Mycobacterium haemophilum: A report of cutaneous Infection in a Patient with end-stage renal disease

AbstractIntroductionMycobacterium haemophilum is a slow-growing nontuberculous mycobacterium (NTM) that can cause ulcerating cutaneous or subcutaneous nodular skin lesions in immunocompromised and immunocompetent patients. Acid-fast staining cannot distinguish NTM from M. tuberculosis; culturing at two temperatures with iron-supplemented media and polymerase chain reaction (PCR) are needed for optimal detection of M. haemophilum.Case presentationA 32-year-old man with end-stage renal disease, undergoing hemodialysis twice a week, presented with multiple, painless, nonpruritic nodular lesions. A formalin-fixed paraffin-embedded tissue block from his finger lesion was sent to the Department of Pathology, Masih Daneshvari Hospital for consultation. The lesions were primarily diagnosed to be dermatofibroma by another pathologist.On microscopic examination, vague granuloma with areas of necrosis was observed. The diagnosis was established by positive acid-fast staining, negative PCR results for M. tuberculosis complex, and positive nested PCR results for M. haemophilum.ConclusionCutaneous lesions in immunocompromised patients with positive results in acid-fast staining and negative results for M. tuberculosis should be further assessed using skin culture and molecular techniques to identify rare, atypical mycobacterial species like M. haemophilum

The incidence of mTOR marker in tracheal adenoid cystic carcinoma by immunohistochemical staining

Introduction: There is an association between the activation of mammalian target of rapamycin (mTOR) signaling and aggressive tumor growth in multiple forms of cancer, including adenoid cystic carcinoma (ACC). ACCs are uncommon yet a malignant form of neoplasms that arises within the secretory glands. Therefore, the aim of this study was to investigate the increase of mTOR in the ACC tumors in order to survey the possibility of treating these tumors with mTOR inhibitors.Material and methods: Samples from known cases of the lung and tracheal ACC were retrieved from the archives of the pa-thology department of Masih Daneshvari hospital, and immunohistochemical (IHC) staining for mTOR was performed on them. After preparation of the blocks with specific antibodies, tumor cells with cytoplasmic and/or nuclear expression of mTOR were considered as positive cells by applying a specific scoring method introduced in this study.Results: The paraffin blocks of 26 patients were surveyed and the IHC marker of mTOR was positive in the tumors of 10 patients (38.5%). Out of 10 mTOR positive cases, 5 were females and 5 were males. The primary site of the surveyed tumors was the trachea and bronchus in 12 cases (46%), salivary glands in 7 individuals (27%), and lung tissue in 7 cases (27%), and there was no significant correlation between the primary site of the ACC tumors and the existence of the mTOR markers in them (P = 0.67). From all cases, 13 patients (50%) had cribriform and tubular cells without solid components, 9 cases (34.6%) had cribriform and tubular with less than 30% of solid components, and 4 cases (15.4%) had cribriform and tubular cells with more than 30% of solid com-ponents. There was no significant difference between the morphologies and the existence of mTOR markers in them (P = 0.741). Conclusions: As the incidence of mTOR markers is seen in patients with tracheal ACC, evaluation and scoring of mTOR in these persons can be helpful as further studies can distinguish the use of it in the treatment of the disease.

Frequency of Multi-Drug Resistance and Molecular Characteristics of Resistance to Colistin in Acinetobacter baumannii Collected from Patients in Intensive Care Units with Ventilator-Associated Pneumonia

Background: Acinetobacter baumannii is one of the most common causes of ventilator-associated pneumonia (VAP) in patients hospitalized in ICU. Multiple resistance has resulted in excessive use of Colistin antibiotic, which is the latest treatment option for this bacterium. Therefore, the purpose of this study was to determine the abundance of multi-resistance and molecular characteristics of resistance to colistin among A. baumannii isolated from patients that are infected with VAP and hospitalized in ICU of “Qazvin” and “Masih Daneshvari” hospitals. Materials and Methods: In this study, 200 A. baumannii isolates related to VAP were collected from ICU of “Masih Daneshvari” (2012-2018) and “Qazvin” (2017-2018) hospitals, from bronchoalveolar lavage & tracheal aspirate specimens. Isolates were detected as A. baumannii by PCR with specific primers of the blaOXA-51-like gene. Antibacterial susceptibility of isolates to colistin was determined by the MIC method, and other antibiotics were examined by the disk diffusion method, according to the CLSI criteria. Multi-drug resistance (MDR) and extended–drug resistance (XDR) isolates were determined according to standard definitions of the CLSI. Results: All the isolates were susceptible to colistin. Moreover, they were resistant to piperacillin, piperacillin-tazobactam, ceftazidime, cefotaxime, ceftriaxone, amikacin, gentamycin, levofloxacin, co-trimoxazole, and ciprofloxacin. Antimicrobial resistance rates for tetracycline and ampicillinsulbactam were 8.5% and 20%, respectively. All isolates were MDR and XDR. All isolates were susceptible to colistin (MIC50=1 and MIC90=2 µg/ml). The sequencing results did not show any point mutation in pmr CAB genes, and mcr-1 gene was not detected in any isolates. Conclusion: In this study, all A. baumannii isolates collected from VAP patients were MDR and XDR. Although all isolates were susceptible to colistin, and this agent seems the most appropriate antibiotic for treatment of VAP, colistin resistance can become endemic in the world rapidly due to plasmid-mediated mobile colistin resistance mcr genes

Use of Napsin-A, TTF-1, ER, GCDFP-15, GATA-3 and GATA-3 Markers to Differentiate Breast Metastasis from Lung Adenocarcinoma

Background and Aim: Breast carcinomas with metastasis to lungs and primary lung adenocarcinomas have significant overlap. This study aimed to investigate the differential expression of a panel of IHC markers in primary lung adenocarcinomas and invasive ductal carcinomas (IDC) of the breast. Methods: In this cross sectional study, total of 50 specimens including 25 primary lung adenocarcinomas and 25 invasive ductal carcinomas of the breast were collected from Masih Daneshvari and Shohada-e-Tajrish hospitals. After all of the cases were stained with hematoxylin - and - eosin, the histologic diagnosis and grading of the slides were reviewed and reported by experienced pathologists based on standard classifications. The patients’ medical records were reviewed for demographic data, clinical information and histopathologic reports. Results: The median age of the patients with lung adenocarcinoma and IDC was 59 (32-78) and 50 (35-74) years, respectively. In this study, regarding lung adenocarcinomas, the most common type was acinar (56%), followed by solid (20%), mucinous (16%), lepidic (4%), and colloid (4%). Immunohistochemical expression for Napsin-A, TTF-1, ER, GCDFP-15, and GATA-3 in primary lung adenocarcinomas and invasive ductal carcinomas of the breast were different. Conclusion: Napsin-A, TTF-1, ER, GCDFP-15, GATA-3 and GATA-3 Markers can differentiate the breast cancer from lung adenocarcinoma. Napsin-A and TTF1 only present in lung adenocarcinoma

An End-Stage Renal Disease Patient with Invasive Fungal Rhinosinusitis

Mucormycosis is one of the invasive fungal infections particularly in immunocompromised patients with impaired host defense. It is characterized by fungal rhino sinusitis with invasion of adjustment structures including brain, pulmonary, or gastrointestinal systems or can be presented as a disseminated disease. Predisposing factors are diabetic ketoacidosis, neutropenia, corticosteroid or deferoxamine use, iron overload, malnutrition and skin macerations. We present a known case of end-stage renal disease patient under hemodialysis without history of diabetes or other risk factors listed above, who admitted because of fever and diagnosed with invasive rhino -sinusitis mucormycosis.</p

The impact of COVID-19 on TB in Iran: An illustrative study

The COVID-19 pandemic has caused significant disruptions in TB services across the globe. Like many other countries, TB case notifications decreased during the pandemic in Iran. In this paper, we describe two cases of concomitant COVID-19 and TB infection whose diagnosis of pulmonary TB was delayed amid the pandemic. We depict how atypical imaging findings may guide physicians to pulmonary TB diagnosis and discuss strategies to maximize TB case detection

Immunohistochemical findings of the granulomatous reaction associated with tuberculosis

Objective/background: The histological diagnosis of Mycobacterium tuberculosis (MTB) has long been a diagnostic challenge in the anatomical pathology field despite availability of different laboratory methods. Immunohistochemistry (IHC) could not only confirm granulomatous tissue involvement but also demonstrate MTB antigen immunolocalization. This study tries to clarify the details of IHC staining for MTB with pAbBCG. Methods: A total of 50 patients undergoing simultaneous biopsy and tissue culture with positive tissue culture for MTB during 2005–2009 were selected from the MRC Department at Masih Daneshvari Hospital, Tehran, Iran. Using the archives of the Pathology Department of this hospital, which is a referral center for pathological lung lesions, hematoxylin and eosin slides of the selected patients were evaluated. Twenty-three confirmed TB granulomatous tissue samples with adequate tissue and number of granulomas were chosen and studied by Ziehl–Neelsen and IHC staining with pAbBCG. Results: A total of 23 cases were evaluated, of which 17 (73.9%) were males. The types of tissue obtained from study cases were as follows: pleura (9 cases, 39.1%), lymph node (cervical, axillary, and thoracic [9 cases, 39.1%]), and lung tissues (5 cases, 21.7%). IHC staining was positive in all samples, whereas Ziehl–Neelsen staining was positive in nine cases of 23 (39.1%). IHC showed positive coarse granular cytoplasmic and round, fragmented bacillary staining. In this study, epithelioid cells clearly showed more positive staining at the periphery rather than at the center of granuloma. There is also positive staining in endothelial cells, fibroblasts, plasma cells, macrophages, and lymphocytes outside the granuloma. Conclusion: Detection of TB in tissue slides is still based on the histological pattern of the granuloma, which has several differential diagnoses with different treatments. Presence of mycobacterial antigens and tissue morphology can be evaluated using the IHC technique. Considering the criteria of positive IHC staining of TB granulomatous reactions, this stain not only highlights the presence of mycobacterial antigens for tissue diagnosis, but also could morphologically localize their distribution in different cells. Pathologists must be familiar with adequate staining pattern, elimination of background staining, and type of selected antibody. This method is especially important for application in countries with high prevalence of TB as a technique with early diagnostic value in tissue specimens. Early diagnosis using this technique can reduce related morbidity and mortality and decrease the rate of complications due to misdiagnosis and mistreatment of TB

The Incidence of mTOR Marker in Tracheal Adenoid Cystic Carcinoma by Immunohistochemical Staining

Introduction: There is an association between the activation of mammalian target of rapamycin (mTOR) signaling and aggressive tumor growth in multiple forms of cancer,including adenoid cystic carcinoma (ACC). ACCs are uncommon yet a malignant form of neoplasms that arises within the secretory glands. Therefore, the aim of this study was to investigate the increase of mTOR in the ACC tumors in order to survey the possibility of treating these tumors with mTOR inhibitors. Material and methods: Samples from known cases of the lung and tracheal ACC were retrievedfrom the archives of the pa-thology department of Masih Daneshvari hospital, and immunohistochemical (IHC) staining for mTOR was performed on them. After preparation of the blocks with specific antibodies, tumor cells with cytoplasmic and/or nuclear expression of mTOR were considered as positive cells by applying a specific scoring method introduced in this study. Results: The paraffin blocks of 26 patients were surveyed and the IHC marker of mTOR was positive in the tumors of 10 patients (38.5%). Out of 10 mTOR positive cases, 5 were females and 5 were males. The primary site of the surveyed tumors was the trachea and bronchus in 12 cases (46%), salivary glands in 7 individuals (27%), and lung tissue in 7 cases (27%), and there was no significant correlation between the primary site of the ACC tumors and the existence of the mTOR markers in them (P = 0.67). From all cases, 13 patients (50%) had cribriform and tubular cells without solid components, 9 cases (34.6%) had cribriform and tubular with less than 30% of solid components, and 4 cases (15.4%) had cribriform and tubular cells with more than 30% of solid com-ponents. There was no significant difference between the morphologies and the existence of mTOR markers in them (P = 0.741). Conclusions: As the incidence of mTOR markers is seen in patients with tracheal ACC, evaluation and scoring of mTOR in these persons can be helpful as further studies can distinguish the use of it in the treatment of the disease

Evidence for M2 macrophages in granulomas from pulmonary sarcoidosis: a new aspect of macrophage heterogeneity

BACKGROUND: Sarcoidosis is a granulomatous disease of unknown etiology. Macrophages play a key role in granuloma formation with the T cells, having a significant impact on macrophage polarization (M1 and M2) and the cellular composition of the granuloma. This study evaluates macrophage polarization in granulomas in pulmonary sarcoidosis. MATERIALS AND METHODS: Tissue specimens from the Department of Pathology biobank at the Masih Daneshvari Hospital were obtained. Paraffin sections from 10 sarcoidosis patients were compared with those from 12 cases of tuberculosis using immunohistochemical staining. These sections consisted of mediastinal lymph nodes and transbronchial lung biopsy (TBLB) for sarcoidosis patients versus pleural tissue, neck, axillary lymph nodes and TBLB for tuberculosis patients. The sections were stained for T-cells (CD4+, CD8+) and mature B lymphocytes (CD22+). CD14+ and CD68+ staining was used as a marker of M1 macrophages and CD163+ as a marker for M2 macrophages. RESULTS: Immunohistochemical staining revealed a 4/1 ratio of CD4+/CD8+ T-cells in sarcoidosis granuloma sections and a 3/1 ratio in tuberculosis sections. There was no significance difference in single CD4+, CD8+, CD22+, CD14+ and CD68+ staining between sarcoidosis and tuberculosis sections. CD163 expression was significantly increased in sarcoidosis sections compared with those from tuberculosis subjects. CONCLUSION: Enhanced CD163+ staining indicates a shift towards M2 macrophage subsets in granulomas from sarcoidosis patients. Further research is required to determine the functional role of M2 macrophages in the immunopathogenesis of sarcoidosis