Comparison of pathologic characteristics of breast cancer in younger and older women

Background: Breast cancer is the most common invasive cancer with high mortality in women all around the world. The present evidence shows that younger patients have poor survival. Thus, the aim of this study was to compare the pathologic characteristics of breast cancer in women younger than 40 years compared with older. Methods: This is a cross-sectional study which contains 681 patients with a confirmed diagnosis of breast cancer, who referred to Babolsar Shahid Rajaei Hospital as a referral cancer therapeutic center in the North of Iran. The data included age, residence area, occupation, location, histopathologic characteristics of the tumor, TNM classification and staging. Results: The mean age (SD) of patients was 49.7 (11.9) years, of which 19.5 were under 40. Ductal carcinoma was the most common histopathologic type (90.0) but patients at a younger age had a higher incidence of lobular and other rare carcinoma compared to the older ones (P=0.04). The younger had a greater tumor size (P=0.01), lymphatic node involvement (P=0.04) and higher staging (P=0.004). The younger age was not associated with positive estrogen/progesterone receptors. Conclusion: These findings indicated more aggressive tumor characteristics and serious breast cancer in women less than 40 years compared with older ones

Benign schwannoma of posterior mediastinum accompanied by bloody pleural effusion misdiagnosed as solitary fibrous tumor: A case report

Background: Schwannoma is a peripheral nerve sheath tumor originating from schwann cells. It is the most common neurogenic tumor of the posterior mediastinum. Pleural effusion is a rare presentation of benign schwannoma and it is mainly related to malignant tumors. Histologically, schwannoma as well as solitary fibrous tumor should be considered as a differential diagnosis of spindle cell lesions. Case presentation: Here, we report a case of an asymptomatic 61-year-old female misdiagnosed as solitary fibrous tumor of posterior mediastinum which was revealed to have blood stained pleural effusion during the video-assisted thoracic surgery. Eventually pathological study and immunohistochemistry profile of the tumor was reported as benign schwannoma. Conclusion: This report indicates that benign schwannoma can be accompanied by bloody pleural effusion and it also emphasizes the role of immunohistochemistry in the diagnosis of biopsy specimen of spindle cell lesions. &#160

Benign schwannoma of posterior mediastinum accompanied by bloody pleural effusion misdiagnosed as solitary fibrous tumor: A case report

Background: Schwannoma is a peripheral nerve sheath tumor originating from schwann cells. It is the most common neurogenic tumor of the posterior mediastinum. Pleural effusion is a rare presentation of benign schwannoma and it is mainly related to malignant tumors. Histologically, schwannoma as well as solitary fibrous tumor should be considered as a differential diagnosis of spindle cell lesions. Case presentation: Here, we report a case of an asymptomatic 61-year-old female misdiagnosed as solitary fibrous tumor of posterior mediastinum which was revealed to have blood stained pleural effusion during the video-assisted thoracic surgery. Eventually pathological study and immunohistochemistry profile of the tumor was reported as benign schwannoma. Conclusion: This report indicates that benign schwannoma can be accompanied by bloody pleural effusion and it also emphasizes the role of immunohistochemistry in the diagnosis of biopsy specimen of spindle cell lesions. &#160

Myofibroblasts in calcifying odontogenic cyst and dentigerous cyst

Introduction:Calcifying odontogenic cyst (COC) is an odontogenic cyst that sometimes shows aggressive behavior, while dentigerous cyst (DC) always has a benign nonaggressive course. There are evidences that myofibroblasts are involved in invasion and their role in biologic behavior of odontogenic cysts has been less understood. So, the aim of the present study was to compare the role of myofibroblasts in COC and DC. Methods:In this cross-sectional study, paraffin-embedded tissue blocks of 20 COCs and 20 DCs were studied. Four-micron sections were prepared from tissue blocks and stained with α-SMA antibody using immunohistochemistry. Percentages of myofibroblasts were semi quantitatively classified into negative (50% of cells were positive). Percentage of myofibroblasts was compared between COC and DC groups using t-test and Chi-Square statistical tests. Results:Means of myofibroblasts percentages in COC and DC groups were respectively 35±33 and 32±30 that did not show significant difference between COC and DC groups (P=0.76). There was not any significant difference between COC and DC groups with respect to semi quantitative classification of percentage of myofibroblasts (P=0.62). Conclusion:Myofibroblasts probably do not play a significant role in different biologic behaviors of calcifying odontogenic and dentigerous cysts

Relationship between β-Thalassemia minor and Helicobacter pylori infection

Background: Until now, no study has been reported investigating the association between β-thalassemia minor and Helicobacter pylori (H. pylori) infection. This study was designed to compare H. pylori infection rate between β-thalassemia minor patients and healthy controls. Methods: A number of 100 β-thalassemia minor patients (50 males, 50 females) and 100 gender-matched healthy controls were prospectively recruited in this study in a period of 3 months. The study population consisted of the people who referred to a health center in Babol, North of Iran, for premarital counseling. H. pylori status was assessed by measuring the anti-H. pylori IgG antibodies using enzyme-linked immunosorbent assay. Demographic information and informed consent were collected from all participants. Results: The overall H. pylori infection rate was 43%. The infection was significantly more prevalent in thalassemia patients (53%) than in the controls (33%) in both univariate (OR=2.29, 95% CI: 1.3-4.06) and multivariable analyses (OR=2.05, 95% CI: 1.12-3.76). Age was the only significant factor which was positively correlated with the infection in β-thalassemia minor cases (OR=1.11, 95% CI: 1.02-1.2). Gender, blood groups, residency, and education level were not related to the infection. Conclusions: According to the results, it can be concluded that β-thalassemia minor patients are possibly more susceptible to H. pylori infection than healthy people. Further studies are needed to discover more about the exact mechanisms of increased susceptibility to H. pylori infection in β-thalassemia minor patients

Non-invasive diagnostic tests for Helicobacter pylori infection

BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions

Comparison of anti Chlamydia antibodies in tubal and non-tubal infertile patients

Background and purpose: Chlamydia trachomatis infection is one of the most prevalent bacterial sexually transmitted infection in most countries. This organism may stay in genital tract for long time and cause subtle yet progressive damage in fallopian tubes. In this study we evaluate the correlation between chlamydia antibodies and tubal and other factors of infertility.Materials and Methods: In this case control study, 28 patients with tubal factor infertility, 28 patients with non tubal factor infertility and 30 normal patients were enroled. Presence or absence of tubal factor was assessed by direct vision via laparscopy, then titres of IgA and IgG were evaluated in all of them using ELISA method in the same labratory. Data were recoded and analyzed using SPSS software and chi-square, Fisher's exact, T-test and Mann- Whitney test.Results: Positive titre of IgG was higher in tubal factor infertility but it was not statistically significant between three groups (p>0.294). Positive titres of IgA were more common in non tubal factor infertility (p=0.007). Though positive and negative titres of IgA (P=0.224) and IgG (P=0.273) were not statistically different in fertile and infertile patients. Positive and negative titres of IgA and IgG were also not statistically different in patients with or without PID (p>0.05).Conclusion: No correlation was found between the positive titres of IgG and IgA against Chlamydia and tubal factor infertility

Comparison of maternal and neonatal serum leptin levels in preeclampsia and normal pregnancy

Background: Leptin is a protein product of obesity gene and is synthesized mainly by adipose tissue. Objective: The aim of this study was to determine maternal and neonatal serum leptin levels in term preeclamptic and normal pregnancies. Materials and Methods: This cross sectional study was performed on 37 preeclamptic and 40 normotensive term pregnant women without other disease. Serum level of leptin was measured in all of pregnant mothers and after delivery, their neonates. This study was performed in Babol Yahyanejad Hospital from March 2006 to December 2006. Results: Infants with preeclamptic mothers had significantly lower leptin level than control group (p=0.02). There was no significant difference in serum leptin levels between normal and preeclamptic women (p=0.749). Conclusion: According to the results, it would be concluded that leptin level in infants of preeclamptic mothers is lower than infants of normal mothers. This can only confirm the diagnosis of disease after birth but it cannot predict the preeclampsi

Comparison of maternal and neonatal serum leptin levels in preeclampsia and normal pregnancy

Background: Leptin is a protein product of obesity gene and is synthesized mainly by adipose tissue.Objective: The aim of this study was to determine maternal and neonatal serum leptin levels in term preeclamptic and normal pregnancies.Materials and Methods: This cross sectional study was performed on 37 preeclamptic and 40 normotensive term pregnant women without other disease. Serum level of leptin was measured in all of pregnant mothers and after delivery, their neonates. This study was performed in Babol Yahyanejad Hospital from March 2006 to December 2006.Results: Infants with preeclamptic mothers had significantly lower leptin level than control group (p=0.02). There was no significant difference in serum leptin levels between normal and preeclamptic women (p=0.749).Conclusion: According to the results, it would be concluded that leptin level in infants of preeclamptic mothers is lower than infants of normal mothers. This can only confirm the diagnosis of disease after birth but it cannot predict the preeclampsia