IRANIAN JOURNAL OF PATHOLOGY (IJP)
Year:2017 | Volume:12 | Issue:4|Papers Count:14

Background and objective: Langerhans cell histiocytosis (LCH) is a rare histiocytic proliferative disorder of unknown etiology and mainly affects young children. The histological feature is granuloma-like proliferation of langerhans-type dendritic cells. Although the possible role of viruses such as Epstein-Barr virus (EBV, Human Herpes virus-4), Human Herpes virus-6 (HHV-6), Herpes Simplex virus (HSV) types 1 and 2 and Cytomegalovirus (CMV, Human Herpes virus-5) is suggested in the pathogenesis of LCH by some investigators, its exact pathophysiology has not been cleared yet. In this study, we investigated the presence of HSV types 1 and 2 in Iranian children with LCH Methods: In this retrospective study, we investigated the prevalence of presence of HSV types 1 and 2 (in 30 patients with LCH), using paraffin-embedded tissue samples and 30 age and tissue-matched controls (operated for reasons other than infectious diseases) from the Department of Pediatric Pathology, Tehran, Iran, by nested Polymerase Chain reaction method. No ethical issues arose in the study, because only the pathology reports were reviewed and patients were anonymous. Results: We failed to find HSV types 1 and 2 DNA in any of the 30 patients with LCH or the control group. Conclusion: According to our findings, HSV types 1 and 2 do not appear to have any etiologic role in the pathogenesis of LCH in Iranian children. These results are in accordance with previous investigations with negative findings.

Background & objective: Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important nosocomial pathogen which is associated with significant morbidity and mortality, particularly in high-risk populations. Aminoglycoside-modifying enzymes (AMEs) and 16S ribosomal RNA (16S rRNA) methylation are two important mechanisms of resistance to aminoglycosides. The aim of this study was to determine the prevalence of 16S rRNA methylase (armA, rmtA, rmtB, rmtC, and rmtD), and the AME genes [aac(6′ )-Ib, aac(3)-I, ant(3′ ′ )-I, aph(3′ )-I and aac(6')-Id], among clinical isolates of A. baumannii in Tehran, Iran. Methods: Between November 2015 to July 2016, a total of 110 clinical strains of A. baumannii were isolated from patients in two teaching hospitals in Tehran, Iran. Antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standards Institute guidelines. The presence of genes encoding the AMEs and 16S rRNA methylases responsible for resistance was investigated by multiplex polymerase chain reaction. Results: The results showed that colistin was an effective antibiotic and could be used as a last-resort treatment of infections caused by MDR-AB. The resistance rate to aminoglycosides were 100%, 96. 36% and 90. 9% for tobramycin, gentamicin and amikacin, respectively. In this study, AME genes of aac(6′ )-Ib, aac(3)-I and ant(3′ ′ )-I were most prevalent among the isolated strains. Conclusion Markedly high resistance to tobramycin, gentamicin and amikacin was noted in current study. Our results suggested that modifying enzyme genes in conjunction with methylation of 16S rRNA might contribute to aminoglycoside resistance induced in vivo in A. baumannii. Further studies are required to determine the prevalence of the aminoglycoside resistance genes in other hospitals of Iran.

Background & objective: Microarray and next generation sequencing (NGS) data are the important sources to find helpful molecular patterns. Also, the great number of gene expression data increases the challenge of how to identify the biomarkers associated with cancer. The random forest (RF) is used to effectively analyze the problems of large-p and small-n. Therefore, RF can be used to select and rank the genes for the diagnosis and effective treatment of cancer. Methods: The microarray gene expression data of colon, leukemia, and prostate cancers were collected from public databases. Primary preprocessing was done on them using limma package, and then, the RF classification method was implemented on datasets separately in R software. Finally, the selected genes in each of the cancers were evaluated and compared with those of previous experimental studies and their functionalities were assessed in molecular cancer processes. Result: The RF method extracted very small sets of genes while it retained its predictive performance. About colon cancer data set DIEXF, GUCA2A, CA7, and IGHA1 key genes with the accuracy of 87. 39 and precision of 85. 45 were selected. The SNCA, USP20, and SNRPA1 genes were selected for prostate cancer with the accuracy of 73. 33 and precision of 66. 67. Also, key genes of leukemia data set were BAG4, ANKHD1-EIF4EBP3, PLXNC1, and PCDH9 genes, and the accuracy and precision were 100 and 95. 24, respectively. Conclusion: The current study results showed most of the selected genes involved in the processes and cancerous pathways were previously reported and had an important role in shifting from normal cell to abnormal.

Background and objective: Candida albicans (C. albicans) play a significant role in oral mucosal carcinogenesis. It can be identified using various techniques in cytological smears. But, very few studies have been conducted on histopathological sections using calcofluor white M2R under fluorescent microscopy. Additionally, detection and quantification of Candida colonies and its correlation with various grades of oral leukoplakia and oral carcinomas have not been explored much. Methods: The current retrospective study included 80 samples from archives consisting of 60 samples in the study group (10 cases each of mild, moderate, and severe epithelial dysplasia (totally 30) and 30 cases of oral carcinoma). Sections were stained with calcofluor white (CFW) and 10% KOH for the observation under fluorescent microscopy and correlated with different grades of oral leukoplakia and oral carcinomas. Chi-square test was used in SSPS software to study the presence and absence of Candida sp. in different groups. Results: The study groups of oral carcinoma and dysplasia showed a significant association with Candida sp. (P=0). When carcinoma was compared with each grade of dysplasia, except mild dysplasia (P=4. 4E-05), both moderate (P=0. 402195) and severe dysplasia (P=0. 558746) showed an insignificant P-value. When the groups of mild (13. 3%), moderate (30%), and severe (33. 3%) dysplasia were considered independently, the incidence of Candida sp. increased as the grade of dysplasia increased. The number of colonies have been counted and the maximum number of colonies have been observed in carcinoma and the least have been observed in mild dysplasia. Conclusion: A significant association of Candida colonies with epithelial dysplasia and oral cancer was established. Further, CFW was found a promising candidate to identify Candida colonies in tissue sections using fluorescent microscopy.

Background & Objective: Neonatal sepsis is one of the leading causes of mortality in neonatology wards. The aim of this study was to assess sepsis pathogens and antibacterial resistance patterns in a teaching hospital during seven years in Tehran, Iran. Methods: In this retrospective study, all neonates suspected to sepsis and fulfilling the sepsis criteria admitted to NICU ward of Mustafa Khomeini Hospital, Tehran, Iran during 2007 to 2014 were included. Demographic information, blood test results, blood culture results of neonates and antibiogram findings were extracted from their documents. Data was analyzed using SPSS 15. Results: Ninety neonates with positive culture test were included. Fifty-three were male (58. 9%). Thirty neonates were delivered vaginally (33. 3%) and 60 caesarean section (66. 7%). Most bacterial growths in culture were Staphylococcus aureus and E. coli. The rates of resistance for antibiotics like ceftriaxone, cefotaxim and gentamycin were 5%, 30% and 15%, correspondingly. There were 15 cases (16. 7%) with resistance to imipenem. Conclusion: Antibacterial resistance patterns vary in different parts of the world and even within a country, therefore assessing resistance patterns in a region is of great importance for proper management and treatment. Our findings might help physicians for proper selection of antibiotics for treatment of neonatal sepsis.

Background & Objective: Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA), represent serious nosocomial and community infections. Biofilm formation as an important virulence factor may be affected by sub-inhibitory levels of antibiotics. Few studies examined the effects of all therapeutic antimicrobial agents on clinical S. aureus. The current study aimed at observing the inducing and reducing effects of antibiotics, commonly used to treat staphylococcal infections on the production of staphylococcal biofilm. Methods: Four MRSA (1ATCC and 3 clinical) and 1 methicillin-susceptible Staphylococcus aureus (MSSA) strains with biofilm forming ability, evaluated by the Congo red agar (CRA) plate test, were employed. Biofilm formation was measured by crystal violet microtiter plate assay. Cefazolin, rifampicin, vancomycin, oxacillin, clindamycin, cotrimoxazole, minocycline, linezolid, azithromycin, and clarithromycin were added to wells ranging from 0. 06to 128 μ g/mL (1× to 1/1024 MIC dependent on the MIC value of each strain). Results: The current study showed that azithromycin and vancomycin had a significant inducing effect on biofilm formation. In contrast, linezolid, cefazolin, and clarithromycin, and in the second place, clindamycin and minocycline could inhibit the level of biofilm production in the sub-minimal inhibitory concentrations. Conclusion: The findings demonstrated that the biofilm formation as an important virulence factor may be affected by the subinhibitory levels of antibiotics.

Background & Objective: Since the symptoms of Brucellosis are often atypical and nonspecific, using clinical signs alone to diagnose brucellosis is not advised; therefore, the diagnosis relies predominantly on laboratory testing. Currently, molecular, serological, and microbiological methods are used for diagnosis of this disease. In this study we examined ELISA, PCR and serum agglutination (SAT) methods on human patient serum samples. Methods: A total of 100 serum samples were collected from suspected patients. Fifty serum samples gave a positive result with the Wright test. The ELISA method was first employed on all samples for the detection of IgG and IgM antibodies against Brucella. Subsequently, the rapid PCR methodology was used to identify presence of Brucella genome in 500 μ L of each serum sample. The B4/B5 primer pair was used for PCR amplification. Results: Out of the 100 serum samples obtained from patients with suspected brucellosis, 50 samples tested positive by SAT and displayed high titers of 1/160. Of these 50 positive samples, 49 samples were positive as per the ELISA test whereas one sample tested negative. The PCR test was conducted on all 100 serum samples and results showed that the 45 serum samples that gave a positive agglutination test were also positive by PCR. Conclusions: Various laboratory methods have been used or introduced for the detection of Brucella. Molecular methods such as PCR, a rapid and sensitive method for detection of bacteria, have also been reported. Based on the results of this study, we propose that the simultaneous use of serology and molecular techniques has the potential to overcome limitations of detection thereby enabling the selection of appropriate treatment for the patient.

Background and Objectives: Since the fluoroquinolones are the broad-spectrum antibiotics, they affect both Gram-negative and Gram-positive bacteria. These antibiotics are widely prescribed by physicians. As a result, some bacteria, especially Enterobacteriaceae, have shown a resistance to this family of antibiotics. The current study aimed at detecting the frequency of qnrA, qnrB, and qnrS genes, novel plasmid-mediated quinolone-resistance genes, among extended-spectrum β-lactamases (ESBL)-positive and ESBL-negative Klebsiella pneumoniae isolates. Materials and Methods: One hundred and thirty isolates of K. pneumoniae were collected from Imam Reza Hospital and its associated clinics from May 2011 to July 2012. The isolates were tested for ESBLs by the conventional methods. Polymerase chain reaction (PCR) was performed to amplify qnr A, B, and S. Results: Thirty-eight (29. 3%) isolates were ciprofloxacin-resistant. Among 130 K. pneumoniae infectious isolates, 56 (43%) were capable of producing ESBL; 10. 8% (n=14), 15. 4% (n=20), and 20. 8% (n=27) of ESBL-producing K. pneumonia were positive for qnrA, qnrS, and qnrB, respectively, and 13. 8% (n=18) of the isolates harbored 2 or 3 qnr genes. Conclusion: The results of the current study showed that quinolone-resistance genes were more frequent in ESBL-producing K. pneumoniae (37. 5%) isolates, compared with the ESBL-negative isolates (20. 89%). The prevalence of qnr genes was high in K. pneumoniae isolates, with higher frequency in ESBL-positive strains. Most of the isolates were positive for all 3 groups of qnr genes and the qnrB was the most common one.

Background and objective: Gingival bleeding reduction in smokers has been associated with decreased blood vessel density. The mechanism of suppressive effect of cigarette smoking on blood vessel density is not precisely defined. The aim of this study was to evaluate the impact of smoking on angiogenesis by assessing mast cells density and VEGF expression in chronic periodontitis. Materials& Methods: 52 paraffin embedded block of gingiva tissues with periodontitis obtained from 30 nonsmokers and 22 smokers undergoing flap surgery were examined immunohistochemically for VEGF expression. Mast cell counts was completed on toluidine blue stained slides. Exposure to cigarette smoking was calculated by the number of packs × year. Patients were classified into 4 groups based on the number of smoked cigarettes. The correlation between VEGF expression and mast cell counts was evaluated and compared in nonsmokers and smokers. Results: The mean number of mast cells (p=0. 004) and average value of VEGF expression (p = 0. 000) in nonsmokers was significantly higher than smokers. No correlation was noted between VEGF expression / mast cell counts and number of smoked cigarettes in four groups of smokers (p=0. 29, 0. 12, 0. 20 and 0. 11, respectively). Conclusion: Mast cells and VEGF expression may account for suppressive effect of cigarette smoking on blood vessels in periodontitis.

Background & objective: Beta-lactam antibiotics resistance specifically Imipenem and Meropenem, the last choices of treatment, causes fatal events in patients with P. aeruginosa infection. The aim of this study was to detect the VIM and IMP of metallo-beta-lactamase genes in 103 isolates of P. aeruginosa in two Iranian hospitals. Methods: In this study, we evaluated the susceptibility of P. aeruginosa to a range of β-lactam antibiotics using disk diffusion method as a standard biochemical test. Combined disk test of Imipenem (IMP) and Imipenem plus Ethylenediaminetetraacetic acid (EDTA) was performed as a phenotypic method to find metallo-beta-lactamase producing isolates. Using conventional PCR method; we evaluated VIM and IMP of metallo-beta-lactamase (MBL) genes in 103 isolates of P. aeruginosa. Results: Twenty six (25. 2%) out of 103 isolates were resistant to Imipenem and 26 (25. 2%) to Meropenem. Among 26 Imipenem and Meropenem-resistant strains (25. 2%), 19 cases (73. 0%) were MBL producing. Using PCR method, we detected the blaVIM and blaIMP genes in 6 (5. 8%) and 2(1. 9%) of 19 MBL producing isolates, respectively. Conclusions: Evaluation of these carbepenemases genes improve epidemiologic researches and also, can be used as a diagnostic tool for discriminating between antibiotics resistant and sensitive strains of P. aeruginosa as well as follow-up the patients after treatment.

Ovarian sex cord-stromal tumors are relatively infrequent neoplasms that account for approximately 8% of all primary ovarian neoplasm. Sex cord-stromal tumors of the ovary include granulosa cell tumors, fibrothecomas, Sertoli-Leydigcell tumors, steroid cell tumors, and sclerosing stromal tumors (SST). Sclerosing stromal tumors account for 2% to 6% of ovarian stromal tumors. Despite the rarity of this particular neoplasm, it is not always possible to predict the presence of this tumor preoperatively on the basis of clinical and sonographic findings. Histopathological and immunohistochemical (IHC) examinations confirm the diagnosis. Herein, the clinical findings and histopathological features of SST are described in a 24-year-old female.

Hibernomas are extremely rare benign tumors of adipose tissue characterized by an admixture of brown fat cells with granular, multivacuolated cytoplasm and white fat cells. Hibernomas account for 1. 6% of benign adipose tissue tumors and approximately 1. 1% of all adipocytic tumors. Around 10% of these cases are intramuscular. It was initially described in the early 1900s as being composed of brown fat. Hibernomas usually occur in third to fourth decades of life and the most frequent sites being thigh, trunk, shoulder, back etc. Cytological differential diagnoses of hibernoma include well differentiated liposarcoma, myxoid/round cell liposarcoma, chondroid lipoma and benign granular cell tumor. Due to its abundant vascularity evident on angiography, it can sometimes mimic a malignant lesion, from which it needs to be distinguished as complete surgical excision is the only treatment required for a hibernoma. Moreover, it has no malignant or metastatic potential. We presented a rare case of intramuscular hibernoma of the scapular region in a 34-year-old male, in which cytology was reported as pleomorphic fibrolipomatous malignant lesion.

Basal cell carcinoma (BCC) commonly affects the elderly and is mostly confined to the head and neck region. Only 10% of all cases occur on the trunk. We presented a case of bullous lesion on the abdomen in a young male, initially diagnosed by clinicians as a vascular nevus. Histopathological examination and immunohistochemistry (IHC) revealed it to be Nodular cystic variant of BCC. This rare variant of BCC morphologically resembles benign skin adnexal tumor of Eccrine syringofibroadenoma. Ber Ep4 positivity on IHC established the correct diagnosis. This case highlights that nodular cystic variant of BCC can be a diagnostic dilemma for clinicians and pathologists.

Dear Editor-in-Chief Myxoid tumors of the oral cavity encompass a broad spectrum of lesions, primarily neoplastic (1). Significant variations in the biological behavior ranging from completely harmless to malignant neoplasm require an accurate histopathological diagnosis to ensure a proper treatment (2)...