Pure testicular choriocarcinoma with gastrointestinal metastasis and paraneoplastic symptoms: a case report.

BACKGROUND: Pure testicular choriocarcinoma is a rare type of non-seminomatous germ cell tumor extremely poor prognostic with the tendency to bleed at the metastatic site. At the time of the diagnosis, 70% of patients have metastatic lesions. Depending on the site of the metastasis, symptoms vary. Gastrointestinal involvement is seen in less than 5% of cases, mostly in the duodenum. CASE PRESENTATION: We present a 47 years old male with testicular choriocarcinoma involving the jejunum, lung, liver, and kidney presenting with acute abdominal pain, melena, and dyspnea with some paraneoplastic symptoms. The patient had increased, severe and constant pain in the right lower quadrant for the previous four days. Additionally, he was complaining of nausea, vomiting, anorexia, and a history of melena for the last 10 days. Dyspnea on exertion, hemoptysis, and dry cough were the symptoms he was suffering from, for almost one year. The patient's general appearance was pale, ill, and thin with 10 kg of weight loss during the last some months. The computed tomography (CT) scan reported multiple metastatic lesions in both liver lobes and the left kidney. Pathologic study of the samples of small bowel lesions showed metastatic choriocarcinoma. Following the patient had been referred to an oncologist to start the chemotherapy regime. Finally, the patient has expired after 40 days of his first admission. CONCLUSIONS: Testicular choriocarcinoma is a rare but fatal malignancy among young men. Gastrointestinal metastases are infrequent involvement represented by melena and acute abdominal pain, obstruction, and mass. Physicians should consider it as a differential diagnosis for acute abdomen and gastrointestinal bleeding causation.

Occurrence of microsporidia spp. infection in children with diarrhea in southern Iran.

Microsporidia spp. are recognized emerging zoonotic microorganisms in immunocompromised and immunocompetent populations. Therefore, we conducted a study to investigate the occurrence, sociodemographic and risk factors of microsporidia spp. infection using microscopic and molecular techniques in children with diarrhea in Jahrom city (Fars province, southern Iran). Stool samples were gathered from 395 children aged ≤ 14 years between January 2017 and January 2018. Next, a questionnaire includes the age, sex, living area, immune system status, breast milk consumption, contact with animals, and type of water source was completed for all children. For microscopic assessment, modified acid-fast trichrome staining was applied for detection of microsporidia spores. Furthermore, DNA extraction and PCR were accomplished for all samples. A total of 15 (3.79%; 95% confidence interval [CI] 2.14-6.19) and 8 (2.02%; 95% CI 0.88-3.95) samples were positive for microsporidia infection by microscopic and molecular techniques, respectively. Although none of the sociodemographic and risk factors were significant (p value > 0.05), the prevalence of this infection was higher in some variables (e.g., rurality, contact with animals and well water consumption). Three random samples were sequenced that all isolates belonged to Enterocytozoon bieneusi. Cognizance of microsporidia occurrence, risk factors, and disease disorders for the health specialists, physicians, children's families are important for appropriately control the infection.

EBV seroepidemiology in married and unmarried women and men in Iran.

BACKGROUND: Among the eight known human herpes viruses, Epstein- Barr virus (EBV) is considered to be sexually transmissible. This study was conducted to evaluate the seroepidemiology of this infection in married and unmarried Iranian couples. METHODS: In this comparative observational and cross-sectional study, 160 men and women were divided into married and unmarried groups. Serum IgG and IgM antibodies to the EBV viral capsid antigen were analyzed by Enzyme-linked Immunosorbent Assays (ELISAs). RESULTS: In this study 78 men and 82 women were enrolled. Ninety percent of the married and 76.2% of the unmarried women were anti-EBV IgG positive (P = 0.08), while 80% of the married and 94% of the unmarried men were antiEBV IgG positive (P = 0.052). CONCLUSION: Seroepidemiology of EBV is not significantly different in married vs. unmarried women and men in Iran; therefore, sexual contact may not be the primary mechanism of EBV transmission in Iran and other developing countries. Attention to other possible routes of transmission is recommended.

Cutaneous leishmaniasis associated with visceral leishmaniasis in a case of acquired immunodeficiency syndrome (AIDS).

INTRODUCTION: Leishmania/human immunodeficiency virus (HIV) coinfection is emerging as an increasingly frequent and extremely serious new disease. Although many reports have described the association of visceral leishmaniasis and AIDS, cutaneous leishmaniasis associated with AIDS is very uncommon. CASE SUMMARY: We describe a case of visceral leishmaniasis/HIV coinfection associated with cutaneous Leishman body-positive lesions in a patient from Jahrom, a city in Fars province in Iran. CONCLUSION: Our case demonstrated that it is better to evaluate the diagnosis of visceral leishmaniasis in patients who present with cutaneous leishmaniasis and HIV infection.

Brush cytology of colorectal malignancies.

OBJECTIVE: To evaluate the specificity and sensitivity of brush cytology and biopsy in colorectal malignancies. STUDY DESIGN: The study was performed over 3 years, 1998-2000. Seventy-six patients with any colorectal lesion on colonoscopy were selected, and in all of them brush cytology and biopsy were done at the same time. The cytologic smears and biopsies were reviewed separately. The cytologic smears were categorized as negative, suspicious, suggestive or positive for malignancy. The results of cytology and biopsy were compared based on sensitivity and specificity. The gold standard for positive cases was the tissue specimen after surgery; negative cases were followed for at least 1 year. Cases with 1 year of disease-free survival were considered negative. RESULTS: Among 76 cases, 4 were excluded because of unsatisfactory cytologic smears. Of the remaining 72 cases, 31 were male and 41 female. The age range was 19-80 years. Cytology showed 23 positive and 49 negative cases (1 false positive and 3 false negative). Biopsy showed 24 positive and 48 negative cases (no false positives and 1 false negative). There were 47 negative cases, followed for at least 1 year, and after that we considered them definitively negative for malignancy. Sensitivity of cytology and biopsy was 88% and 96%; specificity was 98% and 100%, respectively. Combined use of brush cytology and biopsy had the highest sensitivity, 100%. CONCLUSION: Brush cytology of the colon is a safe, fast and reliable method for the diagnosis of colorectal cancer. We recommend performing it in conjunction with biopsy. It is also reasonable to perform a repeat biopsy in patients with negative biopsy and positive cytology for a definitive diagnosis.