Prolonged generalized osteomalacia associated with a sinonasal cavity phosphaturic mesenchymal tumor: A case report.

Phosphaturic mesenchymal tumor (PMT) is a rare disorder primarily affecting the extremities. It is notable for its correlation with hypophosphatemic osteomalacia and high FGF23 serum levels, which results in renal phosphate wasting and clinical symptoms associated with low serum phosphorus. We presented a patient with a 5-year history of progressive osteomalacia who recently experienced a major pathological bone fracture. Laboratory findings showed a persistent low serum phosphate, normal calcium, elevated alkaline phosphatase activity, high parathyroid hormone levels, and increased renal excretion of phosphate. According to ultrasonography and nuclear imaging, there was no evidence of parathyroid adenoma. During further diagnostic assessment, a sinonasal cavity tumor was found and resected. Histologically, the tumor was composed of bland spindle cell proliferation in the background of a calcified matrix with foci of osteoid formation, hemangiopericytoma-like (HPC-like) vasculature, and osteoclast-like giant cells. Tumor cells showed variable positivity for SMA, but CD34, S100, CD99, Melan-A, p63, and desmin were all nonreactive. Regarding the clinical context, histological and immunohistological findings, a final diagnosis of tumor-induced osteomalacia (TIO) secondary to a PMT was made. After surgery, laboratory results returned to normal, clinical symptoms disappeared, and the patient did not experience a recurrence during a six-month follow-up.

COVID-19 associated with sensorimotor polyradiculoneuropathy and skin lesions: A case report.

A novel betacoronavirus,SARS-CoV-2, causes Coronavirus disease 2019 typically presented with fever, myalgia and cough, but central and peripheral nervous system manifestations such as stroke, encephalitis and Guillain-Barre-Syndrome are being increasingly reported. Acute immune-mediated polyradiculoneuropathy (Guillain-Barre-Syndrome) mostly occurs after viral or bacterial infections, presenting with ascending flaccid tetraparesis, dysautonomia and respiratory failure. We reported a patient with COVID-19 (confirmed with Lung HRCT scan and positive SARS-CoV-2 PCR) who developed acute progressive flaccid tetraparesis and maculopapular pigmented plaques on the limbs, 2 weeks after respiratory symptoms. He was treated with IVIg as the Electrophysiologic study showed sensorimotor polyradiculoneuropathy with demyelinating features and skin biopsy showed interface dermatitis and vasculopathic reaction. The causal association between Guillen-Barre-Syndrome and COVID-19 is uncertain yet, but neurologists should be aware of early diagnosis and treatment of acute polyradiculoneuropathy which may cause fatal dysautonomia and respiratory failure in the context of COVID19 pandemic.

Serum Vitamin D3 Level in Patients with Female Pattern Hair Loss.

BACKGROUND: Female pattern hair loss (FPHL) is the most common cause of alopecia in women, characterized by diffuse nonscarring hair loss in frontal, central, and parietal areas of the scalp. Pathophysiology of FPHL is still not well known, and it is probably a multifactorial genetic trait. FPHL is also observed in women without increased androgen levels, which raises the likelihood of androgen-independent mechanisms and explains the lack of response to antiandrogen treatments in some patients. Vitamin D is a factor that has recently been considered in dealing with these patients. The purpose of this study was to evaluate the serum levels of Vitamin D in patients with FPHL and compare it with healthy controls. METHODS: In this case-control study, 45 women with FPHL were evaluated as well as the same number of healthy women matched for age, hours spent under sunlight per day, and body mass index. Serum 25(OH) D3 level was measured using ELISA. RESULTS: 60% of FPHL patients were in 15-30 years old age group with the mean standard deviation (SD) age of 29.11 (7.30) years. In the majority of patients (66.7%), severity of hair loss was Ludwig I. Mean (SD) serum Vitamin D3 level in patient and control group was 13.45 (8.40) and 17.16 (8.96), respectively. T-test showed a significant difference between the two groups in terms of Vitamin D3 serum levels (P = 0.04). CONCLUSIONS: This study indicated the correlation between the incidence of FPHL and decreased serum levels of Vitamin D3. It is recommended to evaluate serum Vitamin D3 levels as well as other hormone assays in these patients.

Serum 25-OH Vitamin D Level in Psoriatic Patients and Comparison With Control Subjects.

BACKGROUND: Vitamin D has been shown to have immunomodulatory effects, and previous studies have proposed a role of vitamin D deficiency in multiple autoimmune diseases, including psoriasis. OBJECTIVES: The aim of this study was to investigate serum vitamin D levels in psoriatic patients and compare them with levels in controls. METHODS: This study was carried out in 50 psoriasis patients. Serum vitamin D was measured by enzyme-linked immunosorbent assay. RESULTS: The mean serum vitamin D levels in psoriatic patients and controls were 14.92 ± 6.31 and 12.52 ± 4.54 ng/mL, respectively. The difference was not statistically significant (P = .06). The prevalence of vitamin D deficiency (<20 ng/mL) was 84.0% in psoriatic patients and 93.0% in controls (P = .21). CONCLUSIONS: Most of the patients with psoriasis had vitamin D deficiency, which may have contributed to the evolution of their psoriasis. However, considering the high prevalence of vitamin D deficiency in Iran, no difference was noted between the psoriatic patients and the controls.

No Evidence of Human Papilloma Virus Infection in Basal Cell Carcinoma.

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer among whites, and several risk factors have been discussed in itsdevelopment and progress. Detection of human papilloma virus (HPV) deoxyribonucleic acid (DNA) BCCs in some studies suggests that the virus may play a role in the pathogenesis of this disease. Several molecular studies showed conflicting reports. AIMS: The purpose of this study was to investigate the association between HPV and BCC using polymerase chain reaction (PCR). MATERIALS AND METHODS: HPV DNA detection was done for 42 paraffin-embedded tissue specimens of BCC and 42 normal skin samples around the lesions by PCR using GP5+/GP6+ primers. RESULTS: HPV DNA was not found in any of the 42 samples of BCC, and only one normal skin sample around the lesions was positive for HPV DNA by PCR. CONCLUSION: In this study, no statistically significant difference was seen between the presence of HPV DNA in BCC and normal skin around the lesion, and HPV is not likely to have an important role in pathogenesis of BCC.

Evaluation of the Association Between Epstein-Barr Virus and Mycosis Fungoides.

INTRODUCTION: Mycosis fungoides (MF) is the most common cutaneous T-cell lymphomas. Despite extensive studies, etiopathogenesis of MF is unknown. Environmental, infectious and genetic factors have been proposed as potential risk factors of MF. Herpes virus family members, especially Epstein-Barr virus (EBV), have been among the viral factors of interest in recent years. The aim of this study was to investigate the possible association of EBV infection with MF. MATERIALS AND METHODS: This case-control study was performed on skin biopsy samples of 57 MF patients referred to Pathology Department of Mashhad Emam Reza Hospital from 2000 to 2011 and also on 57 melanocytic nevus samples matched with patients for age and sex. The presence of EBV in samples was evaluated by polymerase chain reaction. Statistical analysis of the data was conducted with the Statistical Package for the Social Sciences version 11.5 (SPSS Inc., Chicago, IL, USA). RESULTS: In this study, out of 57 MF samples, there were 34 male and 23 female patients, with male:female ratio of 1.04. Mean patient age was 51.4 years. There were 22 and 4 positive cases of EBV in the case and control groups, respectively. Chi-square statistical test showed that EBV was significantly higher in case group than control (P = 0.000). There was no correlation between the presence of EBV in samples with lesion type, age and gender of the patients. CONCLUSION: According to our study results, EBV is a likely etiologic agent or potential promoter in the pathogenesis of MF.

No Evidence of Human Papillomaviruses in Non-genital Seborrheic Keratosis.

BACKGROUND: Seborrheic keratosis (SK) is a benign epidermal tumor of unknown etiology. Because of its wart-like morphology, Human papillomaviruses (HPVs) have been suggested as a possible causative agent. Viral involvement, however, has not been confirmed yet despite research and the association between HPVs and seborrheic keratosis has not been studied among Iranian population by PCR. OBJECTIVES: The aim of this case-control study was to evaluate the presence of HPVs DNA in non-genital SK by PCR. MATERIALS AND METHODS: Fifty biopsy specimens obtained from patients with non-genital SK and 50 controls were analyzed using polymerase chain reaction (PCR). RESULTS: No HPVs DNA was detected by PCR within the tissue extracts from paraffin-embedded SK samples, while one of the controls was HPVs DNA positive. The age range of the patients was 20 to 82 yrs (mean = 52). Twenty-eight patients (56%) were males and 22 patients (44%) were females. The most common anatomic site was the face. Histopathologic changes due to viral infection such as koilocytosis (10%), dyskeratosis (66%), mitosis (28%), and parakeratosis (88%) were evident within the lesions. The most common histologic type was acanthotic type. CONCLUSION: Our results showed that there is no association between HPVs and seborrheic keratosis in investigated subjects.

Therapeutic effects of acoustic cavitation in the presence of gold nanoparticles on a colon tumor model.

OBJECTIVES: Acoustic cavitation can be fatal to cells and is used to destroy cancerous tumors. The particles in a liquid decrease the ultrasonic intensity threshold needed for onset of cavitation. Bubble generation from intense pulsed light-irradiated gold nanoparticles was investigated as a means of providing nucleation sites for acoustic cavitation in cancer tissues. METHODS: This study was conducted on colon carcinoma tumors in BALB/c mice. The tumor-bearing mice were randomly divided into 7 groups (each containing 15 mice): (1) control, (2) gold nanoparticles, (3) intense pulsed light irradiation, (4) intense pulsed light + gold nanoparticles, (5) ultrasound alone, (6) ultrasound + gold nanoparticles, and (7) intense pulsed light + ultrasound + gold nanoparticles. In the respective groups, gold nanoparticles were injected into tumors. Intense pulsed light and ultrasound irradiation were performed on the tumors 24 hours after injection. Antitumor effects were estimated by evaluation of the relative tumor volume, doubling time, and 5-folding time for tumors after treatment. The cumulative survival fraction of the mice and percentage of the lost tissue volume (treated) were also assessed in different groups. RESULTS: A significant difference in the average relative tumor volumes 15 days after treatment was found between the intense pulsed light + ultrasound + gold nanoparticle group and the other groups (P < .05). The longest doubling and 5-folding times were observed in the intense pulsed light + ultrasound + gold nanoparticles and ultrasound + gold nanoparticle groups. CONCLUSIONS: Acoustic cavitation in the presence of gold nanoparticles and intense pulsed light has been introduced as a new way for improving therapeutic effects on tumors by reducing the relative tumor volume and increasing the cumulative survival fraction.

A novel nanosonosensitizer for sonodynamic therapy: in vivo study on a colon tumor model.

OBJECTIVES: The particles in a liquid decrease the ultrasonic intensity threshold needed for cavitation onset. In this study, a new nanoconjugate composed of protoporphyrin IX and gold nanoparticles was used as a nucleation site for cavitation. The nonradiative relaxation time of protoporphyrin IX in the presence of gold nanoparticles is longer than the similar time without gold nanoparticles. METHODS: This study was conducted on colon carcinoma tumors in BALB/c mice. The tumor-bearing mice were randomly divided into 6 groups (each containing 15 mice): (1) control, (2) protoporphyrin IX, (3) gold nanoparticle-protoporphyrin IX conjugate, (4) ultrasound alone, (5) ultrasound + protoporphyrin IX, and (6) ultrasound + gold nanoparticle-protoporphyrin IX conjugate. In the respective groups as indicated above, protoporphyrin IX or the gold nanoparticle-protoporphyrin IX conjugate was injected into the tumors. Ultrasound irradiation was performed on the tumors 24 hours after injection. Antitumor effects were estimated by evaluation of the relative tumor volume, doubling time, and 5-folding time for the tumors after treatment. The cumulative survival fraction of the mice and percentage of the lost tissue volume (treated) were also assessed in the different groups. RESULTS: A significant difference in the average relative volumes of the tumors 13 days after treatment was found between the ultrasound + gold nanoparticle-protoporphyrin IX group and the other groups (P < .05). The longest doubling and 5-folding times were observed in the ultrasound + gold nanoparticle-protoporphyrin IX and ultrasound + protoporphyrin IX groups. CONCLUSIONS: Protoporphyrin IX conjugated to gold nanoparticles has been introduced as a promising compound and a new sonosensitizer for improving the tumor response to sonodynamic therapy by reducing the relative tumor volume and increasing the cumulative survival fraction.

Primary glomus tumor of the liver.

Primary glomus tumors are extremely rare in the liver. To this date, only two cases of primary glomus tumors of the liver have been reported in the literature. This report is the third case of this specified tumor. The patient was a 50 year-old Iranian woman who presented with a history of epigastric pain and nausea. Abdominal computed tomography (CT) scan showed a huge hepatic mass that replaced the entire left lobe. Surgical biopsy showed that the specimen consisted of a vascular network confined by the proliferation of epithelioid cells with round-to-oval nuclei and eosinophilic cytoplasms. The cells expressed diffuse reactivity for vimentin, smooth muscle actin and CD34, whereas no reactivity was observed with carcinoembryonic antigen, synaptophysin, chromogranin, cytokeratin, and human melanoma black 45. We conclude that glomus tumors must be considered in the differential diagnosis of hepatic masses, with immunohistochemical staining for smooth muscle actin being a useful method to prove the diagnosis.

Epidermolytic hyperkeratosis in inflammatory linear verrucous epidermal nevus.

Epidermolytic hyperkeratosis presents with perinuclear vacuolization of the keratinocytes in spinous and granular layers, keratinocytes with ill-defined limits, which leads to a reticulate appearance of the epidermis, an increased number of variously shaped and sized basophilic keratohyalin granules and the same sized eosinophilic trichohyalin granules, at any level of epidermis, mainly in the stratum granulosum, and compact hyperkeratosis. This minor reactive pathologic reaction pattern of skin is found in large variety of diseases. This paper is the first case report of such pattern in inflammatory linear verrucous epidermal nevus. Our case is of a 23-year-old man with pruritic verrucous lesions of trunk and extremities initiated since 13 years ago. Physical examination revealed white linear hyperkeratotic lesions, some of them on erythematous background and also classic epidermal nevus. No skeletal, ophthalmic, and nervous system involvement was detected. Microscopic study of pruritic verrucous lesions showed psoriasiform acanthosis, mild papillomatous, hyperkeratosis, and epidermolytic hyperkeratotic changes in hair follicles and acrosyrinx accompanied with moderate perivascular inflammation.

Evaluation of HER2/neu oncoprotein in serum and tissue samples of women with breast cancer: correlation with clinicopathological parameters.

BACKGROUND: HER2/neu (HER2) is a proto-oncogen of the EGF Receptor family. The assessment of serum HER2 level is useful for predicting the patients' response to chemotherapy or hormonal therapy and selection of proper patients for treatment with Herceptin. We aimed to compare serum HER2 levels with immunohistochemistry in tumoral tissues and investigate correlation between these levels and various prognostic factors. MATERIALS AND METHODS: This cross-sectional study was conducted on 75 patients with breast carcinoma referred to surgical ward of Mashhad Imam Reza's hospital from November 2008 to February 2009. Pre-operative serum samples were collected and stored in -20°C. Surgical samples were investigated for the type of carcinoma, tumor size, lymph node metastasis, stage as well as grade of the tumor. Tissue HER2 over-expression was evaluated by immunohistochemistry (IHC) staining and HER2 levels were studied by ELISA method. Statistical analysis was performed by SPSS software. RESULTS: Serum HER2 cut-off level was 18.4 ng/ml; 46.7% of patients were serum HER2-positive and 43% were IHC positive. There was a high statistical correlation between these two parameters (P=0.018). Statistically, there was no significant correlation between serum HER2 and age, tumor size, stage, grade and metastatic lymph nodes (P>0.05). CONCLUSION: Serum HER2 level assay can be considered as a complementary method besides tissue methods.

Evaluation of coexistence of the Human Herpesvirus type 8 (HHV-8) infection and pemphigus.

BACKGROUND: Human Herpesvirus type 8 (HHV-8) is a new member of the herpes virus family, first found in the tissue of acquired immune deficiency syndrome (AIDS)-related Kaposi's sarcoma. Environmental factors including viral infection may play a role in the onset and/or development of pemphigus. Some studies based on polymerase chain reaction findings suggest an association between HHV-8 and pemphigus. The aim of this study is investigation of the association of pemphigus with HHV-8 and the relationship between inflammatory and acantholytic cells with HHV-8 infection. METHODS: Tissue-extracted DNA from 41 paraffin-embedded skin tissues from patients first presenting with pemphigus was tested using nested PCR for the presence of HHV-8. A total of 37 cases had pemphigus vulgaris (PV) and 4 patients had pemphigus foliaceus (PF). For our control group, normal skin of 21 cosmetic surgery patients were included. Furthermore, microscopic slides with H&E staining were evaluated for the number of inflammatory and acantholytic cells per microscopic field. RESULTS: Skin lesions from 13 of 37 patients (35.1%) with PV and 2 of 4 cases (50%) with PF were positive for HHV-8 DNA. All specimens in our control group were negative for this virus. CONCLUSION: HHV-8 infection might be a contributing factor in the initiation or development of pemphigus.

Clinicopathological evaluation of radiation induced basal cell carcinoma.

BACKGROUND: Development of skin neoplasms is one of the most important chronic complications of radiation therapy. Basal cell carcinoma (BCC) is the most frequent carcinoma occurring at the region of the body to which radiotherapy was delivered. AIM: The aim of this study was to evaluate clinical and histological aspects of basal cell carcinoma in patients with a history of radiotherapy. MATERIALS AND METHODS: Medical records and microscopic slides of 80 patients with basal cell carcinoma who had received radiotherapy (1996-2006) were reviewed in pathology department of Imam Reza hospital of Mashhad, Iran. Collected data were analyzed statistically using descriptive test. RESULTS: 60 men and 20 women were included, majority of them in their sixties. Plaque was the most common clinical pattern of basal cell carcinoma. Fifty one percent of the patients had pigmented and 42.5% had multiple lesions. Scalp was the most common site of involvement. Histologically, macronodular and pigmented carcinoma were the most predominant forms of basal cell carcinoma. DISCUSSION: Majority of patients had scalp involvement and multiple lesions. Nodular and pigmented forms were the most common histological findings. We suggest the need for close supervision in patients with a history of radio therapy in the past.

Clinicopathologic evaluation of mammary Paget's disease.

UNLABELLED: Mammary and extramammary Paget's diseases are rare neoplasms of epidermis and mucosal epithelium. Due to their nonspecific and variable clinical view, they have differential diagnosis with eczema, melanoma, Bowen's disease, etc. To the best of our knowledge, no such study has been performed in Iran regarding the prevalence, clinical aspects, underlying disease and pathological characteristics of these two diseases. In this study, we have evaluated the clinical and histopathological aspects of this disorder. MATERIALS AND METHODS: In this retrospective study, all Paget's biopsied samples referred to the Pathology Department of Imam-Reza hospital, Mashhad, since 1984 till 2004 were evaluated. Collected data were analyzed by descriptive statistical methods. RESULTS: Among 98925 specimens, there were 29 cases of Paget's disease. All cases were married women suffering from mammary Paget. The mean age was 53 +/- 11 years. Left and right breast involvement was observed in 17 and 12 cases, all unilateral. The most common clinical view was ulcerated (27%) and then erythematosus exudative plaques. More than 50% of patients were symptomatic. Most common symptoms were itching, pain and burning. The exclusive underlying pathological diagnosis was ductal carcinoma (55%). DISCUSSION: In most cases, the clinical view of mammary Paget's disease was helpful. Unilateral ulcerated plaque was the most common clinical sign. Majority of the accompanying pathology was ductal carcinoma. We had no cases of extramammary Paget's disease in our study.