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Article
Clinicopathological Profile of Patients with Unilateral Sinonasal Masses in Karbala

Authors: Adil Hadi Ibrahim --- Nazar J. Metib --- Haider Jebur Kehiosh^
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 1 Pages: 2408-2416
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: A variety of non-neoplastic and neoplastic conditions involving the nasal cavity, paranasal sinuses, and nasopharynx. Most patients present with complaints of nasal obstruction. Other symptoms include nasal discharge, epistaxis, and disturbances of smell, oral symptoms, facial swelling, orbital symptoms, and ear symptoms. The presence of unilateral symptoms or pathology is regarded with caution as sinonasal neoplasms which may also present during their early stages with subtle symptoms that mimic an inflammatory pathology.Objectives: The aim of the study was to analyze the histopathologic diagnosis of patients with unilateral nasal mass and identify their different clinical presentations.Methods: A cross sectional prospective study was carried out on 34 consecutive patients with unilateral sinonasal mass at Al-Hussein Teaching Hospital and Maythem Al-Tammar Private Hospital, Karbala between April to August 2015 focusing on patient’s age, sex, and complaints. . Clinical examinations and proper investigations were carried out for all patients. Biopsy was taken from all cases for histopathologic examination to confirm diagnosis.Results: Out of total 34 patients with unilateral sinonasal masses 25 (73.5%) were males and 9 (26.5%) were females (M: F=2.8:1). The age range was 7 to 60 years with a mean age of 29.2 years. Twenty two patients were found to have non-neoplastic unilateral conditions (64.7%), while 12 patients had neoplastic unilateral conditions (35.3%). Inflammatory nasal polyp was the most common condition in non-neoplastic group (59.9%). Inverted papilloma was the commonest benign neoplastic condition (17.7%), 3 cases of non-Hodgkin’s lymphomas (8.9%) represents the commonest malignant neoplasms among malignant neoplastic group and single case of adenoid cystic carcinoma.Conclusions: Sinonasal masses have various differential diagnoses that otolaryngologists have to consider this variability in diagnosis and treatment. Nasal obstruction is the most common symptom while epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be higher in the neoplastic conditions. The clinician must have a high index of suspicion to rule out a neoplastic etiology in all cases of unilateral nasal mass.


Article
Rhinoscleroma in Karbala -- Case Report --

Authors: Ahmed Abdullah Alwan --- Nadhim Omran Khadhim --- Haider Jebur Kehiosh
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2582-2587
Publisher: Kerbala University جامعة كربلاء

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Abstract

a 14 year old boy presented with a history of progressive nasal obstruction with frequent bleeding episodes, for the last three months. The otolaryngological examination revealed slight dilated and flattened nose with grey red lobulated mass filling only the right side of the nose with no extension to the postnasal space. The mass excised completely and send for histopathology and the result was highly suggestive of chronic granulomatous inflammation of sinonasal cavity. The condition recurs six months later and the patient presented with the same lesion filling both sides of the nose. The patient underwent complete excision of the mass. The pathological report consistent with rhinoscleroma. The patient received ciprofloxacin with good improvement. He has remained asymptomatic up to the last visit six months following treatment and has shown no evidence of recurrence. This case report to raise awareness of this condition among physicians and aid in early diagnosis so as to reduce morbidity.


Article
Correlation and frequency of HER-2/neu Status With Estrogen and Progesterone Receptors in Breast Carcinomas

Authors: Nazar J. Metib --- Haider Jebur Kehiosh --- Sabah K. Hamzah
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2588-2599
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Breast cancer is the most common malignant tumor in Iraqi females accounting for a third of registered female cancers. Prognosis and management are influenced by the classic variables such as histologic type and grade, in addition to tumor size, lymph node status, status of hormone receptors of the tumor and HER-2/neu status. HER-2/ neu, also known as c-erb B-2 (HER-2), a proto-oncogene located on chromosome 17, is amplified and/or the protein (HER-2) overexpressed in 15% to 25% of invasive breast carcinomas and is associated with a worse clinical outcome. The interrelationship of ER(estrogen receptor), PR (progesterone receptor), and HER-2 expression in invasive breast cancer has come to have an important role in the management of breast cancer. It has been shown that patients with breast carcinoma overexpressing HER-2 do not respond to tamoxifen therapy.Objectives: To evaluate HER-2/neu overexpression in breast cancer by immunohistochemical study and to study the correlation between HER-2/neu status and expression of ER and PR receptors and other clinicopathological features in invasive breast carcinoma.Patients and methods: Immunohistochemical analyses were performed successfully for ER, PR, HER-2/neu by streptavidin biotin indirect immunohistochemical methods using monoclonal antibodies for 41 specimens of formalin-fixed, paraffin embedded breast cancer tissue.Results:. There was a significant difference in HER-2/neu overexpression between invasive ductal carcinoma of NOS (Not Otherwise Specified) type from other histopathologic types (lobular, and specified type ductal carcinoma). No significant correlation was observed between HER-2/neu overexpression and higher histological grades of invasive ductal carcinoma. The expression of ER or PR was decreased significantly in HER-2/neu positive tumors in comparison with HER-2 negative tumors .Only 7.3 % of all cases (3/41) were negative for estrogen , progesterone receptors (ER/PR) and HER2/neu oncoprotein (Triple negative breast cancers).The two cases of lobular carcinoma and the three cases of the special-type carcinomas were negative for HER-2/neu. Conclusions: HER-2/neu protein was expressed more in ductal carcinoma ( NOS type ) than in lobular or in carcinoma of special type and frequently detected in higher-grade invasive ductal carcinoma tumors.The expression of ER or PR was decreased significantly in HER-2/neu positive tumors. HER-2/neu positivity was not correlated with other clinico-pathological parameters like age of the patient, menopausal state, primary tumor size and axillary lymph nodes status.

Keywords

Breast carcinomas --- HER-2/neu --- ER --- PR


Article
Spindle Cell (Sarcomatoid) Carcinoma of the Larynx -- Case Report --

Authors: Nadhim Omran Khadhim --- Ihsan Hadi --- Ahmed Abdullah Alwan --- Haider Jebur Kehiosh
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2014 Volume: 7 Issue: 1 Pages: 1829-1835
Publisher: Kerbala University جامعة كربلاء

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Abstract

A 56 year old male patient presented with a history of recurrent attacks of progressive hoarseness and stridor for the last 9 months, he underwent six laryngeal surgery and the biopsy results were negative for malignancy except the last pathology report which revealed the diagnosis of spindle cell carcinoma of the larynx confirmed by immunohistochemistry. The patient refuses radiotherapy and went to India where they failed to diagnose the disease. The presented case demonstrates that spindle cell carcinoma or sarcomatoid carcinoma is very rare malignant tumor of the larynx but should be suspected in spindle cell tumours of the larynx and awareness of the pathologist to the unusual immunohistochemical presentation of this tumor with the use of expanded immunohistochemical markers panel.


Article
Prevalence of Epstein - Barr virus types in subtypes of Hodgkin lymphoma in Kerbela city, Iraq
انتشار انواع فيروس الابسن بار في الانواع الفرعية للاورام اللمفاوية الهودجكن في مدينة كربلاء ، العراق

Authors: Hussein Abd Ali Mohamed Sadeq Al Her --- M ohanad Mohsen Ahmed --- Haider Jebur Kehiosh
Journal: karbala journal of pharmaceutical sciences مجلة كربلاء للعلوم الصيدلانية ISSN: 70272221 Year: 2019 Issue: 16 Pages: 77-90
Publisher: Kerbala University جامعة كربلاء

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Abstract

Background: Epstein-Barr virus (EBV) is a ubiquitous virus associated with lymphomas. However, in Karbala as other parts of Iraq, EBV detection is not a part of the workup for lymphoma diagnosis. The aim of this study: to study the prevalence of EBV types in the subtype of Hodgkin lymphoma among patients from Kerbala province, Iraq. Methods: Archival formalin-fixed paraffin embedded blocks from 31 patients with mean age 32.56±15.685 (range from 5 to 70years) diagnosed Hodgkin lymphoma during the period from 2010 to 2018 in Karbala city included in this study. Histological diagnosis was reviewed. Around 25mg of archival tissue were used to extract DNA. DNA extracts were used Polymerase Chain Reaction (PCR) targeting the EBNA3C region of the viral genome. This PCR system offered detection and typing of the EBV. T-test and chi-square were used to evaluate the association between age with the subtype of Hodgkin lymphoma, gender and EBV state. Results: The majority of the Hodgkin lymphomas belonged Mixed Cellularity HL (MCHL) [n=18, 58%] where Nodular Sclerosis HL (NSHL) was seen in 42 % (n=13). The other subtypes of HL were not reported in this study. Male more affected with HL than female (16 vs.15) and the peak age range of HL 31to 40 years. EBV was detected in 18(58%) out of all cases. EBV type 1 was more common in MCHL were types 2 was the most common among NSHL cases. To our knowledge, this is the first time such data has been generated in Iraq. Conclusion: most of the HL cases in Kerbela are associated with EBV. there is a difference in the distribution of the EBV types according to the subtypes of lymphoma.

الخلفية: فيروس الابسن بار هو فيروس شائع الانتشار ويكون عادة مرتبط بالأورام اللمفاوية. ومع ذلك ، في كربلاء وفي مدن العراق الاخرى ، لا يعتبر كشف الفايروس جزءًا من عملية تشخيص الإصابة بالورم اللمفاوي. الهدف من هذه الدراسة: دراسة مدى انتشار أنواع الفايروس في الانوع الفرعية من الاورام اللمفاوية الهودجكين بين المرضى من محافظة كربلاء ، العراق.االطريقة: من الشرائح النسيجية المثبتة بالفومالين والمغمورة بالشمع لــ 31 مريض بمتوسط العمر 32.56 ± 15.685 ( من 5 إلى 70سنة ) المشخصين بورم الغدد اللمفاوية هودجكين خلال الفترة من 2010 إلى 2018 في مدينة كربلاء تم دراستها. تم مراجعة التشخيص النسيجي . استخدم حوالي 25 ملغم من المقاطع النسيجية المخزونه لاستخلاص الحمض النووي. تم استخدام مستخلصات الحمض النووي في تفاعلات الكوثرة باستهداف منطقة الجين EBNA3C في الجينوم الفيروسي. استخدم التفاعل لتشخيص الفايروس و تميز انواع فايروس الابسن بار .تم استخدام اختبار تي و مربع كاي لتقييم الارتباط بين العمر بالانواع الفرعية من سرطان الغدد اللمفاوية هودجكين والجنس و مقارنتها مع نتائج تشخيص الفايروس .النتائج: كانت غالبية الأورام اللمفاوية هودجكين تنتمي إلى النوع الفرعي MCHL حيث كانت 18 (58%)حالة من 31 ثم النوع الفرعي NSHLفي 13(42%) حالة. و لم تسجل حالات من الأنواع الفرعية الأخرى من الاورام الهوجكن في هذه الدراسة. الذكوراكثر اصابة من الإناث بالاورام اللمفاوية الهوجكن (16 مقابل 15) . كانت الفئة العمرية من 31 إلى 40 عاما الاكثر اصابة بالاورام اللمفاوية الهوجكن . تم الكشف عن الفايروس في 18 حالة من جميع الحالات (58 ٪). كان EBV1 أكثر شيوعًا في النوع الفرعيMCHL . كان EBV2 الأكثر شيوعًا بين حالات NSHL . على حد علمنا هذه هي المرة الأولى التي يتم فيها تسجيل مثل هذه البيانات في العراق.الاستنتاج: ارتبطت معظم حالات الاصابات بالاورام اللمفاوية الهوجكن مع فايرس الابسن بار .هناك اختلاف في توزيع أنواع الفيروس وفقا لأنواع سرطان الغدد اللمفاوية.

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