Iranian Journal of Pathology最新文献

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: Melanomas have diverse pathological features that mimic other tumors, such as lymphoma, sarcoma, and even poorly differentiated carcinoma. The most recently identified variant, the plasmacytoid variant, is an uncommon variant that can appear as a solitary tumor or a metastatic disease. Due to its rarity, the epidemiologic profile of this variant is not well characterized. This case report illustrates a diagnostic challenge of plasmacytoid cell mimicker, which is rarely found in daily practice.

Case presentation: A 49-year-old man presented with multiple subcutaneous soft tissue nodules in the thoracic area and multiple pathological fractures in the left distal humerus and distal ulna. Clinical and radiological findings were suggestive of metastatic bone disease with differential diagnosis of multiple myeloma. Fine needle aspiration biopsy and histopathological findings were suggestive of multiple myeloma with differential diagnoses of metastatic carcinoma, rhabdomyosarcoma, and amelanotic melanoma. Thus, immunostaining for CD138, CK, desmin, vimentin, S-100, and HMB45 were requested and the results were compatible with the final diagnosis of amelanotic plasma melanoma.

Conclusion: It is crucial to consider melanoma as one of the differential diagnoses of a tumor with plasmacytoid feature and CD138 positive staining as it can mimic multiple myeloma as demonstrated in this case report.

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: 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: Heterotopic pancreas (HP) or ectopic pancreas is the occurrence of pancreatic tissue in an atypical location with absence of any neurovascular or anatomic connection with the normal pancreas. In an autopsy series, the incidence of this embryologic anomaly is 0.55% to 13.7% of patients. Gallbladder is an extremely rare site for ectopic pancreatic tissue with approximately 40 documented cases.

Case presentation: We hereby report a case of incidental discovery of ectopic pancreatic tissue in the excised gallbladder from a 27-year-old female who presented with nausea, vomiting, and abdominal pain intermittently. The gallbladder lumen was filled with biliary sludge containing a single gallstone. Histopathology revealed chronic cholecystitis along with a tiny focus of ectopic pancreatic tissue comprising only pancreatic acini.

Conclusion: This case highlights that histopathology should be mandatory for all excised gallbladder specimens and that this entity should be considered among the differentials for nodular/polypoidal gallbladder lesions. Although the cases where the ectopic pancreas is discovered incidentally do not have much clinical significance, this may prevent the patient from undergoing more aggressive treatment reserved for conditions like pancreatitis or malignancy in cases where the ectopic pancreas mimics a malignancy.

Background & objective: Clear cell renal cell carcinoma (CCRCC) is the most common type of renal cancer. Limited studies have been conducted about factors affecting the survival of patients with CCRCC. In this study, we aimed to evaluate the association between histologic growth patterns (HGPs) and some pathologic features and survival in CCRCC.

Methods: This cross-sectional study evaluated the association between HGPs and other pathologic features and the survival of 145 patients with CCRCC after nephrectomy in Emam-Reza Hospital (Mashhad, Iran) from 2012 to 2022. Two expert pathologists assessed HGPs and other pathologic features, like cytopathologic changes. All analyses were performed using IBM SPSS version 26 software. A P value less than 0.05 was considered statistically significant.

Results: In the current study, we assessed the association of the 6 most prevalent growth patterns with the patient's survival. Some clinicopathologic features like tumor stage and grade, tumor size, and necrosis are negatively linked with survival. Two important cytologic features, including sarcomatoid and rhabdoid, were also associated with survival time in patients with CCRCC (P values < 0.05). Regardless of the nuclear grade of the tumor, some patterns like solid sheet, papillary, and thick trabecular were associated with lower survival.

Conclusion: Some HGPs are significantly associated with the patient's survival in CCRCC. A greater variety of patterns within each specimen has been associated with a reduced survival rate. The impact of HGPs on patient survival may be as significant as the nuclear grade.

A rare condition, blastic plasmacytoid dendritic cell neoplasm, is classified as acute myeloid leukemia-related precursor neoplasms according to the World Health Organization's 2022 classification. Previously thought to originate from natural killer cells, T cells, or monocytes, it is now believed to arise from plasmacytoid dendritic cells. The cause of this condition is not well understood, but it is often associated with the deletion of tumor suppressor genes such as RB1, CDKN1B, CDKN2A, and TP53. The disease is aggressive and typically presents with initial cutaneous lesions that can progress to bone marrow involvement and leukemic dissemination. Flow cytometry/ immunohistochemistry can detect enhanced CD56, CD4, and CD123 expression. The differential diagnoses include myeloid sarcoma/acute myeloid leukemia, T-cell lymphoblastic leukemia/lymphoma, NK-cell lymphoma/leukemia, and certain mature T-cell lymphomas/leukemias. Although initial chemotherapy may elicit a patient response, relapse is common. Survival may be improved by stem cell transplantation. This case report details the medical history of a 64-year-old woman who presented with a skin mass that exhibited slow growth over 6 months. The mass was firm on palpation. Extensive testing, including a bone marrow (BM) smear and biopsy, revealed numerous abnormal or blastic cells. Furthermore, flow cytometric analysis of the BM confirmed the presence of plasmacytoid dendritic cell-neoplastic precursor cells exhibiting CD4+ and CD56+ characteristics.