Fine needle aspiration diagnosed skin metastasis in a young man with rectal cancer

Introduction: Although colon cancer is one of the most common human cancers, skin metastasis in this disease is rare and necessitates pathological confirmation

Report of the Case: Herein we present a 33 year old man with rectal cancer with ascites. Six cycles of Oxaliplatin based chemotherapy were given. The ascites improved. After three weeks, skin lesions appeared in the upper trunk, both chest wall and back, with extension to the anterior neck Fine Needle Aspiration from the lesions showed malignancy and second line chemotherapy was started. Although the skin lesions showed partial response, unfortunately, the patient died after the fourth chemotherapy injection

Conclusion: Skin metastasis in colorectal cancer, although rare, is a devastating sign, and a careful dermatologic examination should be included in these patients' follow up visits

Isolated renal mucormycosis after liver transplantation: an unusual case report

Mucormycosis is a rare complication of immunosuppression. Most of the reported cases have been rhinocerebral or disseminated. Isolated renal involvement is extremely rare and until now less than 30 patients have been reported in the English literature. Isolated renal mucormycosis with renal artery rupture in a liver transplant patient has not been reported so far. Herein we report an extremely rare case of isolated renal mucormycosis in a liver transplant patient who was successfully treated with nephrectomy

healing effect of Arnebia Euchroma in second degree burn wounds in rat as an animal model

Finding more efficient agents with fewer side effects for treatment of burns has always been a concern for researchers. Silver sulfadiazine [SSD], apparently due to its antimicrobial effect, is still one of the most common prescribed agents. Previous studies suggested that Arnebia euchroma [AE] has shown antimicrobial and anti-inflammatory activities. This study investigates the healing effect of AE extract in comparison with SSD in second degree burn wounds. Forty eight female Wistar rats [220 +/- 20 g] were divided into four groups. Standard second degree burn wounds were induced on the back of their necks. One group was treated with SSD; two groups were treated with AE cream at concentrations of 10% [AE10] and 20% [AE20] and the control group which received no treatment. The duration of treatment was 28 days. This study revealed that AE and SSD noticeably improved re-epithelization, fibroblasts proliferation, and collagen bundle synthesis and had a noticeable anti-inflammatory effect compared with the control group. Results of the present study revealed that Arnebia euchroma herbal extract was an effective treatment for second degree burn wounds when compared with SSD

Human bone marrow-derived mesenchymal stem cell: a source for cell-based therapy

The ability of mesenchymal stem cells [MSCs] to differentiate into many cell types, and modulate immune responses, makes them an attractive therapeutic tool for cell transplantation and tissue engineering. This project was designed for isolation, culture, and characterization of human marrow-derived MSCs based on the immunophenotypic markers and the differentiation potential. Bone marrow of healthy donors was aspirated from the iliac crest. Mononuclear cells were layered over the Ficoll-Paque density-gradient and plated in tissue cultures dish. The adherent cells expanded rapidly and maintained with periodic passages until a relatively homogeneous population was established. The identification of adherent cells and the immune-surface markers was performed by flow cytometric analysis at the third passage. The in vitro differentiation of MSCs into osteoblast and adipo-cytes was also achieved. The MSCs were CDllb [CR3], CD45, CD34, CD31 [PCAM-1], CD40, CD80 [B7-1], and HLA-class II negative because antigen expression was less than 5%, while they showed a high expression of CD90, and CD73. The differentiation of osteoblasts, is determined by deposition of a mineralized extracellular matrix in the culture plates that can be detected with Alizarin Red. Adipocytes were easily identified by their morphology and staining with Oil Red. MSCs can be isolated and expanded from most healthy donors, providing for a source of cell-based therapy

Evaluation of cytomegalovirus infection after six months of liver transplantation in children in Shiraz, Southern Iran

Liver transplantation [LT] is a life-saving treatment for end-stage liver diseases [ESLD]. Cytomegalovirus [CMV] infection is one of the important causes of morbidity after LT. To evaluate the incidence of late-onset [after 6 months of LT] CMV infection in pediatric recipients. A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. Three recipients [6%] developed late-onset CMV infection. These patients finally responded to ganciclovir. CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children

Evaluation of candida infection after six months of transplantation in pediatric liver recipients in Iran

Liver transplantation [LT] is the standard treatment of end-stage liver diseases [ESLD]. Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. To determine the incidence of late-onset [after 6 months of LT] Candida infection in recipients. A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. One recipient [2%] developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder [PTLD]. The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications

molecular and antigenic tissue impact of viral infections on liver transplant patients with neonatal hepatitis

Pathogenesis of neonatal hepatitis relates to various underlying causes including viral infections. Both hepatotropic and non-hepatotropic viruses may induce liver failures in infants before birth, during delivery, or shortly after birth. The tissue impact of HCMV, HSV, HBV, HCV, and rotavirus and adenovirus infections was evaluated in studied infants with neonatal hepatitis. The history of viral infections was analyzed in paraffin-embedded biopsy and autopsy tissues of 22 infants with neonatal hepatitis between years 1996 and 2007, retrospectively. The tissue molecular presentation of HBV, HCV, HCMV, HSV, adenovirus, and rotavirus was evaluated by different qualitative simple and nested PCR and RT-PCR protocols. Immunohistochemistry [IHC] method was used for studying the antigenic prevalence of HSV-1, 2; HBV, HCMV and adenovirus infections. Also the laboratory liver indices of all patients with neonatal hepatitis were analyzed. The HBV and HSV genomes were detected in 3 [14%] of 22 infants. The rotavirus and HCV-RNA and also the HCMV-DNA were detected separately in 1 [4%] of 26 paraffin-embedded autopsy and biopsy tissues. The HBV and HSV-1 specific antigens were separately diagnosed in 1 [4%] of 26 neonatal samples by IHC protocols. Also the HSV-2 antigen was seen in 5 [23%] of 22 liver autopsy and biopsy specimens. Co-infections with HCMV, HSV, HBV, HCV, and rotavirus were detected in these infants with hepatitis. Diagnosis of single and mixed molecular and antigenic traces of HCMV, HSV, HBV, HCV and rotavirus underlines the etiologic role of these viruses in clinical pathogenesis of neonatal hepatitis

Primary hydatid cyst of the adrenal gland: a case report and review of the literature

Hydatid cyst of adrenal gland is rare and usually incidentally found as a part of disseminated disease. Herein we report a rare case of primary adrenal hydatid cyst who presented with unusual symptom of arterial hypertension from an endemic country

Squamous cell carcinoma of the esophagus and adenocarcinoma of gastroesophageal junction, a rare coincidence

Simultaneous squamous cell carcinoma [SCC] of esophagus and gastroesophageal adenocarcinoma has rarely been reported. It is often difficult to diagnose this coexistence preoperatively due to the presence of esophageal stenosis. Herein, we report a patient with esophageal SCC whose gastroesophageal adenocarcinoma was also detected after pathologic examination of the resected specimen

Association of the co-stimulatory molecules polymorphisms with CMV infection in liver transplant recipients

Co-stimulatory molecules play a critical role in regulating T-cell function during CMV infection after liver transplantation. To investigate the relationship between the polymorphisms of the co-stimulatory genes and the susceptibility to CMV infection after liver transplantation. Single nucleotide polymorphisms [SNPs] in PD-1 gene [PD1.1 A/G, PD1.3 A/G, PD1.9 C/T] ICOS [-693 A/G, 1720 C/T], CTLA-4 gene [-318 C/T, 1722 T/C, 1661 A/G, 49 A/G] and CD28 [+17 C/T] were analyzed by PCR-RFLP in 70 liver transplant patients. CMV infection was determined in these patients by antigenemia test. CTLA-4 49G showed significant association with CMV infection [p=0.03, OR=3.82, 95% CI: 0-3.5; p=0.01, OR=004, 95% CI: 0-1.3]. G and T alleles in CTLA-4 gene [-318 C/T and 1661 A/G] [p=0.03, OR=0, 95% CI: 0-3.5; p=0.01, OR=0.04, 95% CI: 0-1.3] were significantly higher in CMV-infected rejector group. CTLA-4 have significant role in CMV pathogenesis and rejection among CMV-positive liver transplant patients

Endothelial nitric oxide synthase gene t-786c polymorphism in renal transplant recipients

Nitric oxide [NO] is a major mediator in vascular biology, regulating regional blood flow. NO and the enzymes required for its production contribute to ischemia-reperfusion injury. The T-786C functional polymorphism in the promoter region substantially reduces promoter activity of the endothelial nitric oxide synthase [eNOS] gene and compromises endothelial NO synthesis. To examine the association between T-786C [rs 2070744] single nucleotide polymorphism [SNP] in eNOS gene and the development of acute rejection in renal transplant patients. 60 renal transplant recipients [30 with episodes of acute rejection [ARs] and 30 without rejection [non-ARs]], between June 2008 and March 2010, were included in this study. The polymorphism was determined by PCR-restriction fragment-length polymorphism analysis. The distribution of the genotypes were TT/TC/CC 60%, 33.4%, 6.6%, and 43%, 46.7%, 13.3% in ARs and non-ARs, respectively [p=0.28]. The frequency of T-allele was 76.7% and 66.3%; and for C-allele was 66.6% and 33.3% in ARs and non-ARs, respectively [p=0.09]. There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection. We could not detect any significant association between polymorphism in T-786C of eNOS gene and the development of acute rejection

case of gastric zygomycosis in a diabetic patient successfully treated with total gastrectomy

Zygomycosis is regarded as a rare fetal infection in diabetics and other immunocompromised patients. The usual manifestations of this infection are: rhinosinusitis, pansinusitis, rhino-orbital and rhinocerebral. Primary gastrointestinal [GI] zygomycosis is a rare disease with a high mortality rate. The stomach is the most common site involved in GI mucormycosis. There are few reported cases of GI zygomycosis in the literature. Here we report a case of a diabetic woman with abdominal pain secondary to gastric zygomycosis that successfully responded to surgical treatment

Histopathological study of chronic hepatitis B: a comparative study of Ishak and METAVIR scoring systems

Ishak and METAVIR scoring systems are among the most commonly used histopathological systems to evaluate chronic hepatitis. To assess the level of agreement between these two scoring systems in patients with chronic hepatitis B. Liver biopsy samples taken from 92 patients with chronic hepatitis B were considered as the training set; 57 more biopsy specimens were used as the validation set. In the training set, grade of necroinflammation and stage of fibrosis for each liver biopsy specimen were determined by two expert liver pathologists using both Ishak and METAVIR systems. Inter-observer variability between the two pathologists was evaluated. Biopsy specimens of the validation set were seen and scored by a third expert pathologist. In the training set, criteria were developed to categorize Ishak grading and staging systems separately to best fit with the METAVIR scoring system. The criteria found in the training set, was then tested in the validation set. The level of agreement between the two scoring systems was assessed by weighted kappa statistics. For the training set, agreement between the two pathologists was excellent. Using our proposed criteria in the training set, there was excellent level of agreement in grading [Kappa = 0.89] and staging [Kappa = 0.99] between Ishak and METAVIR systems. In the validation set, the criteria led to substantial correlation [Kappa = 0.61] in grading, and excellent correlation [Kappa = 0.94] in staging between the two systems. Using our proposed criteria, excellent or at least substantial concordance between Ishak and METAVIR scoring systems can be achieved for the degree of both necro-inflammatory changes and fibrosis

Congenital hepatic fibrosis and need for liver transplantation

Herein, we describe two patients who underwent liver transplantation with the clinical diagnosis of hepatic failure and cryptogenic cirrhosis; histopathology of the explanted hepatectomy specimen revealed congeni- tal hepatic fibrosis. To the best of our knowledge, coexistence of hepatic failure and cirrhosis in congenital hepatic fibrosis, have not yet been reported in the English literature