A nested variant of urothelial carcinoma of the urethra and urinary bladder: A case report and review of literature.

Nested variant of urothelial carcinoma (NV-UC) is an extremely rare cancer with a nonspecific presentation. It is usually identified at a late stage, which makes the treatment challenging. Herein we report the case of a 52-year-old woman with an advanced NV-UC treated by anterior exenteration after a poor response to neoadjuvant chemotherapy. One year after completion of adjuvant radiotherapy, the patient remains disease-free.

Design and characterization of adipose-derived mesenchymal stem cell loaded alginate/pullulan/hyaluronic acid hydrogel scaffold for wound healing applications.

Recently, significant attention has been focused on the progression of skin equivalents to facilitate faster wound healing and thereby skin restoration. The main aim of this study was the design and characterization of a novel polysaccharide-based hydrogel scaffold by using alginate, pullulan, and hyaluronic acid polymers to provide an appropriate microenvironment to deliver Adipose-derived mesenchymal Stem Cells (ASC) in order to promote wound healing in an animal model. Characterization of synthesized hydrogel was done by using a field emission scanning electron microscope (FE-SEM), Fourier Transform-Infrared spectroscopy (FT-IR), and Differential Scanning Calorimetry (DSC). Also, contact angle analysis, the swelling and mechanical tests were performed. As a result of in vitro studies, cells can be attached, alive, and migrate through the prepared hydrogel scaffold. Finally, the therapeutic effect of the cell-seeded hydrogels was tested in the full-thickness animal wound model. Based on obtained results, the hydrogel-ASC treatment improved the healing process and accelerated wound closure.

Direct Smear Versus Liquid-Based Cytology in the Diagnosis of Bladder Lesions.

BACKGROUND & OBJECTIVE: Urine cytology is an important diagnostic method for urinary tract cancers (especially carcinomas), which is suitable for follow-up of residual urothelial tumors after surgery of malignant bladder tumors. Liquid-based cytology (LBC) was used for the first time in cervical cytology Compared to direct smear cytology (DSC), LBC reduced background elements (including cellular debris, inflammatory cells, and blood cells), provided better cell preservation, and had a higher satisfaction rate. In this study, we performed two different methods (DSC and LBC) to detect bladder lesions; also, we determined the sensitivity and specificity of these methods. METHODS: A total of 146 samples were taken from patients with suspected bladder cancer and processed for direct smear and LBC. In both methods, findings were reported according to the Paris System. Then, patients underwent cystoscopy and biopsy. Next, the accuracy of cytology methods was evaluated according to biopsy reports. The sensitivity and specificity of these methods were also calculated. RESULTS: Credit indices obtained for the direct smear method included sensitivity (62.5%), specificity (89%), positive predictive value (89.5%), and negative predictive value (91.5%). For LBC methods, credit indices included sensitivity (85.7%), specificity (99%), positive predictive value (96%), and negative predictive value (96%). Agreement between the two methods was statistically significant (P<0.000) in negative biopsies but not in positive biopsies (P>0.05). CONCLUSION: This study showed that LBC has higher sensitivity and specificity than the direct smear.

Rare Case of Small Cell Metastatic Prostatic Adenocarcinoma, Properly Staged by 68Ga-PSMA PET/CT Scan.

ABSTRACT: Small cell carcinoma (SCC) of the prostate is a very rare entity and one of most aggressive neuroendocrine malignancies of prostate. We present a 60-year-old man with pathology-proven prostatic SCC by transrectal biopsy with ultrasonography guidance and Gleason score of 5 + 5. He was referred to perform 68Ga-PSMA PET/CT scan for staging. The scan showed PSMA uptake in the prostate bed and multiple large pelvic lymph nodes. As we know, 68Ga-PSMA uptake in the de novo form of SCC of prostate is not commonly found in the literature.

Polyomavirus Associated Nephropathy: Frequency and Graft Survival Analysis in Northeast of Iran.

BACKGROUND & OBJECTIVE: Polyomavirus-associated nephropathy (PVAN), mainly caused by the BK virus, is one of the most important infectious complications of kidney transplantation. The leading histopathologic characteristics of PVAN is viral cytopathic effects, such as nucleomegaly with smudged or clumped chromatin and intranuclear ground-glass inclusion, mostly in tubular epithelial cells. Moreover, tubular necrosis, tubulitis, interstitial inflammation, atrophy, and fibrosis have been noted. Positive immunohistochemistry (IHC) staining for SV-40 highlights the infected epithelial cells of renal tubules. METHODS: A total of 85 core needle biopsies of transplanted kidneys were evaluated histologically and were stained for SV-40 using the IHC method. In addition, a follow-up of graft failure was performed. RESULTS: Our findings revealed that the frequency of polyomavirus infection in kidney transplant patients in the Northeast of Iran is 4.7%. There was no significant correlation between PVAN and graft rejection. Although a higher rate of graft loss was observed in PVAN patients, in comparison with non-PVAN patients (25% vs. 14.8%), the difference was not statistically significant. Moreover, patients with immunohistochemically confirmed PVAN and those with histopathologic features of viral-like cytopathic effects had significantly lower graft survival in the follow-up period (42.5 vs. 196.8 months and 109.4 vs. 205.7 months, respectively). CONCLUSION: The frequency of polyomavirus infection in kidney transplant patients in the Northeast of Iran is 4.7%. There was no significant correlation between PVAN and graft rejection. Furthermore, we observed that polyomavirus infection accelerates the course of graft loss.

The relation between zero-time pretransplant deceased donor renal biopsy and kidney transplant survival.

INTRODUCTION: There are several investigations about preimplantation biopsy results in alive donors. However, assessment of the biopsies in deceased donors' kidney and its correlation with patient survival is limited. In this study, we evaluated the correlation between zero-time pretransplant kidney biopsy and survival of kidney in deceased donors. PATIENTS AND METHODS: This was a cohort study conducted at Montaserieh Hospital, Mash-had, between January 2016 and December 2017. We included all brain dead patients who were referred to Montaserieh transplantation center. After vascular anastomosis of kidneys in recipient patients, in the operation room, and de-clumping of vessels, biopsies were taken from upper pole of donated kidney. Blocks of biopsies were evaluated by expert pathologists and then reported. We followed patients for 1 year and compared the pathologic findings and renal survival in them. RESULTS: The mean age of deceased donors was 32.32±1.49 years and that of the recipient patients was 36.33±1.27 years. Thirty-eight recipient patients (45.2%) were female and 46 were male (54.8%). The most pathologic pattern in our study was grade I separation, followed by blebs, dilatation, and loss of attenuation. We showed that most of the transplantations were safe after 1-year follow-up (85.7%) without any complications. We observed thrombosis in two cases (2.4%) and rejection of transplantation in ten patients (11.9%). Cox regression analysis showed that end-stage renal disease grade (HR =3.84, 95% CI =2.315-6.348; P<0.0001) and gender of the deceased donors (HR =0.34, 95% CI =0.145-0.797; P=0.013) were related to graft survival rate. CONCLUSION: Only cast feature in pathologic exam was related to graft survival, which is a marker of tissue ischemia. There was no significant correlation between other histological findings and graft survival.

Amelioration of regulatory T cells by Lactobacillus delbrueckii and Lactobacillus rhamnosus in pristane-induced lupus mice model.

Regulatory T cells (Tregs) play an indispensable role in the control of immune responses and induction of peripheral tolerance. Dysregulation of Tregs is involved in the pathogenesis of systemic lupus erythematosus (SLE). Tolerogenic probiotics have shown beneficial effects in the control of autoimmune diseases. We evaluated the prophylactic and therapeutic effects of Lactobacillus delbrueckii and Lactobacillus rhamnosus on Tregs and their related molecules in pristane-induced lupus mice model. Fifty-four female BALB/c mice (3-5 weeks) were randomly divided into nine groups. Lupus was induced in all groups using pristane. Prophylactic groups were treated from Day 0 (at the time of pristane injection) and treatment groups were treated 2 months later with L. rhamnosus, L. delbrueckii, mix of both probiotics, and prednisolone. One group was considered as SLE-induced control group without any treatment. Presence of antinuclear antibodies (ANA), antidouble-stranded DNA (anti-dsDNA), antiribonucleoprotein (anti-RNP), proteinuria, and serum level of creatinine, urea, the expression of forkhead box P3 (Foxp3), interleukin 6 (IL-6), IL-10, transforming growth factor ß, and the number of Tregs were determined. SLE induction by pristane led to the formation of lipogranuloma, presence of ANA, anti-dsDNA, and anti-RNP. Probiotics consumption decreased the level of lipogranuloma, ANA, and anti-dsDNA. In addition, in probiotics receiving groups, Tregs and the expression level of Foxp3 increased, while IL-6 decreased. The effect of probiotics in the prophylactic group was more prominent. The results may indicate the effectiveness of L. delbrueckii and L. rhamnosus in the enhancement of Tregs and the decrease of inflammatory cytokines and disease severity in SLE-induced mice.

Assessment of clinicopathologic features in patients with pituitary adenomas in Northeast of Iran: A 13-year retrospective study.

BACKGROUND: Intracranial lesions of the pituitary gland are common pituitary adenomas, accounting for 6-10% of all symptomatic intracranial tumors. In this retrospective study, the clinicopathologic features and survival rate of pituitary adenomas were evaluated. METHODS: The present retrospective study was conducted on 83 patients with pituitary adenomas, referring to radiation oncology departments of Ghaem and Omid Hospitals, Mashhad, Iran, over a period of 13 years (1999-2012). Data obtained from clinical records including clinical features, type of surgery (if performed), treatment modality, overall survival rate, and progression-free survival rate were analyzed. RESULTS: Eighty-three patients including 44 males (53%) and 39 females (47%) participated in this study. The median age was 40 years (age range: 10-69 years). Chiasm compression was reported in 62 patients (74.4%), and 45.78% of the subjects suffered from headaches. Functional and non-functional adenomas were reported in 44 (53.01%) and 39 (46.99%) patients, respectively. In cases with functional and non-functional adenomas, the disease was controlled in 95 and 84.5% of the subjects for 3 years, respectively. Furthermore, 1- and 3-year survival rates for functional adenoma were 84.6 and 23%, respectively; the corresponding values were 90.9 and 22.7% in non-functional adenomas, respectively. CONCLUSION: In this study, a significant correlation between headache severity and type of adenoma was observed. So, application of surgery and radiotherapy together could be a highly effective approach for treating functional adenomas, although it is less efficient for the non-functional type.

p63 is more sensitive and specific than 34ßE12 to differentiate adenocarcinoma of prostate from cancer mimickers.

OBJECTIVES: Prostate cancer is the world's leading cause of cancer and the second cause of cancer-related death in men after lung cancer. Differentiation of prostate adenocarcinoma from benign prostate lesions and hyperplasia sometimes cannot be done on the basis of morphologic findings. Considering the fact that in the prostate adenocarcinoma there is no basal cell layer, basal cell markers can help to differentiate prostate adenocarcinoma from cancer mimickers. MATERIALS AND METHODS: We studied 98 prostate biopsy blocks (40 adenocarcinoma and 58 benign lesions) for basal cell marker expression. RESULTS: p63 and 34ßE12 were negative in all prostate adenocarcinoma specimens, but all benign prostate hyperplasia and high grade intraepithelial neoplasia cases expressed them. CONCLUSION: Basal cell markers can help to distinguish prostate adenocarcinoma from cancer mimickers.

Primary malignant chest wall tumors: analysis of 40 patients.

BACKGROUND: Primary chest wall tumors originate from different constructions of thoracic wall. We report our multidisciplinary experience on primary thoracic tumor resection and thoracic reconstruction, the need to additional therapy and evaluating prognostic factors affecting survival. METHODS: We performed a retrospective review of our prospectively maintained database of 40 patients treated for malignant primary chest wall tumor from 1989 to 2009. Patients were evaluated in terms of age, sex, clinical presentation, type of imaging, tissue diagnosis methods, pathology, surgical technique, early complications, hospital mortality, prevalence of recurrence and distant metastases, additional treatment, 3 years survival and factors affecting survival. RESULTS: Male/Female (F/M) = 1, with median age of 43.72 years. Mass was the most common symptoms and the soft tissue sarcoma was the most common pathology. Resection without reconstruction was performed in 5 patients and Thirty-five patients (87.5%) had extensive resection and reconstruction with rotatory muscular flap, prosthetic mesh and/or cement. Overall, 12.5% (5/40) of patients received neoadjuvant therapy and 75% (30/40) of patients were treated with adjuvant therapy. The 3-year survival rate was 65%. Recurrences occurred in 24 patients (60%), 14 developed local recurrences, and 10 developed distant metastases. The primary treatment modality for both local and distant recurrences was surgical resection; among them, 10 underwent repeated resection, 9 adjuvant therapy and 5 were treated with lung metastasectomy. The most common site of distant metastasis was lung (n = 7). Factors that affected survival were type of pathology and evidence of distant metastasis. CONCLUSION: Surgery with wide margin is the safe and good technique for treatment of primary chest wall tumors with acceptable morbidity and mortality.

Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer during pregnancy: case report and review of literature.

For pregnant patients with cervical cancer, treatment recommendations are individualized and dependent on the stage of the disease, gestational age at the time of diagnosis, and the patient's desire as to the cosntinuation of the pregnancy. The aim of this study is to describe the outcome of neoadjuvant chemotherapy with radical surgery and pelvic lymphadenectomy in a woman with cervical cancer who wished to maintain her pregnancy. This is a report of a 26-week pregnant woman with locally advanced cervical cancer stage I(b2) (FIGO) who was successfully treated with neoadjuvant chemotherapy Paclitaxel plus platinum, followed by C/S and radical surgery. Her neonate was healthy and had no abnormalities. This case was the first cervical cancer during pregnancy that was treated using this method at the tumor clinic, Mashhad University of Medical Sciences, Iran. Neoadjuvant chemotherapy is an effort to allow time for the fetal to reach viability by preventing the progression of the disease.

Expression of Bcl-2 and Bax in advanced or metastatic prostate carcinoma.

PURPOSE: To evaluate the correlation of Bcl-2 and Bax protein expressions with biochemical failure-free survival in patients with advanced or metastatic prostate carcinoma (PCa) undergoing androgen deprivation therapy. MATERIALS AND METHODS: This retrospective study was performed on patients with locally advanced (≥ T3) or metastatic PCa, who were referred to Omid Hospital between years 2003 and 2007. All subjects had undergone androgen deprivation therapy. Samples were analyzed immunohistochemically for Bax and Bcl-2 expression. The H-score was calculated for each sample based on intensity and percentage of stained cells. H-score > 50 was considered positive. RESULTS: Thirty-seven patients (13 metastatic and 24 locally advanced) were eligible for analysis. Thirty-six (97.3%) samples were positive for Bax and 26 (70.3%) for Bcl-2 expression. The median H-score for Bax and Bcl-2 was 200 (range, 40 to 300) and 85 (range, 0 to 220), respectively. While there was no correlation between Bax expression and Gleason score, high Bcl-2 expression (H-score > 85) was significantly associated with Gleason score > 7 (P = .004). The median time to progression in the advanced and metastatic groups was 22 (range, 10 to 37) months and 16 (range, 9 to 26) months, respectively. High Bcl-2 expression (P = .01) and prostate-specific antigen > 20 ng/mL (P = .01) were significant predictors of lower biochemical progression-free survival. CONCLUSION: High Bcl-2 expression was associated with higher Gleason scores and lower biochemical-free survival in patients with advanced PCa undergoing androgen deprivation therapy.

P53 overexpression in bladder urothelial neoplasms: new aspect of World Health Organization/International Society of Urological Pathology classification.

INTRODUCTION: The aim of this study was to investigate the probable differences in P53 expression between papillary urothelial neoplasm of low malignant potential (PUNLMP) and varying grades of transitional cell carcinoma (TCC) of the bladder. MATERIALS AND METHODS: Ten biopsy specimens of the patients with PUNLMP, 20 of the patients with papillary low-grade TCC, 20 of those with invasive high-grade TCC, and 10 of healthy individuals were stained for P53 protein by immunohitochemical methods. Histological grading was performed according to the World Health Organization/International Society of Urological Pathology consensus classification of urothelial neoplasms of the urinary bladder. RESULTS: Nuclear P53 protein in invasive high-grade TCC was slightly more frequent than that in noninvasive low-grade papillary TCC (P = .35). Ten percent of specimens with PUNLMP had nuclear P53 accumulation, while in low-grade and high-grade TCCs, 75% and 85% of the specimens were positive for P53 protein accumulation (P < .001). Expression of P53 was nil in all normal transitional epithelium specimens. CONCLUSION: Overexpression of P53 in papillary low-grade TCC and invasive high-grade TCC, while lacking of expression in PUNLMP indicates that mutations of P53 gene are not usually associated with the development of urothelial neoplasms and they may play a crucial role only in progression of PUNLMP to low-grade TCC.