Author Archives: د.حسام أبو فرسخ

Not uncommonly we encounter cases of prostate biopsy where we see small focus of glands that we can not call benign and at the same time we can not be sure that it is malignant. We the new advances in Immunohistochemistry , now we can examine the basal layer in the prostate glands. This basal layer is present in benign prostate glands but is absent in malignant prostate glands. By performing special stains for this basal layer we can be sure that this focus is a malignant focus

This stain (which is a subdivision of cytokeratin types) can be performed in our lab on prostate tissue sections to give the most and the best accurate diagnosis in questionable cases

Please do not hesitate to contact us for further inquiries

We, in the First Medical Laboratory, are dedicated to bring the best of laboratory medicine to clinical practice to Jordan

Dr. Hussam Abu-Farsakh

American Board of Anatomic & Clinical Pathology, and Cytopathology
 

Circular: is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature

Carcinoma in Situ (CIS) of the urinary bladder can be confused by the histopathologist for reactive atypia in some cases and vise versa. Since making this diagnosis is of paramount importance, unequivocal diagnosis is not helpful. The recent advances made in Immunohistochmistry can help in solving this problem. An immnunostaining panel consisting of cytokeratin 20 and P53 can help in differentiating CIS from other reactive atypical lesions

Usual immnunostaining pattern in the urothelium in benign and reactive atypical lesions is one of characteristic pattern. The positive cytoplasmic staining for cytokeratin 20 on the superficial umbrella layer, and negative nuclear staining for P53 in all the layers is the usual pattern. In CIS , cytokeratin 20 positive cytoplasmic immunostaining is present in all the epithelial layers, and p53 nuclear stain is positive in all the cell layers nuclei

This panel is particularly useful in cases in which the pathologist strongly favors the diagnosis of CIS but has reservation making a definite diagnosis, in diagnosing CIS at initial presentation with no known history of a papillary lesion, or in confirming unusual morphologic presentation of CIS such as cancerization of the urothelium

Please do not hesitate to contact us regarding all cases of CIS, inflammatory atypia and dysplasia diagnosis

We in the First Medical Lab are dedicated to bring the best of Laboratory medicine to clinical practice in Jordan

Dr. Hussam Abu-Farsakh

American Board of Anatomic & Clinical Pathology, and Cytopathology

Circular: is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature

Inhibin is a glycoprotein hormone that is produced from Sertoli cells (in the seminiferous tubules) of the testis. It has a positive action on the spermatogenesis and it inhibits the secretion of FSH from the pituitary

Inhibin rarely circulates freely in the blood. It combines with alpha₂-macroglobulin protein. The administration of FSH increases the secretion of inhibin in normal men, but it is much more pronounced in males with secondary hypogonadism

Serum inhibin levels are strongly positively correlated with testicular volume and sperm counts. In infertile patients, inhibin decreases and FSH increases. In general, there is very good correlation with the degree of spermatogenesis damage, with the arrest at the earlier stages having the lowest inhibin levels

Inhibin and FSH together are a more sensitive and specific marker for spermatogenesis than either one alone

Suppression of spermatogenesis with testosterone and gestagens leads to a partial reduction of inhibin in serum, but it is never completely suppressed. In contrast, testicular irradiation leads to rapid and dramatic decrease of inhibin , which becomes undetectable when germ cells are completely absent

In summary: Inhibin is considered one of the best hormones in detecting the spermatogenesis status in males. It can predict testicular damage and correlates with testicular size. Its measurement may give an invaluable assessment of male infertility

Please do not hesitate to contact us for further inquiries

We, in the First Medical Laboratory, are dedicated to bring the best of laboratory medicine to clinical practice to Jordan

Dr. Hussam Abu-Farsakh

American Board of Anatomic & Clinical Pathology, and Cytopathology

“Circular” is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature

 Autoimmune hepatitis is a treatable liver disease; this makes its diagnosis of paramount importance

:Three types of Autoimmune Hepatitis are recognized

Type I: Positive Anti-smooth muscle antibody (ASMA) and ANA. Represents the most common type of auto-immune hepatitis. 38% of the patients may have concomitant immunologic diseases: autoimmune thyroiditis, Grave’s disease, Synovitis, or ulcerative colitis. 40% may present as acute hepatitis

Type II: positive for Liver/Kidney microsomal antibodies (Anti-LKM1) occurs usually in children. But can occur in 20% of adults with autoimmune hepatitis. Associated with antibodies against thyroid, parietal cells and islet cells of Langerhan’s

Type 3: positive for soluble liver Antigen (SLA), has similar clinical presentation as type I (except that it is negative for ASMA and ANA). Most of the patients are women (91%), with mean age of 37 years

Primary biliary cirrhosis: Anti-mitochondria M2 is a specific marker for primary biliary cirrhosis

It is strongly recommended to perform the following auto antibodeis for primary liver disease suspected of autoimmune origin: ANA, ASMA, Anti-LKM1, Anti-SLA, and Anti-M2

Test Price for the three antibodies: Anti-LKM1, Anti-SLA, and Anti-M2: 50 J.D

We, at the First Medical Laboratories, are dedicated to bring the best of Laboratory medicine in clinical practice to Jordan

Please call us for any further details

.Dr. Hussam Abu- Farsakh, M.D

American boards of Anatomic, Clinical Pathology and Cytopathology

Circular: is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature

In our lab we do several stains for diagnosing diverse liver disease. Of the new stains that we have now in our lab and essential in diagnosing different liver diseases

Copper Stain :is important in cases of suspected Wilson disease, biliary cirrhosis, Indian childhood cirrhosis – Lead stain: important in suspected lead intoxication – Alpha1-anti-trypsin : important in all cases of liver disease occurring in pediatric age group to rule out alpha-1 anti-trypsin deficiency –

We ,in the First Medical Laboratories, are dedicated to bring the best of clinical tests to Jordan

Please call us for any further inquiries

.Dr. Hussam Abu- Farsakh, M.D

Consultant Pathologist and Cytopathologist

American boards of Anatomic, Clinical Pathology and Cytopathology

Diffuse large B cell lymphoma (DLBCL) is not one disease, but it is at least 3 different diseases. DLBCL can be of different cell origin. The cell origin determines the prognosis in such lymphomas. The cell of origin can be of germinal center B-cell (GCB ) or from Activated B-cells (ABC), or from an in between group �Activated GCB�. The overall survival of DLBCL for 5 years is about 50%. But it is better for DLBCL of �GCB� origin, reaching 67% and much worse for the �ABC� group (16%) and 39% for the �Activated GCB� cell group. The protein expression in the GCB group is CD10, CD38, BCL6 positive; the ABC group is MUM1,CD138, and BCL-2 positive. The �in between group� which is �Activated Germinal center B� cell pattern has at least one of GCB markers (CD10, BCL-6 or CD38) and one activation marker MUM1 or CD138. Within the same group also, the higher the proliferation index (ki-76), the worse is the prognosis

In summary: in each CD20 positive DLBC lymphoma, other markers (CD10, BCL2, BCL6, CD38, CD138, MUM1 and ki-67) should be done to define the prognosis and possibly modify the chemotherapy accordingly

We, in the First Medical Laboratory, are dedicated to bring the best of laboratory medicine to clinical practice to Jordan

.Dr. Hussam Abu- Farsakh, M.D

Consultant Pathologist and Cytopathologist

American boards of Anatomic, Clinical Pathology and Cytopathology

ANCA (Anti-Neutrophilic Cytoplasmic Antigen) is very important test for vasculitis and inflammatory bowel diseases and certain hepatic lesions. It is important in the differential diagnosis of “Lung diseases” , “hematuria and/or proteinuria”, “abdominal pain and bloody diarrhea” and in “Cholestatic liver diseases”

(ANCA has 2 different patterns: Perinuclear ANCA (P-ANCA) and Cytoplasmic ANCA (C-ANCA

 C-ANCA is present more commonly in the following diseases: Wegener’s granulomatosis, Microscopic polyarteritis, Churg-Strauss syndrome

 P-ANCA is present in more wide variety of diseases: polyarteritis nodosa, idiopathic cresentic glomerunephritis, SLE, Rheumatoid Arthritis, Ulcerative Colitis, Crohn’s Disease, Primary Scleroing Cholangitis, Autoimmune Hepatitis, Primary Biliary Cirrhosis

Both tests are performed in our lab by immunofluorescence techniques

We, in the First Medical Laboratory, are dedicated to bring the best of laboratory medicine to clinical practice to Jordan

.Dr. Hussam Abu- Farsakh, M.D

American boards of Anatomic, Clinical Pathology and Cytopathology

Tissue Transglutaminse (TG) is an enzyme that is involved in protein synthesis and wound healing. It is present in the gut in abundant amount to build the villi and endomysium connective tissue from the continuous damage. This enzyme uses gliadin ( a component of gluten) as

its major substrate. TG converts glutamine (part of gliadin) into glutamic acid by a process known as �deamidation�. This conversion is important for making a bound between glutamic acid and lysine for protein synthesis. When TG combines with gliadin normally, this complex combines with Major Histocompatibility complex type II (HLA Q variants) without any consequences and it is then absorbed in the gut. If this HLA happened in the patient to be HLA-Q2, this complex combination is very antigenic and can be recognized by T-cells as a foreign antigen and start to order B-cell to produce IgA antibodies against TG. This leads to inhibition of this enzyme action with much lower protein synthesis leading to inability to rebuild the destroyed villi and the endomysium in the lamina propria of the mucosa. This leads to villous atrophy and increased lymphocyte and plasma cells in the lamina propria

Measurement of Anti-TG IgA is important in the diagnosis of celiac disease. It carries very high sensitivity and specificity reaching up to 100%. This test is preformed by ELISA test

Required material: 2 ml of serum

Conclusion: Anti-tissue transglutminase Antibody is an important test that carries very high sensitivity and specificity for the diagnosis of celiac disease. It should be performed on all suspected patients even if other celiac antibodies are negative

In our effort to bring the best of clinical tests to medical practice in Jordan, we would like to announce that these tests are available now in Jordan in our lab only

Please contact us for any further inquiries

.Dr. Hussam Abu- Farsakh, M.D

Consultant Pathologist and Cytopathologist

American boards of Anatomic, Clinical Pathology and Cytopathology

We would like to inform you that we have, in the First Medical Laboratories, several tumor markers that can be of great help in the diagnosis of different tumors. Diagnosis and classification of tumors now become much easier in Jordan with these new tests

Calcitonin: essential for the diagnosis of medullary carcinoma of the thyroid in primary and metastatic sites

Multi-drug resistant protein (MRP): important for treatment modalities in leukemia, multiple myeloma, neuroblastoma, lung, breast and lung carcinoma

(O 13: essential for the diagnosis of Ewing’s sarcoma and Primitive Neuroectodermal tumor (PNET

Mesothelin (CAK1): essential for confirming diagnosis of mesothelioma

Alpha-fetoprotein: essential for the diagnosis of primary liver masses (Hepatocellular carcinoma) and for diagnosis of germ cell tumors ovaries, testis, retroperitoneal areas, mediastinal masses

B-HCG: important for diagnosis of germ cell tumors

Apha-1-antitrypsin: important for the diagnosis of malignant fibrous histiocytoma and other sarcomas

S-100 : important for the diagnosis of melanomas, Histiocytosis X, malignant nerve sheath tumors

Estrogen and progesterone receptors: importune for prognosis and treatment modalities of breast cancer

Her-2-neu: important for prognosis and treatment modalities of breast cancer

These are some of the tests that we have in our lab, in addition to many others, which all can be performed on tissue section , paraffin blocks

We, in the First Medical Laboratory , are determined to bring the best of laboratory medicine in clinical practice to Jordan

Please call us for any further information

.Dr. Hussam Abu-Farsakh, M.D

American boards of Anatomic, clinical pathology & Cytopathology

P53 is a tumor suppressor gene, that is present in all normal cells on Chromosome 17. It is very important molecule in the control of cancer formation in the cancer cycle. Mutation in P53 results in the loss of P53 function and progression of cells into cancer cells. This form of P53 is called “mutant” form. The mutant form is stained by Immunostaining and its presence can be evaluated

In gastrointestinal disease, P53 is overexpressed in many pre-neoplastic conditions. Its presence indicates that the “early” step toward cancer progression did happen and careful follow up is recommended

:Barrett’s esophagus and P53

It is considered of great importance to performed P53 Immunostaining in Barrett’s with intestinal metaplasia. It documents (by molecular biology techniques) the presence of dysplasia and its overexpression can be evaluated for cases that may progress to high grade dysplasia and to carcinoma

Gastric intestinal metaplasia and P53: in cases of gastric intestinal metaplasia, the progression into carcinoma is usually preceded by dysplasia. However, morphologic assessment of dysplasia is subjective and the need for molecular staining parameter, has emerged to find that P53 overexpression is associated with dysplasia and more chance of progression into carcinoma

:Ulcerative colitis and P53

Dysplastic changes in ulcerative colitis are better assessed by P53 overexpression . The ones that express P53 are the ones that have more chance to develop carcinoma of the colon

In summary, P53 is a molecular marker, and it is the first to be lost in cancer control, can be measured in the tissue samples in cases of high risk for carcinoma. Careful follow up of these cases will lead to discovery of selective cases that may require elective surgery to prevent cancer formation

We, in the First Medical Laboratory, are dedicated to bring the best of laboratory medicine to medical practice to Jordan

Dr. Hussam Abu-Farsakh

American Board of Anatomic & Clinical Pathology, and Cytopathology

Circular: is a periodic circular that distributed to clinician informing them about new and important tests available at First Medical Laboratory. All information listed are supported by recent literature