Background: Pleural effusion refers to accumulation of any fluid in the in the pleural space. Lymphocytic exudative pleural effusion (LEPE) is considered as one of the medical problems. A wide range of causes can produce (LEPE).This study aimed to the evaluation of causes of the pleural effusion in patients with lymphocyte- predominant exudative pleural effusion.

Methods: In this descriptive cross-sectional study, medical records of all patients admitted to the Razi and Aria Hospitals in the years 2015 to 2016 due to (LEPE). The information was derived using a form of information prepared according to the contents of the medical records, including the variables of age, gender, diagnosed cause, percentage of clinical symptom lymphocyte and diagnostic method. Patients were exposed to lymphocyte under open biopsy or thoracotomy to determine the cause of pleural effusion. In addition, the analysis of effusion and the used imaging method were examined.

Results: In this research, 119 patients with pleural effusion with lymphocyte preference were examined. Out of them, 71 cases (59.7%) were male and 48 cases (40.3%) were female. In terms of diagnostic and sampling method, 81 cases (68.1%) underwent VATS and 38 cases (31.9%) underwent thoracotomy. In terms of cause of the disease, 40 (33.6%) had lymphocytic pleuritis, 15 cases (12.6%) had lung cancer, 52 cases (43.7%) had TB, 5 cases had cancer metastases to other parts of the body and 7 cases (5.9%) had lymphocytic granulomatosis. The clinical symptom of shortness of breath had the highest frequency (52.9%). The mean age of subjects was 53.5 years and mean lymphocyte in the subjects was 81.8%. After analyzing the data and using one way Kruskal-Wallis, a significant difference was found between the mean age of subjects and different lymphocytic pleural effusion diagnoses (P = 0.0001).

Conclusion: The age factor as a determinant and predictive indicator can be helpful in diagnosis of the disease, so that at the ages lower than 40-45 years, infectious and inflammatory factors, and in the ages above 55-60 years, malignant and metastatic factors can be considered as pleural effusion factor.

While breast cancer is the most prevalent form of cancer in women worldwide, the rare and aggressive subtype of primary squamous cell carcinoma of the breast represents an area of unmet need in breast cancer diagnosis and management. Currently, there is no agreed consensus on primary treatment options, neoadjuvant and adjuvant therapy, or prognosis of this rare type of carcinoma. In addition, definitive diagnosis of this entity represents a significant diagnostic challenge and strict criteria should be applied to make such diagnosis. We present a case of a 78-year-old female who presented to her physician with a left breast mass. The final diagnosis proved to be a primary squamous cell carcinoma of the breast. Here, we discuss and detail the diagnostic criteria and what we currently know regarding possible management options. It is our hope that this report raises awareness of clinicians and pathologists to this uncommon entity and promotes continued investigation to drive further development of efficacious diagnosis and safe treatment options to improve patient outcomes.

Introduction: Bullous lung disease is characterized by the development of bulla within the lung parenchyma. Smoking is considered as a main risk factor of bulla formation. The clinical manifestation varies from asymptomatic bulla to severe respiratory distress. The exact medical approach is still controversial. Here in we aimed to evaluate the patients’ characteristic and the indication of surgery in the patients

Methods: This study was an analytic cross-sectional study in Razi, Rasht in 2012- 2017. The 110 patients with newly diagnosed lung bulla underwent evaluation based on a check list which assessed the variables as clinical characteristics, bulla features, the medical treatment and its complication. Eventually, the statistical analysis was performed by using SPSS v21.0.

Results: 110 patients were enrolled. All the patients were smoker. In 72.9% the primary presentation was respiratory distress which needed surgical resection with no recurrence over 8 month. The clinical manifestation varies from asymptomatic bulla in 4.3%, pneumonia in 34.3% to respiratory distress in 61.4%. There was not a statistical correlation between clinical manifestation and all the studied variables excluding respiratory distress (p value: 0.659). The seventy patients underwent surgical treatment in which twenty cases were complicated by air leak that was managed by chest tube in 16 patients and Heimlich valve in 4 patients. No evidence of recurrence was detected.

Conclusion: The main risk factor of bullous formation is smoking. Due to various clinical presentations, the appropriate medical approach is in paramount of importance

Diagnosis of acinar cell carcinoma (ACC) in small cytology samples can be challenging and can be confused with the diagnosis of pancreatic neuroendocrine tumors (PNET). Both tumors can present with similar cytomorphologic features, and both tumors can be presented with positivity for cytokeratin and for neuroendocrine markers. This case highlights utility of immunocytochemistry in small cytology samples not only to distinguish ACC from PNET, but also to achieve the diagnosis of the rare entity “mixed acinar-neuroendocrine carcinoma of the pancreas” (MANEC). It is our hope that reporting this case will raise awareness of including this rare possible diagnosis  in the differential diagnosis of a pancreatic mass, and that continued reporting of such cases will improve efficacious diagnosis and patient outcome.

Osteochondroma is the most common form of benign bone tumors. Chondrosarcoma is a rare malignant bone tumor that may be primary or secondary to a malignant transformation of a benign cartilage tumor. We report the case of a 41-year-old man with chondrosarcoma secondary to malignant transformation of osteochondroma of the left third rib. We discuss osteochondromas, chances of malignancy  secondary to osteochondromas, assessment of the tumor in our case, as well as treatment options that have shown significant benefits in patient’s outcomes.