ياسر علاء محمد حسن شبر

Abstract: Background Breast carcinoma primary tumors and synchronous axillary lymph node(s) metastases may represent different malignant clones, although the daily clinical practice depends only on the molecular subtypes of primary tumorto select the adjuvant systemic treatment.In some instances the absence of primary tumoror or presence of technical difficulties that prevent the identification of exact tumor subtypes in the primary mass mandate seeking for alternative to test , so our Aim was comparison of molecular subtypes between primary tumor &metastatic lymph node(s). Method In this prospective cohort study , 50 patients with node positive breast carcinoma included. Immunohistochemical analysis by using Envision method for detection of biomarkers: ER,PR,Her2/neu and Ki-67 to determine the four molecular subtypes then comparison between the primary tumor and its metastatic lymph node(s). Results :In this study there was 22 (44%) cases with luminal-A molecular subtype in both mass and lymph node, 21 (42%) cases with luminal-B in primary mass in comparison to 18 (36%) cases in their metastatic node,3(6%) cases with Her2/neu enriched in the primary mass in comparison to 6(12%) cases in its metastatic node.There was 4 (8%) cases with triple negative molecular subtype which had no difference between them.. In Conclusions: There is no statistically significant difference between primary tumor and its metastatic lymph node(s) this concordance regarding the molecular subtypesmay answer the question that pathologist can depends on the result of molecular subtypes on lymph node with good certainty if cannot do it on the primary tumor.

Abstract Background: Celiac disease is an autoimmune disorder triggered by the ingestion of wheat gluten and related proteins of rye and barley in genetically susceptible individuals. Its diagnosis is based on clinical manifestations, endoscopic finding serological markers and histopathology Aims: to correlate the degree of mucosal damage according to modified Marsh grading system histopathological with clinical finding, endoscopy and serology. Methods: in this cross sectional study, one hundred patients included, for each one upper GIT endoscopy, microscopic examination of biopsy specimens from duodenum, serum anti tissue transglutaminase antibodies level were analyzed. Results: 83% of patient have tipical clinical feature of celiac disease but with accuracy (54.7%).The upper intestinal endoscopy reveal (53 %) of cases had features of celiac disease, with accuracy of (84.1 %) more than clinical finding in the diagnosis .A significant correlation (p value < 0.001) obtained between serum level of anti tTG antibody and histopathology with sensitivity of (95.7%) and specificity of (91.8%). In addition there is positive linear correlation between these two parameters (r=+0.942). Conclusion: Clinical presentations lack specificity. Endoscopy has relatively good sensitivity and specificity. Serum level of anti-tTG antibody have high sensitivity and specificity therefore, it is reliable mean for prediction and diagnosis of celiac disease.

Abstract - Background: Breast cancer is the most common malignancy with a high mortality in females worldwide. Tumor suppressor genes had significant role to maintain genome integrity and the cell cycle. In particular PTEN is a candidate tumor suppressor gene, It has a negative regulator of PI3K/AKT signaling pathway which has a major role in carcinogenesis and dysregulation of it occurs repeatedly in breast cancer. Aim: this article aimed to appraise the associations between PTEN expression in patient had breast cancer with clinic pathological parameters including: age, histological types, and status of estrogen receptor, progesterone receptor, and HER-2/nue receptor, to check the impact of its expression on clinical outcome. Materials and methods: in this case-control study, formalin fixed paraffin embedded tissue from sixty patients with breast carcinoma and twenty patients without cancer (as control groups). Labeled Streptavidin -Biotin (LSAB+ ) method used to detect PTEN protein expression, HER2/neu, ER and PR receptors by immunohistochemical assay, and then we correlate PTEN expression with each biomarkers and clinic pathological characteristics. Results: 29/60 (45.3%) of cases decreased PTEN expression while its expression retained in 31/60 (51%) of cases. Loss of expression significantly associated: with lymph node metastasis ( p-value=0.0008 ), high grade (p< 0.05 ) , high stage (p-value=0.0001 ) and with triple negative breast cancer (p-value=0.03) . However, loss of PTEN protein expression did not correlate with age, histological types, estrogen, progesterone and HER-2 receptors status. Conclusion: PTEN loss can predict aggressive behavior and worse outcome in patients had breast cancer

Objective: The aim: To correlate variable clincopathological parameters with molecular subtypes of the breast carcinoma, which affect the prognosis and management of breast malignancy. Patients and methods: Materials and methods: In this study a total of 511 female patients with breast carcinoma were included, ranging from 32 to 85 years of age, with 35.8% premenopausal and 64.1% being post-menopausal. The sample slides were stained immunohistochemically for estrogen receptors (ER), progesterone receptors (PR), ki67 and HER2, the tumors were graded histologically using the Nottingham criteria system. Results: Results: Most tumors (72.8%) ranged between 2 and 5 cm in size; the most common histological type of breast carcinoma (49.7%) was invasive ductal carcinoma of no special type, with grade 2 presented in 51.8% cases; most frequent stage at time of presentation was stage 3A, found in 39.9%; the most frequent molecular subtype was ER and/or PR+, Her2- with low proliferation rate ki67<14% subtype in 48.5%, and those group were more likely (statistically significant) to be older, have stage 3 breast cancer, present with tumor size between 2 and 5 cm and tend to be well differentiated histological grade (grade1), mostly with lymph node positive, and most likely have tumor type of invasive ductal carcinoma of no special type. Conclusion: Conclusions: the most common histological type of breast carcinoma in Iraq south was invasive ductal carcinoma of no special type and most cases showed (ER and/or PR+, HER 2-, low ki67) as the most common molecular subtype.