Renal Actinomycosis in Presence of Renal Stones in a Patient with End Stage Renal Disease

Renal actinomycosis is a rare infection, and actinomycosis mostly acts as a normal flora in mouth, colon and vagina. We present a case of 56 years old man, who referred to our center for renal transplantation with kidney stone and diagnosed  with renal actinomycosis.  This case has risen possibility of rare infection that can be considered in the setting of renal transplantation

The Correlation Between Liver Fat Content and Ulcerative Colitis Disease Severity

To evaluate the association between disease severity and hepatic steatosis in patients with ulcerative colitis (UC) and non-alcoholic steatohepatitis (NASH). Consecutively selected UC patients admitted to the gastroenterology clinic were enrolled in the study. UC severity was assessed by Truelove and Witts classification. Patients with severe UC were excluded from the study. NASH was determined based on persistently elevated serum aminotransferase levels and detection of fatty liver ultrasound. Patients with other etiologies for elevated aminotransferase levels were excluded. Liver fat content (LFC) was assessed by measuring liver fat score (LFS). One hundred patients (42% male) were included in the study. According to liver ultrasound examination, 62 (%) patients were identified with grade 1 fatty liver disease, and 38 (%) patients were classified as advanced (grade 2 and 3) fatty liver disease. Sixty-one patients had left-sided UC and (46%) had mild UC disease severity index. LFS was significantly higher in UC patients with the moderate disease than patients with mild disease (3.53±2.68 vs. 5.89±2.85, respectively; P<0.01). Nevertheless, no significant difference was observed in LFS regarding UC extension. There was no significant difference between NASH ultrasound grades in view of UC severity and extension. LFC might be associated with UC severity

Myofibroblastoma of the Breast: A Morphologic and Immunohistochemical Study of Three Cases

Myofibroblastoma (MFB) of the breast is an uncommon entity of benign spindle neoplasms of the breast. This tumour possesses a broad spectrum of histomorphological patterns. Distinguishing of myofibroblastoma variants from malignant mimics of this benign neoplasm is essential for pathologists to avoid further invasive surgical procedures. In this article, we report the clinical, morphological, and immunohistochemical features of three cases, including two females and one male patient with mammary myofibroblastoma with emphasis on the histomorphological findings. As there is not yet enough information about MFB, more reports of MFB are still required to more clarify the pathogenesis and potential predisposing factors of this rare type of breast tumours

Local Facial Edema: a Novel Presentation of Subcutaneous Panniculitis-Like T-Cell Lymphoma in a 30-Year-Old Iranian Woman

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an infrequent cytotoxic T-cell lymphoma of the skin with a unique immunophenotypic profile. Here we describe this lymphoma in a 30-year-old Iranian woman. She presented with periorbital edema, mandibular swelling with edematous areas on her face and two small lymph nodes (6-7mm) in the cervical area. Histopathological findings revealed lobular infiltration of atypical lymphoid cells in subcutaneous tissue, especially around individual fat cells. Immunohistochemical evaluation of the atypical lymphocytes showed CD3 and CD8 immunoreactivity and CD4 and CD56  negativity. She was diagnosed as SPTCL based on clinical, histopathological and immunohistochemical findings. This report suggests that SPTCL should be considered in the differential diagnosis of any atypical skin lesion involving subcutaneous fat. Suitable deep skin biopsy and immunohistochemical staining are essential to differentiate between SPTCL and other more common diagnoses

Cutaneous Involvement in Plasma Cell Myeloma: Report of a Case

Plasma cellmyeloma constitutes about 10% of all  hematologicmalignancies. Metastatic cutaneous lesions without underlying bony involvement are rare and associated with advanced disease, poor prognosis and high tumor burden. IgG is the most common subtype and IgD is believed to have a more aggressive course.  

The utility of IMP3 immunohistochemical staining in differentiating nodular lymphocyte predominant Hodgkin Lymphoma from T-Cell/Histiocyte-Rich large B-Cell lymphoma

Abstract Introduction Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) and T cell/histiocyte-rich large B-cell lymphoma (THRLBCL) have overlapping histological features that make their diagnosis challenging. Insulin-like growth factor II mRNA-binding protein 3 (IMP3) is a recently proposed diagnostic marker for Hodgkin’s lymphoma. The aim of this study was to determine the ability of IMP3 in differentiating NLPHL from THRLBCL. Methods In this retrospective study, the formalin-fixed paraffin-embedded blocks from 56 patients (28 NLPHL and 28 large B cell lymphoma (LBCL, including 16 THRLBCL and 12 DLBCL, NOS) cases based on immunohistochemistry (IHC) were included. Sample sections were stained for IMP3 using IHC method. Moderate to strong staining in at least 10% of tumor cells was considered positive IMP3 expression. Results The mean age of the patients was 41.25 ± 16.08 years old. The majority of the patients were male. There was a significant age difference between NLPHL (34.61 ± 16.44 years old) and LBCL (47.89 ± 12.85 years) groups (p = 0.001). No significant difference was seen in gender and site between NLPHL and LBCL groups. The expression of IMP3 was mainly strong in LBCL group, while it was heterogeneously distributed among NLPHL samples ranging from weak to strong (p < 0.001). It was determined that strong IMP3 expression at 55.00% can differentiate LBCL from NLPHL with 71.4% sensitivity and 71.4% specificity. Conclusion Our findings showed that IMP3 may be a good complement in differentiating NLPHL cases from THRLBCL

Stiff‐person syndrome revealing an occult gray zone lymphoma: A diagnostic challenge

Key Clinical Message Stiff‐Person Syndrome (SPS) can be associated with various malignancies, including lymphomas. Therefore, clinicians should always remain vigilant for the presence of an underlying malignancy, especially in older patients presenting with SPS. Abstract Stiff‐person syndrome (SPS) is a rare neurological disorder characterized by painful muscle spasms. It can occur as a paraneoplastic syndrome associated with various malignancies. We present a case of an older male adult with a history of recurrent fever episodes and elevated inflammatory markers for 1 year who subsequently developed neurological symptoms. The presence of positive amphiphysin antibodies led to the diagnosis of SPS, which prompted further investigations revealing an underlying Gray Zone lymphoma (GZL). This case highlights the challenges in diagnosing lymphoma and emphasizes the importance of considering SPS as a paraneoplastic syndrome in guiding toward the final diagnosis. The diagnostic challenge in our case is summarized in Chart 1

Mediastinal gray zone lymphoma in a pregnant woman presenting with cardiac tamponade

Abstract Background Mediastinal gray zone lymphoma is a newly recognized rare B cell neoplasm, which is challenging in diagnosis and treatment. Case presentation In the current study, we aimed to report a 25-year-old pregnant woman at 25 weeks of gestation who presented with chronic cough and progressive shortness of breath, hypotension, tachycardia, and tachypnea. A large circumferential pericardial effusion with compressive effect on the right atrium and right ventricle and a large extracardiac mass with external pressure to mediastinal structures were seen on trans thoracic echocardiography. The emergency pericardiocentesis was performed with the diagnosis of cardiac tamponade. Also, CMR revealed a huge heterogeneous anterior mediastinal mass, and the pathology and the immunohistochemistry of the mass biopsy revealed gray zone lymphoma with positive CD3, CD20, CD30, CD45, PAX5, and negative CD15 expression. Three courses of chemotherapy with the CHOP regimen were performed with an acceptable response every three weeks before delivery. A caesarian section was performed at 37 weeks without any problem for the patient and fetus, and chemotherapy will be started three weeks after delivery. Conclusion Cardiac tamponade as an emergency condition occurred in this pregnant patient by malignant pericardial effusion and mediastinal mass pressure. Accurate diagnosis and on time interventions caused a significant improvement and a successful delivery