Introduction. As a common interferer in clinical chemistry, lipemic specimens could be a source of significant analytical errors. Ultracentrifugation has been by far the only reliable, but an unavailable and expensive, method to eliminate the lipemic effect. Materials and Methods. Among the daily samples, those with triglyceride >400 mg/dL (4.6 mmol/L) and also turbid were selected, divided into three groups, based on triglyceride concentration, and three pooled serums were made for each group. Then all pooled serums were investigated by using a DIRUI biochemistry analyzer CS-800 for routine chemistry tests in different methods including direct measurement, serum blank, serum dilution, and measurement after ultracentrifugation. Results. According to our study, there were significant differences before and after ultracentrifugation in all lipemic levels and for all parameters except for alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin, and uric acid. Based on allowable inaccuracy for each parameter, calcium, magnesium, phosphorus, total protein, iron, total iron-binding capacity (TIBC), urea, and chloride are being influenced by all lipemic degree and neither serum dilution nor using serum blank is as effective as ultracentrifuge for elimination. Serum blank was a proper method of lipid removal for the measurement of glucose. Conclusion. Lipemia is a well-known interferer in clinical chemistry. One cannot avoid lipemia, but fortunately, severe lipemia is a rare phenomenon in the laboratory, and for assessment of some analytes in a lower degree of lipemia, use of serum blank eliminates the need for ultracentrifuge.

Primary Squamous cell carcinoma (SCC) of the kidney is rarely reported in the literature. It is usually associated with renal stone, and due to lack of clinical symptoms and radiological diagnostic features, patients often present at the late stages of the disease. We reported a 59-year-old woman presented with a longstanding history of flank pain and hematuria. Imaging techniques revealed enlargement of the right kidney associated with multiple staghorn stones. The patient subsequently underwent right radical nephrectomy, and histopathological examination of the mass revealed well-differentiated keratinized squamous cell carcinoma. There was no primary source for her SCC. Although the primary SCC of the kidney is a rare entity, it should be considered in patients with longstanding renal calculi, particularly for large staghorn stones of renal pelvis. On the other hand, conventional imaging could not detect this type of malignancy. In most cases, CT and MRI play an essential role in the diagnosis of such tumors.

Background and Objective: Epidermal growth factor receptor (EGFR) gene mutation, especially in exons 18 to 21, is an important predictor of the response rate of lung adenocarcinoma to tyrosine kinase inhibitors. There are variable reports from Asian and European countries, as well as North America, about the frequency of the EGFR mutation in lung adenocarcinoma, yet molecular study about this incidence has been published from Iran. In this study, we investigated the frequency of this mutation in our center, which is the largest referral center in the south of country. This report will be the first published article about EGFR mutational analysis from Iran. Methods: During the study period (September 2011 till September 2016) i.e. 5 years, there have been 50 cases of pathologically-confirmed lung adenocarcinoma. These cases underwent mutational analysis for exons 18 to 21 of the EGFR gene by PCR and DNA sequencing. All demographic findings were also extracted from the patients’ charts and recorded. Results: There were 30 male and 20 female patients, with an average age of 58 years. The overall frequency of EGFR mutation was 28% (14 out of 50). The most common mutation was Del 19 (10 of 14, 71.4%), 3 mutations were found in exon 20 and one mutation was found in exon 21. EGFR mutations were more frequent in women than in men (30% versus 26.7%) and in nonsmokers than in smokers (37.9% versus 14.3%). Conclusion: Lung adenocarcinoma with EGFR mutation shows strong association with female non-smokers. Our results showed an intermediate frequency of this mutation, which was higher than results from Western countries and lower than most Asian countries.

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Background. Although the automation of instruments has reduced the variability of results and errors of analysis, in some laboratories, repeating a test to confirm its accuracy is still performed for critical and noncritical results. However, the importance of repeat testing is not well established yet, and there are no clear criteria for repeating a test. Materials and Methods. In this cross-sectional study, all repeated tests for 26 biochemical analytes (i.e., albumin, alkaline phosphatase (ALP), alanine aminotransferase (ALT), amylase, aspartate aminotransferase (AST), bilirubin total (BT), bilirubin direct (BD), blood urea nitrogen (BUN), calcium, chloride (Cl), cholesterol total (CholT), creatine kinase (CK), creatinine (Cr), glucose, gamma-glutamyl transferase (GGT), high-density lipoprotein-cholesterol (HDL-c), iron, lactate dehydrogenase (LDH), LDL-c, lipase, magnesium (Mg), phosphorus (Ph), protein total (ProtT), total iron binding capacity (TIBC), triglyceride (TG), and uric acid) were assessed in both critical and noncritical ranges over two consecutive months (routine subjective test repeats in the first month and rule-based repeats in the second month). To determine the usefulness of test repeats, differences between the initial and verified results were compared with the allowable bias, and repeat testing was considered necessary if it exceeded the allowable bias range. All causes of repeat testing, including linearity flags, delta checks, clinically significant values, and critical values, were also documented. All data, including the cause of repeats, initial and verified results, time, and costs in the two consecutive months, were transferred to Microsoft Excel for analysis. For comparison of data between the months, Student’s t-test was used. Results. A total of 7714 repeat tests were performed over two consecutive months. Although a significant decline (38%) was found in repeated tests in the second month ( P  < 0.001), there was no significant change in the percentage of unnecessary repeats (77% in the first month and 74% in the second month). In both consecutive months, AST and ALT were the most commonly repeated tests, and delta check was the most common cause of repeat testing. Mg, ALP, AST, and lipase showed the highest rates of necessary repeats, respectively (the least stable tests), while albumin, LDL, and CholT tests showed the highest rates of unnecessary repeats, respectively (the most stable tests). The total cost and delay in turnaround time (TAT) due to repeated testing decreased by 32% and 36%, respectively. Conclusion. Although repeat testing has been shown to be unnecessary in most cases, having a strict policy for repeat testing appears to be more valuable than avoiding it completely. Each laboratory is advised to establish its own protocol for repeat testing based on its own practice.