Angiosarcoma of gallbladder, a literature review.

BACKGROUND: Angiosarcoma of the gallbladder is a rare diagnostic entity rarely encountered by pathologists and has rarely been reported in literature. This review aimed to examine the clinicopathological features, immunohistochemistry, treatment, and outcomes of gallbladder angiosarcoma. METHODS: A search of the PubMed, Science Direct and Google Scholar was done with the search terms ("angiosarcoma" OR "angiosarcomas") AND ("gallbladder" OR "gallbladders"). Based on inclusion and exclusion criteria, only case reports could be used for this review. RESULT: 8 case reports were chosen in the end for analysis. The mean age of the patients at presentation was 65 years. It was most frequently observed in males. Abdominal pain and palpable mass were the most commonly reported symptoms. Cholelithiasis and anemia were also reported. On histopathology morphologically epithelioid appearance of angiosarcoma was evident. Cytokeratin (CK) AE1/AE3, Von willebrand factor, Factor VIII antigen, Vimentin, CD31 were positive. Meanwhile, UEA, CD34, CD117, S-100, Keratin, EMA, and CEA showed negative outcome. Surgery was the preferred method of treatment and a mean 10-months follow-up was done. CONCLUSION: Despite the unavailability of convincing data, histological and immunohistochemical analyses play a major role in the diagnosis of gallbladder angiosarcoma. Nevertheless, more comprehensive clinical studies are required to provide universal guidelines for the treatment and diagnosis of angiosarcoma of the gallbladder.

Histiocytic sarcoma in renal transplant patients: a literature review.

BACKGROUND: Histiocytic sarcoma (HS) is defined as neoplasm resembling morphological and immunophenotypic characteristics of mature histiocytes. It is a rare form of lymphoid neoplasms. Despite advances in treatment and diagnosis of histiocytic sarcoma, majority of cases had poor prognosis due to progressive nature of the disease. In the following article, all reported cases of histiocytic sarcoma in renal transplant patients are reviewed. METHODS: In our literature review, all relevant reports were collected electronically by entering the necessary keywords. A Boolean approach using Medical Subject Heading (MeSH) keywords was implemented. After establishing the inclusion/exclusion criteria, article titles and abstracts were evaluated by Systematic Reviews and Meta-Analyses (PRISMA) standards for 2020. All cases of histiocytic sarcoma in renal transplant patients were included. RESULT: Based on our inclusion and exclusion criteria 4 case reports were yielded in this review. Two were males and 2 were females with the mean age of 42.25 years. Fever was the most common symptom. Although tumor originated from the native kidney on one patient, the site of the primary tumor was thorax, oropharynx, and transplanted kidney in the rest. Metastasis was detected in all cases. Prednisone was used for all cases. EBV was positive in 2 cases and negative in one of them. Histology was diagnostic and similar in all cases. Immunohistochemistry was done for 3 cases. Although chemotherapy was done for 3 patients, all 4 cases ended in mortality. CONCLUSION: Despite the fact that neoplasms are post renal transplant complications, histiocytic sarcoma is a scarce and fatal entity in such patients. Histological and immunohistochemistry tests are the corner stone in diagnosis of histiocytic sarcoma.

Membranous fat necrosis of gall bladder, a case report and literature review.

INTRODUCTION AND IMPORTANCE: Membranous fat necrosis is a rare histological finding. Despite its low incidence and lack of clinical significance, it can involve various organs. Majority of membranous fat necrosis cases are diagnosed in breast lumps and skin in comparison to intra-abdominal lesions. There has been only one reported case of membranous fat necrosis of gall bladder in literature. CASE PRESENTATION: A 56-year-old female patient with previous history of diabetes mellitus and hypertension was administered due to abdominal pain and fever. Based on her physical exam, lab data, and ultrasonography, she was diagnosed by cholangitis. After primary care, she went under cholecystectomy. The histological finding of gall bladder revealed crenulated fatty membranes phagocytized by macrophages in Hematoxylin and Eosin (H&E) staining. Moreover, necrosis and giant cells were seen on Sudan black staining. Hence, the diagnosis of membranous fat necrosis in gall bladder was made. CLINICAL DISCUSSION: Membranous fat necrosis occurs when peripheral blood circulation is compromised. Ischemia of fat tissue cause fatty membranous material accumulation acting as foreign bodies. Hence, it can attract inflammatory response. Regarding pathology, phagocyted membranous by macrophages and giant cells is diagnostic. Sudan black, Luxol fast blue (LFB), long Ziehl-Neelsen, and D-PAS are positive in membranous fat necrosis. CONCLUSION: Membranous fat necrosis of gall bladder is a rare entity. This is the second reported case of such diagnosis. Nonetheless, further pathological investigations are necessary.

Splenogonadal fusion: A rare case report and literature review.

INTRODUCTION AND IMPORTANCE: Splenogonadal fusion is a rare congenital anomaly occurs when splenic tissue presents near or within a gonad. It mostly involves male children. Although it is benign and rare, making a pre-operation precise diagnosis is challenging which can lead to unnecessary invasive treatments. CASE PRESENTATION: A 3-year-old boy was presented by the chief complaint of a painless mass on the left testis and left inguinal hernia. He had a previous history of bilateral cryptorchidism and orchiopexy. Ultrasonography showed a small mass on the inferior pole of left testis and left reducible inguinal hernia. He went under left orchiectomy and hernia repair. Pathological investigation of the specimen resembled normal splenic tissue next to testicular tissue and the diagnosis of splenogonadal fusion was made. CLINICAL DISCUSSION: Splenogodal fusion cases can be challenging. Pain and sensation of mass in the scrotal sac are the most common presentation of splenogonadal fusion. Testicular malignancies can be considered as their main differential diagnosis, despite the fact that imaging and intra-operation frozen section can be helpful in making a definite diagnosis in some cases. It is mostly diagnosed incidentally during other procedures such as hernia repair or orchiopexy. Since it is benign, removal of tumor without orchiectomy is curative. CONCLUSION: In dealing with testicular mass in children, raising awareness of splenogonadal fusion have utmost importance to prevent unnecessary radical surgical interventions.

Utero-ovarian low grade endometrial stromal sarcoma, a case report.

INTRODUCTION: Endometrial stromal sarcoma (ESS) is a rare malignancy of uterine in middle aged women. There are numerous subtypes for ESS which share the same clinical picture of uterine bleeding and pelvic pain. Consequently, diagnosis and treatment modalities of LG-ESS with metastasis are challenging. However, both molecular and immunological study of samples can be useful. CASE PRESENTATION: In this case study, we report a 52-year-old woman presenting with the chief complaint of unusual uterine bleeding. There was no specific finding in her past medical history. The CT study revealed enlarged bilateral ovary with a significantly large left ovarian mass and suspicious mass in uterus. By the diagnosis of ovarian mass, patient went under total abdominal hysterectomy with bilateral salpingo-oophorectomy (BSO), greater omentectomy, and appendectomy followed by post-op hormone therapy. Her follow-up was uneventful. The IHC and pathological study of samples revealed incidental LG-ESS uterus mass with metastasis to ovaries despite her primary diagnosis. DISCUSSION: LG-ESS has low metastasis rate. Surgical modalities and neoadjuvant therapies are recommended base on the stage of ESS. In the following study, we represent a case of incidental LG-ESS with bilateral ovarian invasion who was initially diagnosed as an ovarian mass. CONCLUSION: Our patient was successfully managed by surgical intervention. Despite scarcity of LG-ESS, it is advised to consider LG-ESS as a differential diagnosis in management of patients with a uterus mass with bilateral ovarian involvement.

Dermatofibrosarcoma protuberans challenges: a case series and review of the literature.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare variant of skin sarcoma which is characterized by proliferation of spindle cells in a storiform pattern. Although it is mostly benign in its primary stages, it can cause a high burden of morbidity unless it is thoroughly excised. CASE PRESENTATION: Here, we review six cases of DFSP which were characterized by skin lesions in various parts of the body. Patients were from 26 to 51 years old; four were Asian men and two were Asian women. Wide surgical excision was performed for all these patients and no extra treatment was considered. Samples were studied by hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) tests. Only one of our patients experienced recurrence after the initial surgery. CONCLUSION: Determining the best surgical method is still a dilemma in the treatment of DFSP lesions. There are numerous studies to prove the efficacy of various surgical interventions. Although DFSP is not commonly known as a malignant skin lesion, delay in treatment will have a catastrophic impact on patients' lives. Thus, applying an in-time surgical method (wide local excision in our cases) in treating DFSP is crucial in preventing recurrence as well as decreasing the morbidity burden of DFSP.

Impacts of land use and land cover change on the interactions among multiple soil-dependent ecosystem services (case study: Jiroft plain, Iran).

The spatial and temporal distribution pattern is an outstanding feature of the relationship among ecosystem services (ESs) that explains links between human activities and disturbed chemical composition of ecosystems. This study investigated the spatiotemporal variation of land use/cover changes (LUCC) and quantifies the change in four essential ecosystem services with an emphasis on soil (nutrient delivery ratio, carbon storage, crop production, and water yield) and their relationships in the Jiroft plain, Iran, during 1996-2016 through analytical tools including Land Change Modeler, and the Integrated Valuation of Ecosystem Services and Tradeoff. During the 20-year concentrate period, there was a considerable overall gain in cropland (5396 km2) and urban (1787 km2), loss of unused land (5692 km2), water (2088 km2), and forest (1083 km2). As a result of LUCC, while crop production and nutrient delivery ratio showed a rising trend, overall carbon storage and water yield decreased. The spatiotemporal trade-off between carbon storage and crop production, the temporal trade-off between crop production and water yield, and synergy between water yield and crop production were widespread in Jiroft plain. These results showed that the interaction among ESs mutates over time and can be changed under planning and policies. This study will enrich the research of the geographical distribution of ESs interaction in dryland ecosystems to provide practical ecosystem management under local conditions.

Associating liver partition and portal vein ligation for staged hepatectomy: A surgical technique for liver resections.

BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel surgical technique liver resection in traditionally nonresectable primary intrahepatic tumors or colorectal liver metastases. MATERIALS AND METHODS: From June 2013 to March 2014, patients with primary tumor of liver or colorectal tumors with liver metastasis were selected to evaluate whether they met the initial criteria for ALPPS procedure. RESULTS: Nine patients enrolled in the study with primary diagnoses of colon and rectosigmoid cancer, carcinoid tumor, gastrointestinal stromal tumor of small intestine, hepatocellular carcinoma, and pancreatic neuroendocrine tumor (PNET). Four candidates excluded from the study prior or during the first step operation due to fatty liver, hepatic fibrosis, peritoneal seeding, and multiple small intestine metastases. Five patients underwent two stages of ALPPS with the interval of about 1 week. Liver hypertrophy was 100% among our candidates after the initial step. One postoperative death happened because of massive pulmonary thromboembolism Recurrence of liver metastasis was seen in one patient. Hepatic failure Class B and A were observed in two patients which did not progress during follow-up period. One patient developed an enterocutaneous fistula. DISCUSSION: We recommend to use 2 organ bags, one for wrapping right lobe and the other one for covering visceral organs and also do liver biopsy in suspicious cases of damaged liver parenchyma and laparoscopic exploration of abdomen for seeding and multiple metastases prior to laparotomy. CONCLUSION: As the procedure has not been well established and verified by oncologists yet, further studies are required to define the exact indications of ALPPS.

Distribution of mediastinal ectopic thymic tissue in patients without thymic disease.

BACKGROUND: Different approaches to treat myasthenia gravis showed variable outcomes probably because of remained ectopic thymic tissue. The aim of this study is to determine incidence of thymic tissue in cases without any thymic disease. MATERIALS AND METHODS: Seventy-two patients scheduled for open heart surgery during 2000 and 2007 without thymic disease that were enrolled in the study at Chamran Hospital. Intraoperative biopsies were taken form aortopulmonary window, aortocaval groove and left and right pericardiophrenic regions. Finally, the distribution of ectopic thymic tissue was evaluated in above regions. RESULTS: Thymic tissue was found overall in 70.85% of patients. The most common sites for thymic tissue were left pericardiophrenic (50%) and right pericardiophrenic (31.9%) regions. Frequencies of ectopic thymus in aortopulmonary window and aortocaval groove were 19.4% and 12.5%, respectively. CONCLUSION: Because of high incidence of ectopic thymic tissue in mediastinum in patients without thymic disease, we recommend wide excision of thymus gland and all of adipose tissue in patients with myasthenia gravis.

Land suitability assessment for wind power plant site selection using ANP-DEMATEL in a GIS environment: case study of Ardabil province, Iran.

Wind energy is a renewable energy resource that has increased in usage in most countries. Site selection for the establishment of large wind turbines, called wind farms, like any other engineering project, requires basic information and careful planning. This study assessed the possibility of establishing wind farms in Ardabil province in northwestern Iran by using a combination of analytic network process (ANP) and decision making trial and evaluation laboratory (DEMATEL) methods in a geographical information system (GIS) environment. DEMATEL was used to determine the criteria relationships. The weights of the criteria were determined using ANP and the overlaying process was done on GIS. Using 13 information layers in three main criteria including environmental, technical and economical, the land suitability map was produced and reclassified into 5 equally scored divisions from least suitable to most suitable areas. The results showed that about 6.68% of the area of Ardabil province is most suitable for establishment of wind turbines. Sensitivity analysis shows that significant portions of these most suitable zones coincide with suitable divisions of the input layers. The efficiency and accuracy of the hybrid model (ANP-DEMATEL) was evaluated and the results were compared to the ANP model. The sensitivity analysis, map classification, and factor weights for the two methods showed satisfactory results for the ANP-DEMATEL model in wind power plant site selection.

Determining the most suitable areas for artificial groundwater recharge via an integrated PROMETHEE II-AHP method in GIS environment (case study: Garabaygan Basin, Iran).

Flood spreading is a suitable strategy for controlling and benefiting from floods. Selecting suitable areas for flood spreading and directing the floodwater into permeable formations are amongst the most effective strategies in flood spreading projects. Having combined geographic information systems (GIS) and multi-criteria decision analysis approaches, the present study sought to locate the most suitable areas for flood spreading operation in the Garabaygan Basin of Iran. To this end, the data layers relating to the eight effective factors were prepared in GIS environment. This stage was followed by elimination of the exclusionary areas for flood spreading while determining the potentially suitable ones. Having closely examined the potentially suitable areas using the Preference Ranking Organization Method for Enrichment Evaluations (PROMETHEE) II and analytic hierarchy process (AHP) methods, the land suitability map for flood spreading was produced. The PROMETHEE II and AHP were used for ranking all the alternatives and weighting the criteria involved, respectively. The results of the study showed that most suitable areas for the artificial groundwater recharge are located in Quaternary Q(g) and Q(gsc) geologic units and in geomorphological units of pediment and Alluvial fans with slopes not exceeding 3%. Furthermore, significant correspondence between the produced map and the control areas, where the flood spreading projects were successfully performed, provided further evidence for the acceptable efficiency of the integrated PROMETHEE II-AHP method in locating suitable flood spreading areas.

Playground injuries in children.

BACKGROUND: Rapid urbanization and unplanned population development can be detrimental to the safety of citizens, with children being a particularly vulnerable social group. In this review, we assess childhood playground injuries and suggest safety mechanisms which could be incorporated into playground planning. METHODS: Inclusion criteria were "children" as the focus group, "playground" as the main field of study, and "unintentional injury" and "safety" as the concepts of study. The keywords used for the PubMed search were "playground", "children", and "injury". Initially we 182 articles. After screening according to inclusion criteria, 86 articles were found, and after reading the abstracts and then the full text, 14 articles were finally included for analysis. The papers reviewed included four case-control studies, three case studies, three descriptive studies, two interventional studies, one retrospective study, one cross-sectional study, and one systematic review. RESULTS: Playground-related fractures were the most common accidents among children, underscoring the importance of safety promotion and injury prevention in playgrounds, lowrisk equipment and playing hours (week days associated with higher risk), implementation of standards, preventing falls and fall-related fractures, and addressing concerns of parents about unsafe neighborhoods. With the exception of one study, all of the reviewed papers had not implemented any practical safety plan. Safe engineering approaches were also ignored. CONCLUSION: We recommend a systematic safety approach based on the "safety circle" which includes three main areas, ie, equipment, environment, and children.

Role of water-saving devices in reducing urban water consumption in the mega-city of Tehran, case study: a residential complex.

Iran is one of 27 countries that are likely to face increasing water shortage crises between now and 2025 unless action is taken to reduce currently high-per-capita urban water consumption. Accordingly, consumption control in the mega-city of Tehran will be an invaluable achievement. A study of Tehran water consumers has determined that household consumers are responsible for 70 percent of the total consumption. Keeping that figure in mind, the authors set out to assess rates of consumption by water fixtures, with an emphasis on household users, and to examine the effects of installing subcounters and reducers. They selected an apartment complex in which it was possible to install water subcounters for each unit. The first step was to evaluate resident attitudes. Block 3, which had 10 units, was selected to cooperate with the project. The second step was to install counters for all 10 units to determine consumption by different fixtures. (The counters were installed in kitchens, in bathrooms, on toilets, on washing machines, and on flash tanks). In the next step, data entry forms for fixture consumption were completed for a period of 10 days. Then single-handle faucets and reducers were installed, and the outcomes were logged for a period of 10 days. Counter readings were performed by the volunteer residents or by educated personnel every 24 hours, and the total volume of inside consumption was compared with the consumption registered by a base counter placed outside each unit. In the course of the project, the consumption per capita was calculated every 24 hours to yield a real and unbiased model that is applicable to city of Tehran. The results showed a total reduction in water consumption of about 20 percent. Thus, with suitable planning and application of cultural and technical methods, it is possible to optimize consumption in Tehran in the near future.