Assessment of malignancy rate in thyroid nodules according to the Bethesda system of fine-needle aspiration. Report from a tertiary center in the Southwestern region of Saudi Arabia

To determine the rates of malignancy of thyroid nodules in each standard cytologic diagnostic category of the Bethesda system. In a retrospective cohort study from October 1998 to April 2007 at the Department of Pathology, Aseer Central Hospital, Southwestern region of Saudi Arabia, all cases of thyroid nodules that underwent preoperative cytologic examination by fine-needle aspiration [FNA] and concurrent postoperative histopathologic examination were included. All FNA diagnoses were reclassified using the thyroid FNA Bethesda reporting system, including non-diagnostic [insufficient], benign, atypical follicular lesion of undetermined significance [AFLUS], neoplasm, suspicious of malignancy, and malignant groups. The rate of malignancy based on final histopathologic evaluation was analyzed for each of these cytologic groups. A total of 323 thyroid fine needle aspiration cytology [FNAC] diagnoses were reclassified into non-diagnostic 6.2%, benign 57.3%, AFLUS 13.6%, follicular and Hurthle cell neoplasms 16.1%, suspicious of malignancy 1.5%, and malignant 5.3% groups. The corresponding rate of malignancy on histopathologic examination was as follows: 35% in the non-diagnostic group, 10.3% in the benign group, 15.9% in AFLUS group, 32.7% in follicular and Hurthle cell neoplasms, 60% in the suspicious of malignancy group, and 94% in the malignant group- Applying a standard terminology reporting system for thyroid FNA may enhance the communication between pathologists and clinicians, assists them to find out the rate of malignancy in each cytologic group, and facilitating a more consistent approach for patients' management

Alterations of serum levels of zinc, copper and selenium trace elements in juvenile idiopathic arthritis and acute rheumatic fever: preliminary findings

Some trace elements such as zinc, copper and selenium [Zn, Cu and Se] are catalytic, structural and regulatory ions for enzymes, proteins and transcription factors, and is thus are critical in many homeostatic mechanisms of the body, including immune responses. Our knowledge about changes in Zn, Cu and Se elements in juvenile idiopathic arthritis [JIA] and acute rheumatic fever [ARF] is incomplete. We hypothesize that "development of JIA and ARF is associated with alterations of Zn, Cu and Se trace elements". To test this hypothesis and to fill this existing gap in literature. Serum level of Zn, Cu and Se was examined in healthy individuals [10.0 control cases], JIA and ARF [23 and 19 cases, respectively] using atomic spectrophotometric assays. Compared to the control group, there were a reduction of serum Se levels and Zn levels and elevation of Cu levels in JIA and ARF. These changes were more obvious with disease activity, polyarticular involvement [JIA] and presence of cardiac affection [ARF]. Meanwhile, there was a significant direct correlation among the activity indices and both serum Zn and Se levels. The significant alterations of some serum trace elements in JIA and ARF suggest possible roles for these elements in the development of these lesions. The diagnostic and prognostic ramifications of these findings are open for further investigations

Expression and role of HMSH2 P53 and BCL-2, in human gliomas in upper Egypt

Tumorigenesis involves alterations in the tumor suppressor genes [P53], protooncogenes [Bcl-2] and housekeeping genes [human MutS homologue 2 [hMSH2]. We hypothesized that development of gliomas involves interactions among p53, Bcl-2 and hMSh2 proteins. In Upper Egypt, the clinicopathologic features and genetic changes in these tumors are still unknown. To test our hypothesis and to examine these issues, 60 specimens entailing normal brain tissues, gliosis and gliomas [grade I, II, III, IV] were immunostained for p53, Bcl-2 and hMSH2 protein expression. Gliomas were more common in males than females [2.5:1, p <0.001] with an average age incidence of 36.5 +/- 7.6 years. The tumors were common in the parietal and frontal regions [1.5:1, respectively]. As compared to the normal brain and gliosis, examination of the average weighted scores in gliomas [grade I, II, III, IV, respectively] showed significant upregulation of 1] p.53 proteins [0.0 +/- 0.0; 0.0 +/- 0.0; 0.9 +/- 0.5; 1.6 +/- 0.8; 1.7 +/- 0.5 and 4.1 +/- 0.8, p< 0.0001], 2] hMSH2 [5.3 +/- 1.3; 1.9 +/- 1.1; 1.5 +/- 0.7; 2.2 +/- 0.5; 4.1 +/- 1.5 and 4.7 +/- 1.1, p< 0.0006] and 3] Bcl-2 [0.8 +/- 0.5; 2.0 +/- 0.6; 1.9 +/- 0.6; 1.9 +/- 0.5; 4.4 +/- 1.2, p< 0.001]. Alternatively, downregulation of Bcl-2 immunoreactivity score occurred in grade IV gliomas [0.9 +/- 0.5, p< 0.0001]. There was an insignificant negative correlation between p53 and Bcl-2 [r=-0.07, p>0. 05] and between p53 and phMSH2 [r=-0.08, p>0.05] protein expression. In Upper Egypt: 1] gliomas had similar clinicopathologic features to those in the high risk regions, and 2] alterations of the p53, Bcl-2 and hMSH2 proteins occur during the development of these tumors

Immunohistochemical analysis of the immune cells in bilharzial granuloma of the urinary bladder

Urinary bilharziasis represent a major health problem in Egypt. It is characterized by the formation of localized collection of immune cells i.e. granulomas. In this investigation, we hypothesized that the evolution of the bilharzial ganuloma is associated with recruitment of immune cells of diverse cell lineage. To explore this hypothesis and to fill this existing gap in the literature, We carried out this investigation. Granuloma cell population was immunohistologically examined in thirty cases of cellular bilharzial granulomas using immunoperoxidase staining methods and antibodies targeting antigens for B cells [CD20]. T cells [CD3]. Histiocytes [CFD68] and cytotoxic T cells [Granzyme B]. The mean values of positive cells in the cellular bilharzial granulomas were: 45.5 +/- 5.6 for CD68 cells: 14.8 +/- 1.1 for CD3 T cells; 9.1 +/- 1.1: for CD20 B cells and 1.5 +/- 0.8: for Granzyme B T cells with cytotoxic activity. The numerical dominance of CD68 cells suggests their critical role in the evolution of these lesions. Our study was the first to report immunophenotypic profile of the bilharzial grnauloms

Injurious effect of X-ray irradiation on albino rat enterocytes and potential radio protective effect of melatonin [histological and morphometric study]

Radiation enteritis is a significant clinical problem in patients receiving ionizing radiation directed at the abdomen or pelvis. Although radiation therapy is aimed to be directed against the malignant tissue, adjacent healthy tissues are also affected and the small intestine is the most sensitive organ to radiation. Melatonin has been documented as a direct free radical scavenger and an indirect antioxidant, as well as an important immunomodulatory agent. The aim of the research is to study the histological and ultrastructural changes of X-ray irradiation on rat jejunal mucosa and possible radioprotective role of melatonin. Thirty six adult male albino rats were included in the study and were divided into three groups, the first group was included twelve rats and was served as controls, the second group was included 12 rats and was exposed to a whole body X-ray irradiation dose of 8 Grays [Gy]. The third group was included twelve rats and was subjected to intraperitoneal injection of melatonin [10 mg/kg body weight melatonin one hour before irradiation]. The animals were anaesthized at 48 hours after X-ray irradiation and perfused with fixative solution and laparotomy was performed. Immediately after laparotomy, the small intestine [jejunum] was removed. Some specimens of jejunum were fixed in 10% neutral-buffered formalin, embedded in paraffin, sectioned and stained with haematoxylin and eosin. Other specimens were fixed in 5% buffered glutardehyde and electron microscopic technique was made and semithin and ultrathin sections were obtained and examined to show the ultrastructure of small intestine. The results revealed that X-ray irradiation resulting in loss of architecture and disarrangement of cells of the microvilli which have pale cytoplasm and degenerated nuclei with a reduction of mean villous height, mean crypt diameter and mean number of villi per cross section. Also electromicroscopic feature revealed lack of parallel arrangement of microvilli, loss of glycocalyx covering, desquamation of microvilli, vacoulation of apical part of the cells, dilatation of rough endoplasmic reticulum, and damage of mitochondrial cristae. In group of irradiated animals pretreated with melatonin [group three], these changes were improved and the intestinal mucosal structure was preserved. Administration of melatonin prior to irradiation can protect the intestine against X-rays destructive effects

Alterations of P53, and BCL-2 protein expression in the recurrent laryngeal and pharyngeal squamous cell carcinoma

Identification of molecular events of the recurrent squamous cell carcinoma [SCC] of the larynx and pharynx may aid in refining treatment strategies and improving outcome. The underlying molecular events of these recurrent tumours involves alterations in the tumor suppressor genes [p53] and protooncogenes [Bc1-2]. We hypothesize that the development of these recurrent tumours involves alterations of the p53 and Bcl-2 proteins. To test this hypothesis, 15 laryngeal and pharyngeal biopsy specimens obtained from 15 patients with recurrent laryngeal or pharyngeal squamous cell carcinoma with different grades [II-IV] were immunostained for p53 and Bcl-2 protein expression. Examination of the percentage of positive cells in the normal mucosa and SCC, respectively, showed significant upregulation of p53 [0.0 +/- 0.0 Vs. 51.8 +/- 5.9; p= 0.00] and Bcl-2 protein expression [36.5 +/- 3.5 vs. 74.6 +/- 1.9; p= 0.00]. Alterations of the p53 and Bcl-2 proteins occur during the development of recurrent SCC. Additional studies are needed to confirm and extend our results

Quantitative comparison of infected schistotomiasis mansoni and haematobium: animal model analysis of the granuloma cell population

To evaluate the hypothesis that the granuloma cell population in S. haematobium is different from that of S. mansoni infections, a hamster animal model was established. Infection of hamesters was induced by abdominal skin exposure of male golden hamsters with 300 cercariae. S. haematobium granuloma cell population in the small intestine, urinary bladder, liver and spleen and those of S. mansoni granuloma in the small intestine and liver of infected hamsters were histologically examined between 6 and 12 weeks post-exposure. In both species, the granuloma cell population was fomed of lymphocytes [47%], histiocytes [28%], eosinophils [16%] and polymorphs [8%]. As compared to granuloma cell population in S. haematobium; S. mansoni granulomas had: [a] higher population of eosinophils [28% vs. 11%], [b] lower population of polymorphs [4% vs. 10%] and histiocytes [22% vs. 31%] and [c] similar population of lymphocytes [46% vs. 47%].The mean diameter of liver granuloma was higher in S. mansoni [175.8 +/- 12.34] than for S. haematobium [125.4 +/- 16.12]. As compared to S. haematobium, the numbers of isolated male, female and total worms were significantly higher in S. mansoni [24.5 +/- 2.7 vs. 7.3 +/- 2.3; 6.3 +/- 0.8 vs. 2.2 +/- 0.5; 80 +/- 2.2 vs. 56.3 +/- 3.8, p < 0.05]. The heterogeneity of cell population in granuloma suggests the involvement of different immune mechanisms in their development. The cells achieving numerical dominance in the granulomas were in the following order: lymphoyctes > monocytes > eosinophils > polymorphs. The difference in the granuloma cell population between S. haematobium and S. mansoni may reflect different tissue reactions to the deposited ova