Print ISSN: 0027-1446

Online ISSN: 2309-6217

Main Subjects : Pathology

Diagnostic Yield of PAX5 in Lymphoma

Hiba Rafea; Abdul Kareem Yonis Al-Tae; Nazar Mohamed Jawhar

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 109-118
DOI: 10.33899/mmed.2020.128737.1058

Background: Lymphoma is a heterogeneous group of neoplasm affecting any stage of lymphocyte development. Nowadays, WHO (2017) adapted their classification depending on their morphological, immunohistochemical appearance, and their clinical and molecular characteristics.

Objective: To determine the expression of PAX5 in Hodgkin and Non Hodgkin lymphoma and their association with clinical parameters (age &site).

Patients & Methods: During a period of 1 year starting from June 2019 to June 2020, 60 lymphoma patients" were included in this"prospective-retrospective"case series study from"medical records and histopathological results in governmental and private labs. Immunohistochemistry examination using PAX5 was performed, and data of the positive PAX5 expression were analyzed.

Results: A total of 60 patients were recruited in this study with the majority (58%) were Non Hodgkin lymphoma, dominated by diffuse large B- cell lymphoma subtype (42.8%) and (42%) were Hodgkin lymphoma where nodular sclerosis subtype formed (52%) and mainly of the nodal site in both of them. The age range of Non Hodgkin lymphoma 7-76 years (median 50 years) and 5-67 years (median 21 years) for Hodgkin lymphoma and male predominance in both of them and there is no significant association between the site and lymphoma (p value=0.0647) while a significant association with age (p value =0.037). Moreover, the immunohistochemical examination demonstrates that positive PAX5 was expressed in 77% of Non Hodgkin lymphoma and 100% of Hodgkin lymphoma. The P-value between them was 0.016, which was statistically significant ,no matter of using PAX5 or CD30 in"the diagnosis of Hodgkin lymphoma,in other hand"there is a significant difference between PAX5 and CD3 expression (P value=0.004), while it is not statistically significant when comparing PAX5 and CD20 (P-value =0.317) in the diagnosis of Non Hodgkin lymphoma .

Conclusion: This study demonstrates that PAX5 is one of the most sensitive and reliable immunohistochemical marker in diagnosing Hodgkin lymphoma and B-cell Non Hodgkin lymphoma.

Hematological parameters of β-thalassemia Trait in Premarital Screening in Nineveh Province

bassma adnan; Professor Muna Abdulbasit Kashmoola Abdulbasit Kashmoola

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 157-161
DOI: 10.33899/mmed.2020.128666.1052

Background: β-Thalassaemia syndromes are inherited group of abnormalities of hemoglobin synthesis. These abnormalities characterized by a defect in β-globin genes which may result either in the reduction or absence of one or more of the β-globin chains of hemoglobin. This genetic defect can be homozygous or heterozygous.
Aim of this study was to detect the hematological parameters of β-thalassaemia trait in premarital screening individuals in Nineveh province.
Subjects and Methods: This is a cross sectional study that was performed in Nineveh province in three main centers for premarital screening program. In the period between the 15 November 2019 and the 15 May 2020 a total of 1127 subjects who attend to these centers were screened for carrier conditions of β-thalassemia. Blood samples of the couples were obtained during attendance to the marriage office. Complete blood counts and hemoglobin variant analysis were performed with automated counter and high performance liquid chromatography technique.
Results : Out of 1127, β-thalassaemia trait was diagnosed in 47 subjects, 31 were male (66 %) and 16 were female (34 %). The mean of their hemoglobins was 14.4 g/dl in males, and 12.5 g/dl in females. The mean of mean cell volume and mean cell hemoglobin were 68.3fl and 22.4pg respectively. The mean for HbA2 concentration was 4.9 % and for HbF was 1.2%.
Conclusion: β-thalassaemia trait is usually presented with low MCV and/or low MCH but the accurate and dependable technique in detecting carriers is the use of High Performance Liquid Chromatography (HPLC).

Evaluation of Interleukin- 6 in Lymphoma

Anfal Saleh Mohammed AL-jubory; Sanaa mohammed taib Al- Hayali

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 162-168
DOI: 10.33899/mmed.2020.128731.1057

Background: Cytokines play a pivotal role in lymphoma ,cytokines either can be produced or exert effects on neoplastic or reactive cells. The elevated level of cytokines can contribute to the clinical and histopathologic alterations associated with malignant lymphoma.
Objectives: to assess the level of IL-6 in newly diagnosed lymphoma patients in relation to their level in normal control subjects and to evaluate the correlation between IL-6 and hemoglobin (Hb), stage of disease and B-symptoms ,age and sex.
Methods: This is a case control study, a total of 40 patients with lymphoma (HL & NHL) who attended private Clincs and hospitals in Mosul city and 40 age and sex matched control were included. A venous blood sample were taken for Complete blood count, Retic and IL-6 level. Enzyme-linked immunosorbent assay(ELISA)was used to determined IL-6 level.
Results: There were a significant difference between the mean level of IL-6 of lymphoma cases and control (p-value=0.00). In the subset of patients with anemia, IL-6 levels inversely correlated with hemoglobin levels (p-value=0.00). There was significant correlation between IL-6 and patients with more advanced stage Ⅲ- IV disease(p-value=0.04). there was positive correlation between IL-6 levels and B-symptoms)p=0.05(
Conclusion: IL-6 level was elevated in lymphoma and it was significantly higher in lymphoma patients .IL-6 plays important role in the development of anemia in lymphoma.The adverse impact of elevated IL-6 is consistent with demonstration of higher level of IL-6 in patients with advanced stage of disease.

Application of FISH Technique in Evaluation of Equivocal Cases of HER2/neu in Breast Carcinoma

Saja Faisal Jaafar; Ekhlas Ahmed Ali; Nazar mohmmed jawher

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 133-140
DOI: 10.33899/mmed.2020.128713.1056

Background: Breast cancer in Iraqi females is one of the extreme popular malignant tumors. It represents the third of registered female cancers. Management and outcome of breast cancer are affected by variables such as tumor size and grade, as well as histologic type, HER2/neu status of the tumor and hormone receptor status. HER2/neu (or erbB-2) is a proto-oncogene found on chromosome 17, that is overexpressed and/or amplified in 15% to 25% of invasive breast carcinomas and is connected to worse clinical outcome. Patients with HER2/neu positive breast carcinoma have showed a good response to targeted therapy (Herceptin) that improving the prognosis.
Objectives: To assess the immunohistochemical overexpression of HER2/neu in breast carcinoma, to detect the frequency of amplified HER2/neu by FISH on immunohistochemically equivocal cases, and to correlate HER2 overexpression & or amplification with various clinicopathological parameters.
Patients and Method: A total of hundred breast carcinoma patients at different ages were included in this retrospective and prospective case series study design. Formalin fixed paraffin embedded blocks were collected from different private labs in Mosul, between 1st November 2019 to 1st April 2020. FISH technique was performed on 25 equivocal cases of HER2/neu tested by immunohistochemistry technique using Leica KreatechTM FISH Dual Probe (Red/Green).
Results: Among a total of 100 patients with mean age was (52) years old diagnosed as breast carcinoma via histopathological findings, 58% were tested negative for HER2/neu,17% positives for HER2/neu, and 25% were equivocal by Immunohistochemistry. However, FISH method is conducted for those patients indicated as equivocal at immunohistochemistry and has identified 7(28%) positive cases and 18(72%) negative cases. The association between HER2/neu and the grade of the tumor was statistically considerable (P value=0.03). Furthermore, the analysis indicated that the HER2/neu was not statistically related with histological type of the tumor and age of the patients (P value=0.35, P value= 0.75, respectively). In this study, HER2/neu was statistically inversely associated with both ER and PR receptors (P value=0.03, P value=0.05, respectively).
Conclusion: HER2/neu is overexpressed by immunohistochemistry in 17%. HER2/neu is amplified by FISH (in equivocal cases) in 28%. HER2/neu is statistically significant correlation with tumor grade, and is in inverse statistically significant correlation with estrogen and progesterone receptors while not statistically significant with age and histological types of tumors.

The Significance of CD3 Marker in the Diagnosis of Celiac Disease

Saja Hashim Hammo; Professor Wahda Mohammad Taib Al-Nuaimy; Mohammed A. Hayawi

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 99-108
DOI: 10.33899/mmed.2020.128710.1055

Background: Celiac disease is a common, permanent and reversible health problem of small intestine occurring all over the world in genetically predisposed individuals and in combination with other environmental factors. It causes chronic inflammation of small intestine which is of autoimmune origin. The histopathological features of Celiac disease in duodenal biopsy was stated according to the modified Marsh classification.
The immunohistochemical application of CD3 marker in duodenal biopsy could facilitate the count and the distribution of intraepithelial lymphocytes along the villi, which is regarded as a key for the correct diagnosis in early stages ( Marsh 1).
Objectives: This study was conveyed to correlate the significance of CD3 immunohistochemical expression of intraepithelial lymphocytic population to histopathological changes in Celiac disease, to identify the distribution of CD3 marker along the villi (crescendo or decrescendo) and (diffuse or patchy ) and to delineate the age and sex of Celiac disease in our locality.
Materials and methods: The research was both prospective and retrospective case series study, carried out on 100 cases of endoscopically obtained duodenal biopsies. Data obtained from archives of the pathology department, at AL-Jamhory, AL-Khansaa and AL-Salam Teaching Hospitals/ Mosul city, and collected in a period spanning from January 2019 to May 2020. The information included age, sex and duodenal biopsy location. then assessed histologically and immunohistochemically.
Results: In a total of 100 duodenal samples, patients age was ranged 1 to 69 years ( mean age of 20.74 years), with a female to male ratio ( 2.2:1).
By applying modified Marsh classification: Marsh 0 was detected in 8 % of the cases, Marsh 1 in 30 % , Marsh 2 in 10% , Marsh 3 a in 20%, Marsh 3 b in 17%, Marsh 3 c in 15% and Marsh 4 in 0%. Immunohistochemical expression of CD3 in the sampled cases i.e. CD3 + ≥30 /100 epithelial cells was detected in 79 %. There was a statistically significant difference between CD3+ and modified Marsh classification by Hematoxylin & Eosin (P Value<0.001) for detection of intraepithelial lymphocytosis.
Conclusion: There is a significant relationship between the count of CD3+ T-lymphocytes per 100 epithelial cells and the histopathological changes in the duodenal biopsy according to modified Marsh classification. the immunohistochemical expression of CD3 in intraepithelial T-lymphocyte could lead to a definite assessment in 13 % of the sampled cases with Marsh type 1. All the positive cases are of crescendo pattern of distribution of CD3+ T-lymphocytes as the distribution is more important than the actual count and they distributed diffusely except that associated with Helicobacter pylori infection observed with patchy distribution. The IHC expression of CD3+ marker provides a hint about the distribution of CD3+ marker within the lymphocyte whether global surface or clonal surface and intracytoplasmic to diagnose Refractory Celiac disease. Females were more affected than males and there is a significant relationship between the gender and the histopathological changes. It can be diagnosed at any age and there is no significant relationship between the age distribution and the histopathological changes.

Effectiveness of antiplatelet thromboprophylaxis in myeloma patients using immunomodulators in Kurdistan region-Iraq

Rezhen Botany; Ahmed K. Yassin; Firiad Hiwaizi; Abid M. Hassan; Hisham A. Getta; Najmaddin Salih Husen Khoshnaw; Sana D. Jalal; Akram M. Mohammed; Kawa M. Hasan; Dana A. Abdulla; Ameer I.A. Badi; Nassir A. S. Al-Allawi; Banaz M. Safar; Basil K. Abdulla; Rawand P. Shamoon; Truska A. Amin; Zeki A. Mohamed; Ali I. Mohammed; Diveen J. Hussein; Nawsherwan S. Mohammed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 35-41
DOI: 10.33899/mmed.2020.126833.1023


Objective: To evaluate the effectiveness of antiplatelet drugs in preventing thrombosis in multiple myeloma patients treated by immunomodulatory drugs
Methods: The study includes a hundred seventy six patients of symptomatic multiple myeloma treated in hematology unit of three centers in Kurdistan region of Iraq from February 2014 to July 2019. Demographic data were obtained from patient’s file, including the type of immunomodulatory drugs, antiplatelet use, thrombotic events and their site, presence of other comorbidity, and whether the thrombosis was before or after the diagnosis of multiple myeloma.
Background and objectives: Multiple myeloma is a malignant disease that affect both gender and associated with increased risk of thrombosis, one of the effective method of treating myeloma is through using immunomodulatory drugs especially when combined with high dose dexamethasone with in turn boost the risk of thrombosis, in this study we investigate the effect of antiplatelet in preventing thrombosis.
Methods: This is a retrospective study that include 176 cases that are collected from cancer centers at Kurdistan region of Iraq from Feb/2014 to Jul/2019 information gathered through questionnaire.
Results: Regardless the type of therapy in the study sample 11.1% who were taking anti-platelet therapy developed thrombotic attack compared with 46.9% who were not taking the anti-platelets therapy. The incidence of the thrombotic attack among those myeloma patients who used immunomodulatory drugs was 9.6% who were on anti-platelet drugs which is significantly lower than the rate (52%) among patients not taking the anti-platelet drugs.
Conclusions: As multiple myeloma is a malignant disease and treatment with immunomodulatory drugs associated with increased risk of thrombosis, antiplatelet drug is an effective measure when used as a prophylaxis for preventing thrombosis.
Keywords: Multiple myeloma, Thrombosis, Antiplatelet

Ki-67 Expression in Breast Cancer, Its Correlation with ER, PR and Other Prognostic Factors in Nineveh Province

Hatem Abd-AlMajeed Al-Nuaimi; Elaf Hamdi; Banan Burhan Mohammed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 1-10
DOI: 10.33899/mmed.2020.127375.1037

Objectives: The aggressiveness of malignant tumors of breast can be correlated with the proliferation of neoplastic cells, and this detected by immunohistochemical study of proliferative index (Ki-67). American Society of Clinical Oncology (ASCO) does not recommend the use of Ki-67 routinely to predict the outcome of breast cancers, therefore the aim of current study is to detect the expression of Ki-67 in patients with primary breast cancer in Nineveh Province/North of Iraq and to correlate it with estrogen and progesterone receptors in addition to other prognostic factors.
Methods: In this retrospective-case series study eighty cases of histologically proven primary breast carcinomas were included. The cases were collected from hospitals and private laboratories in Nineveh Province / North of Iraq and studied Immunohistochemicaly for Ki-67, estrogen receptor (ER) and progesterone receptor (PR) were done on tissue sections embedded in paraffin wax. An area with the maximum proliferation was chosen to evaluate Ki-67 and the cases with ≥20% positive nuclei were considered as high Ki-67 expression while those with <20% positive nuclei were considered as low Ki-67 expression.(10-14).
The findings of Ki-67 were correlated with the age of the patients, histological type, grade of the tumors and with the estrogen and progesterone receptors.
Results: The Ki-67 immunoreactivity was highly expressed in (45%) of the cases. Estrogen and progesterone receptors observed in (77.5%) and (67.5%) of the cases respectively. The Ki-67 was significantly associated with grade of tumor, estrogen receptor and progesterone receptor (P= 0.0057, 0.037 and 0.006 respectively). While the association with patientsˈage and histological types were not statistically significant.
Conclusion: Ki-67 expression shows a significant direct correlation with grade of tumors and a significant inverse correlation has been shown with a well-known predictive factors, (estrogen and progesterone receptors).

Endoscopical and Histopathological Interpretation of Gastritis in Nineveh Province

Wahda Al-Nuaimy; Huda M Faisal

Annals of the College of Medicine, Mosul, 2019, Volume 41, Issue 1, Pages 28-35
DOI: 10.33899/mmed.2018.161275

Objectives: To assess the diagnostic value of endoscopical findings compared to histopathological diagnosis, to delineate the relative frequency and pattern of different types of gastritis and their association with H. pylori and intestinal metaplasia in our locality, and to compare the results of this study with those of others.
Methods: In a cross sectional study 150 selected patients with different upper gastrointestinal symptoms have been examined at endoscopy units in Ibn-Sina teaching hospital and Al-Jamhori teaching hospital in Mosul city, from the first of June 2013 to the first of March 2014, all were assessed endoscopically and biopsies from both antral and body mucosa were taken for histopathological examination.
Results: This study has revealed gastritis histopathologically in 96.6% of cases, and the agreement between endoscopical and histophathological diagnosis was 88%. The chronic superficial gastritis represented the highest relative frequency  in this histopathologically diagnosed gastritis, where it was seen in 61.3% of the cases and it’s relative frequency decreased with advance age, while chronic atrophic gastritis was diagnosed in 30% of the cases and it’s relative frequency increased with advanced age, while gastric atrophy wasn’t detected in any case. Acute gastritis was detected in only 5.3% of the cases.
   Helicobacter pylori was detected in 67% of cases. A significant association was detected between chronic gastritis and Helicobacter pylori infection, and its frequency decreased with increased severity of glandular atrophy. Follicular gastritis was diagnosed in 51% of chronic atrophic gastritis and 91.3% of them were Helicobacter pylori positive cases. By the use of the special stain AB/PAS pH (2.5), intestinal metaplasia has been diagnosed in 23% of cases and it’s relative frequency increased with advanced age.
Conclusion: There is a high rate of concordance (88%) between endoscopical findings and histopathological diagnosis of gastritis. Among gastritis chronic variety was the commonest. H. pylori had a significant association with chronic gastritis (chronic superficial gastritis and chronic atrophic gastritis). Intestinal metaplasia has been detected mainly in chronic atrophic gastritis and its frequency increased with advanced age.