Farid Azmoudeh-Ardalan | Tehran University of Medical Sciences (original) (raw)

Papers by Farid Azmoudeh-Ardalan

British Journal of Neurosurgery, 2020

OBJECTIVE To determine the border of glial tumors by diffusion weighted imaging (DWI), apparent d... more OBJECTIVE To determine the border of glial tumors by diffusion weighted imaging (DWI), apparent diffusion co-efficient (ADC), magnetic resonance spectroscopy (MRS) and perfusion brain MRI. PATIENTS AND METHODS Ten patients with brain gliomas were enrolled [mean age: 35.3 ± 13.2, range: 20-62]. Conventional MRI was performed for all patients. Besides, tumor mapping based on Choline (Cho)/Creatine (Cr) color map in MRS, perfusion and diffusion color maps, were gathered. Different tumoral and peritumoral regions [normal tissue, reactive edema, infiltrative edema, and tumor core] were defined. MRI criteria were evaluated in areas targeted for biopsy and histopathologic evaluation was determined. RESULTS Tumor cell positive samples [one necrosis, 26 infiltrative and nine tumor cores] composed 36 (75%) of the 48 samples. Seven (19.4%) of the positive samples were interpreted as not tumor on MRI. Five were identified as reactive edema and two as normal tissue] [kappa: .67, p-value < .001]. Mean of ADC, median of N-acetylaspartate (NAA) and NAA/Cho were statistically different between positive and negative samples (p = .02 and p < .001, respectively). Mean ADC and median Cho/NAA were statistically different in missed tumor containing tissue presented as reactive edema compared to normal and correctly diagnosed reactive edema samples together (p-values < .05). CONCLUSIONS Multimodal MRI could define infiltrated borders of brain gliomas.

Acta Medica Iranica, 2012

It is assumed that about 10% of individuals infected with Mycobacterium tuberculosis develop tube... more It is assumed that about 10% of individuals infected with Mycobacterium tuberculosis develop tuberculosis. The rate of tuberculosis in solid organ transplant recipients has been estimated to be 50-fold higher than in the general population. Candidates for solid organ transplantation are routinely screened for latent tuberculosis infection (LTBI). In this study we aimed to compare Tuberculin Skin Test (TST) with QuantiFERON-TB Gold In-Tube (QFT) for the detection of LTBI in candidate for kidney transplantation. Between October 2009 and November 2010, 64 candidates for kidney transplant who referred to the transplant clinic in Imam Khomeini Hospital, were enrolled in the study. Patients were screened for LTBI with both QFT and TST. Concordance between two test results and variables associated with test discordance were assessed. The mean age of patients was 38.5 years (range 16-65); female/male ratio was 26/38. Positive results were found in 21.9% and 21.9%, by TST and QFT, respective...

The Turkish Journal of Endocrinology and Metabolism, 2021

iranian journal of pathology, 2014

Background and Objectives: HBV DNA monitoring is important in management of chronic viral hepatit... more Background and Objectives: HBV DNA monitoring is important in management of chronic viral hepatitis B infection. HBV DNA measurements are carried out over period of months to years. So the analytical system must be stable and reproducible. The aim of this study was to determine the performance characteristics and to plan a statistical quality control system of a laboratorydeveloped real-time quantitative PCR assay for HBV DNA quantification. Methods: Values of systematic and random error at two clinical decision points;4.2 Log IU/mL (20000 IU/mL) and 3.2 Log IU/mL (2000 IU/mL) were determined. Candidate quality control procedures were selected and performance of the method by application of normalized operational process specification (OPSpecs) charts was determined. Results: The performance of the assay at level of 4.2 Log IU/mL and 3.2 Log IU/mL were excellent and good respectively. Moreover, a1 3.5S rule with two measurements offered 90% probability of error detection at level of...

Urology journal, 2019

PURPOSE This study is aimed to evaluate the effects of opium dependency on testicular tissue in a... more PURPOSE This study is aimed to evaluate the effects of opium dependency on testicular tissue in a rat model. METHODS Thirty-two Wistar male rats (aged 30 days and weighing 200-250 grams) were randomized into two groups. Group A, consisting of 16 rats, received dissolved oral opium tablets in drinking water for 45 days, whereas group B (control group) consisted of 16 rats that received opium-free water. After 45 days vertical and horizontal diameters of testis, number of seminiferous tubules, mean seminiferous tubule diameter, number of germ cells, height of germinal epithelium, percentage of degenerating Leydig and germ cells and glutathione density of testicular tissue (µmol/g of tissue) were compared between study groups. RESULTS Morphological evaluation of testicular tissue revealed a significantly higher percentage of degenerating Leydig and germ cells in the treated group compared to control group. (10.08 ± 0.351 vs. 1.83 ± 0.88, 4.50 ± 0.769 vs. 0.607 ± 0.118, respectively) (P...

npj Breast Cancer, 2021

The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved su... more The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences fro...

Archives of Iranian medicine, 2014

BACKGROUND There are many patients awaiting liver transplantation with only few donors providing ... more BACKGROUND There are many patients awaiting liver transplantation with only few donors providing the organ. The Child-Turcotte-Pugh score (CTP) and the Model for End stage Liver Disease (MELD) are the most common scores for prioritizing patients on waiting lists. In this study, we compared the ability of these scores to predict mortality or removal from the waiting list due to poor medical conditions. METHODS A total of 257 patients were included in our study and we observed their status in the waiting list over a 9-month period. MELD and CTP of the patients at the time of listing were calculated. We used both ROC-curve and Area Under the Curve (AUC) to calculate the predictive ability of these scores. RESULTS During follow up, 22 patients died and 9 patients were removed from the waiting list due to poor medical conditions. Comparing the predictive ability of CTP and MELD, the AUC for CTP was larger than that of MELD (0.75 versus 0.69; P-value = 0.065). The best cutoff point for di...

Sepideh Saleki1, Farid Azmoudeh-Ardalan2, Hamidreza Eftekhari2, Hayedeh Haeri2, Sahra Emamzadehfa... more Sepideh Saleki1, Farid Azmoudeh-Ardalan2, Hamidreza Eftekhari2, Hayedeh Haeri2, Sahra Emamzadehfard2,3 1Legal Medicine Organization of Iran, Kahrizak, Tehran, Iran. 2Pathology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 3Radiology Department, University of Pennsylvania, Philadelphia, USA. Corresponding Author: Farid Azmoudeh-Ardalan, Pathology department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, Tel: +98-912-1055232; Email: azmoudeh@sina.tums.ac.ir

Background: Adenoid cystic carcinoma (AdCC) of the breast is a rare type of invasive breast cance... more Background: Adenoid cystic carcinoma (AdCC) of the breast is a rare type of invasive breast cancer, accounting for less than 1% of all breast cancer cases. It is usually a low-grade tumor that rarely metastasizes to the axillary lymph nodes and distant organs. AdCC of the breast is mostly negative for estrogen receptor, progesterone receptor, and HER2-neu. However, despite being triple-negative, it has favorable outcome, and patients with AdCC of the breast generally have a good to excellent long-term survival.Case presentation: Here we report a case of a 51-year-old female presenting with left breast mastalgia who was finally diagnosed with AdCC of the left breast. The patient underwent breast?conserving surgery and axillary staging followed by adjuvant chemoradiation.Conclusion: Because of the rarity of AdCC of the breast, it has been difficult to conduct prospective trials to determine the best treatment option. Different types of therapy, including BCS and mastectomy with or wit...

Iranian Journal of Pathology, 2021

Background & Objective: The world is facing COVID-19 pandemic, and medical education system and c... more Background & Objective: The world is facing COVID-19 pandemic, and medical education system and consequently the evaluation of students at different levels have been overshadowed. Residency students are among those affected. In the present study, we aim to share our experiences regarding holding exams for pathology residents before and during the pandemic. Methods: This cross-sectional study was carried out in Tehran University of Medical Sciences. The online exam, which consisted of 30 multiple-choice questions, was designed and held in April 2020 to evaluate pathology residents. To assess the quality of the exam, indices such as the number of questions, highest and lowest scores, the average score, the standard deviation, the variance, Cronbach’s alpha reliability coefficient, standard error of measurement, discrimination index, difficulty index, number/percentage of questions on three difficulty levels of easy, normal, hard were reviewed and analyzed. Results and Discussion: The ...

npj Breast Cancer, 2020

Assessment of tumor-infiltrating lymphocytes (TILs) is increasingly recognized as an integral par... more Assessment of tumor-infiltrating lymphocytes (TILs) is increasingly recognized as an integral part of the prognostic workflow in triple-negative (TNBC) and HER2-positive breast cancer, as well as many other solid tumors. This recognition has come about thanks to standardized visual reporting guidelines, which helped to reduce inter-reader variability. Now, there are ripe opportunities to employ computational methods that extract spatio-morphologic predictive features, enabling computer-aided diagnostics. We detail the benefits of computational TILs assessment, the readiness of TILs scoring for computational assessment, and outline considerations for overcoming key barriers to clinical translation in this arena. Specifically, we discuss: 1. ensuring computational workflows closely capture visual guidelines and standards; 2. challenges and thoughts standards for assessment of algorithms including training, preanalytical, analytical, and clinical validation; 3. perspectives on how to r...

npj Breast Cancer, 2020

Stromal tumor-infiltrating lymphocytes (sTILs) are a potential predictive biomarker for immunothe... more Stromal tumor-infiltrating lymphocytes (sTILs) are a potential predictive biomarker for immunotherapy response in metastatic triple-negative breast cancer (TNBC). To incorporate sTILs into clinical trials and diagnostics, reliable assessment is essential. In this review, we propose a new concept, namely the implementation of a risk-management framework that enables the use of sTILs as a stratification factor in clinical trials. We present the design of a biomarker risk-mitigation workflow that can be applied to any biomarker incorporation in clinical trials. We demonstrate the implementation of this concept using sTILs as an integral biomarker in a single-center phase II immunotherapy trial for metastatic TNBC (TONIC trial, NCT02499367), using this workflow to mitigate risks of suboptimal inclusion of sTILs in this specific trial. In this review, we demonstrate that a web-based scoring platform can mitigate potential risk factors when including sTILs in clinical trials, and we argue...

Archives of Breast Cancer, Feb 29, 2020

A 33-year-old female was referred to our hospital with a complaint of left nipple retraction and ... more A 33-year-old female was referred to our hospital with a complaint of left nipple retraction and mass (HER2), protein overexpression and HER2 gene 2 amplification. Patients suffering from TNBC face a high risk of early metastasis and death within five years after diagnosis but high rates of complete pathological response occur following neoadjuvant 3, 4 chemotherapy. One of the current criteria in the guidelines of the National Comprehensive Cancer Network (NCCN) for the test of BRCA1 and BRCA2 includes patients with TNBC diagnosed before the 5 age of 60 years and no family history. Patients with BRCA mutations face an increased risk of getting cancers such as breast, ovary, pancreas, and 6 melanoma. Some studies recommend bilateral riskreducing mastectomy and bilateral salpingo-5, 7, 8 oophorectomy for these patients. Case presentation Breast cancer is the most common malignant disease among women across the world. A recent study found that conversion in breast cancer hormone receptors takes place during the metastatic 1 progression. Triple-negative breast cancer (TNBC) is an aggressive subgroup of breast cancer. Accounting for 12% to 17% of breast cancers, TNBC is characterized by the lack of expression of estrogen receptor (ER) and progesterone receptor (PR), absence of human epidermal growth factor receptor 2 Introduction ARTICLE INFO Background: Triple-negative subtype does not have any of the receptors that are commonly found in breast cancer. Patients suffering from Triple-negative breast cancer are at risk of early metastasis and BRCA mutation. The conversion of the receptors during the metastatic progression or local recurrence of breast cancer is a well-known topic that affects the therapeutic measures and outcome. Confirmation of immunohistochemistry is essential in these conditions, but genetic evaluation is controversial. Question: Does the patient need genetics counseling in a conversion setting? And does the new specimen need CISH/FISH techniques to confirm TNBC tumors? Conclusion: There are no strong guidelines to recommend genetic counseling and BRCA testing for patients with breast cancer biomarkers conversion. Reassessing the specimen for ER, PR, and HER-2 is necessary for this setting. Case presentation: A woman suffering from primary luminal breast cancer presented with femoral bone metastasis in the follow-up after two years. Bone metastasis was compatible with the triple-negative subtype. This case was discussed at the weekly breast multidisciplinary team session of the

Iranian Journal of Diabetes and Metabolism, Jul 15, 2002

Iranian Journal of Pathology

Scan to discover online Occurrence of hepatotoxicity following prescription of etanercept, a tumo... more Scan to discover online Occurrence of hepatotoxicity following prescription of etanercept, a tumor necrosis factor-alpha (TNF-α) antagonist, is a relatively well-known issue. On the other hand, acute hepatic failure which could lead to liver transplantation is extremely rare to the best of our knowledge, and there is no previously published case in the literature. In this article, we presented a case of acute liver failure followed by liver transplantaion, in a 32-year old man with a previous history of ankylosing spondylitis after etanercept usage. On pathologic examination of the explanted liver of the patient, extensive confluent necrosis in all liver segments with prominent infiltration of a mixed population of inflammatory cells in portal tracts was noticed. In conclusion, close follow-up of patients who are receiving etanercept is crucial, since its liver complications could be severe enough to subject the patients for liver transplantation.

Hepatitis Monthly

Introduction: Fasciola hepatica infection is frequently asymptomatic and may be neglected. Howeve... more Introduction: Fasciola hepatica infection is frequently asymptomatic and may be neglected. However, severe conditions may be symptomatic due to stimulatory effects of the liver fluke in the liver. Case Presentation: The present report describes a rare case of fascioliasis accidentally discovered in the explanted liver of a patient with cirrhosis due to chronic hepatitis B virus (HBV) infection. Conclusions: Liver fluke infection may occur in cirrhotic livers. Thus, minute evaluation of liver explants for possible parasitic infestations including F. hepatica is suggested, particularly in endemic areas.

Archives of Neuroscience

Background: Pituitary adenomas are the most common space-occupying lesions in the sellar region. ... more Background: Pituitary adenomas are the most common space-occupying lesions in the sellar region. Pituitary adenomas are usually soft, but 5 to 13% of macroadenomas are fibrous. The resection of firm tumors by curettage or suction is challenging. Therefore, preoperative knowledge of the pituitary adenomas consistency could help neurosurgeons plan more appropriate surgical procedures. In this regard, predicting fibrous adenomas by magnetic resonance imaging (MRI) is typically difficult and the results are controversial. We evaluated the correlation of pituitary adenoma consistency during tumor resection with preoperative diffusionweighted images (DWI) findings and apparent diffusion coefficient (ADC) values. Methods: 45 consecutive patients (21 male, 24 female, mean age 43 ± 10) with pituitary macroadenoma were prospectively enrolled. Radiological evaluation with conventional MR and DWI images was done for all patients. Tumor consistency was evaluated at surgery and classified as soft, intermediated, and hard. Histological examination was performed on tumor specimens. Results: Based on the surgical findings, 12 (26.7%) tumors were classified as soft-, 30 (66.6%) as intermediate-, and 3 (6.7%) as hardconsistency macroadenomas. Although the collagen content showed an association with tumor consistency, neither tumor consistency nor collagen content and secretory status were correlated with conventional MRI measures and ADCs in different b values and planes. Conclusions: Preoperative DW MRI was not useful to predict the tumor consistency, collagen content, and hormone-secreting status of pituitary macroadenomas.

British Journal of Neurosurgery, 2020

OBJECTIVE To determine the border of glial tumors by diffusion weighted imaging (DWI), apparent d... more OBJECTIVE To determine the border of glial tumors by diffusion weighted imaging (DWI), apparent diffusion co-efficient (ADC), magnetic resonance spectroscopy (MRS) and perfusion brain MRI. PATIENTS AND METHODS Ten patients with brain gliomas were enrolled [mean age: 35.3 ± 13.2, range: 20-62]. Conventional MRI was performed for all patients. Besides, tumor mapping based on Choline (Cho)/Creatine (Cr) color map in MRS, perfusion and diffusion color maps, were gathered. Different tumoral and peritumoral regions [normal tissue, reactive edema, infiltrative edema, and tumor core] were defined. MRI criteria were evaluated in areas targeted for biopsy and histopathologic evaluation was determined. RESULTS Tumor cell positive samples [one necrosis, 26 infiltrative and nine tumor cores] composed 36 (75%) of the 48 samples. Seven (19.4%) of the positive samples were interpreted as not tumor on MRI. Five were identified as reactive edema and two as normal tissue] [kappa: .67, p-value < .001]. Mean of ADC, median of N-acetylaspartate (NAA) and NAA/Cho were statistically different between positive and negative samples (p = .02 and p < .001, respectively). Mean ADC and median Cho/NAA were statistically different in missed tumor containing tissue presented as reactive edema compared to normal and correctly diagnosed reactive edema samples together (p-values < .05). CONCLUSIONS Multimodal MRI could define infiltrated borders of brain gliomas.

Acta Medica Iranica, 2012

It is assumed that about 10% of individuals infected with Mycobacterium tuberculosis develop tube... more It is assumed that about 10% of individuals infected with Mycobacterium tuberculosis develop tuberculosis. The rate of tuberculosis in solid organ transplant recipients has been estimated to be 50-fold higher than in the general population. Candidates for solid organ transplantation are routinely screened for latent tuberculosis infection (LTBI). In this study we aimed to compare Tuberculin Skin Test (TST) with QuantiFERON-TB Gold In-Tube (QFT) for the detection of LTBI in candidate for kidney transplantation. Between October 2009 and November 2010, 64 candidates for kidney transplant who referred to the transplant clinic in Imam Khomeini Hospital, were enrolled in the study. Patients were screened for LTBI with both QFT and TST. Concordance between two test results and variables associated with test discordance were assessed. The mean age of patients was 38.5 years (range 16-65); female/male ratio was 26/38. Positive results were found in 21.9% and 21.9%, by TST and QFT, respective...

The Turkish Journal of Endocrinology and Metabolism, 2021

iranian journal of pathology, 2014

Background and Objectives: HBV DNA monitoring is important in management of chronic viral hepatit... more Background and Objectives: HBV DNA monitoring is important in management of chronic viral hepatitis B infection. HBV DNA measurements are carried out over period of months to years. So the analytical system must be stable and reproducible. The aim of this study was to determine the performance characteristics and to plan a statistical quality control system of a laboratorydeveloped real-time quantitative PCR assay for HBV DNA quantification. Methods: Values of systematic and random error at two clinical decision points;4.2 Log IU/mL (20000 IU/mL) and 3.2 Log IU/mL (2000 IU/mL) were determined. Candidate quality control procedures were selected and performance of the method by application of normalized operational process specification (OPSpecs) charts was determined. Results: The performance of the assay at level of 4.2 Log IU/mL and 3.2 Log IU/mL were excellent and good respectively. Moreover, a1 3.5S rule with two measurements offered 90% probability of error detection at level of...

Urology journal, 2019

PURPOSE This study is aimed to evaluate the effects of opium dependency on testicular tissue in a... more PURPOSE This study is aimed to evaluate the effects of opium dependency on testicular tissue in a rat model. METHODS Thirty-two Wistar male rats (aged 30 days and weighing 200-250 grams) were randomized into two groups. Group A, consisting of 16 rats, received dissolved oral opium tablets in drinking water for 45 days, whereas group B (control group) consisted of 16 rats that received opium-free water. After 45 days vertical and horizontal diameters of testis, number of seminiferous tubules, mean seminiferous tubule diameter, number of germ cells, height of germinal epithelium, percentage of degenerating Leydig and germ cells and glutathione density of testicular tissue (µmol/g of tissue) were compared between study groups. RESULTS Morphological evaluation of testicular tissue revealed a significantly higher percentage of degenerating Leydig and germ cells in the treated group compared to control group. (10.08 ± 0.351 vs. 1.83 ± 0.88, 4.50 ± 0.769 vs. 0.607 ± 0.118, respectively) (P...

npj Breast Cancer, 2021

The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved su... more The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences fro...

Archives of Iranian medicine, 2014

BACKGROUND There are many patients awaiting liver transplantation with only few donors providing ... more BACKGROUND There are many patients awaiting liver transplantation with only few donors providing the organ. The Child-Turcotte-Pugh score (CTP) and the Model for End stage Liver Disease (MELD) are the most common scores for prioritizing patients on waiting lists. In this study, we compared the ability of these scores to predict mortality or removal from the waiting list due to poor medical conditions. METHODS A total of 257 patients were included in our study and we observed their status in the waiting list over a 9-month period. MELD and CTP of the patients at the time of listing were calculated. We used both ROC-curve and Area Under the Curve (AUC) to calculate the predictive ability of these scores. RESULTS During follow up, 22 patients died and 9 patients were removed from the waiting list due to poor medical conditions. Comparing the predictive ability of CTP and MELD, the AUC for CTP was larger than that of MELD (0.75 versus 0.69; P-value = 0.065). The best cutoff point for di...

Sepideh Saleki1, Farid Azmoudeh-Ardalan2, Hamidreza Eftekhari2, Hayedeh Haeri2, Sahra Emamzadehfa... more Sepideh Saleki1, Farid Azmoudeh-Ardalan2, Hamidreza Eftekhari2, Hayedeh Haeri2, Sahra Emamzadehfard2,3 1Legal Medicine Organization of Iran, Kahrizak, Tehran, Iran. 2Pathology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 3Radiology Department, University of Pennsylvania, Philadelphia, USA. Corresponding Author: Farid Azmoudeh-Ardalan, Pathology department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, Tel: +98-912-1055232; Email: azmoudeh@sina.tums.ac.ir

Background: Adenoid cystic carcinoma (AdCC) of the breast is a rare type of invasive breast cance... more Background: Adenoid cystic carcinoma (AdCC) of the breast is a rare type of invasive breast cancer, accounting for less than 1% of all breast cancer cases. It is usually a low-grade tumor that rarely metastasizes to the axillary lymph nodes and distant organs. AdCC of the breast is mostly negative for estrogen receptor, progesterone receptor, and HER2-neu. However, despite being triple-negative, it has favorable outcome, and patients with AdCC of the breast generally have a good to excellent long-term survival.Case presentation: Here we report a case of a 51-year-old female presenting with left breast mastalgia who was finally diagnosed with AdCC of the left breast. The patient underwent breast?conserving surgery and axillary staging followed by adjuvant chemoradiation.Conclusion: Because of the rarity of AdCC of the breast, it has been difficult to conduct prospective trials to determine the best treatment option. Different types of therapy, including BCS and mastectomy with or wit...

Iranian Journal of Pathology, 2021

Background & Objective: The world is facing COVID-19 pandemic, and medical education system and c... more Background & Objective: The world is facing COVID-19 pandemic, and medical education system and consequently the evaluation of students at different levels have been overshadowed. Residency students are among those affected. In the present study, we aim to share our experiences regarding holding exams for pathology residents before and during the pandemic. Methods: This cross-sectional study was carried out in Tehran University of Medical Sciences. The online exam, which consisted of 30 multiple-choice questions, was designed and held in April 2020 to evaluate pathology residents. To assess the quality of the exam, indices such as the number of questions, highest and lowest scores, the average score, the standard deviation, the variance, Cronbach’s alpha reliability coefficient, standard error of measurement, discrimination index, difficulty index, number/percentage of questions on three difficulty levels of easy, normal, hard were reviewed and analyzed. Results and Discussion: The ...

npj Breast Cancer, 2020

Assessment of tumor-infiltrating lymphocytes (TILs) is increasingly recognized as an integral par... more Assessment of tumor-infiltrating lymphocytes (TILs) is increasingly recognized as an integral part of the prognostic workflow in triple-negative (TNBC) and HER2-positive breast cancer, as well as many other solid tumors. This recognition has come about thanks to standardized visual reporting guidelines, which helped to reduce inter-reader variability. Now, there are ripe opportunities to employ computational methods that extract spatio-morphologic predictive features, enabling computer-aided diagnostics. We detail the benefits of computational TILs assessment, the readiness of TILs scoring for computational assessment, and outline considerations for overcoming key barriers to clinical translation in this arena. Specifically, we discuss: 1. ensuring computational workflows closely capture visual guidelines and standards; 2. challenges and thoughts standards for assessment of algorithms including training, preanalytical, analytical, and clinical validation; 3. perspectives on how to r...

npj Breast Cancer, 2020

Stromal tumor-infiltrating lymphocytes (sTILs) are a potential predictive biomarker for immunothe... more Stromal tumor-infiltrating lymphocytes (sTILs) are a potential predictive biomarker for immunotherapy response in metastatic triple-negative breast cancer (TNBC). To incorporate sTILs into clinical trials and diagnostics, reliable assessment is essential. In this review, we propose a new concept, namely the implementation of a risk-management framework that enables the use of sTILs as a stratification factor in clinical trials. We present the design of a biomarker risk-mitigation workflow that can be applied to any biomarker incorporation in clinical trials. We demonstrate the implementation of this concept using sTILs as an integral biomarker in a single-center phase II immunotherapy trial for metastatic TNBC (TONIC trial, NCT02499367), using this workflow to mitigate risks of suboptimal inclusion of sTILs in this specific trial. In this review, we demonstrate that a web-based scoring platform can mitigate potential risk factors when including sTILs in clinical trials, and we argue...

Archives of Breast Cancer, Feb 29, 2020

A 33-year-old female was referred to our hospital with a complaint of left nipple retraction and ... more A 33-year-old female was referred to our hospital with a complaint of left nipple retraction and mass (HER2), protein overexpression and HER2 gene 2 amplification. Patients suffering from TNBC face a high risk of early metastasis and death within five years after diagnosis but high rates of complete pathological response occur following neoadjuvant 3, 4 chemotherapy. One of the current criteria in the guidelines of the National Comprehensive Cancer Network (NCCN) for the test of BRCA1 and BRCA2 includes patients with TNBC diagnosed before the 5 age of 60 years and no family history. Patients with BRCA mutations face an increased risk of getting cancers such as breast, ovary, pancreas, and 6 melanoma. Some studies recommend bilateral riskreducing mastectomy and bilateral salpingo-5, 7, 8 oophorectomy for these patients. Case presentation Breast cancer is the most common malignant disease among women across the world. A recent study found that conversion in breast cancer hormone receptors takes place during the metastatic 1 progression. Triple-negative breast cancer (TNBC) is an aggressive subgroup of breast cancer. Accounting for 12% to 17% of breast cancers, TNBC is characterized by the lack of expression of estrogen receptor (ER) and progesterone receptor (PR), absence of human epidermal growth factor receptor 2 Introduction ARTICLE INFO Background: Triple-negative subtype does not have any of the receptors that are commonly found in breast cancer. Patients suffering from Triple-negative breast cancer are at risk of early metastasis and BRCA mutation. The conversion of the receptors during the metastatic progression or local recurrence of breast cancer is a well-known topic that affects the therapeutic measures and outcome. Confirmation of immunohistochemistry is essential in these conditions, but genetic evaluation is controversial. Question: Does the patient need genetics counseling in a conversion setting? And does the new specimen need CISH/FISH techniques to confirm TNBC tumors? Conclusion: There are no strong guidelines to recommend genetic counseling and BRCA testing for patients with breast cancer biomarkers conversion. Reassessing the specimen for ER, PR, and HER-2 is necessary for this setting. Case presentation: A woman suffering from primary luminal breast cancer presented with femoral bone metastasis in the follow-up after two years. Bone metastasis was compatible with the triple-negative subtype. This case was discussed at the weekly breast multidisciplinary team session of the

Iranian Journal of Diabetes and Metabolism, Jul 15, 2002

Iranian Journal of Pathology

Scan to discover online Occurrence of hepatotoxicity following prescription of etanercept, a tumo... more Scan to discover online Occurrence of hepatotoxicity following prescription of etanercept, a tumor necrosis factor-alpha (TNF-α) antagonist, is a relatively well-known issue. On the other hand, acute hepatic failure which could lead to liver transplantation is extremely rare to the best of our knowledge, and there is no previously published case in the literature. In this article, we presented a case of acute liver failure followed by liver transplantaion, in a 32-year old man with a previous history of ankylosing spondylitis after etanercept usage. On pathologic examination of the explanted liver of the patient, extensive confluent necrosis in all liver segments with prominent infiltration of a mixed population of inflammatory cells in portal tracts was noticed. In conclusion, close follow-up of patients who are receiving etanercept is crucial, since its liver complications could be severe enough to subject the patients for liver transplantation.

Hepatitis Monthly

Introduction: Fasciola hepatica infection is frequently asymptomatic and may be neglected. Howeve... more Introduction: Fasciola hepatica infection is frequently asymptomatic and may be neglected. However, severe conditions may be symptomatic due to stimulatory effects of the liver fluke in the liver. Case Presentation: The present report describes a rare case of fascioliasis accidentally discovered in the explanted liver of a patient with cirrhosis due to chronic hepatitis B virus (HBV) infection. Conclusions: Liver fluke infection may occur in cirrhotic livers. Thus, minute evaluation of liver explants for possible parasitic infestations including F. hepatica is suggested, particularly in endemic areas.

Archives of Neuroscience

Background: Pituitary adenomas are the most common space-occupying lesions in the sellar region. ... more Background: Pituitary adenomas are the most common space-occupying lesions in the sellar region. Pituitary adenomas are usually soft, but 5 to 13% of macroadenomas are fibrous. The resection of firm tumors by curettage or suction is challenging. Therefore, preoperative knowledge of the pituitary adenomas consistency could help neurosurgeons plan more appropriate surgical procedures. In this regard, predicting fibrous adenomas by magnetic resonance imaging (MRI) is typically difficult and the results are controversial. We evaluated the correlation of pituitary adenoma consistency during tumor resection with preoperative diffusionweighted images (DWI) findings and apparent diffusion coefficient (ADC) values. Methods: 45 consecutive patients (21 male, 24 female, mean age 43 ± 10) with pituitary macroadenoma were prospectively enrolled. Radiological evaluation with conventional MR and DWI images was done for all patients. Tumor consistency was evaluated at surgery and classified as soft, intermediated, and hard. Histological examination was performed on tumor specimens. Results: Based on the surgical findings, 12 (26.7%) tumors were classified as soft-, 30 (66.6%) as intermediate-, and 3 (6.7%) as hardconsistency macroadenomas. Although the collagen content showed an association with tumor consistency, neither tumor consistency nor collagen content and secretory status were correlated with conventional MRI measures and ADCs in different b values and planes. Conclusions: Preoperative DW MRI was not useful to predict the tumor consistency, collagen content, and hormone-secreting status of pituitary macroadenomas.