Dermatophytosis infections are caused by dermatophytes. Drug resistance and toxicity associated with long-term treatment with conventional antifungal drugs has necessitated search for new drugs to treat fungal infections. Natural products found in plants have been scientifically proved to avoid these side effects. The aim of this study was to formulate herbal antifungal cream containing extract of Acalypha wilkesiana as an anti-dermatophytic preparation and evaluate its physicochemical properties, stability and efficacy of the product. The formulated creams containing 0.5, 1 and 2% w/w of extract were subjected to stability tests using temperature variation method at -10, 4, 30, 37 and 45oC. Freeze-thaw test, Centrifuge test, pH and exposure to UV light test were also carried out using standard method. Efficacies of the cream formulations were determined using albino rats

The percentage yield of the extract was (10.2%). Percentage ethanol phytochemical composition indicated that for Alkaloid it is 4.58 ± 0.01%, saponins (3.10 ± 0.23%), flavonoids (1.61 ± 0.04%) and tannins (0.81 ± 0.02%).The antifungal results are in the increasing order Microsporum audounii = Epidermophyton floccosum < M.furfur < Trichophyton mentagrophtes. Temperature stability tests carried out indicated that the cream was very stable. Centrifuge testing indicated that there was no separation of the cream. Light testing indicated no change in the colour and odour of the products. There was no change observed in all the test samples during the freeze-thaw testing. Animal studies evaluation of the ethanolic formulations of the cream indicated that their efficacy against the dermatophytes is concentration dependent and the efficacy is in the increasing order M.audounii < E.floccosum < M.furfur < T.mentagrophyte which shows that 2% Acalypha wilkesiana cream was statistically significant (P<0.05) against all the test microorganisms.

Tuberculosis (TB) is remains as major public health concern. According to WHO reports in 2018, it estimated 10.7 million TB cases throughout the worldwide. Also there are 1.6 million died from TB and 558,000 rifampin-resistant TB (RR-TB) in 2017.

Introduction: Hydatid cyst is a condition commonly affecting liver and lungs caused most commonly by Echinococcus granulosus where as musculoskeletal or subcutaneous hydatidosis is very rare. and Usually are secondary and resulting from the spread of cysts from other organs, either spontaneously rupture or after spreading from operations for hydatidosis in other regions.

Case Presentation: We present an unusual case of a primary hydatid cyst found in the subcutaneous scalp tissue under occipital region in a 36 year man. Clinical presentation of patient was a huge cystic mass. Ultrasound findings revealed a cyst lesion in the posterior aspect of neck under the occipital region. MRI show a cystic lesion. We removed the entire part of cyst lesion surgically. Macroscopic and microscopic histopathological examinations confirmed the diagnosis of subcutaneous hydatid cyst.

Conclusion: In regions where hydatid disease is endemic, a cystic lesion in any part of the body should be considered a hydatid cyst. The best treatment is surgery and total evacuation of the cyst elements without any spillage of cyst contained and postoperative albendasol therapy.

There is numerous evidence for the efficacy of curcumin on the treatment of infectious disease particularly tuberculosis infection. According to review of the literature, curcumin could be considered as a therapeutic option against tuberculosis; but given that immune modulatory of curcumin in immune-response and limitation of data about the main mechanism of curcumin during tuberculosis infection; we discuss the probability of curcumin as a novel treatment option for tuberculosis disease using current evidence.

Solitary fibrous tumors are rare and difficult to diagnose. The occurrence of this entity in the head and neck region constitutes approximately 6% of the cases and is associated with higher rates of recurrence. We report a case of a 61-year old male diagnosed with this rare tumor by fine needle aspiration.

Intrapericardial Diaphragmatic Hernia (IDH) is the rarest type of adult diaphragmatic hernia and colon obstraction. Only a few cases have been reported. Blunt trauma has been implicated in most cases, but few cases were reported from a stab wound to the anterior chest. Patients presented immediately or up to 15 to 20 years following trauma with symptoms which include of: intermittent bowel obstruction, strangulation, cardiac dysfunction, dyspnea, palpitations, and even cardiac tamponade. The most unusual site for a diaphragmatic hernia to occur is through the central tendon of the diaphragm into the pericardium. Physical findings included bowel sounds in the chest, decreased heart and lung sounds, and an absent point of maximal cardiac impulse. We present the case of a 67-year-old man who suffered a bowel obstruction when the transverse colon and omentum became incarcerated in the intrapericardial cavity from diaphragmatic hernia. Defect presumably resulted from blunt chest and abdominal trauma received six month earlier. Laparatomy is the preferred approach to surgical repair of IDH. Since the symptoms referable to adult IDH can be incapacitating or life threatening, herniorrhaphy should be performed promptly upon diagnosis. In this very rare case with delayed presentation of intrapericardial diaphragmatic hernia, we want to review the symptoms, recommendations of evaluation and the best approach of treatment and outcome of treatment.

Recurrent respiratory papillomatosis is a rare and recurring disease characterized by chronic benign papillomas of the epithelial mucosa in the respiratory tract. It is exclusively caused by human papilloma virus. While the majority of human papilloma virus infections are self-limited, some persist, as is the case in recurrent respiratory papillomatosis. Diagnosis is usually achieved by surgical biopsy and the utility of immunohistochemistry studies. Studies showed that cytology specimens in form of fine needle aspiration could provide definite diagnosis of this entity, especially when cytologic sampling is sufficient to produce a cellblock to be utilized for ancillary studies. We report a case of this rare entity diagnosed solely by cytologic sampling. We also discuss the pathophysiology and management modalities.

Introduction: Primary and isolated hydatid cysts of the spleen are very rare seen even in endemic country. We report here our experience with primary and isolated splenic hydatid cysts.

Methods: We retrospectively analyzed the record of eight cases of primary and isolated spleen hydatid cyst that treated in Arya and Razi Hospital, Iran, Rasht.

Results: Among eight patients, who underwent treatment for primary and isolated splenic hydatid cyst disease, five patients were male and three patients were female. The mean average cyst diameter was 8 cm (4-15cm). Four of patients underwent splenectomy as the surgical procedure and three of patients underwent cystotomy, partial cystectomy, and omentoplasty processes as a spleen preservative surgery. One case underwent medical treatment with albendazole because the size of cyst was 4 cm. Three patients out of eight could not undergo splenectomy because in two of them the cyst was localized in the lower pole of the spleen and in another patient it was localized in upper pole of the spleen.

Conclusion: Primary and isolated splenic hydatid cyst is very rare. A hydatid cyst must be included in the differential diagnosis of other cystic lesions of the spleen. The best toll for diagnosis is the abdominal tomography and U&S. A splenic hydatid cyst should be treated surgically due to the high risk of a rupture, and the ideal procedure in adulthood is standard splenectomy. The outcome of treatment is good without recurrences.

Epithelioid hemangioendothelioma and epithelioid angiosarcoma are both rare malignancies of endothelial origin. Differentiation of these two diagnoses remains difficult due to their heterogeneous presentation and overlapping morphological features. Here we report a case of a 58-year-old female clinically presenting with primary hepatic vascular neoplasm. She was finally diagnosed with Epithelioid Hemangioendothelioma (EHE) based on cytology sampling and core biopsy. The immunohistochemical (IHC) studies and morphological features of this case may be suggestive of a continuum with Epithelioid Angiosarcoma (EAS). Given the mixed findings exhibited, a plausible intermediate diagnostic entity may be proposed, and further studies are warranted to investigate this possible intermediate variant with optimal management and follow up.

Background: The incidence of ectopic thymus in the posterior mediastinum is very uncommon and rare. It is difficult to exclude thymoma before surgical procedure. Thymomas generally arise from the thymus in the anterior mediastinum. Ectopic thymomas arising in the posterior mediastinum are extremely rare. We present a case of thymoma which incidentally arising in the left Posterior Mediastinal, paravertebral sulcus and supra diaphragmatic region.

Case: The patient was a 67-years-old woman who underwent an enhanced-computed tomography examination as preoperative staging for renal mass. A 10cm×6cm mass was found incidentally in the left Posterior mediastinum, paravertebral sulcus region over the diaphragm, which mimicking enlarged possibility metastases from renal mass, lymph node or mediastinal mass. The tumor of mediastinum was resected by surgery after removed renal mass via extension of left flank incision in 10th intercostal space through phrenotomy. Postoperative pathological diagnosis of mass was type AB thymoma and diagnosis of kidney mass was angiolipoma. Patient referred to radiotherapy department. The patient was disease-free and without recurrence one year’s postoperatively.

Conclusion: When a mass located in the posterior mediastinum, ectopic thymus gland should be included in differential diagnosis. Imaging-techniques as CT-scan or MRI can help the extension of the mass. Ectopic thymus usually has a benign clinical course, if preoperative tissue diagnosis was benign, surgical resection is not recommended.

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.

Clear cell chondrosarcoma (CCC) is a rare neoplasm. Reported here, is a case of a female patient with a history of marginal zone lymphoma of the thyroid presented with right hip pain. Magnetic resonance imaging (MRI) of the right hip revealed an abnormal signal, which subsequently was biopsied via fine-needle aspiration (FNA). The cellblock preparation from the cytology sample was further analyzed which revealed atypical chondroid cells with vacuolated cytoplasm, eccentric nuclei, and prominent nucleoli. The cellblock material showed fragments of nonmalignant bone and malignant chondroid cells with enlarged nuclei and prominent nucleoli in a background of multinucleated giant cells. Immunohistochemistry studies performed on cellblock cytology material ruled out other differentials such as malignant melanoma or metastatic epithelial tumor. These findings were consistent with the diagnosis of malignant cartilaginous tumor with features of CCC. Eventually the patient underwent surgical resection revealing a 5.0 x 4.0 – cm, white, cartilaginous mass with scattered fleshy areas involving the greater trochanter and extending into the intertrochanteric area. Histomorphologic features, together with immunohistochemistry (IHC) studies, confirmed the initial diagnosis of CCC made via cytology sample. Our case highlights how cytology material alone can be sufficient to provide a definitive diagnosis of CCC.

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.

Recently, a very powerful web-server predictor has been established for identifying the subcellular localization of a protein based on its sequence information alone for the multi-label systems

Radiation-induced atypia presents a diagnostic challenge in differentiation with squamous cell carcinomas of the upper aerodigestive tract and lung. It is imperative to understand the different features of radiation-induced atypia and differentiate it from squamous cell carcinoma. Immunohistochemistry (IHC) studies play an extremely important role in present-day pathology practice. It is being used for  diagnosis of primary and metastatic cancers, as a prognostic marker, targeted therapy, and identification of certain infectious agents. This case report discusses the features specific to each and proposes an IHC algorithm to assist in providing appropriate diagnosis and subsequent optimal management.

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.

Amyotrophic Lateral Sclerosis is a debilitating disorder characterized by degeneration of upper and lower motor neurons. Approximately 90% of all ALS cases are found to occur sporadically, whereas 10% of them are familial. ALS can characteristically present as bulbar dysfunction. We report the case of an 81-year-old female who presented with worsening dysarthria, dysphagia, and weight loss of one-year duration. She was later diagnosed with clinically possible to probable ALS based both on results of her laboratory tests and the diagnosis classification of Awaji-Shima Consensus Recommendations and the revised El Escorial Criteria. Riluzole and Edavarone are currently the only two drugs approved by the United States Food and Drug Administration (FDA) for ALS treatment. These drugs work mainly by delaying the course of the disease. Given the scant amount of treatment options available, further studies are warranted to better comprehend the pathogenesis of ALS and find novel and more efficacious ways of addressing it.

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.

Benign cystic hypersecretory hyperplasia and cystic hypersecretory duct carcinoma of the breast share similar histologic features including formation of cystically dilated ducts containing a homogeneous eosinophilic secretion that resembles thyroid colloid. However, cystic hypersecretory duct carcinoma of the breast is associated with proliferative malignant epithelium. Cystic hypersecretory lesions of the breast present with a varying morphologic features in the same mass. Strict histomorphologic criteria and confirmatory immunohistochemistry studies are essential for definitive diagnosis and appropriate management. We present a case where secretory proliferation of a breast mass displayed spectrum of changes from benign hyperplasia, to atypical hyperplasia, to frank ductal carcinoma in situ. Due to limited reported cases of these entities, little is known about the biological behavior, prognosis and molecular study of these lesions. By reporting more cases, we may reveal the biologic behavior of these uncommon lesions.