Association of systemic Anaplastic large cell Lymphoma and active Toxoplasmosis in a child

Introduction: Anaplastic large cell lymphoma is a subset of non-Hodgkin lymphoma and an unusual disease in children

Case Presentation: Herein we have reported a 7- year- old girl with a large necrotic skin ulcer on the chest caused by systemic form of anaplastic large-cell lymphoma and simultaneous active toxoplasmosis diagnosed by PCR on lymph node specimen. There were few reports showing a role for toxoplasma infection to cause some malignancies such as lymphoma in adults

Conclusions: Based to our knowledge, this has been the first report of simultaneous systemic anaplastic large cell lymphoma and active toxoplasmosis, documented by positive PCR on tissue biopsy in a child. This case report has suggested more attention to the accompanying Toxoplasma gondii infection as a probable cause of some types of lymphomas

Congenital rhabdomyosarcoma of shoulder

A 16-day-old female was referred with congenital swelling on her right shoulder. On examination, there was a hard, round, ecchymotic, nontender, slightly movable, warm and shiny 10x15 cm mass on the right axillary pits which was extended to the right side of neck and chest wall. The mass separated the shoulder from the chest wall causing paralysis of right hand. Chest X-ray, ultrasound and MRI with contrast demonstrated a soft tissue mass suspected to be a hemangioma. The mass rapidly increased in size despite aggressive steroid therapy with rupture and bleeding. On the 45th post natal day the baby was taken to operating room to control the bleeding and if possible total excision of the mass. The mass was separated easily from the surrounding tissue and was excised along with right upper extremity. At the end of surgery the baby had cardiac arrest, and apparently died of Disseminated Intravascular Coagulation [DIC]. The final pathology report was Rhabdomyosarcoma [RMS]

[Evaluation of MYCN amplification in Iranian patients with neuroblastoma by conventional and real time PCR]

Background: There is an international consensus that evaluation of MYCNamplification should be done in all cases of newly diagnosed neuroblastoma. MYCN is the most important prognostic factor for neuroblastoma and determines treatment strategy

Materials and methods: In this study we evaluated paraffin embedded tissue block and bone marrow aspiration of 75 neuroblastoma patients with mean age of 4.1 years, including 32 female and 43 male, by conventional and also real time quantitative PCR

Results: Forty eight and 43 percent were MYCN amplification positive by Real time and conventional PCR, respectively. 28% of patients less than one year old and 48% of patients older than one year showed MYCN amplification.50 percent of cases with pathological diagnosis of small round cell tumor had MYCN amplification

Conclusion: PCR is a fast, reliable and cost effective method for the evaluation of MYCN amplification and can be performed using DNA extracted from small tissue samples and paraffin embedded blocks. As expected regarding detection power and convenience, Real time PCR was superior to conventional PCR

[Enhancing critical thinking in virtual medical education program: a qualitative study of faculty members' and students' experiences]

Background and Objective: As enrollment in virtual online courses continues to grow, one of the stakeholders' concerns is the enhancement of critical thinking in students. This study was performed in order to answer this core question: "what are the barriers and facilitating factors of critical thinking in virtual environment?

Methods: This qualitative study is part of a mixed qualitative and quantitative study performed for developing the process of teaching critical thinking in virtual medical education program in which 7 e-teachers and 11 postgraduate e-students [out of a total of 12 students] of virtual medical education discipline were investigated. Data were gathered using a semi-structured questionnaire. All interviews were tape-recorded, transcribed and then analyzed using Strauss and Corbin's constant comparative method

Results: Participants had a variety of experiences about critical thinking improvement that were conceptualized in three major themes of: [belief system] including personal beliefs and aspects that are considered as constant during a short time period, [educational management] including factors that can be manipulated by the educational leaders and [critical thinking in virtual environment] including motivating and limiting factors of critical thinking

Conclusion: The results of this study highlight the barriers and facilitating factors of enhancing critical thinking in virtual environment. Teachers, educational planners and leaders can use the results of this study in order to improve their virtual programs and student's critical thinking?

Can we rely on frozen sections of a rectal biopsy for one-stage trans-anal pull-through operation in Hirschsprung's disease?

Successful results after one-stage trans-anal pull-through [OSTAPT] operation for Hirschsprung's disease [HD] depend on accurate identification of the aganglionic segment in intra-operative frozen section [FS]. Misinterpretation of the findings of the rectal biopsy is an anxiety-evoking pitfall for the surgeon. This study aims to describe our experiences in comparing results of FS and permanent Section [PS] rectal biopsies in children with HD who were candidates for OSTAPT in a single-step operation. Subjects under the age of 14 years, admitted from March 2000 to July 2008 in a university-affiliated children's hospital for open rectal biopsy to diagnose HD were included in the study. All biopsies were taken 2-3 cm above the dentate line. 210 specimens of full-thickness rectal biopsy were obtained for both frozen section and permanent biopsy from all patients, examined by two well experienced pediatric pathologists for ascertaining the presence of ganglion cells, and the results were compared. Analysis was performed by SPSS Software version 11.5. Two-hundred one infants and children underwent FS rectal biopsy to exclude HD. Positive results were seen in 63.8% of the specimens examined as PS and in 58.3% of FS samples. 93.9% of positive results in FS studies were confirmed by PS studies. 6.1% of FS reports were false positive and 21.7% were false negative [P<0.001]. The sensitivity of FS was 85.8% and specificity 90.2%. Positive predictive value [PPV] was 93.9% and negative predictive value [NPV] was 78.3% in FS studies [P<0.001]. The accuracy of FS was 80.4%. Although FS of the rectal biopsy is useful in defining the aganglionic segment during operation, according to this study, it cannot be used as the sole base for performing primary pull-through operation before the results of the permanent section are on hand

Autosomal recessive chronic granulomatous disease, IgA deficiency and refractory autoimmune thrombocytopenia responding to anti-CD20 monoclonal antibody

Immunodeficiency and autoimmune disease may occur concomitantly in the same individual. Some of the immunodeficiency syndromes, especially humoral defects are associated with autoimmune disorders. Hematological manifestations such as thrombocytopenia and hemolytic anemia are the most common presentations. Persistent antigen stimulation due to an inherent defect in the ability of the immune system to eradicate pathogens is the primary cause leading to autoimmunity in patients with primary immunodeficiency states. We describe a 10 year old Iranian girl with chronic granulomatous disease -the autosomal recessive type with mutation of NCF1 gene P47- associated with selective IgA deficiency, refractory immune thrombocytopenia that showed an excellent response to Rituximab [Anti-CD20 monoclonal antibody]. Patients with primary immunodeficiencies may have variable autoimmune manifestations. So for early detection and appropriate treatment, autoimmune diseases should always be suspected in such patients

First report of Griscelli syndrome from Afghan population in Iran

A 4 month old Afghan male infant presented with partial albinism, hepatosplenomegaly and pancytopenia. Skin and hair shaft microscopic examination revealed large clumped melanosomes and Griscelli syndrome was diagnosed. Unless treated with bone marrow transplantation, it is a fatal disease in accelerated phase. Pediatricians should consider this syndrome in infants with abnormal light hair because early diagnosis could be life saving

Generalized myelolipoma

Myelolipoma is a benign tumor originating from hematopoietic and adipose tissue. This tumor usually develops in the adrenal gland, but rare presentations of extraadrenal myelolipoma are also reported, which usually arise from the presacral region. Herein, we present a 6-year-old girl with myelolipoma with generalized involvement of her abdomen, pelvis, chest, and retroorbital region