Print ISSN: 0027-1446

Online ISSN: 2309-6217

Volume 41, Issue 2

Volume 41, Issue 2, Summer and Autumn 2019, Page 95-204

Evaluation of Chronic Gastritis in Endoscopic Antral Biopsies Using the Up-dated Sydney System

Hayfa A. Hussein

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 95-105
DOI: 10.33899/mmed.2020.164150

Objectives: To evaluate the histological parameters of chronic gastritis in endoscopic antral biopsies, to grade them according to the up-dated Sydney system and to compare the obtained results with those of others.
Methods:From the 1st of July 2018 to the end of December 2018,100 endoscopic antral gastric biopsies were submitted to the Histopathology Unit in Al-Salam Teaching Hospital in Mosul, obtained from patients complaining of different clinical symptoms and referred for upper gastrointestinal endoscopy. Biopsies were assessed for the histological parameters of chronic gastritis and were also graded using the visual analogue scale of the up- dated Sydney system.
Results:The 100 biopsies belonged to 42 males and 58 females ranging from 9-85 years old with a mean of 42.7 years and a peak age incidence in the fourth decade. The commonest symptom was epigastric pain in (46%) of cases. Antral gastritis was the major endoscopic finding in (66%) of cases. All cases revealed mononuclear cell infiltration(100%), followed by neutrophilic activity (84%), glandular atrophy(22%), intestinal metaplasia(14%) and dysplasia(9%).Helicobacter pylori (H. pylori) was detected in(77%) of cases and a significant statistical association was found between
H. pylori and each of: mononuclear cell infiltration(P<0.001), neutrophilic activity (P<0.001) and glandular atrophy (P<0.05). while insignificant statistical association was observed between H. pylori and both intestinal metaplasia and dysplasia (P>0.05).
Conclusion:Histopathological study of endoscopic antral gastric biopsy is of value in detection of H. pylori and various histological changes of chronic gastritis. A statistically significant association was found between H. pylori and each of : mononuclear cell infiltration, neutrophilic activity and glandular atrophy. Dysplasia is an important histological change in chronic gastritis that requires endoscopic follow up to rule out the possibility of gastric cancer, and it is advisable to be incorporated in the visual analogue scale of the up-dated Sydney system.

Antiphospholipid Antibodies in Patients with Type 2 Diabetes Mellitus

Nada Abdullah Hasso; Ahmed Moayed Hussain; Ali Salah Fatheel

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 106-111
DOI: 10.33899/mmed.2020.164151

Patients with diabetes mellitus type 2 have a greater risk of accelerated atherosclerosis. Antiphospholipid antibodies(aPL)are associated with greater risk for thrombosis. To demonstrate the possible role of anticardiolipin(aCL) and anti-β2 glycoprotein(β2 GP1) antibodies in such patients, we investigate the presence of these antibodies in a group of type 2 diabetic patients.
Objectives: 1. To investigate the presence of anticardiolipin IgM and IgG antibodies and anti-β2 GP1 IgG antibodies in diabetic patients and compare them with a control group.
2. To analyze their potential implication in the occurrence of vasculopathy in such patients.
Patients and Methods: Fifty patients with type 2 diabetes mellitus and 33 healthy subjects were included in the study. Each blood sample was tested for IgM, IgG aCL antibodies and for anti-β2 GP1 IgG antibodies.
Results:  Seven patients were positive for aCL IgM, 6 were positive for aCL IgG and 4 patients were positive for anti-β2 GP1 IgG antibodies. There was no differences in the means of IgM, IgG aCL and anti-β2 GP1 IgG antibodies titers in patients with complicated and uncomplicated diabetes mellitus.
 The aCL and β2 GP1 antibodies positive titer means among type2 diabetics were significantly higher than non-diabetic subjects.
 Positive but low titers of aCL and β2 GPI antibodies could suggest that these autoantibodies may play a minor role in the pathogenesis of atherosclerosis.
Low titers of aCL and β2 GPI antibodies were seen in complicated and non-complicated diabetic populations that probably lessen the importance of these autoantibodies as effective contributors in the pathogenesis of diabetic vasculopathy.               

Biomarkers of Oxidative Stress in Polycystic Ovary Disorder

Fatimah Haitham Fathi

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 112-116
DOI: 10.33899/mmed.2020.164152

Background: oxidative stress(OS) happens when harmful reactive oxygen species (ROS) exceed antioxidants leading to damage of lipid, protein and DNA. OS was documented to participate in pathogenesis and complication of polycystic ovary syndrome(PCOS). PCOS is a common endocrine disorder, with incidence 4-12% between female at fertility period that leads to anovulation and infertility. This syndrome is accompanied with over production of androgen and dysfunction of ovaries which are associated by classical signs and/or symptoms and biochemical characteristics comprising hirsutism, acne, ultrasonic feature of polycystic ovaries, irregular menstrual period, adiposity, dyslipidemia, decrease insulin sensitivity and prediabetes.
Aim of the Study: to evaluate biomarkers levels of oxidative stress in women with PCOS and in healthy control women. This evaluation is necessary to show the effect of oxidative stress on sex hormonal profile of women with PCOS.
Participants and Methods: thirty women (16-38 year) with PCOS and thirty matched age women were enrolled to evaluate oxidative status by measuring serum levels of malondialdehyde(MDA) concentration and total antioxidant capacity(TAC) in all participants.
Results: Women with Polycystic ovary exhibited significantly increased means of MDA levels and significantly decreased mean of TAC levels when compared to healthy participants.
Conclusion: it concluded from this study there is a disturbance of oxidant and antioxidant profile in PCO women supposes a status of oxidative stress, guided by high level of oxidative stress biomarker of lipid peroxidation (MDA) and decreased antioxidant defense mechanism which indicated by TAC. Moreover, the oxidative stress biomarkers can be employed as indicator in early diagnosis of PCOS and utilization of them in monitoring and preventing further complication of it.

The Frequency of Allergic Bronchopulmonary Aspergillosis in Patients with Asthma

Mahdi Saleh Mahdi; Samet Alyas Qasim; Ali Abdulmuttalib

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 117-124
DOI: 10.33899/mmed.2020.164153

Background: Allergic bronchopulmonary aspergillosis ABPA is an unusual but not rare illness that affects young atopic adults with allergic asthma. There are clinical and laboratory tests for the diagnosis of ABPA, these tests include history of asthma, peripheral blood eosinophilia, immediate cutaneous reactivity to Aspergillus fumigatus, serum precipitating antibodies to A. fumigatus or elevated total serum IgE and radiological infiltration.
Objectives: This is a case control study designed to evaluate the frequency ofallergic bronchopulmonary aspergillosis ABPAin patients with asthma.
Methods: This is a case control study carried on 150 asthmatic patients consulting the allergic disease center of Aljumhori Teaching Hospital in Mosul for the period from November 2003 to July 2004 to identify patients with allergic bronchopulmonary aspergillosis ABPA. Their ages ranged from 6-65 years, 52% of them were females and 48% were males. The results were compared with a 60 apparently healthy individuals selected randomly as a control group.
To prove that patients’ symptoms were allergic bronchopulmonary aspergillosis ABPA, the following tests were performed for all patients, peripheral eosinophilia which was found in 40.6% of asthmatic patients, skin test for Aspergillus which was positive in 51.3%, ELISA test for total IgE which was positive in 28% and chest-X ray abnormalities were found in 17.3% of patients mainly as pulmonary infiltration.
Results:The major criteria for allergic bronchopulmonary aspergillosis ABPA were found in 19(12.6%) patients out of 150.  Moreover, it was significantly higher in most age groups mainly in those patients between 6-15 years and 16-25 years of age. Peripheral eosinophilia, Skin test, ELISA and CXR did not appear to be related to the sex of patients or duration of asthma, but they were significantly higher than the control group (P<0.05) in those with atopic asthma associated with other allergic diseases as eczema, urticaria, rhinitis and conjunctivitis.
Conclusion:The current study revealed that 12.6% of asthmatic patients fulfill the criteria of allergic bronchopulmonary aspergillosis ABPA and there was a significant relationship between asthma and Aspergillus fumigatus as a risk factor.

Fluctuation of Serum Leptin Through Menstrual Cycle in Young Fertile Women in Mosul City

Rajaa A. yonis; Fadhila S. Al-Doski

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 125-131
DOI: 10.33899/mmed.2020.164154

Background:  Leptin  is a hormone secreted by adipocytes , it is aprotein  encoded by the ob gene.  Mutations in the ob gene in animals  cause obesity , leptin affects  nutritional homeostasis  and  reproductive function.
Objectives : a  followup  study  was done  to  investigate serum leptin  levels in 30  fertile healthy normal weight  women with regular menstrual  cycle aged (8-45) years   in folicular and luteal phase of menstrual cycle.
Methods: Fasting  blood samples were obtained from normal weight fertile women(BMI 19.5-24.9 Kg/m2) to measurement   serum  concentrations  of  leptin, which  measured  by  using( ELISA)  in follicular phase (2nd day of menstriual cycle )  then ask the women to come back  and  give another blood sample in 21st- 23nd day of the cycle to measure serum progesterone and leptin in luteal phase of the menstrual cycle.
Results: The mean  age ± SD  of the normal fertile women  was (29.1± 8.4) years, the mean weight  value ±SD  was (53±5)kg  and  the mean height   value±SD was(158 ± 6.2) cm and the mean BMI±SD  was (21.2± 1.3).
    Leptin was higher in luteal phase than follicular phase in normal weight  fertile women ,this was statistically significant (p≤ 0.000), the mean   ± SD of progesterone hormone  was (7.8 ± 3.2 ) in day 21-23 of the cycle this was the indicator  for ovulation and starting of luteal phase.
Conclusion: A great variation in serum leptin levels throughout the menstrual cycles with lower  levels in the follicular rather than luteal phase in normal weight fertile women is found.

Frequency of Osteoporosis in Patients with Coronary Heart Disease

Jasim Mohammed Taib Al-Hayali; Abd Al-Razak Salim Mahdy

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 132-138
DOI: 10.33899/mmed.2020.164155

Objectives: To explore and discuss the  possible  relationship  between coronary  artery disease and osteoporosis  in men and in postmenopausal women  in  comparison with healthy control.
Patients and methods: Fifty patients  with ischemic heart diseases, with positive catheterization  results whose ages range between 45 - 65 years old were enrolled  in  the study and referred as Group A.  Fifty  aapparently healthy  subjects, matched for  e with  the patients group ,  were kept as control  group and referred as Group B. We divided the patients understudy into two groups based on the mineral density they have; these groups are  osteoporosis  groupand normal bone mass group .
Results: The frequency  of bone density by using Dexa (T-score)  in studied  subjects  in Group A were normal (T-score=  5.5  to -0.9) in 34 (68%) subjects,  osteopenia  (T• score= -1  to -2.4) in  11  (22%) subjects, and osteoporosis  (T-score  = -2.5)  in 5 (10%) subjects.  For Group B,  32 (64%) hainormal   Dexa results, 17 (34%) were osteopenic,  and 1   (2%) had osteoporosis.
The study has found that the relationship between the two groups was not statistically significant when tested by the chi square test.
Conclusion: There was no relationship  between osteoporosis  and cardiovascular diseases. Gender had no effects on osteoporosis.

Helicobacter pylori in Gastric biopsy: A Histochemical and Immunohistochemical Assessment

Zainab Waleed Aziz; Shuaib Hashim Saleem; Hatim Abdulmajeed Al-Nuaimy

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 139-147
DOI: 10.33899/mmed.2020.164156

Background: Helicobacter species pylori represent one of the medically prominent and most common infections in the world. Contamination with this microbe has set as a causal factor in the development of gastritis, peptic ulcer, and gastric neoplasia. Consequently, prompt diagnosis is essential.
Objectives: This study was conveyed to detect H.pylori in gastric biopsies specimens by using routine Hematoxylin, Modified Giemsa dye as well as immunohistochemical stain, besides to assess the specificity and sensitivity of Helicobacter microbe detection in each method.
Patients and methods:The research was both prospective and retrospective, carried out on 100 cases of endoscopically obtained gastric biopsies. Data obtained from archives of the pathology department, at      AL-Jamhuri Teaching Hospital, Mosul city, and collected in a period spanning from April 2013 to March 2014. The information included; Age, sex, gastric biopsy location, inflammation status, the presence of dysplasia or carcinoma. Helicobacter pylori infection was assessed histochemically and immunohistochemically.
Results: In a total of 100  gastric samples, patients’ age range was 11 to 82 years (mean age of 46.5 years), with a male to female ratio of 1.38:1. Helicobacter pylori bacilli were positive with H&E/MGS in 71 (71%) of cases, increased to 75 (75%) case with IHC. Chronic gastritis noticed in 85 biopsy specimens, 74% were positive for H.pylori. There was a statistically significant difference between IHC and H&E/MGS (p=0.04) for detection of H.pylori. The sensibility and specificity of the H&E/MGS were measured compared with the recommended standard sensitive and specific IHC test; they were 95% and 100% respectively.
Conclusion: The routine ancillary stains request for the detection of H.pylori remains a laboratory and an institution right. This study revealed that, in our laboratory, the regular application of ancillary dyes is not obliged for the description of H.pylori because it was readily recognizable in the bulk of sections with haematoxylin staining. However, we recommend the use of IHC  in specific circumstances.

Antihyperglycemic effect of the alkaloids extracted from Adiantum capillus in diabetic rats

kawa dizaye; Roshna S. Aziz

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 148-157
DOI: 10.33899/mmed.2020.164157

Background: Biomedical researches have long sought to develop novel therapies that are more effective, less costly and possess fewer side effects, to treat chronic diseases including diabetes mellitus. Adiantum capillus is among the medicinal plants that have been widely used in traditional medicine and are known to have hypoglycemic effects. This study was designed to find the chemical constituent of Adiantum capillus that exerts the hypoglycemic effect.
Materials and Methods: Fifty-four rats were split into nine groups. Twelve normal rats were included in the first group; six acted as negative controls and six were administered Adiantum capillus water extract. The second group was comprised of 42 streptozotocin-induced diabetic rats sectioned into seven subgroups of six rats. The first subgroup functioned as a positive control. The second subgroup was administered 100 mg/kg/day of Adiantum capillus aqueous extract for 21 days, while the third and the fourth subgroup received 50 mg/kg/day of metformin and acarbose respectively. The remaining three groups were administered alkaloids (4 mg/kg/day), flavonoids (24 mg/kg/day) and phenolic compounds (30 mg/kg/day) extracted from Adiantum capillus for 21 days. Fasting blood glucose levels, insulin levels, insulin resistance, serum amylase levels, C-peptide levels, liver function and renal function were monitored.
Results: The use of an Adiantum capillus aqueous extract in diabetic rats for 21 days effectively controlled blood glucose levels, elevated amylase level and improved renal and liver function. A significant decrease in blood glucose, AST, ALT, ALP and blood urea levels accompanied by significant increase in the serum amylase of diabetic rats was produced by the alkaloids extracted from Adiantum capillus. However, flavonoids and phenolic compounds did not cause any significant change in blood glucose levels.
Conclusion:It can be concluded that the alkaloids extracted from Adiantum capillus are the chemical constituent that contributes to the antihyperglycemic effect of the plant.

Intra-Gastric Balloon, an Aid for Weight Reduction in Obese Patient

nashwan mahgoob

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 158-162
DOI: 10.33899/mmed.2020.164158

Background: we share our experience with an intra-gastric balloon to evaluate the safety, tolerability, and efficacy for patients with class one and two obesity. Methods: From January 2015 to January 2017, intra-gastric balloons were inserted in the stomachs of 85 patients at the endoscopy unit in CMC Hospital Erbil/Kurdistan/ Iraq. All the patients had a body mass index between 30 to 39 kg/m2 and were within the age range of 17-50 with a mean age of 29 years, there were 55 female 30 male patients, the patients underwent consent, pre balloon insertion investigation tests and anesthesia evaluation. The balloon was inserted via an upper endoscopy device after diagnostic study and then it was filled with 550-600 (mills) of stained saline. All patients' were given an analgesic and antiemetic for a week and anti-secretory proton pump inhibitors for 6 months. Diet and the importance of the exercise were part of the program phase and protocol during the period of the study. The balloon was removed after 6 months. The patients were followed during the 6 months of insertion and 6 months after the removal. The weight reduction and complications were documented and reported.                
Results: Satisfactory weight loss was obtained in 85% of patients after six months and 75% after 12 from insertion respectively.  One patient underwent early removal of the balloon after 7 days of insertion; another patient had balloon leak and shrinkage which necessitated replacement by another one.  Early postoperative pain and vomiting were universal but subsided in 90% during the first 10 days.                                                                                                     
Conclusion: in well-selected patients the intra-gastric balloon is an effective tool that can be used to achieve weight loss with minimum complications.                 

Local Effect of Intramuscular Injection of Meloxicam and Diclofenac: An Experimental, Comparative and Histological Study

Ahmed Hisham Qassim; Omar Riadh Hamdi; Ashraf Abdulraheem Ayoob; Mohammed Taib Taher

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 163-169
DOI: 10.33899/mmed.2020.164159

Objectives: To compare the local effect of therapeutic doses of meloxicam and diclofenac on the muscle of rats at different periods by intramuscular injection.
Materials and methods: Thirty six adult albino rats were divided equally into 6 groups. The 1st and 2nd groups were injected intramuscularly with normal saline for 2 and 4 weeks respectively, the 3rd and 4th groups were injected intramuscularly with meloxicam for 2 and 4 weeks respectively, the last 2 groups were injected intramuscularly with diclofenac sodium also for 2 and 4 weeks respectively. The drugs were injected into the quadriceps femoris muscle of the right femur once each day till the end of the period stated. The specimens were histologically processed, stained with hematoxylin and eosin and examined with light microscope.
Results: No changes were seen in quadriceps femoris muscles of groups 1, 2, 3 and 4, whereas group 5 showed congested blood vessels within normal muscle tissue. In Group 6 mononuclear inflammatory cells infiltration, vascular congestion, fibrosis, degenerative changes and muscle tissue necrosis were seen.
Conclusion: Meloxicam is safer than diclofenac sodium on muscular tissue after a long-term daily intramuscular injection.

Virulence Factors of Yeasts Isolated From Oral Lesions

Nia am N. Jammil; Manahil M. Yehia

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 170-177
DOI: 10.33899/mmed.2020.164160

Objectives: To detect the virulence factors of yeasts which are proteinase and phospholipase                 which have important role in the pathogenesis of oral lesions.                                                                                               Patients and methods: This study included 120 children manifested with oral lesions admitted to the Consultating Clinic and Medical Wards of   Ibn – Sina and Ibn Al – Ather Teaching Hospitals in addition to Neonatal Care Unit of Al – Battol Teaching Hospital. Samples collected during the period from December 2012 – May 2013. Control group was 60 apparently healthy children from whom oral swabs 'were obtained.  Identification' of' the isolated yeasts were conceded by "direct examination, culture, biochemical tests and API – 20 C system, then detection of' protienase and phospholipase of yeasts isolated from oral lesions".                                                       
Results: Candida albicans isolates have a high expression rate for the production of proteinase (95.3%) and phospholipase(97.1%) in comparison to the other candida and yeast species with a significant difference     (p = 0.001). 
Conclusion: The isolates produce two important virulence factors namely proteinase and phospholipase significantly more in Candida albicans than other yeasts.               

Foreign Body Inhalation: A shift in Clinical Pattern

Rabea S. A. Al Sofi; Ziad T. Mahmood; Omer M. T. Hammodat

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 178-183
DOI: 10.33899/mmed.2020.164161

Background: Foreign body inhalation is a common presentation in thoracic surgery and it is well known to present mainly in toddlers, commonly due to sun flower seeds or water melon seeds.
Objectives: To determine the changes in clinical pattern of foreign body inhalation regarding the age, sex, and type of foreign body.
Methods: This is a case series study of patients with foreign body inhalation admitted to Al-Jumhori teaching hospital in Mosul. The parameters used in this study are sex, age group and type of foreign body.
Results: The main age group affected was adolescents, and the commonest foreign body inhaled was the veil pin.
Conclusion: The bad habit of holding pins in mouth while doing other things with your hand has led to this change in clinical pattern of foreign body inhalation.

The role of vitamin C and E in improving hearing loss in patients with type 2 diabetes

Marwan M. Merkhan; Kassim S. Abdullah

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 184-189
DOI: 10.33899/mmed.2020.164162

Objective: to evaluate the effect of antioxidant vitamins on hearing loss in diabetic patients.
Patients and methods: Sixty type 2 diabetic patients with positive pure tone audiogram (PTA) enrolled in the study and divided into two groups: each group consists of thirty patients, group one was put on antioxidant therapy, and group two on placebo therapy, for 2 months duration. Thirty healthy individuals were kept as a control. Fasting blood sugar (FBS), and malondialdehyde (MDA) were measured in all groups. MDA and PTA were repeated after therapy.
Results: The FBS and MDA are higher in diabetic patients, and beneficial effects of the administration of vitamin E and C combination on the oxidative stress and significant improvement, with mean differences of 12.5±7.79 decibel (dB), in the sensorineural hearing loss (SNHL) in diabetic patients were obtained. Conclusion: the present study demonstrated that diabetic patients have exaggerated oxidative stress, and administration of vitamin E and C combination had beneficial effect on the oxidative stress, and on the SNHL in diabetic patients with mean differences of 12.5±7.79 dB (p<0.001).

The Effect of Using Combined Oral Ethinyl Estradiol and Levonorgestrel in the Resolution of Menstrual Pattern Disorder and Functional Ovarian Cyst

Najlaa Saadi Ismael; Sana Jafar Mohamed; Maha Atout; Qutaiba Ahmed Al Khames Aga; Sura Yasir Taha Alkhammas

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 190-196
DOI: 10.33899/mmed.2020.164163

Objectives: To evaluate the usefulness of combined oral contraceptives (ethinyl estradiol and levonorgestrel) in resolving menstrual pattern disorder in reproductive-age women with a functional ovarian cyst in Iraq.
Method:A longitudinal (before and after) ,  interventional study  was used. Data were collected at a single obstetrics and gynaecology outpatient clinic in Mosul City, Iraq. Participants: A sample of 96 women aged between 15 and 45 years participated in the study. Participants diagnosed with ovarian cysts were treated using an oral administration of contraceptive pills (combination of ethinyl estradiol, 0.03 mg, and levonorgestrel, 0.15 mg) on a daily basis for a treatment duration of 2 months. The Outcome Measures are Menstrual pattern disorders (dysmenorrhea, irregular menstrual cycle, and amenorrhea) and cyst dimensions were recorded.
Results: After one therapy cycle, a statistically significant disappearance of menstrual pattern disorder was observed (p=0.000). Cyst resolution was observed in 89.58% of the patients (n=86), while mean ovarian cyst size fell from 4.452 ± 1.0603 cm at the start of therapy to 0 .451 ± 1.5613 cm(p = 0.000). 5 of the 10 persistent cysts disappeared after the second cycle (2 months after the start of therapy) and complete cyst resolution was 94.8% (n = 91) after two cycles. This indicated a further significant reduction of mean ovarian cyst size to 0.335 ± 1.4684 cm. However, no significant difference was observed between mean cyst size in the first and second months of treatment (p=0.329).
Conclusion: Combined oral contraceptives (ethinyl estradiol and levonorgestrel pills) are effective in relieving dysmenorrhea, irregular menstrual cycle, and amenorrhea. They also hasten the disappearance of functional ovarian cysts, and are associated with high rates of success in patients with functional ovarian cysts.

Histological and Immunohistochemical Analysis of Special Compartments of Palatin Tonsils in Relation to Tonsillar Diseases

Zahraa A. Tabou; Abduljabbar Y. AL-Hubaity; Eklas A. Ali

Annals of the College of Medicine, Mosul, Volume 41, Issue 2, Pages 197-204
DOI: 10.33899/mmed.2020.164164

Background:The tonsils are lymphoepithelial tissue, it contains specialized lymphoid functional compartments which include the lymphoid follicles, parafollicular areas, crypt epithelium and high endothelial venules, which together have an essential role in the immunological process. These compartments may be altered histomorphologically throughout life time underneath common pathological condition.   
Aim:The aim of the current study is to evaluate special microstructural functional compartment changes as high endothelial venules, lymphoid follicles, interfollicular and connective tissue areas according to histopathological ground of the palatine tonsils.
Methods:one hundred palatine tonsillar samples which were attained from patients suffering from chronic tonsillitis, recurrent tonsillitis and obstructive hypertrophic tonsils were admitted at Al-Jumhuri Teaching Hospital and Al-salaam teaching hospital in Mosul city during the period from February 2018 to February 2019. Age of patients ranged from  (2-40) years. Specimens of tissue were directly fixed in 10% formalin then processed. Paraffin sections of 4μm thickness were exposed to routine stain with hematoxylin and eosin, while the studied marker (CD34) was detected by immunohistochemical method using labelled streptavidin-biotin (LSAB/HRP) method.
Results: The high endothelial venules found in the subepithelial compartments as well as with in the reticulated crypt epithelium were characterized by prominent nuclei of the endothelial cells with non-epithelial cells were found on the luminal side. The mean count of high endothelial venules was peak with statistically significant in recurrent tonsillitis and hypertrophic tonsil in both surface epithelium1.67±0.24, 0.78±0.22 and crypt epithelium1.89±0.31, 0.89±0.20 (p=0.046, p= 0.032) respectively. However the percentage of follicle area compartment in the tonsillar hypertrophic cases was greater than in other infectious tonsillar diseases (30.33%) respectively. Contradictory, the interfollicular and connective tissue areas reach their maximum in chronic tonsillitis.
Conclusion:The high endothelial venules are dispersed throughout the surface in addition to crypt epithelial. Follicular area percentage in the hypertrophic tonsils is higher than that in the chronic and recurrent tonsillitis group, representing a hyperplastic state of lymphoid cells in the germinal centers. It can also explain the alteration in immune defense mechanism underlying these pathological conditions.