effect of prostate tissue inflammation in benign prostatic hyperplasia on enhancer of zeste homolog 2 ribonucleic acid expression

Enhancer of zeste homolog 2 [EZH2] has been recently found to regulate several genes involved in immunoresponse and autocrine inflammation network. The aim of the study was to quantitate EZH2 messenger ribonucleic acid [mRNA] expression, evaluate its relation to conditions of prostatitis associated with benign prostatic hyperplasia [BPH], and correlate it with the levels of the inflammatory marker interlukin 6 [IL-6]. Cross-sectional study in Middle Eastern men with BPH and prostatitis or BPH only. Transrectal ultrasound-guided prostate biopsies were collected from 106 patients suspected of having prostate cancer; however, the histology revealed BPH. Upon further pathological examination, 56 of these cases were identified as BPH with prostatitis and classified as: acute prostatitis [n=13]; active chronic prostatitis [n=32]; and, chronic inactive prostatitis [n=12]. Serum IL-6 levels and EZH2 mRNA expression were measured and compared between patient groups. EZH2 mRNA was overexpressed in BPH with prostatitis patients compared to BPH only patients [P<.0001]. BPH with active chronic prostatitis had higher EZH2 expression than BPH with acute or chronic inactive prostatitis compared to BPH only [P=.05 and .73, respectively]. EZH2 mRNA expression showed a negative correlation with IL-6 concentrations in BPH with prostatitis patients [rs=-0.31, P=.02]. EZH2 overexpression was associated with an increased risk of having BPH with prostatitis [crude odds ratio 0.20, 95% CI 0.06-0.65, P=.0076]. EZH2 mRNA expression correlates positively with prostatitis conditions associated with BPH and negatively with serum IL-6 levels. This supports the possible involvement of EZH2 mRNA overexpression in the development of prostate inflammation, and its new regulatory role in suppressing the expression of some inflammatory network genes

Urinary survivin mRNA expression and urinary nuclear matrix protein 22 BladderChek[R] and urine cytology in the detection of transitional cell carcinoma of the bladder

To compare the diagnostic performance of urine cytology [UC], survivin mRNA expression, and the NMP22 BladderChek[R] [NMP22BC] test for the detection, grading and staging of transitional cell carcinoma [TCC] of the bladder. Voided urine samples collected from 25 healthy controls and 80 patients diagnosed with TCC of the bladder were subjected to UC, the NMP22BC test and reverse-transcription real-time PCR for survivin mRNA expression. Survivin mRNA expression showed the highest sensitivity [87.5%] followed by the NMP22BC test [61.3%] while UC exhibited the lowest sensitivity [40%]. All three urine markers had a similar specificity of 96% [95% CI 80.5-99.3%]. Survivin mRNA expression was the only urine marker that showed a significant difference in relation to tumour histological grade [X[2] 8.5, p = 0.015]. None of the three urine markers was significantly related to tumour pathological stages. The diagnostic sensitivity of urinary urviving mRNA expression was superior to that of UC and the NMP22BC test and correlates with tumour pathological grade but not stage

Survivin downregulation is associated with vasectomy-induced spermatogenic damage and apoptosis

To evaluate the expression of the apoptotic genes survivin, Bax and Bcl-2 in vasectomized rabbits and to determine their relation with vasectomy-induced spermatogenic impairment and germ cell apoptosis. Twelve adult rabbits [6-12 months old] were divided into three groups: sham control, unilateral vasectomy or bilateral vasectomy. Six months after vasectomy, testicular tissue was analyzed for germ cell apoptosis and DNA fragmentation by the TUNEL assay and gel electrophoresis, respectively. Spermatogenesis was assessed using the Johnsen score. The relative gene expression of survivin, Bax and Bcl-2 was measured using reverse transcription followed by reAl time PCR. Compared to sham animals, a significant decrease in testicular survivin mRNA levels was measured in the two vasectomy animal groups [p<0.05]. This was accompanied by a significant increase in the Bax:Bcl-2 ratio in the vasectomized animals [p<0.05]. In addition, these data showed positive correlation with enhanced apoptotic index, damage to spermatogenesis and DNA fragmentation after vasectomy. These findings demonstrate that vasectomy-induced damage to spermatogenesis due to testicular apoptosis may be associated with survivin downregulation and Bax overexpression

Granulomatous inflammatory response in a case of typhoid fever

To present a case of culture-proven typhoid fever in which granulomas were demonstrated histologically in the ileum and mesenteric lymph nodes. A 47-year-old Pakistani man underwent emergency hemicolectomy for severe bleeding per rectum associated with diarrhea. Two large ulcers in the ileum, near the ileocolic junction, as well as mesenteric lymph nodes showed both necrotizing and non-necrotizing granulomas in addition to mixed inflammatory infiltrate on histology. Typhoid fever may be considered as one of the causes of the differential diagnoses of granulomatous inflammation of the small intestine

Indications of the mechanisms involved in improved sperm parameters by zinc therapy

To determine possible indications of the mechanisms involved in improved sperm parameters by zinc therapy in asthenozoospermic men. Forty-five men with asthenozoospermia [>/= 40% immotile sperm] were randomized into four therapy groups: zinc only: n = 11; zinc + vitamin E: n = 12 and zinc + vitamins E + C: n = 14 for 3 months, and non-therapy control group: n = 8. Semen analysis was done according to WHO guidelines. Malone dialdehyde, tumour necrosis factor-alpha [TNF-alpha], total antioxidant capacity, superoxide dismutase [SOD] and glutathione peroxidase were determined in the semen and serum. Antisperm antibodies IgG, IgM and IgA were evaluated by immunobeads. Sperm chromatin integrity was determined by acid denaturation by acridine orange and sperm apoptosis by light and electron microscopy. The effect of zinc on in vitro induced sperm oxidative stress by NADH was evaluated. Asthenozoospermia was significantly associated with oxidative stress with higher seminal malone dialdehyde [8.8 vs. 1.8 mmol/l, p < 0.001] and TNF-alpha [60 vs. 12 pg/l, p < 0.001], and low total antioxidant capacity [1.8 vs. 8.4, p < 0.01], SOD [0.8 vs. 3.1, p < 0.01] and glutathione peroxidase [1.6 vs. 4.2, p < 0.05], compared to normozoospermia. Zinc therapy alone, in combination with vitamin E or with vitamin E + C were associated with comparably improved sperm parameters with less oxidative stress, sperm apoptosis and sperm DNA fragmentation index [DFI]. On the whole, there was no difference in the outcome measures between zinc only and zinc with vitamin E and combination of vitamins E + C. In the in vitro experiment zinc supplementation resulted in significantly lower DFI [14-29%, p < 0.05] compared to zinc deficiency. Zinc therapy reduces asthenozoospermia through several mechanisms such as prevention of oxidative stress, apoptosis and sperm DNA fragmentation

Experimental colitis is associated with ultrastructural changes in inflamed and uninflamed regions of the gastrointestinal tract

The objective of this study was to examine theultrastructural changes in cell organelles such as mitochondria, endoplasmic reticulum [ER] and Golgi apparatus in inflamed colon and uninflamed ileum in colitic rats. Colitis was induced in rats by intracolonic administration of trinitrobenzenesulfonic acid [TNBS]. The animals were sacrificed on day 5 after TNBS administration and colonic and ileal samples were used for estimation of myeloperoxidase [MPO] activity, malondialdehyde [MDA] concentration, histologic examination and transmission electron microscopy. TNBS caused a significant reduction in body weight and an increase in MPO activity in colonic, but not in the ileal samples in animals with colitis. MDA levels were increased both in inflamed colon and the uninflamed ileal segments in colitis. Electron microscopy revealed swelling of mitochondria with broken cristae and disruption of the inner membrane. Colitis also caused fragmentation of the ER with loss of ribosomes and swelling of the Golgi apparatus with distended vesicles in both smooth muscle and epithelial cells in the ileal and colonic segments. These changes were absent in the control rats without colitis. These findings demonstrate ultrastructural deformities in both the mucosa and smooth muscle in inflamed and uninflamed regions of the gastrointestinal tract in experimental colitis. The structural changes in mitochondria are responsible for reduced ATP, while abnormalities in the ER and the Golgi apparatus may explain a generalized effect on protein synthesis, trafficking and targeting mechanisms, and may account for physiological changes seen in experimental colitis

Serum prostate-specific antigen levels in Middle Eastern men with subclinical prostatitis

To investigate the influence of subclinical or histologically diagnosed prostatitis on serum prostate-specific antigen [PSA] in patients investigated for prostatic disease in Kuwait. Serum PSA was assayed in patients investigated for prostatic disease in Mubarak Al-Kabeer Hospital, Kuwait, between December 2002 and December 2004. These included patients undergoing transrectal ultrasound with needle biopsy of the prostate gland and those who were treated with transurethral resection of the prostate or retropubic prostatectomy. The tissue was evaluated for prostatitis as well as the underlying disease, and the type and severity of prostatitis were compared with levels of serum PSA. Of the 331 tissue specimens, 18 [5.4%] did not show prostatitis, while 233 [70.4%] with benign prostate and 80 [24.2%] with malignant prostate disease showed prostatitis. Of 270 men with known serum PSA levels, 198 and 72 had benign and malignant prostate disease, respectively. Of the 198, 77 [41%] with benign prostate disease and prostatitis and of the 72, 52 [76%] with malignant prostate disease and prostatitis had serum PSA levels >10 ng/ml. The data showed that although raised serum PSA is more commonly associated with prostate cancer, subclinical prostatitis is a significant source of high serum PSA in over 40% of men in Kuwait. That local factors may obscure the usefulness of serum PSA as a screening tool suggests the need for a locally applicable paradigm to identify prostate cancer

BRCA 1 gene expression in breast cancer in Kuwait: correlation with prognostic parameters

This study assessed the BRCA1 gene expression in breast cancer in Kuwait, and compared it with other known prognostic factors for the disease. Materials and Forty-eight random samples of archival paraffin-embedded breast cancer tissues were studied for BRCA1 gene expression. Immunohistochemical method utilizing antibodies against different epitopes on the BRCA1 protein was used to study BRCA1 protein expression. In addition, for 29 patients, reverse transcription-polymerase chain reaction was used to detect BRCA1 mRNA expression. BRCA1 expression was correlated with age, histological type and grade of breast cancer, estrogen and progesterone receptor status, and C-erbB-2 expression. No demonstrable BRCA1 mRNA and protein expression was found in 79 and 83% of the breast cancer tissues, respectively. A positive relationship was demonstrated between lack of BRCA1 [mRNA and protein] expression and high histological grade, negative estrogen and progesterone receptor status, and overexpression of C-erbB-2 in the breast cancer tissues. Conclusions: The study demonstrated lack of BRCA1 gene expression [mRNA and protein] in the majority of breast cancers in Kuwait and confirmed the inverse relationship between BRCA1 expression and parameters that determine poor prognosis in breast cancer

Role of fine needle aspiration cytology in the diagnosis of swelings in the salivary gland regions: a study of 712 cases

A mass in the salivary gland region often presents a diagnostic challenge with regard to its site of origin [salivary versus nonsalivary], benign or malignant nature, and tissue-specific diagnosis. The present study describes the utility of fine-needle aspiration [FNA] cytology in the diagnosis of these lesions. Subjects and Over a 6-year period [January 1994 to December 1999], 712 patients aged between 6 months and 91 years [median, 37 years] were subjected to FNA of swellings in their salivary gland regions. Male:female ratio was 1.28:1. The swellings were mostly located in the parotid [323 cases], submandibular [343 cases], and upper cervical region [27 cases]. Swellings of oral [5 cases] and sublingual [2 cases] sites were rare. The lesions diagnosed by FNA cytology were compared among the major salivary glands. Cytologic diagnoses were correlated with histology in 45 cases. Benign nonneoplastic lesions were the most common [73%], followed by neoplasms [20%], and those with atypical cytology [1%]. Cytologic material was inadequate in 6% cases. Parotid gland region was involved more frequently by neoplasms [27.1%] than the submandibular gland region [13.7%, p < 0.0001]. Inflammatory processes affected the submandibular gland region more commonly [42.0%] than the parotid [32.6%, p = 0.0164]. Pleomorphic adenoma was the most common neoplasm [61.5%], followed by Warthin's tumor [12.6%]. Malignancies accounted for 10.5% of neoplasms. Frequency of involvement of parotid by Warthin's tumor [16.7%] was significantly higher than that of submandibular gland [2.3%, p = 0.0191]. However, the submandibular gland was more commonly affected by malignancy than the parotid gland [p = 0.0003]. Sensitivity, specificity, and diagnostic accuracy of FNA cytology for all neoplastic lesions of the salivary gland were 94.6, 75.0, and 91.1%, respectively. The corresponding figures for malignancies were 60.0, 95.0, and 91.1%, respectively. FNA cytology is very useful for the diagnosis of salivary gland lesions. However, sampling and interpretation errors may occur. The low specificity for the diagnosis of neoplasms as a whole and the poor sensitivity for malignancies found in our study can be attributed to the relatively small number of benign nonneoplastic and malignancy cases with available histopathologic diagnoses

Giant cell arteritis of the breast

To report a rare case of giant cell arteritis of the breast in a 56-year-old woman. Clinical Presentation and Intervention: The patient presented with tenderness in the upper outer quadrant of the left breast, in the absence of any constitutional symptoms. A diagnosis of giant cell arteritis was made only after surgical wedge excision of the affected breast quadrant. She returned 6 weeks later with tenderness in the upper inner medial quadrant of the same breast, with a raised erythrocyte sedimentation rate. She has since been referred to the rheumatologist for further management. The diagnosis of giant cell arteritis of the breast was made only after pathological examination of the excised breast tissue. This study focused attention on the need to be aware of systemic conditions that may present as localised lesions of the breast and to maintain a high index of clinical suspicion in order to adequately investigate them and perhaps avoid unnecessary radical surgical intervention such as mastectomy

Helicobacter pylori-associated chronic antral gastritis in Kuwait- A histopathological study

In order to study the causal relationship between Helicobacter pylori [HP] and various inflammatory reactions in gastric antral mucosa, we have reviewed 268 endoscopic gastric biopsies in the Department of Pathology of Mubarak Al-Kabeer Teaching Hospital in Kuwait. Of the 219 HP-positive biopsies, 95.4% showed chronic gastritis [CG], 59.8% active chronic gastritis [ACG] and 78.5% lymphoid hyperplasia [LH]. The prevalence of LH, CG or ACG, either alone or in combination, increased with increasing density [grade] of HP colonization, assuming statistical significance for LH and ACG [P<0.05], especially when these changes in Grade 1 HP cases were compared to those of Grades 2 and 3 combined. Moreover, the grade of LH by itself also showed statistically significant correlation [P<0.01] with the grade of inflammation. Our results confirm a causal relationship between HP colonization of gastric mucosa and the various forms of gastritis, and also provide evidence in support of induction of mucosa-associated lymphoid tissue [MALT] by HP, an observation which may have significance in the genesis of gastric MALTomas

Breast cancer in a teaching hospital in Saudi Arabia

Clinical and pathological data of 56 cases of breast cancer in our hospital are presented. Our impression of low case incidence of the disease has been confirmed, even though breast cancer ranks highest of all female malignancies in Saudi Arabia. The disease is common in younger age groups, with over half of the cases presenting late and with advanced disease [Stage III or IV]. Pain as a presenting symptom appeared unusually frequently in this study and possible causes of this pain are discussed

Atrophic gostnitis and intestinol metaplona in helicobocter pyloi-amocioted antrol gostnitis

Although the causal relationship between Helicobacter pylori [H. pylori] infection and chronic gastritis and peptic ulcer disease appears established, the relationship between the organism and gastric carcinoma remains tenuous. We have reviewed 268 gastric antral biopsies from the Department of Pathology, Mubarak Al-Kabeer Hospital, Kuwait, in an attempt to assess the relationship between H. pylori colonizations and the presence of atrophic gastritis and intestinal metaplasia, recognized premalignant lesions of the stomach. H. pylori were found in 219 [81.7%] patients of which 62 [28.3%] had atrophic gastritis and 33 [15.1%] intestinal metaplasia. Both atrophic gastritis and intestinal metaplasia increased with age. The mean age of patients with intestinal metaplasia was about 8 years older than that of patients without intestinal metaplasia. Higher prevalences of both lesions were associated with lower density H. pylori colonization as well as an increasing grade of chronic inflammation. Our results confirm previous findings of a probable causal relationship between H. pylori infection and both atrophic gastritis and intestinal metaplasia. The higher prevalence of these premalignant lesions in older subjects would suggest progressive changes associated with persistent H. pylori infection

Fistula-in-ano: a pathological study

A review of 229 cases of fistula-in-ano in our institution has shown that nonspecific inflammatory tissue lines the majority of tracts. Epithelial lining was present in 50 cases and was encountered proportionately more frequently in subjects under 10 years of age, thus supporting a congenital origin as well as infection of anal glands, earlier proposed by other workers. Intestinal contents may have a role in the foreign body response seen in many cases. Locally endemic infectious conditions do not appear to play a significant role in the cause of the disease

Fetus acardius amorphous

An amorphous variety of the acardiac monster is described with a brief review of the literature. Its rarity is emphasized to our knowledge this is the first documented case in Saudi Arabia. Increased awareness of this condition will aid in its antenatal detection using sonographic techniques especially in the presence of polyhydramnios