboratory data were collected from medical records. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to assess associations with mortality.

Results: A total of 114 patients with CA-SAB were included. No significant association was observed between underlying comorbidities and mortality. Although methicillin-resistant S. aureus (MRSA) infection was associated with a higher mortality rate, this difference was not statistically significant (P = .32). Multivariate analysis revealed that older age (odds ratio [OR], 1.053; 95% CI, 1.012-1.095; P = .01), elevated C-reactive protein (CRP) levels (OR, 1.016; 95% CI, 1.005-1.028; P < .01), and lower serum albumin levels (OR, 0.249; 95% CI, 0.097-0.642; P < .01) were independently associated with in-hospital mortality.

Conclusion: Although age was not significant in univariate analysis, it emerged as a significant predictor after adjustment for other variables. Routine laboratory parameters such as CRP and albumin may serve as valuable prognostic indicators. Early identification of high-risk patients using these markers could inform timely interventions and improve outcomes in CA-SAB.

Background & objective: This study presents a rare case of hydatid cysts involving the liver, spleen, and peritoneum, in which clinical features and radiologic findings initially raised strong suspicion for abdominal malignancy with peritoneal seeding.

Case presentation: A 64-year-old man presented with vague epigastric pain, weight loss, and iron deficiency anemia. Abdominal ultrasonography revealed multiple splenic lesions suggestive of hydatid cysts. Hydatid serology was negative. Chest CT was unremarkable. Abdominal and pelvic CT showed splenomegaly with cystic lesions, including a calcified cyst in segment VI of the liver. Numerous hypodense peritoneal nodules were identified, particularly in the mid-omentum and supraumbilical region. Differential diagnoses included hydatid disease, primary peritoneal neoplasms, and peritoneal metastases. Due to anemia, weight loss, and the suspicion of peritoneal carcinomatosis, hydatid disease alone could not fully account for the findings, prompting further diagnostic evaluation. Endoscopy and colonoscopy were unremarkable. The patient underwent exploratory laparotomy and splenectomy, along with partial omentectomy where hydatid involvement was suspected. Postoperatively, he was treated with albendazole 800 mg daily and discharged on postoperative day three. At 3- and 6-month follow-ups, the patient reported resolution of abdominal pain, and physical examinations were normal.

Conclusion: Peritoneal hydatid disease is rare and can mimic peritoneal carcinomatosis, leading to diagnostic uncertainty and treatment delay. Surgical excision followed by antiparasitic therapy remains the cornerstone of management.

Background & objective: Tumor-to-tumor metastasis is a rare phenomenon in which one primary tumor metastasizes into another histologically distinct tumor. This report presents a unique case of breast carcinoma metastasizing to a pheochromocytoma, posing significant diagnostic and therapeutic challenges.

Case presentation: A 71-year-old woman with a history of breast carcinoma-status post mastectomy 7 years prior-presented with elevated levels of cancer antigen 15-3 (CA15-3), raising suspicion of disease recurrence or metastasis. Imaging studies revealed a mass in the adrenal gland. Surgical excision of the adrenal lesion was performed, and subsequent histopathological and immunohistochemical analyses confirmed the coexistence of two distinct tumor components: primary pheochromocytoma and metastatic breast carcinoma.

Conclusion: Although tumor-to-tumor metastasis is exceedingly rare, awareness of this entity is crucial for accurate diagnosis and effective treatment planning. This case underscores the importance of considering prior malignancies in the differential diagnosis of new adrenal masses and highlights the complexities involved in managing a hormone-secreting neoplasm concurrently harboring metastatic disease.

Background & objective: Cervical cancer is the second most common malignancy among women worldwide. The Receptor for Activated C Kinase 1 (RACK1) has a key role in regulating the pathways of cell signaling, angiogenesis, cell migration, invasion, and metastasis. This study investigated the association of polymorphisms rs1279736 and rs3756585 with cervical cancer.

Methods: In this study, 100 LB pap-smear and paraffin block samples of cervical squamous carcinoma associated with Human papillomavirus (HPV) were selected along with 100 LB smear cytology samples from healthy women with normal pap smears, serving as the control group. Genomic DNA was extracted from the samples, and the polymorphisms rs1279736 and rs3756585 in the RACK1 genes were examined using the RFLP-PCR and ARMS-PCR methods, respectively.

Results: The rs1279736 polymorphism shows that the chance of cervical cancer in individuals with CA and AA genotypes is 3.772 and 1.852 times that of CC genotypes, respectively. This suggests that the A allele is involved in developing cervical cancer (P=0.005; OR=2.113). The rs3756585 polymorphism indicates that the chance of cervical cancer in TG and GG genotypes is 0.373 and 4.235 times that of TT genotypes, respectively. This also points towards the involvement of the G allele in the development of cervical cancer (P=0.032; OR=1.800). Also, there was no significant relationship between the genotype of polymorphisms, age, and subtype of papillomavirus 16 and 18 in patients.

Conclusion: The present study was conducted for the first time. Our results showed that two polymorphisms are significantly associated with cervical cancer.

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.