CD8+ T-cell lymphocytes infiltration predict clinical outcomes in Wilms' tumor.

The abundance and location of CD8+ tumor-infiltrating lymphocytes demonstrate important facets of the anticancer immune response. CD8-expressing lymphocytes have been used in immunotherapy for multiple cancers. This study aims to determine the association between the abundance and localization of CD8+ tumor-infiltrating lymphocytes and clinical outcomes of Wilms' tumor. This retrospective study employed 42 pediatric patients diagnosed with Wilms' tumor. CD8+ tumor-infiltrating lymphocyte counts were calculated based on the mean percentage of stroma occupied by CD8+ lymphocytes at the center and the invasive border of the tumor using immunohistochemistry. CD8+ tumor-infiltrating lymphocyte counts were significantly higher in the center and the invasive border of the early-stage tumor samples. CD8+ tumor-infiltrating lymphocytes in the invasive border and tumor center positively correlated with tumor invasion, regional lymph node invasion, histological type, metastasis, and stage of the tumor. A high CD8+ tumor-infiltrating lymphocyte scores at the invasive margin of the tumor correlated with low tumor recurrence. Low CD8+ tumor-infiltrating lymphocyte scores in the two tumor regions correlated with poor prognosis and shorter disease-free survival. Overall, these findings show that patients with high CD8+ tumor-infiltrating lymphocytes are associated with better clinical outcomes. Therefore, measuring the abundance of CD8+ tumor-infiltrating lymphocytes may be useful in predicting response to cancer immunotherapies.

Co-expression of Epstein-Barr virus-encoded RNA1 and viral latent membrane protein 1 in osteosarcoma: A novel insight of predictive markers.

Epstein-Barr virus is an etiologic agent of several malignancies. In this study, we explored the association of Epstein-Barr virus-encoded RNA1 and Epstein-Barr virus latent membrane protein 1 co-expression with osteosarcoma. Epstein-Barr virus-encoded RNA1 expression in tumor cells was quantified using reverse transcriptase polymerase chain reaction and in situ hybridization and Epstein-Barr virus latent membrane protein 1 expression was measured using immunohistochemistry staining. There was a statistically significant association between Epstein-Barr virus latent membrane protein 1 and Epstein-Barr virus-encoded RNA1 co-expression and characteristics of osteosarcoma such as nodal stage (p < 0.04), metastasis (p < 0.04), Ki67 index (p < 0.03), and tumor stage (p < 0.05). Co-expression of Epstein-Barr virus-encoded RNA1 and Epstein-Barr virus latent membrane protein 1 in tumors correlated with advanced osteosarcoma and indicated the aggressiveness of bone sarcoma.

Subcutaneous extraskeletal osteosarcoma of foot: A case report.

INTRODUCTION: Subcutaneous extraskeletal osteosarcoma (ESO) is a rare high grade malignant mesenchymal neoplasm consistent of approximately 1% of soft tissue sarcoma. Less than 10% of ESOs are superficial, originating in subcutis. PRESENTATION OF CASE: We reported a 72 years old male with chief complain of a painless slowly growing soft tissue mass in his plantar aspect of right foot in the last 9 months before admission. The plain radiography showed a large subcutaneous soft tissue mass in plantar area and heel, Magnetic resonance images displayed an irregular subcutaneous soft tissue mass extending from posterior lower leg to ankle and involving calcaneus inferiorly. A percutaneous core biopsy of the mass, obtained. The histopathology examination confirmed an soft tissue osteosarcoma. Subsequent wide local excision of the mass performed. Final histopathological result was subcutaneous extraskeletal osteosarcoma. DISCUSSION: The patient has had no evidence of recurrence or/and distant metastasis at 25 months followed up. However, excising subcutaneous ESOs with a safe surgical margin is paramount for achieving the best outcome. CONCLUSION: A subcutaneous ESO is a rare malignant tumor. We recommended that along with clinicohistological findings, radiological correlation is necessary for ruling out other diagnoses.

Primary papilloma of the proximal ureter in a 13-year old boy: A rare case.

INTRODUCTION: Approximately 1 percent of the tumors observed in the upper urinary tract are primary tumors of the ureter. The exact diagnosis is done by a histologic study. Most cases need surgery, which is done by complete resection of the tumoral segment of the ureter. PRESENTATION OF CASE: This study presents a 13-year-old boy who referred to Ali Asghar pediatric hospital with complaints of right flank pain and hematuria for four months. The ultrasonography revealed moderate-grade hydronephrosis. The retrograde urography confirmed a 1.5 cm lesion with filling defects in the proximal segment of the right ureter. The abdominal CT-scan confirmed a 1.5 cm filling defect lesion with a smooth margin in the right proximal ureter adjacent to the ureteropelvic orifice. On cystoscopy, a sessile mass developed in the proximal portion of right ureter and providing pronounced dilation of the ureter and ipsilateral hydronephrosis. Histopathology examination revealed a benign neoplasm composed of a delicate fibrovascular core covered by normal-appearing urothelium. The patient underwent a successful proximal segment resection of the ureter by surgery. DISCUSSION: Benign tumors of the ureter are much less frequent than malignant ones. Mostly, they involve the lower third of the ureter. Pain, hematuria, and hydronephrosis are the most clinical signs. The final diagnosis can be established with the histologic examination. The choice treatment in is segmental ureterectomy. CONCLUSION: Primary ureteral papilloma is extremely rare in the child. The histopathology study is essential for ruling out malignancy. The recurrence and progression of ureteral papilloma are controversial.

Functional Outcomes of 300 Carpal Tunnel Release: 1.5 cm Longitudinal Mini-incision.

OBJECTIVE: There is an opportunity for median nerve decompression by open surgery in carpal tunnel syndrome which is the most common surgical procedure in neurosurgical practice. The aim of this study is to evaluate the long-term outcomes of carpal tunnel release with 1.5 cm longitudinal mini-incision technique with regarding the effectiveness and safety. METHODS: For this prospective study, 300 hands for 188 patients with advanced carpal tunnel syndrome who had indication for neurolysis underwent carpal tunnel release through a 1.5 cm longitudinal mini-incision between March 2011 and 2015. There were 132 (70%) females and 56 (30%) males with a mean age of 40 ± 29.5 years (ranging from 24 to 73) and female to male: About 2.56.178 operations were performed for the right hand and 122 for the left hand. Preoperatively, all patients were evaluated with clinical examination and nerve conduction studies. The clinical effects of the patients assessed with the Global Symptom Score (GSS) and Visual Analog Patient Satisfaction Scale. RESULTS: The mean follow-up period was 18.6 ± 9.3 months (12-30 months). Postoperatively, 2% (six hands) complained of residual mild pain with tenderness of scar and only 1% (three hands) complained of median nerve damage (neuropraxy) with tingling and numbness but was temporary which improved after 1 week. Five patients (seven hands) loosed strength of their wrists, but muscle force of abductor pollicis brevis reinforced after 1 month. There is no evidence of local infection, stiffness, loss of some wrist strength, or recurrence of the disorder. Postoperative GSS scoring obviously improved than preoperative (P < 0.002). There is no patient who underwent reoperation. The mean time recovery appeared almost 2 weeks. CONCLUSION: 1.5 cm longitudinal mini-incision method in carpal tunnel syndrome decompression showed satisfactory pain relief, wound healing, and nontender scar with good functional outcomes. The technique was performed safely without major complication.

Coexistence of HER2, Ki67, and p53 in Osteosarcoma: A Strong Prognostic Factor.

BACKGROUND: Many laboratories are currently evaluating the usefulness of the determination of human epidermal growth factor receptor 2 (HER2), p53, and Ki67 proliferation indices using immunohistochemical techniques in cancer. Although the available studies suggest that these factors might indeed be helpful in making treatment decisions in osteosarcoma patients, their clinical usefulness is still controversial. AIMS: We proposed to introduce the value of the coexistence of HER2 overexpression, p53 protein accumulation, and Ki67 in osteosarcoma, which could be a prognostic factor in osteosarcoma. MATERIAL AND METHODS: Expression of HER2, p53, and Ki67 was examined by immunohistochemistry in samples of resected bone tumor tissue from 56 patients with osteosarcoma, obtained between 2009 and 2014 (median follow-up period of 48 months), and their significance for prognosis was analyzed. RESULTS: Of the 56 osteogenic sarcoma tissue samples, 80, 89, and 96.5% were positive for HER2 overexpression, p53 protein accumulation, and Ki67 expression, respectively. Overexpression of HER2 and accumulation of p53 protein significantly correlated with reduced disease-free (P < 0.01) and overall survival (P < 0.003). HER2 and Ki67 co-overexpression significantly correlated with decreased disease-free (P < 0.03) and overall survival (P < 0.02). HER2, accumulation of p53 protein, and Ki67 co-overexpression significantly correlated with reduced disease-free (P < 0.01) and overall survival (P < 0.005) as did patients with larger tumor size, high grade of tumor, positive lymph node, and metastasis status within the specified period of follow up. CONCLUSIONS: We found evidence that coexistence of HER2 and Ki67 overexpression and p53 protein accumulation predict the development of lymph node involvement and metastases in patients with high-grade osteosarcoma and were significantly associated with reduced survival.

Open reduction and internal fixation of intraarticular fractures of the humerus: evaluation of 33 cases.

BACKGROUND: Standard treatment of type C elbow fractures is open reduction and internal fixation using reconstruction plates and pins. OBJECTIVES: The aim of this study was to evaluate the functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO Type C) with a minimum follow-up of three years. A retrospective evaluation was undertaken. PATIENTS AND METHODS: Thirty-three patients (28 males, 5 females; mean age 34.3years) type C elbow fractures were treated and observed over a period of three years. Six fractures were open and 27 closed; causes were falls (7 cases), traffic accidents (22 cases) and altercation (4 cases). All operations were performed using a posterior approach with an olecranon osteotomy. Mean duration of follow-up was 18 months (range 6-36). Mean duration of fracture healing was 2.3 months (range 2-4). Functional outcomes were assessed by Jupiter criteria. RESULTS: Excellent results were found in 69.7% (23 cases), very good reaults and good results were found in the remaining 30.3% (10 cases). Three of 33 patients 9% (3 cases) presented postoperative complications. No patient exhibited symptoms of ulnar nerve injury following surgery. One patient had cubitusvarus deformities and one case had heterotopic ossification. One patient had malunion and one case had deep infection. CONCLUSIONS: Complications were minimal and outcomes were satisfactory in patients with type C distal humerus fractures who underwent bilateral plate fixation via a posterior approach.

Histopathologic patterns of adult renal disease in Kermanshah, Iran: A 6-year review of two referral centers.

BACKGROUND: The pattern of glomerular diseases in northwest Iran is unknown. This study was conducted to evaluate the histological pattern of renal diseases in this region. METHODS: We retrospectively studied the reports of 266 native adult renal biopsies at the Imam Reza and Taleghani Hospitals from June 2007 to June 2012. Pathological findings include minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), mesangioproliferative glomerulonephritis (MPGN), mesangiocapillary glomerulonephritis (MCGN), post streptococcal proliferative glomerulonephritis (PSPGN), membranous glomerulonephritis (MGN), hypertensive nephropathy (HN), crescentic glomerulonephritis or rapid progressive glomerulonephritis (CGN or RPGN), chronic tubular interstitial necrosis (CTIN), chronic sclerosing glomerulonephritis (CGN), Alport syndrome, acute tubular necrosis (ATN), lupus nephritis, renal amyloidosis. The data were collected and analyzed. RESULTS: The mean age of the patients was 37.41±15.78 years. Nephrotic syndrome was observed in 155 (58.3%) cases which was higher in frequency in females (61.9%) (p<0.005), followed by renal insufficiency in 87 (32.7%) cases. Totally, 187 (70.3%) had primary glomerulonephritis (GN) whereas, 79 (29.7%) had secondary GN. MCD was found to be the most common histological pattern (44%) and CGN (1.12%) was the least common. The frequencies of secondary glomerulonephritis (GN) include lupus nephritis to be the most frequent (41.8%) followed by chronic tubulo interstitial nephritis (38%) and type II diabetic nephropathy (19%). CONCLUSION: The results showed that minimal change disease ranked first followed by focal segmental glomerulosclerosis. We hope that this will form the basis for developing a renal biopsy registry across the continent in Iran.

The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation.

BACKGROUND: This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. METHODS: Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients' age was 37 years (range 20 to 67). Twenty six patients were men (4 patients with type B and 22 patients with type C fracture) and 12 women (7 patients with type B and 5 patients with type C fracture). The commonest cause was a road traffic accident (N=37, about 97%). Internal fixation was done by plaque with ilioinguinal and Kocher-Langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. RESULTS: There were 11 type-C and 27 type-B pelvic fractures according to Tile's classification. Thirty six patients sustained additional injuries. The commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months).The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005). CONCLUSIONS: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks.

Steroid hormone receptors, MIB-1, p53, and c-erb-B2 expression on breast cancer: Comparison of immunohistochemistry on cell block and fine needle aspiration and tissue sample, in northwest Iran.

BACKGROUND: Fine-needle aspiration of breast cancer often provides moderate cellular material that is representative of the tumors. These samples can be used not only for cytological diagnosis but also to obtain information on the prognosis and likely response to therapy by using immunohistochemical staining studies. METHODS: We assessed the degree of correlation between prognostic biologic markers by means immunohistochemistry (IHC) on cytoblock obtained from fine-needle aspiration (FNA) and immunohistochemical determination on their corresponding tissue sample of five markers; steroid hormone receptors, MIB-1 (Ki-67), p53, and c-erb-B-2 (Her2/neu) in 45 mastectomy of breast cancer. RESULTS: Interobserver reproducibility ranged from 93 to 100%, depending on the marker. A good correlation was observed between immunostaining assessment on cytoblock and on their corresponding tumor tissues as follows: Ki-67 (87%), ER (80%), PR (93%), p53 (96%), and c-erb-B-2 (76%). CONCLUSION: We conclude that cytoblock prepared from fine-needle aspiration specimens of breast cancer is a useful and noninvasive procedure when planning neoadjuvant treatment.