Bladder leiomyoma presenting as uterine pedunculated leiomyoma.

Bladder leiomyoma is a rare benign mesothelial tumor that is more commonly reported in women. Most patients present with frequent urination or obstructive urinary symptoms. Here, we portray a 50-year-old woman who presented to the clinic with abdominal pain and vaginal bleeding. Imaging showed a lobulated mass at the posterior aspect of the urinary bladder. The pathology of the surgery demonstrated a benign mesenchymal neoplasm composed of interlacing bundles of smooth muscle fibers with a whirling pattern, which eventually confirmed bladder leiomyoma. Although this tumor is benign, it can be misdiagnosed with other diseases such as a urothelial lesion or urothelial cell carcinoma of the bladder. Accordingly, it can inevitably affect patient management. Therefore, it must be diagnosed quickly and accurately and appropriate treatment should be applied.

Heerfordt-Waldenström Syndrome, A Rare Presentation of Sarcoidosis in a Patient with Old Ocular Toxoplasmosis.

BACKGROUND: There are similarities between the ophthalmic presentation of toxoplasmosis and sarcoidosis, and there are some concerns of immunosuppressive treatments for sarcoidosis, which may lead to T. gondii reactivation. We report a rare case with acute sarcoidosis (Heerfordt- Waldenström syndrome) with a history of ocular toxoplasmosis from the North of Iran. CASE PRESENTATION: The patient was a 36-year-old woman with left painful eye and swollen parotid, right facial paresis, maculopapular rash in left eyebrow and erythema nodosa on both legs. Anti-Toxoplasma IgG antibody was positive, and IgM was not detectable. Radiographic findings on the chest revealed bilateral hilar lymphadenopathy. The initial treatment was sulfamethoxazole- trimethoprim to prevent the recurrence of retinal toxoplasmosis and corticosteroid and mycophenolate mofetil for sarcoidosis. The patient showed clinical and vision improvement without recurrences during three months follow-up. DISCUSSION: Ophthalmological examinations and laboratory tests to rule out toxoplasmosis could be considered in known cases of sarcoidosis, particularly in ocular sarcoidosis status. To the best of our knowledge, this is the first report of comorbidity of ocular toxoplasmosis/sarcoidosis from Iran and possibly the world.

Expression patterns of seven key genes, including ß-catenin, Notch1, GATA6, CDX2, miR-34a, miR-181a and miR-93 in gastric cancer.

Gastric cancer (GC) is one of the most prevalent cancers and a major cause of cancer related mortality worldwide. Incidence of GC is affected by various factors, including genetic and environmental factors. Despite extensive research has been done for molecular characterization of GC, it remains largely unknown. Therefore, further studies specially conducted among various ethnicities in different geographic locations, are required to know the precise molecular mechanisms leading to tumorigenesis and progression of GC. The expression patterns of seven candidate genes, including ß-catenin, Notch1, GATA6, CDX2, miR-34a, miR-181a, and miR-93 were determined in 24 paired GC tissues and corresponding non-cancerous tissues by quantitative Real-Time PCR. The association between the expression of these genes and clinicopathologic factors were also investigated. Our results demonstrated that overall mRNA levels of GATA6 were significantly decreased in the tumor samples in comparison with the non-cancerous tissues (median fold change (FC) = 0.3143; P = 0.0003). Overall miR-93 levels were significantly increased in the tumor samples relative to the non-cancerous gastric tissues (FC = 2.441; P = 0.0002). ß-catenin mRNA expression showed a strong positive correlation with miR-34a (r = 0.5784; P = 0.0031), and miR-181a (r = 0.5652; P = 0.004) expression. miR-34a and miR-181a expression showed a significant positive correlation (r = 0.4862; P = 0.016). Moreover, lower expression of Notch1 was related to distant metastasis in GC patients with a borderline statistical significance (p = 0.0549). These data may advance our understanding of the molecular biology that drives GC as well as provide potential targets for defining novel therapeutic strategies for GC treatment.

Papillary carcinoma in correlation to thyroidal duct cyst: A case series.

BACKGROUND: Persistent thyroglossal duct leads to a fibrous cyst formation named thyroglossal cyst which is the most common form of congenital cyst and usually located in the midline neck below the hyoid bone. Rarely the thyroglossal cyst is associated with thyroid cancer. Although the Sistrunk procedure is often considered adequate, currently there is no clear consensus on the optimal management of thyroglossal duct cyst especially duct cyst carcinoma. In addition, there is no consensus about concurrent thyroidectomy in patients with thyroglossal cyst duct carcinoma. CASE PRESENTATION: In this article, we present four patients with thyroglossal duct cyst and papillary thyroid cancer. Papillary thyroid cancer was located into the thyroglossal duct cyst (thyroglossal duct carcinoma) in two patients and two patients had thyroglossal duct cyst with thyroid carcinoma in thyroid tissue. Cervical lymph nodes were involved in one of the three patients. Sistrunk procedure and total thyroidectomy were performed for all. The thyroid lobes were not involved in patients with thyroid duct cyst carcinoma. Tumor or thyroglossal duct cyst recurrence did not occur in any of the patients in follow-up. CONCLUSION: The correlation between thyroglossal cyst and papillary thyroid carcinoma is high. In subjects with thyroglossal duct cyst, in addition to cyst assessment, thyroid gland and neck lymph nodes should be evaluated for malignancy.

miR-21: a promising biomarker for the early detection of colon cancer.

PURPOSE: The aim of this study was to compare the expression of miR-21 gene in stages II-IV of formalin-fixed paraffin-embedded (FFPE) tissue in patients with colon cancer and introduce miR-21 as a potential molecular marker for detection of colon cancer in the early stages. INTRODUCTION: Currently, identification of key molecules involved in the pathogenesis of cancer is one of the areas under consideration. miRNAs, are small RNAs which have been identified in many cancers. In this study, we investigated the expression of miR-21 in three pathologic stages in patients with colon cancer in the north of Iran. PATIENTS AND METHODS: A total of 40 FFPE samples were obtained from patients with stages II, III, and IV from hospitals in Mazandaran and Golestan provinces. After extraction of RNA, treatment with DNase I and cDNA synthesis was performed and miR-21 expression was assessed by qPCR. Then, the data were analyzed using statistical software R (3.4.3). RESULTS: The expression of miR-21 in stage II was significantly different from stage IV. However, no significant difference was observed between the other stages. In stage II, the level of miR-21 expression was higher in men than women. Moreover, in the second pathological stage, miR-21 expression was reduced in patients with adjacent lymphoid tissue engagement. In addition, the expression of miR-21 in grade I was significantly higher than grade II. CONCLUSION: The results of this study suggest that miR-21 can be a diagnostic marker for early stages of colon cancer, especially in men. It can also be considered as a good candidate for targeted treatment of colon cancer in the early stages of the disease. Furthermore, for the first time, we suggested that miR-21 can be a good molecular marker for classification of the stages of colon cancer.

Immunohistochemical Expression of Nanog and Its Relation with Clinicopathologic Characteristics in Breast Ductal Carcinoma

Background: Cancer stem cells (CSCs) are a group of tumor cells with self-renewal property and differentiation potential. CSCs play a crucial role in malignant progression of several types of tumors. However, what is still controversial is the clinicopathological relationship between the Nanog marker and its prognostic value in the patients with breast cancer. The expression of Nanog in the patients with breast cancer and its correlation with clinicopathological prognostic factors was explored in the present study. Methods: A sample of 120 breast cancer tissues was obtained from the patients who referred to Imam Khomeini Hospital in Sari City, Iran during January 2012 and December 2016. The associations between Nanog expression and clinicopathological factors were analyzed based on immunohistochemical analysis. Results: The expression of Nanog was detected in 67 (55.8%) patients with a high expression rate in 24 (36%) cases (staining index ≥3). Moreover, there was a statistically significant relationship between Nanog expression and clinicopathological factors, including tumor grade (p = 0.001), lymph node metastasis (p = 0.01), and the stage of the disease (p = 0.003). Conclusion: Findings of the study indicate that Nanog may act as a biomarker for prognostic prediction in patients with breast cancer.

Eosinophilic Granulomatosis with Polyangiitis Manifested by Cholecystitis and Mononeuritis Multiplex: A Case Report.

Eosinophilic granulomatosis with polyangiitis formerly named "Churg-Strauss syndrome (CSS)" is a systemic disease with bronchial asthma, hypereosinophilia, and systemic vasculitis. We report a case of CSS with cholecystitis and mononeuritis multiplex. A 50-year-old woman with a history of sinusitis and bronchial asthma of 8 years' duration was referred with a complaint of left-hand deformity and difficulty in walking. The laboratory findings included remarkable eosinophilia, an elevated erythrocyte sedimentation rate, and a marked eosinophilic infiltration in the gallbladder biopsy. Based on the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with prednisolone and cyclophosphamide.

Evaluation of E-cadherin Expression in Gastric Cancer and Its Correlation with Clinicopathologic Parameters.

Background: Gastric cancer is one of the most common cancers in the world. There are many genomic and molecular factors that cause gastric cancer to occur. Also, many markers that associate with tumor invasiveness have been known. E-cadherin is a calcium- mediated cell adhesion molecule. In some studies, abnormal expression of E-cadherin has been seen in gastric carcinoma. However, in the studies done there has been some conflicting information about abnormal expression of this marker in a variety of gastric carcinoma and also about the expression of this marker and its correlation with various clinicopathologic factors of tumor. Subjects andMethods: A case control study was performed on total or partial gastrectomy tissue samples obtained from 70 patients with gastric cancer and adjacent non-neoplastic tissues. The immunohistochemistry was used to assess E-cadherin expression. The correlation between abnormal E-cadherin expression and tumor histopathology was evaluated in all patients. Results: Among 70 patients who were analyzed, 48.6% showed abnormal E-cadherin expression. A significant correlation was seen between abnormal E-cadherin expression and tumor stage, grade, lymph node metastasis, tumor phenotype, tumor type, depth of invasion and age. Conclusion: Abnormal E-cadherin expression is a common phenomenon in gastric cancer. Because there was a strong correlation between abnormal E-cadherin expression and tumor stage, tumor grade, depth of invasion and regional lymph node involvement, this marker may be used as a predictive factor for tumor invasiveness in gastric cancer.

Human Epidermal Growth Factor Receptor Expression in Colorectal Cancer and Its Relationship with Clinicopathological Characteristics.

BACKGROUND Some recent studies reported human epidermal growth factor receptor (HER-2/neu) as a marker that can be used in immunological studies of colorectal carcinoma for predicting the prognosis and the treatment. Therefore, we aimed to investigate the frequency of HER-2 expression in patients with colorectal cancer, and explore the relationship between clinicopathological prognostic factors and its expression based on immunohistochemical analysis. METHODS This study included 50 patients with a histologically proven diagnosis of colorectal carcinoma who received surgery at Imam Khomeini Hospital affiliated to Mazandaran University of Medical Sciences. First, HER-2/neu protein expressions were detected by immunohistochemistry and then the data extracted from recorded files. RESULTS The median age of the patients was 60.2±13.9 years (range: 25-93 years). There was no significant relationship between size of tumor, age, sex, lymph node metastases, distant metastasis, differentiation, and stage of the disease with positive expression of HER-2 in this study. CONCLUSION No significant relationship between expression of HER-2 and clinicopathological prognostic factors was found in our study. Further comprehensive and prospective trial with standard method to evaluate the role of HER-2 expression among patients with colorectal cancer is needed.

Serum immunoglobulin A concentration is a reliable biomarker for liver fibrosis in non-alcoholic fatty liver disease.

AIM: To evaluate the diagnostic accuracy of serum Immunoglobulin A (IgA) for differentiating early stage nonalcoholic fatty liver disease (NAFLD) from nonalcoholic steatohepatitis (NASH). METHODS: All cases had fatty liver change confirmed by ultrasound and aminotransferases of at least twice the normal level. Clinical and biochemical data, including serum IgA, were obtained from 50 histologically proven NAFLD cases and 54 healthy controls. Fasting whole blood samples were obtained from the study population. Immunoturbidimetric methods were used to measure the IgA levels. All NAFLD cases were hospitalized for liver biopsy. Liver specimens were examined for steatosis, steatohepatitis and fibrosis within hepatocytes. Patients were categorized into two groups: NASH and non-NASH. Variables were compared within cases (NASH vs non-NASH) and controls. Cut-off values of serum IgA were evaluated using analysis of receiver operating characteristic (ROC curves). Associations between the variables were tested using calculations of correlation coefficients. Statistical significances were assigned to P values < 0.05. RESULTS: The extent of liver fibrosis correlated positively with IgA levels. Subjects with no fibrosis in their liver biopsies had a lower IgA level (301.5 ± 91.2 mg/dL) than subjects with any degree of fibrosis (388.8 ± 140.8 mg/dL), (P = 0.01). IgA levels were higher in NASH cases, and its value was significantly higher for higher degrees of fibrosis. Patients with perisinusoidal or pericellular fibrosis had significantly higher levels of IgA (403.5 ± 133.9 mg/dL, 418.2 ± 129.5 mg/dL) compared to those without it (301.8 ± 94.9 mg/dL, 297.7 ± 91.5 mg/dL), respectively. No significant correlation was found between steatosis grade and serum IgA levels. Based on ROC analysis, the best predictive IgA cutoff value for detecting liver fibrosis was 360 mg/dL (61% sensitivity, 81% specificity). CONCLUSION: The serum IgA level is useful to evaluate the severity of liver fibrosis and can be used serially for evaluation and follow-up of NAFLD cases.

Combination of aspiration and non-aspiration fine needle biopsy for cytological diagnosis of thyroid nodules.

BACKGROUND: Good cytological sample is very important for the cytological diagnosis of thyroid nodules. The aim of this study was to evaluate the adequacy of prepared samples by the combination of aspiration and non- aspiration fine needle biopsy. METHODS: In this descriptive - analytical study, sampling was done simultaneously for each patient in fine needle aspiration and non-aspiration biopsy. The sufficiency of samples was studied using Mair Scoring System. Wilcoxon Signed Rank test was used for the data analysis. RESULTS: Three hundred two cases (289 females, 13 males) with the mean age of 43.83±12.9 years were evaluated. Inadequate samples were 31 (10.3%) in fine needle aspiration, 40 (13.2%) in non-aspiration and 13 cases (4.3%) by using two methods together (p=0.0001). The average total score was 6.00±2.17 in fine needle aspiration and 5.76±2.26 in non-aspiration method (p=0.08), and 6.6±1.98 in the combination of the two methods (p<0001 comparing with one method alone). CONCLUSION: The results show that using both methods simultaneously in each nodule considerably increases the efficiency of samples for cytological diagnosis.