Prevalence of Human Papilloma Virus in Sinonasal Papilloma in Southern Iranian Population

STATEMENT OF THE PROBLEM

Sinonasal papilloma (SNP) is a rare benign lesion characterized by high recurrence rate and malignant transformation.

PURPOSE

This study aimed to investigate the prevalence of human papilloma virus (HPV) infection in these lesions in South of Iran.

MATERIALS AND METHOD

In this cross sectional retrospective study, a total of 41 patients, 38 SNP and 3 SNP/Squamous cell carcinoma cases, from 2007 to 2014 were studied. Human papilloma virus (HPV) DNA detection was performed by nested PCR method and positive cases were analyzed for high risk HPV-16 and HPV-18.

RESULTS

HPV was detected in 31.7%; HPV- 16 in 4.9% and HPV 18 was not detected at all. Dysplastic epithelium was detected in 53% that was not associated with HPV. Three cases were accompanied with malignant transformation that HPV genome was detected in only one case and none of them were positive for HPV16 /18 genomic DNA.

CONCLUSION

Current research suggests that HPV may be involved in the development of SNP. But the high risk HPV is not important in malignant transformation. More studies are needed to elucidate the possible etiologic mechanism between HPV, inverted papilloma, and squamous cell carcinoma.

The Prevalence of Human Papilloma Virus in Squamous Cell Carcinoma of Oral Tongue

BACKGROUND AND OBJECTIVE

Oral tongue Squamous Cell carcinoma (SCC) commonly involves males between the sixth to eighth decades of life. Major risk factors are tobacco usage and alcohol consumption. The increasing number of patients developing oral tongue cancer without these well-known risk factors suggests that a viral infection, such as Human Papillomavirus (HPV), may be responsible for this increase, by acting as an oncogenic agent. This study investigated the prevalence of HPV infection and its clinicopathologic significance in oral tongue SCCs.

METHODS

Tissue blocks from a total of 50 cases (patients with oral tongue SCC) and 50 controls (palatine tonsillar tissues with benign diagnosis) were selected. DNA was extracted from tumoral and non-tumoral tissue blocks. Detection of common HPV DNA by nested Polymerase Chain Reaction (PCR), and high-risk genotypes, HPV 16 and HPV 18, by conventional PCR, was achieved and the results correlated with clinicopathological parameters.

RESULTS

Of the 50 patients (18 males and 32 females with a mean age of 57.36±12.18 years, and age range of 27 to 86 years), 7 (14%) had HPV positive results. None of the control group subjects had HPV DNA positive results (P-value of 0.012). The HPV genotype 16/18 was not detected in positive cases. No statistically significant association was found between HPV status and gender, age, tumor grade, tumor stage or lymph node involvement.

CONCLUSION

Although there was a significantly higher prevalence of HPV in oral tongue SCC, its association with carcinogenesis in this area requires further studies.

Quantitative polymerase chain reaction for detection of human herpesvirus-7 infection in umbilical cord blood donors

OBJECTIVE

Umbilical cord blood (UCB) has been a reasonable alternative to granulocyte colony-stimulating factor-mobilized peripheral blood or bone marrow, as a source of hematopoietic stem cells with a lower risk of graft-versus-host disease. In immunocompromised hosts after transplantation, the risk of viral infection in adults, especially with beta-herpesviruses such as human herpesvirus-7 (HHV-7), may be increased. This virus in immunocompromised patients can be reactivated from latency and converted to an active phase. Therefore, light-upon-extension real-time polymerase chain reaction (PCR) was developed to assess the prevalence and load of HHV-7 in the plasma and buffy coat of donors.

METHODS

About 825 UCB samples under standard protocol from donors were collected. Then, DNA from plasma and buffy coat was extracted and quantitative real-time PCR was performed with light-upon-extension primers.

RESULTS

Overall, HHV-7 was detected in 3.64% (30/825) of UCB donors. HHV-7 DNA was detected in 26 (3.2%) buffy coat samples (latent infection), and only 4 (0.48%) of them were positive for HHV-7 DNA in plasma samples (active infection); the mean HHV-7 viral load was 1.31 × 10(1) copies/mL in latent infection, and 1.94 × 10(5) copies/mL in active infection.

CONCLUSIONS

We suggest that real-time PCR in plasma and buffy coat could be a useful method to detect active and latent HHV-7 infection in UCB donors and determine its role in subsequent transmission events.

Anaplastic Solitary plasmacytoma of mandible, masquerading as sarcoma

Plasma cell neoplasm is characterized by a monoclonal neoplastic proliferation of plasma cells and solitary plasmocytoma of bone (SPB) is a localized form. It usually occurs in vertebrae and secondarily in long bones. Its presence in mandible is extremely rare event. A 48-year-old man consulted to our clinic with a chief complaint of pain in his mandible. Radiography revealed a destructive lesion in body and ramus. The initial pathologic evaluation revealed a high grade pleomorphic neoplasm. The diagnosis was confirmed by immunohistochemical markers. Overall, plasmacytoma with anaplastic features can be confused with high grade sarcoma clinically and histologically.

Extramedullary plasmacytoma of the nasal cavity report of three cases with review of the literature

Extramedullary plasmacytoma is a rare neoplasm characterized by monoclonal proliferation of plasma cells. Most lesions occur in the head and neck, primarily in the upper aerodigestive tract. The nasal cavity and nasal septum are the most common sites of occurrence. In this report, three patients admitted in our clinic with history of nasal obstruction and/or epistaxis. Patients were diagnosed with extramedullary plasmacytoma and mass were completely excised. This entity usually occurred in 5th-6th decade of life. One of our patients, a young man, was completely asymptomatic and following a paroxysm of coughing, a polypoid mass was expectorated. The clinical and histopathologic findings of plasmacytoma are discussed. In order to exclude systemic involvement, systematic approach using clinical, laboratory, and radiologic investigations was performed. Extramedullary plasmacytoma of the nasal cavity is rare and should be considered in the differential diagnosis of nasal cavity masses especially in young age group.

Prevalence of GJB2 (CX26) gene mutations in south Iranian patients with autosomal recessive nonsyndromic sensorineural hearing loss

Hereditary hearing loss is a genetically heterogeneous disorder. Mutations in connexin 26 (CX26), are a major cause in many countries and are largely dependent on ethnic groups. The purpose of our study was to evaluate the prevalence of GJB2 mutations among affected individuals from south of Iran. Fifty patients presenting with autosomal recessive non-syndromic hearing loss from Fars, province in south of Iran, were studied for mutations in GJB2 gene and screened by direct sequencing. Mutations were detected in 15 out of 50 patients (30 %). Eight different mutations were identified; six of them were previously identified (35delG, V27I M34V, V153I, A149T, V198M). The remaining two alleles, L28I and N169T, were novel variants. The most common mutations were 35delG followed by V153I with an allele frequency of 7 and 6 %, respectively. In this study, 30 % of our subjects were found to have the causative variants or polymorphisms in GJB2 and the c.35delG mutation was the most common cause in our patients. However, more study with larger sample size as well as in vitro functional study for these new variants in Xenopus oocytes is required.

The effect of calendula officinalis in therapy of acetic Acid induced ulcerative colitis in dog as an animal model

BACKGROUND

In patients with ulcerative colitis (UC), the repeated cycle of injury and repair of intestinal mucosa has been reported to increase the risk of colon cancer. So, a safe and efficient therapy is required for the treatment and prophylaxis for the disease.This study aims to investigate the efficacy of Calendula officinalis extract in treatment of experimentally induced ulcerative colitis in dog animal model.

METHODS

During fall 2010, 10 out-bred female German dogs (1-2 years old; weighs of 20-25 kg) were enrolled. Ulcerative colitis was induced with 6% acetic acid as enema and method of treatment was retrograde (via enema) too by C. officinalis.

RESULTS

Loose stools, diarrhea, gross bleeding and loss of body weight happened after administration of acetic acid and crypt damage, loss of epithelium, infiltration of inflammatory cells and depletion of goblet cells were noticed histologically. C. officinalis could successfully resolve the damages of UC.

CONCLUSION

Treatment with C. officinalis can broaden the current therapy options for UC.

A clinico-pathologic study of 82 intraoral minor salivary gland tumors

BACKGROUND

Intraoral minor salivary glands tumors (MSGT) are uncommon, with geographic variations in frequency and distribution. This study analyzed the clinic-pathologic features of these tumors in Shiraz, southern Iran.

METHODS

All of cases histopathologically recorded as epithelial MSGT in Pathology Department of Khalili Hospital from 2002 to 2009 were evaluated with regard to patient's age and gender, tumor location and type, retrospectively.

RESULTS

Out of 82 cases of MSGT, 53.7% were benign and 46.3% were malignant. Pleomorphic adenoma and adenoid cystic carcinoma were the most common benign and malignant tumors, respectively. The palate was the most common site of involvement (64.6%). Male to female ratio was 1:1.27. The mean age of the patients was 35.0±17.2 years for benign and 48.8±18.2 years for malignant tumors.

CONCLUSION

MSGTs in the present study represent many characteristics of other studies. However, our patients who were affected by benign tumors were young.

Relation between Actinomycosis and Histopathological and Clinical Features of the Palatine Tonsils: An Iranian Experience

BACKGROUND

Actinomycosis of the tonsils has been reported in a variable percentage of tonsil specimens by other authors. This study determines the incidence of actinomyces in the palatine tonsil and evaluates the clinical diagnoses and histopathological features of tonsillectomy specimens.

METHODS

In a retrospective study, 204 patients who had undergone tonsillectomy for recurrent tonsillitis (group A) and for sleep apnea without a history of recurrent tonsillitis (group B) were enrolled.

RESULTS

The prevalence rate was significantly higher in the adult compared with the pediatric population. The prevalence of tonsillar actinomycetes colonization was higher in patients who had undergone tonsillectomy for recurrent tonsillitis (43.9%) than in patients who had undergone tonsillectomy for obstructive sleep apnea (26.3%). The prevalence did not differ by sex of patient. Histopathological analysis of resected tonsils did not show active tissue infection. There was a statistically significant relationship between the presence of actinomycosis and age, with a greater occurrence of actinomycosis in adult patients.

CONCLUSION

Although actinomyces colonization is more prevalent in patients with recurrent tonsillitis than sleepdisordered breathing, but the presence of actinomyces does not indicate any active disease.

Distant metastases to nasal cavities and paranasal sinuses case series

Metastatic tumors to the nasal cavity and paranasal sinuses are far less common than primary cancer in this location. Review of the 2004-2010 pathology records of patients with sinonasal malignancy, revealed three cases with distant metastases to this region from primary sites in kidney, prostate and breast. The clinical presentation, histopathological findings and clinical outcome is presented for each patient. Metastases to the nose and paranasal sinuses usually respond poorly to treatment and have a poor prognosis. This report highlights the importance of suspecting metastases in patients with a previous history of malignancy. Therefore, thorough history and clinical evaluation is mandatory in any known/treated case of cancer.

Study the polymorphism of CYP3A5 and CYP3A4 loci in Iranian population with laryngeal squamous cell carcinoma

Cancer reflects a complicated network of interactions between genes and environmental factors. Cytochrome P450 (CYP) is a multi-gene superfamily participating in the metabolism of xenobiotics. The aim of our study was to examine whether polymorphisms in the CYP enzyme genes affect the risk of developing larynx squamous cell carcinoma (SCC). Polymorphism of CYP3A5 and CYP3A4 genes were investigated in 50 patients with laryngeal SCC and 100 control subjects by polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP). In patients the CYP3A5 3/3 and 1/3genotypes were detected in 92% and 8% respectively. There was no relation between genotype, allele frequency and grade/stage of tumor. In control group, the frequency of CYP3A5 3/3 and CYP3A5 1/3 genotype were 98% and 2% respectively. There was no significant difference in genotype and allele frequency of this gene between patient and control group. In respect of CYP3A41A/B, people in both patient and control groups had the same genotype of CYP3A41A/1A. In this study, the CYP gene variants were not associated with increased risk of laryngeal SCC. Study on the other genetic factors which are involved in activation/detoxication of procarcinogenes, such as CYP1A1, CYP1B1, CYP2E1 and gluthation S transferase is recommended.

Expression of Ki67 and P53 in primary squamous cell carcinoma of the larynx

We studied a series of untreated laryngeal carcinomas in an attempt to determine the relationship between Ki67 and p53 expression and clinicopathological findings. The relationship between expression of these markers in non-tumoral tissue was also evaluated in order to investigate the possible role of immunohistochemistry as a diagnostic aid in evaluating laryngeal biopsies.

MATERIALS AND METHODS

Samples from 54 patients with laryngeal squamous cell carcinoma (SCC) were analyzed retrospectively. The uninvolved vocal cord was evaluated as a non-tumoral sample. Paraffin sections of tumors were immunohistochemically stained for p53 and Ki67 expression.

RESULTS

Overall, p53 expression was found in 35 (64.8%) of the patients. There was a significant correlation among tumoral p53 expression and tumor location, tumor stage and lymph node involvement. Most grade I tumors had a Ki67 labeling index <50% and a labeling index ≥ 50 was found mainly in high-grade tumors. Tumoral Ki67 expression correlated significantly with tumor grade and mitotic count. There was no correlation between Ki67 labeling index and tumor region. In non-tumoral tissue, 95% of high-grade pre-neoplastic lesions revealed a high expression of Ki67. Non-tumoral p53 expression did not correlate with histological findings.

CONCLUSION

p53 and Ki67 expression in tumoral tissue may be a prognostic marker in patients with laryngeal SCC. Evaluation of the proliferative index in biopsy samples of dysplastic laryngeal mucosa is potentially useful for predicting the progression toward carcinoma.

Squamous cell carcinoma associated with tall cell variant of papillary carcinoma of the thyroid

We report the simultaneous occurrence of the tall cell variant of papillary carcinoma and squamous cell carcinoma in the thyroid gland. Histology and immunohistochemical findings are discussed and it seems that the malignant squamous component was transformed from the tall cell variant of papillary carcinoma. Metastasis from the squamous cell carcinoma is diagnosed in the regional lymph node.

Histopathological screening of tonsillectomy and/or adenoidectomy specimens: a report from southern Iran

BACKGROUND

The need for pathologic examination of all tonsillectomy and/or adenoidectomy (T&A) specimens is controversial. Microscopic pathologic examination of these specimens is costly, but neglecting this step may miss diagnoses of significant diseases, especially malignancies. This study was designed to determine the rate of unexpected malignancies among patients who underwent T&A.

METHODS

All patients who underwent T&A at Shiraz University of Medical Sciences between February 2004 and February 2008 were included in a prospective study. Gross and microscopic pathologic examinations were done on all the specimens. The charts of the patients with significant pathological finding were reviewed. Information about pre-operative signs, symptoms, and risk factors were used to verify unexpected pathologic findings.

RESULTS

A total of 5058 patients were included. The age distribution was 10 months to 92 years (mean 14.0 years). There were 2498 males (49.4) and 2560 females (50.6%). Significant pathological findings were detected in 54 patients (1%). One unexpected malignancy (0.019%) was found in an adult patient. No unexpected malignancies were found in pediatric patients.

CONCLUSIONS

All T&A specimens in the adult population should be sent for microscopic pathological examination. Also specimens of nonroutine T&A in children (with positive findings in the medical history or on physical examination) should be sent for microscopic pathological examination. In children without positive findings in their history or on physical examination, gross pathological evaluation of routine T&A specimens by a pathologist is sufficient.

Fine needle aspiration findings in angiofollicular hyperplasia with eosinophilia: a case report

BACKGROUND

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon vascular inflammatory lesion usually involving the dermis or subcutaneous tissue of the head-neck region of middle-aged women. Histologically, this lesion shows a florid proliferation of vessels lined by particular endothelial cells and an inflammatory infiltrate composed of lymphocytes and eosinophils.

CASE

A 30-year-old woman presented with multiple periauricular skin nodules. Fine needle aspiration cytology shows a mixed population of lymphoid cells with an admixture of eosinophils and large cells with vesicular nuclei and prominent nucleoli. A diagnosis of AHLE was confirmed on histopathologic examination.

CONCLUSION

Various conditions, both benign and malignant, may mimic Kimura's disease clinically and on smears. These must be ruled out before making a diagnosis of Kimura's disease. The cytologic features of Kimura's disease have to be interpreted in the appropriate clinical setting in order to make a correct preoperative diagnosis.

Histological analysis of the effect of accelerated portland cement as a bone graft substitute on experimentally-created three-walled intrabony defects in dogs

BACKGROUND AND AIMS

Recent literature shows that accelerated Portland cement (APC) is a non-toxic material that may have potential to promote bone healing. The objective of this study was to histologically evaluate periodontal healing focusing on new bone regeneration following implantation of APC into intra-bony defects in dogs.

MATERIALS AND METHODS

Three-wall intra-bony periodontal defects were surgically created at the mesial aspect of the first molar in both sides of mandible in six dogs. One side was randomly filled with the material and other received a flap operation only. The animals were euthanized eight weeks post-surgery when block sections of the defect sites were collected and prepared for qualitative histological analysis.

RESULTS

Compared to control group, stimulation of growth of new bone tissue in the cavity con-taining APC was significantly prominent in three of six cases, showing osteoid formation with osteoblastic rimming and new bone trabeculla. New bone formation was observed just close to cavity containing APC. Connective tissue proliferation and downgrowth of epithelium were signif-icantly less than those of control group.

CONCLUSION

Our results are encouraging for the use of APC as a bone substitute, but more comprehensive study are necessary before warranting clinical use.

Diagnosis of pleomorphic adenoma in a heterotopic salivary gland: a case report

BACKGROUND

The histologic diversity encountered in pleomorphic adenoma may cause diagnostic difficulty in fine needle aspiration cytology (FNA) due to limited and selective sampling.

CASE

A 40-year-old woman presented with a mass in the anterior aspect of the neck along the sternocleidomastoid muscle. FNA revealed a cellular tumor with a chondrimyxoid background and epithelial cells intermingled with a few mesenchymal cells. The diagnosis of pleomorphic adenoma was confirmed on histopathology.

CONCLUSION

Primary ectopic pleomorphic adenoma can confidently be diagnosed by FNA. This technique is a useful tool in the initial assessment of the tumor.