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Immunohistochemical Expression Of Estrogen And Progesterone Receptors In Endometrial Hyperplasia And Endometrioid Carcinoma
S Sarmadi,N Izadi-Mood,B Rajabian
Tehran University Medical Journal , 2012,
Abstract: Background: Endometrial carcinoma (EC) is the most common gynecologic malignancy; however, mechanisms underlying its pathogenesis remain obscure.Endometrial carcinoma has been classified into two major categories: type I (related to estrogen or endometrioid adenocarcinoma)and type II (unrelated to estrogen).Estrogen is the main trigger for the abnormal proliferation in the endometrial epithelium but progesterone can inhibit this process. The aim of this study was to analyze the expression of estrogen and progesterone receptors in all types of endometrial hyperplasia in comparison to endometrioid adenocarcinoma of endometrium. Methods: Forty-seven specimens including 23 cases of histopathologically confirmed hyperplastic endometrium (12 simple hyperplasia, 5 complex hyperplasia without atypia, and 6 complex hyperplasia with atypia) and 24 cases of endometrial carcinoma were studied. Immunohistochemical staining of estrogen and progesterone receptors was performed in paraffin-embedded blocks and expression of estrogen and progesterone receptors were scored according to the proportion of positive staining cells. Results: Overexpression of progesterone receptors was seen in 18 (75%) out of 24 cases of endometrial carcinoma and 23 (100%) of all types of endometrial hyperplasia. The aforesaid differences were statistically significant (P=0.023). 70.8% of cases with endometrial carcinoma were 3+ for immunohistochemical staining of progesterone receptors as were 85.7% of the cases with endometrial hyperplasia; the difference being also statistically significant (P=0.02).Conclusion: Considering the increased proportion of progesterone receptor expression in all types of hyperplastic endometrium in comparison to endometrial carcinoma, hormonal therapy by progestinal agents is recommended as a treatment of choice.
Determining the interobserver reproducibility of Pap smears in the diagnosis of epithelial cell abnormalities
Izadi-Mood N,Sarmadi S,Heydari-Farzan F,Haeri H
Tehran University Medical Journal , 2011,
Abstract: "n 800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Background: Cancer of uterine cervix is the second cause of death in women in the world and the most common cause in developing countries. Because the majority of women with invasive cervical cancer of the uterine have not previously undergone screening, many clinicians assume that Pap smear has a high degree of accuracy; but problems such as false positive and false negative interpretations, as well as interobserver variability have questioned its validity."n"nMethods : We retrieved 162 positive cervical smears that had been originally interpreted as ASC-US, ASC-H, LSIL, HSIL, SCC, AGC and adenocarcinoma from the cytology archives of Women's Hospital in Tehran, Iran. The slides were rescreened by an experienced pathologist and reclassified in the mentioned categories. All the 162 slides were reviewed by three more pathologists in a blind study using interpretative criteria utilized in their daily routine to evaluate interobserver reproducibility. To increase the level of interobserver agreement, the diagnostic categories were reduced to squamous Vs. glandular abnormalities and invasive (SCC and adenocarcinoma) Vs. non-invasive abnormalities."n"nResults : The results obtained in this study indicated slight interobserver agreement (k=0.26). The most reproducible category was the invasive category (SCC in addition to adenocarcinoma) and the least agreement was seen for HSIL (k=0.19). "n"nConclusion: This study showed that reproducibility of cytological interpretation of conventional Pap smears varies among interpretive categories and the overall interobserver agreement is slight. Since convening on the reduction of interobserver discrepancy in Pap smear interpretations necessitates more reliable information of interpretative variability, larger studies need to be undertaken.
The Burden of Diabetes in a Developing Country  [PDF]
Mohammad Khajedaluee, Maliheh Dadgarmoghaddam, Reza Saeedi, Zahra Izadi-Mood, Maryam Abrishami
Open Journal of Preventive Medicine (OJPM) , 2014, DOI: 10.4236/ojpm.2014.44023
Abstract:

Introduction: People with diabetes often develop diverse microvascular, macrovascular, and neuropathic complications. Diabetes named high disease because of its high prevalence, high incidence, chronicity and high costs. Accurate projections of diabetes burden are essential for health planning so the aim of this study was to calculate the burden of diabetes in Razavikhorasan population, in Iran. Methodology: We used Disability Adjusted Life Years (DALYs) index using computer model (DisMod) for assessment of burden of diabetes and complications in Razavikhorasan province in Iran in year 2010-2011. Results: Burden of diabetes in Razavikhorasan population was 64,733 DALY in year 2010-2011. The total Years Life Lost (YLL) from diabetes mellitus was 62,883 (34,216 in men and 28,667 in women) due to premature death and the total Years Life Disability (YLD) was 1850. Conclusion: Diabetes mellitus and lesser forms of glucose intolerance can now be found in almost every population and epidemiological evidences suggest that, without effective prevention and control programs, diabetes will continue to increase and therefore advances in all levels of prevention may help reduce the number of people with diabetes.

Altered PTEN expression; a diagnostic marker for differentiating normal, hyperplastic and neoplastic endometrium
Soheila Sarmadi, Narges Izadi-Mood, Kambiz Sotoudeh, Seyed Tavangar
Diagnostic Pathology , 2009, DOI: 10.1186/1746-1596-4-41
Abstract: In a study in a referral gynecologic hospital in Tehran, Iran, immunohistochemical (IHC) evaluation of PTEN was performed on 87 consecutive specimens to the following three groups; group A- normal proliferative endometrium(n = 29); group B- hyperplastic endometrium [including simple hyperplasia without atypia(n = 21) and complex hyperplasia with atypia (n = 8)] and group C- EECA(n = 29). Immunostaining of cells was analyzed by arbitrary quantitative methods according to both slide's area staining and intensity of color reaction.PTEN immunoreactivity was present in all normal proliferative endometrium, all simple hyperplasia, 75% of atypical complex hyperplasia and in 48% of EECA (P < 0.001). The intensity of PTEN reaction was significantly higher in group with proliferative endometrium than hyperplastic endometrium and EECA (P < 0.001).PTEN expression was significantly higher in cyclical endometrium than in atypical hyperplasia and endometrioid carcinoma.Endometrioid endometrial carcinoma (EECA) accounts for three fourths of endometrial cancers and are thought to develop following a continuum of premalignant lesions ranging from endometrial hyperplasia without atypia, to hyperplasia with atypia and finally to well differentiated carcinoma[1,2]. Based on light microscopic appearance and clinical behavior, endometrial cancers have long been classified into major categories (type I and II) [2-4]. Accurate diagnosis of premalignant lesions in routine endometrial biopsies has a great clinical value in patient management. Unfortunately several recent studies have shown that cytological atypia which is predominant criterion for diagnosis of premalignant lesions (atypical endometrial hyperplasia), have poor reproducibility [1,3]. Therefore, solving these problems needs new insights into the morphology of biologically defined premalignant lesion of endometrium [1]. Recent molecular diagnostic methods have provided new ancillary tools for premalignant lesion diagnosis. EECA h
Altered PTEN expression; a diagnostic marker for differentiating normal, hyperplastic and neoplastic endometrium
Sarmadi Soheila,Izadi-Mood Narges,Sotoudeh Kambiz,Tavangar Seyed
Diagnostic Pathology , 2009,
Abstract: Background Different molecular alterations have been described in endometrioid endometrial carcinoma (EECA). Among them the most frequently altered is loss of the PTEN protein, a tumor suppressor gene. The purpose of this study was to evaluate the expression pattern of PTEN gene in normal, hyperplastic and neoplastic endometrium. Methods In a study in a referral gynecologic hospital in Tehran, Iran, immunohistochemical (IHC) evaluation of PTEN was performed on 87 consecutive specimens to the following three groups; group A- normal proliferative endometrium(n = 29); group B- hyperplastic endometrium [including simple hyperplasia without atypia(n = 21) and complex hyperplasia with atypia (n = 8)] and group C- EECA(n = 29). Immunostaining of cells was analyzed by arbitrary quantitative methods according to both slide's area staining and intensity of color reaction. Results PTEN immunoreactivity was present in all normal proliferative endometrium, all simple hyperplasia, 75% of atypical complex hyperplasia and in 48% of EECA (P < 0.001). The intensity of PTEN reaction was significantly higher in group with proliferative endometrium than hyperplastic endometrium and EECA (P < 0.001). Conclusion PTEN expression was significantly higher in cyclical endometrium than in atypical hyperplasia and endometrioid carcinoma.
Reproducibility determination of WHO classification of endometrial hyperplasia/well differentiated adenocarcinoma and comparison with computerized morphometric data in curettage specimens in Iran
Narges Izadi-Mood, Maryam Yarmohammadi, Seyed Ahmadi, Guity Irvanloo, Hayedeh Haeri, Ali Meysamie, Mahmood Khaniki
Diagnostic Pathology , 2009, DOI: 10.1186/1746-1596-4-10
Abstract: Although traditional microscopic diagnosis is by far the most applicable method and the gold standard for histomorphologic diagnosis, digitized image analysis has been used as a powerful adjunct to maximize the histologic data retrieval and to add some detailed objective criteria for correct diagnosis in difficult cases.A series of 100 endometrial curettage specimens with diagnosis of endometrial hyperplasia or well differentiated adenocarcinoma were blindly reviewed by 5 pathologists; their intra and interobserver reproducibility determined and further compared to the objective morphometric data i.e. D-score and volume percent of stroma (VPS).The results were assessed using the weighted kappa statistics. Mean intraobserver kappa value was 0.8690 (99.44% agreement). Mean interobserver kappa values by diagnostic category were: simple hyperplasia without atypia: 0.7441; complex hyperplasia without atypia: 0.3379; atypical hyperplasia: 0.3473, and well-differentiated endometrioid carcinoma: 0.6428; with a kappa value of 0.5372 for all cases combined.Interobserver agreement was in substantial rate for simple hyperplasia (SH) and well differentiated adenocarcinoma (WDA) but was in fair limit for complex hyperplasia (CH) and atypical hyperplasia (AH). Intraobserver agreement was almost perfect. The specimens were divided in two groups according to the computerized morphometric analysis: Endometrial Hyperplasia (EH) ( D Score ≥ 1 or VPS ≥ 55%) and Endometrial Intraepithelial Neoplasia (EIN) (D-Score < 1 or VPS < 55%). Morphometric findings were closely compatible with routine WHO classification made by one expert pathologist; however; diagnosis of (CH) and (AH) made by other pathologists were not concordant with morphometric data.It may be necessary to make some revisions in WHO classification for endometrial hyperplasia and precancerous lesions.Endometrial hyperplasia which is believed to increase the risk of endometrial carcinoma, is a common disease and comprises a wide
Twin Pregnancy with Hydatidiform Mole and Coexisting Fetus: Report of Three Cases and Review of Literature
Fariba Yarandi,Zahra Eftekhar,Narges Izadi-Mood,Zahra Elahi-Panah
Journal of Family and Reproductive Health , 2009,
Abstract: A twin pregnancy with a coexisting complete hydatidiform mole and a healthy fetus (CMCF) is rare. Here we report three cases of CMCF with different clinical courses but similar outcome without a surviving neonate. Two women required uterine evacuation before 20 weeks of gestational age because of vaginal bleeding and medical complications and the other patient underwent termination of her pregnancy at 24 weeks of gestation due to severe pre-eclampsia. The pathologic diagnosis of complete hydatidiform mole was confirmed in each case and the chromosome complement was 46XX in two molar gestations and 46XY in one gestation. One of the three women required chemotherapy for treatment of low-risk gestational trophoblastic disease. The hCG level was normalized after 4 cycles and the patient was free of disease at 1 year follow-up. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with CMCF are presented.
Pure ovarian choriocarcinoma: report of two cases
Narges Izadi-Mood,Nasrin Samadi,Parvaneh Rahimi-Moghaddam,Soheila Sarmadi
Journal of Research in Medical Sciences , 2009,
Abstract: Pure primary ovarian choriocarcinoma is an extremely rare condition of gestational or nongestational origin. The possibility of gestational origin can be suspected by the presence of a corpus luteum of pregnancy but definite diagnosis would be based on genetic analysis. Here, we present two cases of pure ovarian choriocarcinoma in the forth decade of life with the possibility of gestational origin. Keywords: Gestational, choriocarcinoma, ovary.
Frequency of tumor diathesis in the smears of cervical carcinoma in a University Hospital
Izadi Mood N.,Hakimi J.
Tehran University Medical Journal , 2008,
Abstract: Background: Tumor diathesis (TD) refers to the granular proteinaceous precipitates on the slide surface of cytologic (Pap) smears. Found in the background of smears from some, but not all, invasive carcinoma cases, TD is present in the majority of smears from large cell nonkeratinizing carcinoma. It is more pronounced than keratinizing SCC also is almost always present in small cell carcinoma. Smears from patients with adenocarcinoma are frequently associated with dense inflammatory and fresh blood exudates and less often there is a recognizable tumor diathesis. Methods: To determine the prevalence of TD in cervicovaginal smears from patients with uterine cervix carcinoma, cytologic smears and histologic slides of 46 patients with histologically-confirmed uterine cervix carcinoma were reviewed for the presence or absence of TD, red blood cells and neutrophils on cytologic smears, as well as depth of invasion, histologic types and grade of differentiation of tumor on histologic slides.Results: TD was identified in 28 smears (60.9%), 18 patients with squamous cell carcinoma (62.1%), seven patients with adenocarcinoma (58.3%), two patients with adenosquamous carcinoma (66.7%) and one patient with endometrial carcinoma that involved the uterine cervix. TD was seen in smears from four (33.3%) patients with uterine cervix carcinoma with invasion <5 mm and 17 (65.4%) carcinomas with invasion >5mm. However, some of the patients with invasive carcinoma lacked TD on the cytologic smears. Red blood cells were identified on 16 (34.8%) smears.Conclusions: Although TD is the hallmark of invasive carcinoma of the cervix on cytological smears, there have been few studies performed on it. We found that tumors with greater depth of invasion and reduced differentiation are associated with TD cytologic smears. TD was absent in some cases, particularly in micro-invasive carcinoma. This study reinforced what has been recognized from other studies.
"ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE: A CYTOHISTOLOGIC STUDY"
N. Izadi Mood A. Haratian
Acta Medica Iranica , 2004,
Abstract: Although the diagnostic category of atypical squamous cells of undetermined significance (ASCUS) has been known since 1988, its use and appropriate clinical follow up and management still remains controversial. This study was carried out to evaluate the diagnostic value of ASCUS, using cytohistologic correlation. A retrospective review of archival materials in our cytology laboratory files was performed for cervicovaginal smears diagnosed as ASCUS from March 1999 to February 2002. In 8551 cervicovaginal smears examined, ASCUS was reported in 236 (2.76%) cases, with histologic follow up in 98 (41.2%). During the follow up period of patients with ASCUS, 51 patients (52%) had benign/reactive lesions, 43 patients (43.9%) were diagnosed as having a squamous intraepithelial lesion (SIL), 2 (2.1%) specimen were insufficient and finally two cases (2%) proved to be invasive cervical carcinoma on histology. Of cases diagnosed as SIL, 22 (22.4%) were interpreted as flat condyloma, 9(9.1%) cervical intraepithelial neoplasia (CIN) 1, 2 (2.1%) CIN 1-2, 3 (3.1%) high grade SIL, 6 (6.1%)basal cell abnormality of undetermined significance, and 1 (1%) had features of CIN 1 in presence of severe inflammation. Patients whose smears fall into the category of ASCUS may exhibit a spectrum of findings, ranging from benign/reactive lesions to frequent SIL and rarely to invasive carcinoma. Therefore, patients with a diagnosis of ASCUS justify careful follow-up and investigation.
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