[Isolated corneal squamous cell intraepithelial neoplasia in a patient with unilateral dry eye symptoms]

To report a case of isolated corneal squamous cell intraepithelial neoplasia in a patient with unilateral dry eye symptoms. A 48 year old man presented with history of thermal corneal injury in his left eye two years ago, with decreased visual acuity and dry eye symptoms a short time thereafter. He was treated for dry eye with no improvement in symptoms. Upon presentation, slit lamp examination revealed near total hypertrophy of the corneal epithelium with distinct and scalloped border, without limbal or conjunctival involvement. The patient underwent excisional biopsy [debridement] of the corneal epithelium. Histopathology revealed severe corneal dysplasia [carcinoma in situ]. After excision, the patient was treated with fluorouracil drops 50 mg/dl QID and there was no sign of recurrence up to 1.5 months after surgery. At final follow-up, visual acuity was 9/10 and dry eye symptoms had completely disappeared. In patients with unilateral chronic dry eye refractory to treatment and signs of corneal epithelial involvement, isolated corneal neoplasia should be considered even without limbal or conjunctival involvement

Microsatellite instability in young women with endometrioid type endometrial cancer

This study was designed to determine the frequency of Microsatellite Instability [MSI] in young Iranian patients with endometrial carcinoma and to evaluate its association with histopathologic and clinical features of disease. Microsatellite status was analyzed in 23 patients with endometrioid type endometrial cancer who were less than 55 years. Clinicopathologic characteristics such as age, International Federation of Gynecology and Obstetric [FIGO] grading and staging of tumor, family history of Hereditary Non-polyposis Colorectal Cancer [HNPCC], oral conception [OC] consumption, number of pregnancies, fertility, menstrual cycles and underlying disease were considered. Chi-square and Fisher exact tests were used to find the significant relationships. MSI analysis showed 8 patients [34.8%] were MSS [Microsatellite Stable], 15 patients [62.5%] were MSI positive. Among cases with MSI phenotype, 4 cases [17.45] had low instability [MSI-L] and 11 cases [47.8%] had high instability [MSI-H]. Three cases with MSI-H had family history of HNPCC related cancers. Five cases [21.7%] had infertility in which 4 of them [80%] had MSI phenotype. There was no statistically significant relationship between MSI phenotype and tumor grade and stage. Few studies reported high frequency of MSI among young patients. Some studies mentioned similar results in endometrioid type of tumor. This study showed even higher frequency [65%] when MSI analyzed in young endometrioid type endometrial patients. Most cases with infertility had MSI-H phenotype. It may suggest that beside women with family history of HNPCC, EC screening using MSI would be beneficial in infertile women too

[Serum human chorionic gonadotropin as a predictor of outcome in assisted reproductive technology pregnancies]

Assisted reproduction treatment [ART] entails a risk of ectopic pregnancy and early pregnancy loss. Serum sharp s-human chorionic gonadoropin [sharp s-hcg] has been found to be predictive of pregnancy outcome. Our aim was to determine whether serum sharp s-hcg levels obtained 16 days after ovulation are reliable predictors of pregnancy outcome. In this retrospective study, 200 women who have achieved a pregnancy through ART treatment at the infertility clinic of Mashhad Medical Sciences University were evaluated. The treatment included IUI in 196 [98%], ICSI in 2 [1%] and IVF in 2 [1%]. Serum samples were obtained on days 16 and serum sharp s-hcg concentration was measured by immune-radiometric assay. The mean age at treatment was 29 [range 19-35 y]. One hundred and sixty women aged above 30 y and 40 cases aged below 30 y .Out of 200 patients with ART cycles 175 cases were found to be viable pregnancies [live fetus at 20 weeks gestation] and 25 patients resulting in spontaneous abortion. A statistically significant difference was found between the mean sharp s-hcg value of the non-viable and viable pregnancies [P<0.001]

[Establishment of a PCR technique for determination of HTLV-1 infection in paraffin-embedded tissues]

HTLV-1, the first known human retrovirus belongs to oncovirus subfamily of ietroviruses. The malor characteristic of HTLV-1 is its highly restricted geographic prevalence. Northern part of Khorasan is an endemic region oF HTLV-1 infection. Epidemiological studies can help in designing preventive programs for I-ITLV- I infection, The aim of this study was the establishment of a PCR technique for determination of HTLV-1 infection in paraffin-embedded tissues. In this experimental laboratory study for establishment of a technique, PCR was initially optimized using Beta-actin primers on various formalin fixed paraffin-embedded tissues from liver, spleen, skin and lymph nodes. The optimized concentration of Mgcl2 was 2mm, primer was 8 pmol. Optimized concentration of DNA was different according to the kind of tissue. HTLV-1 infection was determined by applying tax, pol, env and LTR primers on 50 paraffin-embedded lymph node tissues. The reproducibility of this technique was shown for skin and lymph node tissues infected with HTLV-1. In 50 lymph node tissues, one case with pathologic diagnosis of NHL was positive with all 5 sets of primers [tax, Pol, env and LTR primers] and the other case was positive with only two sets of tax primers but was negative with pol, env and LTR primers. The prevalence of infection was 2% among lymph node specimens. [1 of 50 specimens] and if the second case is considered, the prevalence would be 4%. Comparison of the results of this study with another study on blood specimens [seroprevalenee2.3%] was not statistically significant thus confirming the results of one another. [P=0.883]

[Evaluation of diagnostic value of fine needle aspiration in thyroid nodules]

Thyroid diseases particularly nodular lesions are among the most common diseases of human. Approximately 5% of the populations have palpable thyroid nodules which are detected in the routine Autopsy. Nearly 95% of thyroid nodules are benign wherease malignant nodules include 5% of them. Fine needle aspiration [FNA] has been recognized as a simple, inexpensive and available procedure for rapid diagnosis. The objective of this study was to determine the value of FNA in thyroid diagnosis. In this retrospective research, 536 patients with thyroid nodules reffered for FNA or hospitalized for thyroid surgery in Imam Reza Hospital from March 2002 until March 2005 were studied. Individual and laboratory data were gathered in a questionnaire and analyzed by descriptive statistics. This study included 107 men and 429 women and the average age of patients was 40 years. Out of 536 patients 12.7% had malignant, 70.3% benign and 8.6% yield suspicious results and 2.4% of FNAs were insufficient. Comparing the results of FNA and biopsy, FNA had the specificity of 89.5%, sensitivity of 91.5%, and accuracy of 93.7%; negative and positive predictive values were 80.9% and 95.5% respectively. These results reemphasized that, FNA is a simple and non invasive procedure and if performed carefully and evaluated by an expert pathologist is of high sensitivity and specificity

[Effects of transcranial doppler on therapeutic decisions in neurologic patients]

TCD is an expensive diagnostic investigation for patients and health insurance companies. Based on the therapeutic view, cost-effectiveness of transcranial doppler [TCD] is important in patients with cerebrovascular disease. This descriptive study was conducted in Neurosonology Center, Ghaem Hospital, Mashhad, within 2006-2007. Indication of TCD was made by neurologists previously. 200 TCD on 166 patients was performed by neurosonologists based on the standard protocol with AKAI device, France and 2MHz probe. The effect of TCD results on changing the dose and type of medicine and neurosurgical consultation of the patients was recorded. Data was analyzed with descriptive statistics and frequency distribution tables. 166 patients [64 males and 80 females] with mean age of 53.4 years were investigated. Abnormal results were found in 27.5% of TCD. Performance of 3D TCD [15%] had influence on therapeutic decisions of the patients. Among this later group, 83% were patients with subarachnoid hemorrhage and 17% had high risk cardiac source of embolism or sever carotid stenosis with recurrent cererbral ischemic events. The cost of 200 TCD in non-private center was evaluated to be about 10 million thomans. Due to high expenses and low percentage of therapeutic influences, performance of TCD is recommended in a restricted group of patients. However TCD is a safe and non-invasive test for assessment of main cerebral arteries, which provide useful information

[ rare case of primary orbital yolk sac tumour [YST]]

The endodermal sinus tumor [EST] or yolk sac tumor [YST] is a malignant germ cell neoplasm that usually arises in gonads, but on rare occasion occurs in extragonadal sites such as mediastinum, retoperitoneum and intra cranium. Orbit is an extremely rare location for this tumor. In this report a primary yolk sac tumor in the orbit of a 17 months old child is presented. Patient had a rapidly progressive proptosis and high level of serum alpha fetoprotein [12500 IU/ml]. After surgical biopsy and histopathological diagnosis, the patient treated with 4 courses of a 3 drugs chemotherapeutic regimen. A period of 6 months follow up did not reveal any sign of recurrence. Although yolk sac tumor is very rare in orbit, a rapid and correct histopathological diagnosis in conjuction with immunohistochemical and other paraclinical evaluation and at last, effective chemotherapeutic regimens can provide a good prognosis and even cure for the patient

Chronic meningitis in acute promyelocytic leukemia [a case report]

The occurrence of extramedullary disease [EMD] at presentation or at relapse has long been considered a rare event in Acute Promyelocytic Leukemia [APL]. Our purpose from recent reports of EMD at presenting in APL have raised increasing concern about one of causes of chronic meningitis. This study describe a case of acute promyelocytic leukemia [APL] in 25 years old female patient admitted in Emam Reza hospital, presenting with severe headache and vomiting and showed signs of meningeal irritation as well as papilledema. Cytocentrifuge examination of CSF showed an excess of promylocytes, but peripheral blood didn't show any abnormal cell or blasts where as BMA showed increase of promyelocyte with multiple auer rod. After 2 weeks of aleukemic phase, this patient developed hematologic picture of APL diagnosed myeloid origin cells with myelopperoxidase stain. She was diagnosed as having leukemic meningitis and after 3 weeks in spite of chemotherapy, she dead Leukemic relapse or first presentation of leukemia may be the etiology of aseptic meningitis. Rarely central nervous. system leukemia and leukemic meningitis are associated with normal bone marrow and sometimes patients at Aleukemic phase present with meningitis. therefore we suggested that in patients with aseptic meningitis cerebrospinal fluid cytospine smear should be evaluated for neoplasic and leukemic cells

[Comparing the prevalence of mast cells out the stroma of basal cell carcinoma and control group]

Basal cell carcinoma is the most frequently observed neoplasm of human skin. Many genetic and environmental factors contribute to pathogenesis of skin. It is shown that mast cell-derived histamine is an important mediator of systemic immunomodulation caused by UVB. The aim of this study was to compare the prevalence of dermal mast cells in BCC patients and control subjects with not inflammatory lesions in sunlight exposure site. Biopsy samples from sun-exposed skin were obtained from 40 BCC patients and 10 control subjects. Histological sections were prepared using H and E and Giemsa stains. Mast cells were counted in the whole specimen and mean number of mast cells per high power field [x40] was determined. We found a significant increase in the number of peritumoral mast cells comparing those in control group. [p< 0.001, student t-test] No significant association was found between the frequency of mast cells and age or gender. The association between high dermal mast cell prevalence and BCC development support for the concept that mast cells may be important to UVB-induced systemic immunosuppression in human. The results can be used as the baseline for future studies and development of new methods for medical treatment leading to prevention, suppressing the development and invasion, or eventually elimination of the tumor

[ case of polypoid sygmoid endometriosis like to colon cancer]

Ntestinal endometriosis is a rare but clinicaly significant complication. The most commonlly involved sites are the rectosigmoid and rectovaginal septum. Although serosal involvement is not uncommon in women of child bearing age. The mucosal involvement is rare and differential diagnosis from colon cancer may be difficult due to the lack of pathogonomonic symptoms and the poor diagnostic yield of colonoscopy and colonic biopsies. We present a case of a 31-year young woman with sigmoid endometriosis is presented with rectal bleeding in which the initial diagnostic workup suggested colon cancer. Histological evidence obtained from a colonoscopy along with clinical history Led to the final diagnosis of intestinal endometriosis

[Epithelial mesothelioma with desiduoid features a case report]

Deciduoid mesothelioma is an unusual morphologic variant of epithelial mesothelioma that closely simulate peritoneal decidusis, florid mesothelial hyperplasia and peritoneal metastatic carcinoma. We reported a rare case of epithelial mesothelioma with deciduoid features in a 12 years old girl with abdominal tightness and swelling and weight loss without history of asbestos exposure. CT scan and Sonography showed severe ascitis and multiple masses in peritoneal cavity. In the time of surgery very much fluid was evacuated and a multicystic huge mass occupying the pelvis was resected. In histopathologic examination malignant desiduoid epithelial neoplasm with psammoma bodies was seen which cells were positive for Vimentin, Cytokeratin, EMA, Calretinin

[Detection of HTLV-1 genome in primary gastrointestinal lymphomas: A study on 22 years [1981- 2003] pathology archive biopsy specimens in Imam Reza Hospital, Mashhad, Iran]

Non-Hodgkin's lymphoma [NHL] with primary gastrointestinal localization [GI-NHL] represents only 1-4% of the malignant tumors in the gastrointestinal tract. However, the gastrointestinal tract is the most common extra nodal site of NHL. The etiology of GI-NHL remains unknown, however, recent studies have shown that infection with viruses like HTLV-I in the gastrointestinal tract may increase the risk of T cell NHL. The present study was designed to investigate the presence of HTLV-1 genome using PCR on paraffin embedded tissue of primary GI-NHL specimens diagnosed during the period from 1981 to 2003 in the Department of Pathology, Imam Reza Hospital, Mashhad, Iran. The total number of biopsies was 103, 573; and 65 cases with primary GI-NHL were found. All these 65 specimens were stained with Immunohistochemical markers such as LCA, CD20 and CD3. The presence of HTLV-1 genome was detected in 48 selected patients using tax, LTR, pol and eny [GD21] primers. Our results show that male to female distribution was 1.5: 1. Most of the patients were in their second of third decades of life. Eight patients [12.3%] had primary lymphoma in the stomach, 52 [80%] in the small intestine, two [3%] in the large intestine, and three [4.7%] patients had multifocal involvements [Ileocecal]. According to the Revised European-American Lymphoma [REAL] classification, IPSID Lymphoma was the most frequent histologic subtype, comprising 40% of the cases. Sixty-four cases were classified as B cell lymphomas, and one as T-cell lymphoma. Out of 48 specimens which were amplified using PCR, two [4.2%] were positive for HTLV-1. The first case was a 55-year old male with diffuse pleomorphic T cell lymphoma who had a lesion in stomach; and the second case was a 15-month-old female with IPSID lymphoma who had involvement at duodenum