Primary hepatic lymphoma mimicking cholangiocarcinoma

Primary hepatic lymphoma [PHL] presenting with obstructive jaundice is rare and can mimic a preoperative diagnosis of cholangiocarcinoma. We should consider PHL in patients with radiological hepatic disease with normal serum alpha-fetoprotein and carcinoembryonic antigen levels, and elevated lactate dehydrogenase

We present the case of a 67-year-old male with no significant medical history presented with abdominal pain, jaundice, fever, and abnormal liver function tests. Abdominal sonography and computed tomography scan suggested a diagnosis of obstructive jaundice and cholangitis due to cholangiocarcinoma [Klatskin tumor]

A subsequent liver biopsy diagnosed PHL, and the patient was treated with combination chemotherapy, including rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [R-CHOP]. PHL should be considered in patients presenting with biliary obstruction

Laparoscopic approach to a large ovarian fibroma: a case report

Ovarian fibroma is the most common benign solid tumor of the ovary, which is often difficult to diagnose preoperatively. The choice treatment for ovarian fibroma is surgical removal, but discussions for the operative approach, laparoscopic or open, in the literature seem to be scant. Case Presentation: We presented a unique clinical experience of laparoscopic approach to a case of 15 cm unilateral ovarian fibroma in a 24 year old patient, with a successful and complete resection of the tumor beside ovarian tissue preservation in December 2012 in Rasoul-e-Akram hospital, Tehran, Iran. In conclusion, we should not forget the role of laparoscopy as a diagnostic procedure even in suspicious cases of ovarian fibroma with solid tumor, ascites, and pleural effusion

Guinea Pig as an appropriate model for colonization of helicobacter pylori

Animal models have been proven useful in elucidating the details of interaction between pathogenic bacteria and their human hosts, in addition to assessing the efficacy of therapeutic compounds and vaccines. In this study, we investigate the colonization of Helicobacter pylori [H. pylori] in experimentally-infected guinea pigs over a six-month period. A bacterial suspension was prepared by mixing four H. pylori isolates obtained from patients diagnosed with gastric ulcer. Within a one week period, five female guinea pigs were dosed orally with bacterial suspension for a total of three times. One control animal was gavaged with normal saline. Stool samples were collected at two-week intervals for six months. We used PCR, the stool antigen test, and indirect immunofluorescence assay [IFA] to assess samples for the presence of H, pylori. Stomachs obtained from two chloroform-killed animals, at 8 and 24 weeks, were investigated for histopathologic changes. H. pylori 16S rDNA was amplified from the stool samples of five guinea pigs. The stool antigen test was also positive in all five animals. IFA demonstrated the presence of H, pylori antigens in the stools from all five animals. PCR, stool antigen test and IFA results showed no H. pylori in the stool of the control animal. We observed infiltration of mature lymphocytes and plasma cells in the stomachs of animals killed at 8 and 24 weeks. The occurrence of H, pylori 16S rDNA and antigens in stool samples of guinea pigs demonstrated persistent colonization off H, pylori in the stomachs of guinea pigs. Histopathological findings have confirmed mild-severe gastritis induced by the bacterial infection. The stomach of a guinea pig is similar to the human stomach, in that it is sterile, lined by glandular epithelium, lacks a vitamin C synthesizing system and produces the cytokine interleukin-8. Accordingly, the guinea pig can be considered an appropriate animal model for long-term experiments to follow the process of H, pylori pathogenesis or to assess the efficacy of antibiotics or vaccines

[6 years evaluation of prevalence of abdominal wall endometriosis in patients with definite histopathological diagnosis of endometriosis admitted in Rasool-Akram, Shariati and Atieh Hospitals in Tehran]

Endometriosis is a benign disease of female genital system, which often occurs in the reproductive age and it is defined by the presence of tissue resembling endometrial glands and stroma outside the uterine cavity. Endometriosis is found in two types of pelvic and extrapelvic. The most common type of extrapelvic endometriosis is cutaneous endometriosis which can occur either spontaneously or secondary to abdomino-pelvic surgeries. Abdominal wall endometriosis is the most common type of cutaneous endometriosis that its diagnosis is difficult. The purpose of this study is to determine the prevalence of abdominal wall endometriosis in patients with endometriosis. In this retrospective cross-sectional study, 323 patients with endometriosis and definite histopathological diagnosis who admitted in Rasool-Akram, Shariati and Atieh Hospitals during 1384 to 1389, were enrolled. The sampling method was census and the study variables included patient age, history of pelvic or abdominal surgery, history of cesarean section and the delivery frequency of patients, location of endometriosis and its clinical presentation. Information was gathered from medical records of patients. Finally, data analysis was performed using SPSS software. The prevalence of Extra Pelvic endometriosis was calculated 14.8% [48 cases that 40 cases were abdominal wall endometriosis, 5 cases cervical endometriosis, vaginal endometriosis in 1 case and 2 cases of perineal endometriosis]. The prevalence of abdominal wall endometriosis was 12.3 percent of all cases of endometriosis in which cesarean scar endometriosis and umbilical endometriosis were found in 38 cases [11.7%] and 2 cases [0.6%] respectively. History of previous cesarean section in patients with abdominal wall endometriosis was significantly more than patients with other types of endometriosis [100% vs. 24.6%] [p=0.0001]. Average number of delivery and cesarean section in patients with abdominal wall endometriosis were significantly higher than other patients [p= 0.002 and p= 0.0001 respectively]. Infertility in patients with endometriosis in other places was significantly higher than patients with abdominal wall endometriosis [p= 0.01]. The predominant symptom in patients with abdominal wall endometriosis was, localized pain and swelling in abdominal wall at the surgical scar that become worse during menstruation. abdominal wall endometriosis is seen in two forms of surgical scar and umbilical endometriosis. The prevalence of abdominal wall endometriosis among all types of endometriosis was 12.3% and all the cases of abdominal wall endometriosis have the positive history of cesarean section. The mean age of these patients was 34 years, and attention to this prevalence, predominant symptoms, prevalent age, and history of cesarean section in patients, will help and facilitate the diagnosis

Anal sphincter injuries during hemorrhoidectomy: a multi center study

Hemorrhoidectomy is the treatment of choice for patients with third or fourth-degree hemorrhoids. Although the majority of surgeons believe that surgical hemorrhoidectomy is the most effective approach with excellent results in the management of hemorrhoid disease, but hemorrhoidectomy is not a simple procedure. One of the complications of this surgery is an injury to anal sphincters that can lead to incontinency in some patients. In this study, we aimed to reveal the percentage of external and internal anal sphincter injuries in surgical hemorrhoidectomy. We prospectively enrolled 128 patients from April 2006 to February 2007. They underwent hemorrhoidectomy in three general hospitals in Tehran. All patients were in grade III or IV and underwent open hemorrhoidectomy [Milligan-Morgan]. After surgery, all resected material was histopathologically examined by two expert pathologists and the results confirmed by other one if there is any discrepancy. From all specimens which sent to the pathology department 15.8% [21 Pts.] had muscle fibers that Smooth muscle fibers were seen in 80.5% [17 Pts.] of them and striated muscle fibers were found in 19.5% [4 Pts.]. Although hemorrhoidectomy is a safe and effective method for treatment of hemorrhoid, but the inadvertent removal of smooth and striated muscle during open hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function.

child with intestinal basidiobolomycosis

Fungal infections of the gastrointestinal tract are not common in children, especially in immunocompetent ones. In this case report we describe a child who was presented with abdominal pain and mass, bloody diarrhea and fever. He was treated for amebiasis, but due to treatment failure and deterioration of his condition, he underwent a laparatomy. Histologic examination of the excised bowel in the second look revealed Basidiobolomycosis, a fungus belonging to the order Entomophthorales. The signs, symptoms, treatment and diagnosis of the present case indicate that fungal infections must be considered not only in immunocompromised patients with abdominal pain and mass, but also in apparently immunocompetent ones

[ immunohistochemical assessment of ALDH1 activity in breast cancer and it's correlation with pathologic features]

Aldehyde dehydrogenase 1 [ALDH1] is a marker of normal and malignant human mammary stem cells that has been reported to be associated with poor prognosis. Studies on the detection of ALDH1+cells can help the treatment of patients with breast cancer. The aim of this study was to determine the activity of ALDH1 in breast cancer and its relationship with the pathological features of the tumors. ALDH1 activity was studied by immunohistochemistry in 121 paraffin-embedded histological samples of breast cancer patients from Department of Pathology of Milad Hospital, Tehran, Iran during 2006-2007. The relationship of ALDH1 with the pathological features of the tumors [size, grade, lymph node metastasis and vascular invasion] was also investigated. Eighty-five percent of breast cancer samples expressed ALDH1 in their cytoplasm with a wide range of intensity [weak, moderate and strong], while 18 samples [14.9%] were completely negative. The majority of cases [97.1%] showed ALDH1 positivity in the stroma of tumors which varied from weak [2.9%] to strong [73.5%]. ALDH1 H-score [ALDH1% x intensity] of tumor cells varied from 0 to 240 [mean=80]. ALDH1 H-score was 80 in 59 [48.8%] samples. There was no statistically significant relationship between ALDH1 H-score and age [P=0.358], tumor size [P=0.375], tumor grade [P=0.207], lymph node metastasis [P=0.125] or vascular invasion [P=0.190]. ALDH1 activity was demonstrated in 85.1% of breast cancer samples although its level of expression was not correlated with the pathologic features of breast tumors

Helicobacter pylori in patients suffering from pulmonary disease

Recently, research of indirect evidence suggested a possible association between Helicobacter pylori and pulmonary disease. This study aimed to determine if H. pylori could be detected in endobronchial specimens collected from patients undergoing bronchoscopy. This prospective study was conducted on 34 consecutive patients with any type of lung disease undergoing bronchoscopy in which biopsy was required for their diagnosis. A written informed consent was obtained from all participants. Three bronchial mucosa biopsy samples were obtained using fenestrated biopsy forceps. One sample was used to determine urease activity, the second one for histopathological examination, and the third one for diagnosis. All subjects were fully informed regarding the gastroesophageal reflux disorder [GERD] Questionnaire. There were 34 patients with pulmonary diseases [12 males and 22 females, mean age 58.2 +/- 18.2 years] out of which, 11 [32.4%] had GERD. No significant difference was found between the histopathological assay and GERD. Our study found no direct evidence supporting the theory that H. pylori may cause pulmonary disease and no relation with GERD was detected. However, a possible indirect role could not be excluded. Further studies in patients with GERD and lung disease may reveal a potential pathogenic link between H. pylori and pulmonary disease