Myeloid Sarcoma: Case Series with Unusual Locations.

Myeloid sarcoma (MS) or chloroma is a localized mass composed of blastic cells of granulocytic lineage. It is a subtype of acute myeloid leukemia and usually presents as a complication of acute myeloid leukemia, myeloid dysplastic syndrome, or myeloproliferative disorder. MS occurs in 2.5-9.1% of patients with AML, precedes the clinical disease, coincidence with the onset or at relapse and in rare conditions, it can occur with no evidence of hematologic disorders. Here, we presented seven cases of MS in unusual locations or with rare presentations at presentation or relapse. We concluded that MS should be considered in the differential diagnosis of any high-grade tumor, especially in a patient with previous history of any myeloid neoplasm.

Coexistence of mucinous nevus and multiple collagenoma with unilateral, dermatomal, and multi segmental distribution.

Connective tissue nevus is a hamartoma composed of excess amounts of one or several components of the dermis, such as collagen, elastin, and proteoglycans. This report introduces a 14-year-old girl with grouped flesh color papules and skin color nodules distributed unilaterally with a dermatomal pattern. These lesions involved more than one segment. Histopathology is the gold standard for diagnosing collagenoma and mucinous nevus. We reported the first case of mucinous nevus with multiple collagenoma that shows the specific clinical features.

Metformin-Induced Generalized Bullous Fixed-Drug Eruption with a Positive Dechallenge-Rechallenge Test: A Case Report and Literature Review.

Metformin is a commonly used medication in diabetic patients. It can cause different complications including cutaneous adverse reactions. Metformin-induced fixed-drug eruption (FDE) has been reported in limited cases. Due to the popularity of metformin, clinicians need to be aware of uncommon drug reactions for proper diagnosis and treatment. Herein, we report a 43-year-old man with generalized bullous lesions with a positive dechallenge-rechallenge test diagnosed as metformin-induced generalized bullous fixed-drug eruption. Metformin dosage was stopped and lesions were treated with topical clobetasol propionate and oral prednisolone and cyclosporine-A. After a 6-month follow-up, he was well without any relapsing episodes.

Histopathological Characteristics of Cutaneous Melanoma in Isfahan, Iran, from 2013 to 2018.

Objectives: To investigate the histopathological characteristics of cutaneous melanoma in Isfahan from 2013 to 2018, according to histopathological subtype, lesions location, Clark level, and Breslow thickness. Methods: A descriptive, retrospective study in reports of Alzahra Hospital and Dr. Rajabi Pathology Laboratory in Isfahan. Results: In total, 45 patients were included in this study. The most prevalent histopathological subtype was acral lentiginous melanoma (48.89%), followed by lentigo maligna melanoma (17.78%), nodular melanoma (11.11%), and superficial spreading melanoma (8.89%). Most malignant lesions were on the foot and toes (31.1%) and face (24.4%). Tumor invasion level was mainly at Clark level IV (42.2%). Furthermore, the mean depth of tumor penetration (Breslow thickness) was 3.87 ± 3.35. Conclusions: Our study revealed the characteristics of melanoma in the Iranian population. Our results showed a similar trend with previous studies in the Asian population. Further investigations are needed to elucidate the role of ethnic and environmental risk factors for developing melanoma in different populations.

Coexistence of cutaneous endometriosis and ovarian endometrioma: a case report.

BACKGROUND: Umbilical endometriosis is a rare entity accounting for 0.5-4% of cases with endometriosis. CASE PRESENTATION: Here we report a rare case of umbilical endometriosis with concurrent ovarian endometriomas in a 37-year old primiparous Iranian woman. CONCLUSION: This interesting coexistence reflects the importance of thorough gynecological assessment in patients with cutaneous endometriosis to enable appropriate management.

Interferon α-induced lupus-like reaction in a mycosis fungoides patient: A case report.

Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphomas and interferon α is one of the treatment modalities for MF patients. So far, various side effects have been reported in connection with interferon use, including lupus-like reaction, which is relatively rare and classified as an injection-site reactions (ISR). We report a 38-year-old female with history of MF for 2 years who developed cutaneous lesions at the sites of interferon α-2b injections. There are few reports of lupus-like reaction due to therapy with interferon in malignant melanoma and multiple sclerosis (MS) patients, but there is no report in the literature about this side effect among patients with MF.

Multiple Disseminated Pyogenic Granuloma Post-Oil Burning: A Review of Literature.

Pyogenic granuloma (PG) is a common acquired vascular tumor and may appear mostly as a solitary papulonodular lesion on the face, trunk, and extremities. Although the etiology of PG is unclear, trauma, infections, and hormones may play a role. Multiple disseminated PGs are a very rare form and mostly are seen after traumas such as burn. We presented a patient with multiple PGs secondary to oil burning. There has been no report of PG caused by scald burn due to oil before. We also reviewed the literature in English and found 24 other cases of disseminated PG that most of them developed post-boiling milk.

The effects of olive oil and cholesterol enriched diets on aortic fatty streak development and lipid peroxidation in rabbits.

BACKGROUND AND AIM: High plasma cholesterol levels, mainly low-density lipoprotein-cholesterol (LDL) is a widely recognized major risk factor for coronary heart disease (CHD). According to epidemiologic studies' findings, people from the Mediterranean countries have lower CHD rates than other countries; in these countries the usual diet is high in olive oil. The present study compares the effects of a cholesterol-enriched diet with or without adding olive oil on serum lipoproteins, lipid peroxidation, and atherosclerosis development. METHODS: Twenty Dutch male rabbits were categorized into four groups (one group as control, and others as experimental). They received one of control (CON), olive oil-rich (OIL), cholesterol-rich (CHOL), and cholesterol + olive oil (COIL) diet for 12 weeks. Fasting blood samples from the heart were collected at the beginning and the end of the experimental period. RESULTS: Means of serum lipids were not significantly different at the beginning of the experimental period. After the intervention, significant differences were shown in total cholesterol (TC) (CON: 27.75 ± 4.83, OIL: 19.75 ± 2.62, CHOL: 1757.20 ± 149.62, COIL: 2906.40 ± 421.01; P < 0.001), high-density lipoprotein-cholesterol (HDL-C) (CON: 16 ± 1.47, OIL: 10.25 ± 1.70, CHOL: 22.2 ± 3.83, COIL: 28.60 ± 6.27; P = 0.04), triglyceride (CON: 65 ± 12.21, OIL: 71.75 ± 6.23, CHOL: 244.2 ± 44.45, COIL: 775.6 ± 105.07; P < 0.001), and MDA between groups (CON: 0.57 ± 0.10, OIL: 0.63 ± 0.15, CHOL: 5.62 ± 0.18, COIL: 2.06 ± 0.64; P < 0.001). The comparison of CHOL and the COIL groups showed a higher mean of malondialdehyde (MDA) in group CHOL (4.47 ± 0.28 vs 1.1 ± 0.6; P < 0.001). Aortic lesion was not observed in CON and OIL groups. Aortic lesion degree was significantly lower in the COIL group compared to the CHOL (2.4 ± 0.6 vs 3.66 ± 0.33; P = 0.02). CONCLUSIONS: These findings showed the preventive effect of olive oil on atherosclerosis development. However, it is independent of the plasma lipoprotein effect, and olive oil probably acts on arteries directly.

A Report of Unusual Case of Acquired Dermal Melanocytosis on the Scalp of a Caucasian Man with a Literature Review.

Dermal melanocytosis includes several benign pigmented lesions which present as blue-gray color which is a result of the color transmission of melanin pigment through the dermis. While some types are present at birth, there is an acquired variant, acquired dermal melanocytosis (ADM), which usually involves faces of middle-aged Asian women. To the best of our knowledge, there are limited reports of extra facial ADM which all are on the trunk and extremities. Herein, we report a unique case of extra facial ADM affecting the scalp of a middle-aged man and provide a review of all extra facial ADM cases that have been reported.

Azathioprine-induced pellagra in a child with autoimmune hepatitis: A case report and literature review.

Pellagra is a clinical syndrome resulting from niacin deficiency with variety of manifestations. Azathioprine is among drugs that can lead to such condition. Physicians should be aware as proper management can lead to full resolution.

Comparison of expression of CD1a and CD68 markers in skin leishmaniasis samples with positive and negative Leishman body.

BACKGROUND: Leishmaniasis is one of the most important infectious illnesses around the world. Given the high commonness of this disease, specifically its skin type in Iran and due to the role of the Leishman bodies in diagnosis, the aim of present study was evaluating the expression of two CD1a and CD68 markers in cutaneous leishmaniasis lesions with and without Leishman bodies. METHODS: In this case-control study, 70 skin samples of patients with cutaneous leishmaniasis (35 patients with Leishman body as case group and 35 patients without Leishman boy as control group) were investigated during 2018-2019. The expression of CD1a and CD68 markers and immunohistochemistry staining (IHC) were investigated in this study. RESULTS: The expression of CD1a in the group with Leishman body was significantly higher than group without Leishman body (P=0.01), but there was no significant difference between groups as expression of CD68 (P=0.40). The frequency of hyperkeratosis, parakeratosis, exocytosis, acanthosis, spongiosis, hydropic degeneration of basal cell layer, lichenoid reaction, pseudoepitheliomatous hyperplasia, ulcer, thinning of the epidermis, mononuclear cells, and extension of inflammation into lower dermis in the group with Leishman body was higher than group without Leishman body (P<0.05). CONCLUSION: The expression of CD1a and other morphological findings help to diagnose the difference between leishmaniasis with and without Leishman body.

Multiple disseminated pyogenic granuloma post-oil burning-Review literature.

Disseminated pyogenic granuloma is a rare entity. Patients need reassurance for this benign condition and are advised about the risk of recurrence and the risk of scarring with a total surgical excision. Red-flag diagnoses should be ruled out.

Isotretinoin for the treatment of facial lichen planopilaris: A new indication for an old drug, a case series study.

Despite the little information about the facial papules due to Lichen planopilaris (LPP), we have many cases with facial skin roughness in which histological study has showed LPP. Additionally, in those patients treating for frontal fibrosing alopecia or scalp LPP there was no improvement in facial papules.

Acral Eruptive Syringoma: An Unusual Presentation with Misdiagnosis.

Eruptive syringoma is a rare variant of syringoma presenting with skin-colored or slightly pigmented papules mostly before or during puberty. In this report, we presented a rare case of eruptive syringoma in a 30-year-old woman. She exhibited multiple skin lesions in dorsal areas of her both hands, developed from the age of 15.

Beneficial effects of pumpkin seed oil as a topical hair growth promoting agent in a mice model.

OBJECTIVE: Pumpkin (Cucurbita pepo L.) seed oil mainly consists of saturated and unsaturated fatty acids. Previously, it was reported that oral administration of pumpkin seed oil (PSO) improved hair growth in male pattern alopecia. This study aimed to evaluate hair promoting activity of topical PSO in an animal model. MATERIALS AND METHODS: Male Swiss mice (25-30 g) were used. Dorsal hair of mice (2 x 2.5 cm) was gently removed. Groups were treated as follows: (A) Intact control (did not receive testosterone) (B) Testosterone solution only (5% w/v); (C) Testosterone (5%) + PSO (5%); (D) Testosterone (5%) + PSO (10%) (E) Testosterone (5%) + minoxidil (2%). Application of drugs (100 µl) was done for six days a week, for 3 weeks. Observational and microscopic examinations were performed and results of different groups were compared. RESULTS: Topical application of testosterone significantly (p<0.01) prevented hair growth (compared with intact control). PSO (10%) increased hair growth score after 3 weeks and histopathological findings confirmed these results. After 3 weeks of treatment, the percentage of follicles in anagen phase was 95±4.6 and 44.4±15 for intact control and testosterone-only treated group, respectively. These percentages for PSO (10%) and minoxidil were 75±5.3 and 91.3±4.4, respectively and they could significantly (p<0.001) reverse the effects of testosterone. CONCLUSION: In conclusion, as topical application of PSO showed hair growth promotion, it might be regarded as a promising alternative for treatment of male pattern alopecia. Also, considering its composition, free fatty acids and minor components like phytoestrogens and vitamin E may have contributed to this effect.

Immunohistochemistry for Immunoglobulin G4 in the Diagnosis of Pemphigus.

INTRODUCTION: Pemphigus comprises of a group of autoimmune bullous disorders with intraepithelial lesions involving the skin and mucous membranes. Pemphigus is characterized histologically by an intraepidermal blister and immunopathologically by the finding of in vivo bound immunoglobulin G (IgG) antibodies against desmosomal adhesion proteins on the surface of keratinocytes. Indirect immunofluorescence for IgG is considered as a gold standard method for diagnosis of this group of bullous disorders on the condition that fresh frozen tissue is accessible. AIM: We designed a new diagnostic method by immunohistochemistry (IHC) for IgG4 on paraffin sections instead of fresh frozen tissue and evaluated sensitivity, specificity, and positive and negative predictive values of this method. MATERIALS AND METHODS: We searched our pathologic archive of pemphigus of 35 patients, including 29 cases of pemphigus vulgaris (PV) and 6 patients with pemphigus foliaceus (PF). In all cases, the diagnosis was confirmed by indirect immunofluorescence studies. Thirty-five specimens served as controls, including 31 specimens of safe margins of basal cell carcinoma and 4 specimens of normal skin. Sections with condensed and continuous immunoreactivity localized to the intercellular junctions of keratinocytes were considered as positive. RESULTS: Sensitivity of IgG4 was estimated to be 72.4% in PV group and 83.3% in PF group. The overall sensitivity and specificity of IgG4 IHC for diagnosis of pemphigus were 74.2% and 82.8%, respectively, in PV and PF groups. Furthermore, positive predictive value and negative predictive value were 81.2% and 76.3%, respectively. CONCLUSION: Immunohistochemical labeling for IgG4 on paraffin-embedded tissue provides a sensitive and specific test for diagnosing pemphigus in a situation when fresh frozen tissue is unavailable.

The Study for Diagnostic Value of ß-Catenin Immunohistochemistry Marker in Distinction of Aggressive and Non-Aggressive Basal Cell Carcinoma.

BACKGROUND & OBJECTIVE: Basal cell carcinoma (BCC) is a common skin cancer arising from the basal layer of the epidermis and its appendages. They are locally invasive, aggressive, and destructive of skin and the surrounding struc- tures. ß-Catenin is a multifunctional protein located to the intracellular side of the cytoplasmic membrane coded by the CTNNB1 gene, which maps to chromosome 3p22.1. It has a critical role in cell-to-cell adhesion by linking cadherins to the actin cytoskeleton and has a central role in transcriptional regulation in the Wnt signaling pathway. We evaluated the diagnostic value of the Beta catenin immunohistochemistry marker in distinction of aggressive and non-aggressive Basal cell carcinoma. METHODS: This cross sectional and descriptive-analytical study was done on archived formalin fixed, paraffin embed- ded tissue blocks in pathology library of Al-Zahra hospital in Isfahan city. We used immunochemistry to determinate the role of ß-Catenin in aggressiveness in BCC with higher rate of relapse. RESULTS: A total of 76 samples were evaluated in two groups (aggressive &none aggressive). The mean percentage of cytoplasmic ß-Catenin staining in aggressive group was more significant than the other group (sensitivity: 86.8% specificity: 81.6%, PPV: 81.5% and NPV: 86.1%) and the mean percentage of membranous ß-Catenin staining in non- aggressive group were significant more than the aggressive group. Intensity of membranous staining in both groups significant less than normal epithelium. CONCLUSION: Cytoplasmic ß-Catenin staining in aggressive BCC is more significant than non-aggressive subtypes, so this indicates that the use of ß-Catenin IHC marker maybe helpful in the diagnosis of aggressive BCC.

A case of prolonged generalized exanthematous pustulosis caused by hydroxychloroquine-Literature review.

Acute generalized exanthematous pustulosis (AGEP) is a self-limited drug reaction. Hydroxychloroquine (HCQ) is an uncommon cause of AGEP with a prolonged recovery course; Thus, the physicians should take the possibility of this rare but severe event in their minds and try to diagnose correctly and better management.

Ectopic Thyroid in Stomach; a Case Report.

An ectopic thyroid is a form of thyroid dysgenesis in which an entire or parts of the thyroid gland may be located in another part of the body than what is the usual place. The most frequent location is the base of tongue. Although most cases are asymptomatic, symptoms related to tumor size and its relationship with surrounding tissues, hormonal dysfunction and seldom malignancy may also occur. Any disease affecting the thyroid gland may involve the ectopic thyroid, including malignancy.

Pharmacokinetics and in vitro/in vivo antitumor efficacy of aptamer-targeted Ecoflex® nanoparticles for docetaxel delivery in ovarian cancer.

PURPOSE: Epithelixal ovarian cancer is the fourth cause of cancer death in developed countries with 77% of ovarian cancer cases diagnosed with regional or distant metastasis, with poor survival rates. Docetaxel (DTX) is a well-known anticancer agent, with clinically proven efficacy in several malignancies, including ovarian cancer. However, the adverse effects caused by the active ingredient or currently marketed formulations could even deprive the patient of the advantages of treatment. Therefore, in the current study, polymeric nanoparticles (NPs) equipped with aptamer molecules as targeting agents were proposed to minimize the adverse effects and enhance the antitumor efficacy through directing the drug cargo toward its site of action. MATERIALS AND METHODS: Electrospraying technique was implemented to fabricate poly (butylene adipate-co-butylene terephthalate) (Ecoflex®) NPs loaded with DTX (DTX-NPs). Afterward, aptamer molecules were added to the DTX-NPs, which bound via covalent bonds (Apt-DTX-NPs). The particle size, size distribution, zeta potential, entrapment efficiency, and release profile of the NPs were characterized. Using MTT assay and flow-cytometry analysis, the in vitro cytotoxicity and cellular uptake of the NPs were compared to those of the free drug. Following intravenous administration of Taxotere®, DTX-NPs, and Apt-DTX-NPs (at an equivalent dose of 5 mg/kg of DTX), pharmacokinetic parameters and antitumor efficacy were compared in female Balb/c and HER-2-overexpressing tumor-bearing B6 athymic mice, respectively. RESULTS: The obtained results demonstrated significantly enhanced in vitro cytotoxicity and cellular uptake of Apt-DTX-NPs in a HER-2-overexpressing cell line, comparing to DTX-NPs and the free drug. The results of in vivo studies indicated significant increment in pharmacokinetic parameters including the area under the plasma concentration-time curve, mean residence time, and elimination half-life. Significant increment in antitumor efficacy was also observed, probably due to the targeted delivery of DTX to the tumor site and enhanced cellular uptake as evaluated in the aforementioned tests. CONCLUSION: Hence, the proposed drug delivery system could be considered as an appropriate potential substitute for currently marketed DTX formulations.