A case of large-cell undifferentiated carcinoma of the bladder.

Large-cell undifferentiated carcinoma of the urinary bladder is an extremely rare and aggressive neoplasm. We present a unique case of painless gross hematuria and a past surgical history of cystolithotomy. The patient underwent transurethral resection of the bladder tumor, which revealed high-grade urothelial cell carcinoma with lamina propria involvement. Subsequent radical cystoprostatectomy with orthotopic neobladder urinary diversion and pelvic lymphadenectomy was performed, and the postoperative pathologic examination indicated large-cell undifferentiated. This case report highlights the importance of accurate diagnosis and management for this rare malignancy and adds to the limited existing literature on Large-cell undifferentiated carcinoma.

Challenging diagnosis of Kimura disease in a child with nephrotic syndrome: A case report.

Kimura disease (KD) is a rare condition with a challenging diagnosis because it may be misdiagnosed and not differentiated from other disorders. We reported a 13-year-old patient who presented with growing neck masses and was hospitalized due to the nephrotic syndrome relapse but was eventually diagnosed with KD.

Inflammation Progresses to Normal Tissue in Patients with Anthracosis after Discontinuation of Exposure to Fossil Fuel.

Background: Exposure to toxic materials predisposes the lungs to infectious agents and inflammatory responses. The present study was performed on patients with anthracosis caused by exposure to fossil fuels in previous years, and histopathological features of airways' normal-appearing tissue were compared with histopathological features of anthracotic plaques in these patients. Methods: Bronchoscopic evaluations were performed on bakery workers who were directly in contact with fossil fuels. Samples were taken from anthracotic plaques (Group A) or seemingly intact tissues at their periphery (Group B). Pathological evaluations were done after hematoxylin and eosin staining. Then, microbiological cultures were performed for the diagnosis of Mycobacterium tuberculosis. Data obtained from bronchoscopy, pathology, and cultures were compared between anthracotic and normal-appearing peripheral tissues using chi-square and analysis of variances (ANOVA) at a 95% confidence level. Results: Sixty-eight patients were diagnosed with anthracotic plaques. The mean ± SD of the patients' age was 72.12 ± 13.74 years. Females comprised 58.8% of the sample, and 85.3% of the patients were Iranian. The frequency rates of disseminated plaques and obstructive types were 86.8% and 48.5%, respectively. Ten patients (14.70%) were diagnosed with tuberculosis, and 4.41% (3 of 68) had granuloma, which was detectable only in samples gathered from Group A. Fibrosis was more common in Group A (10.3%, p = 0.03), and most of the evaluated samples in both groups exhibited inflammatory features. Conclusion: Inflammatory changes and tissue damage can be seen in anthracotic plaques and the surrounding normal-appearing tissue, even after removing the triggering factors. So, it is suggested to take a biopsy from seemingly intact tissue at the periphery of the anthracotic plaque when a biopsy is needed in a patient with anthracosis to reduce the risk of bleeding. Besides, medical treatment should be done to control inflammation.

Ovarian Tissue Reservation and Risk of Reimplantation in a Young Girl with Acute Lymphocytic Leukemia after 6-Month Chemotherapy: A Case Report.

In the fertility preservation programs, ovarian cryopreservation is usually offered when the risk of premature ovarian failure is high (>30-50%) while the risk of ovarian metastasis is low. According to the guidelines, it must be done before the patient receives chemotherapy. A 22-year-old girl with acute lymphocytic leukemia was a candidate for ovarian cryopreservation after 6 months of chemotherapy. Despite chemotherapy, the anti-Mullerian hormone survey was within normal range. Ovarian tissue cryopreservation was done. In the histology survey, follicular density was 7.48. This case shows that only having a history of chemotherapy does not exclude the patient from the fertility preservation program. Regarding referring the patients for fertility preservation, cumulative factors such as a history of gonadotoxic treatment, age, and treatment protocol should be considered. In addition, the case was negative for assessing of CD45 marker. New data may challenge previous strict criteria, and extend the indications of this effective method in preserving fertility among cancer patients.

Cyclin D1 Expression in Patients with Laryngeal Squamous Cell Carcinoma.

BACKGROUND & OBJECTIVE: Laryngeal squamous cell carcinoma (LSCC) is considered to be one of the most common cancers of the head and neck, accounting for roughly 90% of all malignant tumors of the larynx. To have a timely diagnosis for a better and practical therapy, molecular markers have to be investigated. The aim of this study was to determine the expression of Cyclin D1 (CD1) in patients with laryngeal squamous cell carcinoma. METHODS: In this study the demographic data of 82 patients with laryngeal squamous cell carcinoma, including age, gender and geographical region history of smoking and drug abuse, paraclinical findings, surgical description, and pathologic reports were extracted from their medical records. The stage and grade of the disease and tumor location were determined using their medical records. An appropriate tissue sample was selected. Then, the selected cancerous tissue samples stored as formalin-fixed paraffin-embedded tissue then were (Immunohistochemistry) IHC stained and analyzed in terms of the expression of CD1. RESULTS & CONCLUSION: According to the results, 75 out of 82 (91.5%) investigated samples were positive for CD1 expression. There was a significant relationship between stage of the disease (P=0.041) and CD1 expression in patients with laryngeal squamous cell carcinoma. There was no significant relationship between gender (P=0.055), age (P=0.256), history of smoking and drug abuse (P=0.192), location of the tumor (P=0.90), grade of the disease (P=0.515) and geographical region (P=0.466) and CD1 expression in patients with laryngeal squamous cell carcinoma. The results of the present study showed that CD1 expression was higher (91.5%) in patients with laryngeal squamous cell carcinoma in comparison to the other studies. According to the results we can conclude that stage of the disease can significantly affect CD1 expression in patients with squamous cell carcinoma.

Bayesian approach for cure models with a change-point based on covariate threshold: application to breast cancer data.

In this study, a Bayesian approach was suggested to estimate a change-point according to a covariate threshold when some patients never experienced the event of interest. Gibbs sampler algorithm with latent binary cure indicators was used to simplify the implementation of Markov chain Monte Carlo method. Then, the accuracy of new model was demonstrated by simulation studies to compute the point and interval estimates of parameters. Finally, an effective threshold was suggested in age at surgery time to experience the metastasis when the model was applied for a data set of breast cancer patients.

Lobular Capillary Hemangioma of the Ethmoid Sinus: A Report of Two Cases.

Soft-tissue tumors are rare in the paranasal region. Lobular capillary hemangioma (LCH) is a distinctive vascular lesion most commonly seen on the skin and oral mucosa in the fourth and fifth decades of life. Forasmuch as the nasal cavity and paranasal sinuses are rare locations for LCH, it is not well known by many ENT surgeons. Here we present two cases of LCH of the ethmoid sinus. These cases are being reported owing to their scarcity as per the literature published global.

Curcumin attenuates hepatic fibrosis and insulin resistance induced by bile duct ligation in rats.

Recent studies have strongly indicated the hepatoprotective effect of curcumin; however, the precise mechanisms are not well understood. This study aimed to determine the protective effect of curcumin on hepatic damage and hepatic insulin resistance in biliary duct ligated (BDL) fibrotic rat model. To accomplish this, male Wistar rats were divided into four groups (eight for each): sham group, BDL group, sham+Cur group and BDL+Cur group. The last two groups received curcumin at a dose of 100 mg/kg daily for 4 weeks. The mRNA/protein expression levels of Ras-related C3 botulinum toxin substrate 1 (Rac1), Rac1-GTP, dinucleotide phosphate oxidase 1 (NOX1), signal transducer and activator of transcription 3 (STAT3), suppressor of cytokine signalling 3 (SOCS3), insulin receptor substrate 1 (IRS1), extracellular signal-regulated kinase 1 (ERK1), specific protein 1 (Sp1) and hypoxia-inducible factor-1α (HIF-1α) were measured by real-time PCR and Western blotting, respectively. Fasting blood glucose, insulin and Leptin levels were determined and homoeostasis model assessment-estimated insulin resistance, as an index of insulin resistance, was calculated. Curcumin significantly attenuated liver injury and fibrosis, including amelioration of liver histological changes, reduction of hepatic enzymes, as well as decreased expression of liver fibrogenesis-associated variables, including Rac1, Rac1-GTP, NOX1, ERK1, HIF-1α and Sp1. Curcumin also attenuated leptin level and insulin resistance, which had increased in BDL rats (P<0·05). Furthermore, compared with the BDL group, we observed an increase in IRS1 and a decrease in SOCS3 and STAT3 expression in the curcumin-treated BDL group (P<0·05), indicating return of these parameters towards normalcy. In conclusion, Curcumin showed hepatoprotective activity against BDL-induced liver injury and hepatic insulin resistance by influencing the expression of some genes/proteins involved in these processes, and the results suggest that it can be used as a therapeutic option.

Comparison of effect of kangaroo mother care, breastfeeding and swaddling on Bacillus Calmette-Guerin vaccination pain score in healthy term neonates by a clinical trial.

BACKGROUND/AIM: The purpose of this research was to compare the analgesic effect of kangaroo mother care (KMC), breastfeeding and swaddling in Bacillus Calmette-Guerin (BCG) vaccination in term neonates. METHODS: In a randomized 120 healthy term neonates who received routine BCG vaccination in the first day of their life are distributed into three groups. In group 1, neonates breastfed two minutes before, during and one minute after BCG vaccination. In group 2, neonates received KMC 10 minutes before, during and one minute after vaccination and in group 3, they were swaddled 10 minutes before, during and one minute after vaccination. Primary outcomes included pain score during, one minute and two minutes after BCG vaccination and obtaining pain score of less than three during vaccination . RESULTS: Pain scores during, one minute and two minutes after vaccination in group 1 were lower than in groups 2 and 3. Group 1 had higher success rate in painless vaccination and had lower crying duration in comparison to another groups (p < 0.05) Conclusion: Breastfeeding was more effective than KMC and swaddling in reduction of BCG vaccination pain in healthy term neonates.

Primary histiocytic sarcoma of the uterine cervix: an extremely rare entity.

OBJECTIVE: Histiocytic sarcoma (HS) is an extraordinary rare tumor and it has an offensive clinical course. HS of the uterine cervix is a far uncommon tumor with just a few cases described so far. Here we presented a case of primary HS of the uterine cervix in a 62-year-old female initially misdiagnosed as large cell non-keratinizing squamous cell carcinoma. To the best of our knowledge, this is the first reported case of HS of the uterine cervix from Iran. CASE REPORT: The patient presented with post-menopausal vaginal bleeding. Further evaluations revealed the presence of a relatively large cervical mass that was sampled. Under the preliminary diagnosis of large cell non-keratinizing squamous cell carcinoma, the patient underwent radical surgery. Postoperative pathological examination confirmed the diagnosis of HS of the uterine cervix. The patient received chemotherapy. CONCLUSION: Clinical presentations of HS of the uterine cervix are very similar to more common cervical tumors; as a result its diagnosis relies on immunohistochemical methods. A correct diagnose could lead to the proper and timely treatment.

Ten years of experience in clinicopathologic characteristics, treatment and outcome of patients with nasopharyngeal pathologies in Yazd, Iran.

INTRODUCTION: Although there are some studies regarding the clinical characteristics and outcome of nasopharyngeal tumors, one such study from Iran has not been reported to date. This study aimed to evaluate the clinical features, treatment, and consequences of nasopharyngeal lesions. METHODS: In this cross sectional study, we conducted a retrospective review of patients who were diagnosed with nasopharyngeal pathologies and treated at Shahid Sadoughi Hospital and Shahid Ramazanzadeh Radiotherapy Center in Yazd, Iran, over a period of 10 years (from 2005 to 2014). The variables in the study were the patient's hospital registration number, date, name, age, gender, address, topography, clinical symptoms, morphology, stage, types of treatment, and survival for each subject. Survival data were analyzed using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression method. Statistical analyses were performed using IBM-SPSS, version 22. RESULTS: In the study, there were 123 patients, 85 males and 38 females, who had nasopharyngeal lesions. The mean age at diagnosis was 41.51 ± 20.33 years. There were 83 patients with malignant neoplasms and 40 patients with non-malignant lesions. The most common malignant tumor was nasopharyngeal carcinoma, and the most common benign lesion was angiofibroma. Survival analysis was performed for the 83 patients who had malignant neoplasms, and survival was found to be 94.5 ± 4.32 months. There were significant differences in survival based on the stage of the disease, histological type, and the type of treatment (p = 0.001, 0.02, and 0.003, respectively). CONCLUSION: In our institutional study, malignant tumors were more common than benign lesions. Patients with nasopharyngeal carcinoma presented relatively late and at an advanced stage. Regular follow-up is necessary for early detection, recurrence, or metastases of malignant tumors.

Diagnostic value of sputum adenosine deaminase (ADA) level in pulmonary tuberculosis.

INTRODUCTION: Tuberculosis is still a considerable health problem in many countries. Rapid diagnosis of this disease is important, and adenosine deaminase (ADA) has been used as a diagnostic test. The aim of this study was to assess the diagnostic value of ADA in the sputum of patients with pulmonary tuberculosis. METHODS: The current study included 40 patients with pulmonary tuberculosis (culture positive, smear ±) and 42 patients with non tuberculosis pulmonary diseases (culture negative). ADA was measured on all of the samples. RESULTS: The median value of ADA in non-tuberculosis patients was 2.94 (4.2) U/L and 4.01 (6.54) U/L in tuberculosis patients, but this difference was not statistically significant (p=0.100). The cut-off point of 3.1 U/L had a sensitivity of 61% and a specificity of 53%, the cut-off point of 2.81 U/L had a sensitivity of 64% and a specificity of 50% and the cut-off point of 2.78 U/L had a sensitivity of 65% and a specificity of 48%. The positive predictive values for cut-off points of 3.1, 2.81 and 2.78 U/L were 55.7%, 57.44% and 69.23%, respectively. The negative predictive values for the abovementioned cut-off points were 56.75%, 57.14% and 55.88%, respectively. CONCLUSION: Our results showed that sputum ADA test is neither specific nor sensitive. Because of its low sensitivity and specificity, determination of sputum ADA for the diagnosis of pulmonary tuberculosis is not recommended.

Malignant Myopericytoma of Shoulder: A Rare Lesion.

Myopericytoma is a soft tissue tumor with perivascular myoid differentiation. It accounts for 1% of the vascular tumors and involves mostly cutaneous or subcutaneous tissue of the limbs in adults. Malignant myopericytoma is exceedingly rare. A 15-year old girl presented with slowly progressive mass over left shoulder region. Histopathology and immunohistochemistry after complete excision revealed it as malignant myopericytoma.

Evaluation of Vaccines Injection Order on Pain Score of Intramuscular Injection of Diphtheria, Whole Cell Pertussis and Tetanus Vaccine.

OBJECTIVE: To determine, whether or not intramuscular injection of diphtheria, pertussis and tetanus (DwPT) vaccine should be given first and subcutaneous injection of measles, mumps and rubella (MMR) thereafter or vice versa and can this cause less pain of DwPT vaccine injection. METHODS: In a randomized parallel group clinical trial, seventy 18-mo-old healthy children who were referred for routine vaccination to Akbari Health Care Center, Yazd, Iran from September 2014 through March 2015 were randomly allocated to two groups to receive DwPT and then MMR vaccines or MMR first, and then DwPT. Primary outcomes included pain score during DwPT injection, pain score during MMR injection, overall pain score of vaccination and obtaining a pain score of less than three during DwPT injection. Pain scores were assessed based on Modified Behavioral Pain Scale. Secondary outcome was crying duration during DwPT injection. RESULTS: Thirty seven girls and 33 boys were evaluated in two groups. Pain scores of DwPT and MMR injections, the frequency of pain score obtained to be less than three during DwPT injection and the crying duration were not different in both groups. But, overall pain score of vaccination was lower when subcutaneous injection of MMR vaccine was given before intramuscular injection of DwPT vaccine. (14.23 ± 1.35 vs. 15.61 ± 2.65; P = 0.04). CONCLUSIONS: Overall pain score of vaccination in multiple vaccine injection at the same visit might be reduced if subcutaneous vaccine is injected before intramuscular one.

Proliferating Myositis: An Inflammatory Lesion often Misdiagnosed as A Malignant Tumor.

Proliferative myositis (PM) is a rare inflammatory disease. Most commonly, the lesion occurs in the extremities. Regarding its fast growth and bizarre shape of the cellular components this entity commonly misdiagnosed and the patients undergo improper therapeutic approaches. In other words, it is often misdiagnosed as sarcoma. The diagnosis can only be made by the microscopic examination, so biopsy is mandatory. Here the authors report a patient with PM who was initially misdiagnosed as pleomorphic sarcoma of the lower extremity and explain this rare entity. Proliferative myositis should be taken into account if a fast growing, intramuscular mass occurs in the extremities.

Subungual Ewing sarcoma/PNET tumor family of the great toe: a case report.

Ewing's sarcoma is seen mainly in patients less than 18. This aggressive tumor generally affects the axial skeleton and only rarely involves the acral regions. Ewing's sarcoma in the foot is inordinately scarce. Clinical features are uncertain and can imitate other common diseases. This paper presents a case of 62-year-old malewith complaints of pain and swelling of the subungual area of his right great toe. The lesion was excised, and histopathological diagnosis of Ewing's sarcoma was made. Histopathological examination, supported by immunochemical methods, remains the mainstay of diagnosis. Surgical ablation along with chemotherapy is the therapy of choice. To our knowledge, this is the first report of Ewing's sarcoma involving the nail bed of the great toe without bone erosion. The key messages of this case report is "Subungual Ewing sarcoma is a rare case, and Ewing's sarcoma must be kept in mind for acral lesions, especially in the adult population."

Primary Testicular Pre-B Lymphoblastic Lymphoma.

Primary testicular lymphoblastic lymphoma is a rare entity. We report a case of a 13-year-old boy referred with unilateral testicular swelling. After preliminary work-up orchiectomy was performed Histopathology detected primary testicular lymphoblastic lymphoma. Lymphoblastic lymphoma should be considered in the differential diagnosis of testicular masses in children.

Disseminated Skeletal Angiomatosis Initially Misdiagnosed As Metastatic Tumor: A Case Report.

Disseminated angiomatosis, also referred to as cystic angiomatosis, is a generalized disease that involves bones and soft tissue. It is characterized by multifocal hemangiomatous lesions of the bones with possible visceral organ involvement. The clinical manifestations differ according to the site and the extension of disorder. Here we describe a case of generalized angiomatosis occurring in a 35-yr-old Iranian woman, initially misdiagnosed as osseous metastasis, who presented at Shahid Sadoughi Hospital, Yazd, Iran in February 2014. Although the clinical, radiological and pathological features are diagnostic, the process is often mistaken with other lytic lesions of the bones, especially malignant tumors. The case is being reported owing to its scarcity as per the literature published globally.

Efficacy of zinc sulfate supplement on febrile seizure recurrence prevention in children with normal serum zinc level: A randomised clinical trial.

OBJECTIVE: Serum zinc level might be related to pathogenesis of febrile seizure (FS). The purpose of this study was to evaluate efficacy and safety of oral zinc supplementation on FS recurrence prevention in non-zinc-deficient children. MATERIALS AND METHODS: In a randomized clinical study, one hundred 18 to 60 mo old children with normal zinc level with first simple FS were referred to Shahid Sadoughi Hospital, Yazd, Iran from May 2012 to June 2013, were randomly assigned to two groups to receive 2 mg/kg/d zinc sulfate for six consecutive months or placebo as control group and were followed up for 1 y for FS recurrence. RESULTS: 41 girls and 59 boys with mean age of 2.47 ± 1.01 y were evaluated. Race, mean weight, height and body fat were similar in both groups. FS recurrence occurred in 19 children (38%) in the control group [95% confidence interval (CI): 19.45%-53.95%] and in 11 children (22%) in the zinc sulfate (95% CI: 57.47%-89.13%) groups, respectively; and the zinc group had lower FS recurrence (P = 0.03). The mean serum zinc level before intervention was lower in children with FS recurrence (72.43 ± 14.58 µg/dL versus 96.33 ± 12.69 µg/dL, P = 0.04). Gastrointestinal side effects (vomiting in five children, heartburn in two children and abdominal pain in one child) were seen in 16% of the zinc group and vomiting occurred in two children (4%) in control group and frequency of adverse events was similar in the two groups (P = 0.1). CONCLUSION: Zinc supplementation should be considered as effective and safe in prevention of FS recurrence.

Laryngeal Paraganglioma: A Diagnostic Challenge.

Paragangliomas are neoplasms of neural crest origin. In the head and neck, they uncommonly involve the larynx. The distinction between paragangliomas and other neuroendocrine tumors can be difficult. Precise diagnosis is important in order to optimize patient treatment. Diagnosis relies mostly on histopathologic examination followed by immunohistochemistry. Here we report a 77-year-old woman with laryngeal paraganglioma that initially misdiagnosed as laryngeal carcinoid tumor.