Middle East Journal of Cancer
Volume:1 Issue: 1, Jan 2010

Esophageal cancer is the second and third most common malignancy in Iranian malesand females, respectively; killing approximately 5800 Iranians each year. Squamouscell carcinoma (SCC) is presently the most common type accounting for about 90%of all esophageal cancers in Iran. Recent studies in Iran have shown that there is a gradualincrease in the incidence of adenocarcinoma of the distal esophagus along with gastriccardia adenocarcinoma.Thirty-five years ago, the age adjusted incidence rate of esophageal SCC in thecity of Gonabad (Golestan Province, northeast Iran) and further to the east, was foundto be one of the highest rates for any single cancer that had been reported worldwide(age-adjusted rates >100/105/year). Recent studies have shown that the incidence ofSCC in Gonabad has declined to less than half of what it was in the past. This declinein the incidence of esophageal SCC parallels an improvement in the socioeconomicsituation of people living in this region. According to recent cancer registry data in Iranthere is still an obvious intracountry variability between the incidence of esophagealcancer in the south with an age standardizied rate (ASR) of 3 for males and 2 for femalesin Kerman and 43 and 36 in the northeastern province of Golestan, respectively formales and females. The reasons for the very high rate of SCC in northeastern Iran havebeen the subject of several studies during the past 35 years. According to results ofthese studies the suspected risk factors are: low intake of fruits and vegetables, drinkinghot tea, consumption of opium products and tobacco, H.pylori infection in the stomach,using unhealthy drinking water from cisterns and genetic susceptabilty. The mainsuspected mutagens are polycyclic aromatic hydrocarbons (PAH) and N-nitrosocompounds. In order to embark on a primary and secondary prevention of this fatalcancer further prospective studies are presently underway in northeastern Iran. TheGolestan esophageal cancer cohort study with an enrollment of 50,000 subjects is nowin its follow-up phase. We expect both simple and feasible evidence based preventivestrategies to be implemented in the future from the results of these studies.

Cytotoxic T-cell lymphocyte antigen 4 (CTLA-4) is a member ofthe superfamily of immunoglobulins that are mainly expressed by activated T cells.It is established that blockade of CTLA-4 receptors leads to the enhancement of animmune response. Different polymorphisms of the CTLA-4 gene have been describedwhich cause increased susceptibility to various malignancies such as lymphoma ormultiple myeloma. Considering that bladder cancer is one of the most prevalent cancersworldwide, we have evaluated the role of CTLA-4 gene polymorphism at position+49 A/G in the formation or progression of bladder cancer in southern Iran. Atotal of 226 individuals between February 2005 andJune 2006 were included and placed into two subgroups: patients diagnosed withbladder cancer and a control group. Demographic data and risk factors were collectedfrom both groups. The DNA of all subjects was extracted from their blood samples.Different genotypes of the CTLA-4 gene were determined using the restrictionfragment length polymorphism (RFLP) technique and data were compared in bothgroups by using Pearson''s chi-square test. The prevalence of AA, AG and GG genotypes at position 49, accordingto the PCR-RFLP method, were 57.5%, 37.2% and 5.3% in the control group,respectively. In the patient group, the prevalence of these genotypes was: AAin 57.5%,AG in 32.7% and GG in 9.8%. Statistical analysis of data showed no significantdifference in both groups (P value=0.40). Also there was no correlation betweendifferent genotypes of the CTLA-4 gene and invasiveness of the disease in ourcases. Although polymorphism of the CTLA-4 gene at position 49 ofexon-1 increases susceptibility to several malignancies, our study showed norelationship between polymorphism at this position and genetic susceptibility to thedevelopment of bladder cancer, nor was there any association with disease progression.

Alternative splicing of the Fas transcript can produce a naturalsecreted isoform of this molecule. Some cancer cells can also produce soluble Fas (sFas)which may have suppressive effects on the immune system''s anti-tumor response.Elevated concentrations of sFas have been detected in the sera of patients with differentmalignancies. The concentrations of sFas in sera of patients with headand neck carcinoma (HNC, n=98) and healthy individuals (n=30) were measured bySandwich ELISA and compared to values obtained six months after surgical removalof the tumor (n=48). Data were correlated with different clinical findings of thepatients. sFas concentrations in the sera of HNC patients were found to besignificantly higher in patients with different tumor stages. sFas concentration did notcorrelate with age or tumor invasiveness, however a higher concentration of sFas wasfound in the sera of patients who had higher tumor grades. Surgical removal oftumors in patients resulted in a substantial decrease in sFas concentration. The initial rise in sFas concentration in the sera of HNC patients andits consequent decrease could be regarded as a sign of tumor suppressive mechanisms.Additional studies are needed to fully elucidate this mechanism however these findingsmight show the prospective use of such biomarkers to determine disease prognosis andeven immunotherapeutic applications.

Pancreatic cancer has not been well studied, especially in developing countries. We studied the variations in genetic mutations inpancreatic adenocarcinoma between Moroccan and Egyptian populations. Themolecular pathology of 30 tumors from a large hospital in Casablanca, Morocco wereexamined and compared with the findings of 44 tumors from the Gharbiah Governatein Egypt. K-ras mutations in codons12 and 13 in addition to p53 mutations in exons5-8 were evaluated. Overall, differences in the rates of K-ras mutations were not statisticallysignificant (48.00 and 34.09%, respectively); however differences in rates of p53mutations were statistically significant with p53 mutations more common in Moroccantumors than in Egyptian tumors (46.67 and 16.28%, respectively). GT mutations ofthe K-ras gene were most commonly seen Egyptian tumors, whereas GAmutationswere the most common type of mutations in Moroccan tumors. Logistic regressionanalysis showed that a p53 mutation in any exon as well as a p53 mutation in exon 5predicted the country of residence and those mutations occurred more frequently inMoroccan patients. Our study shows that differences exist within the Arab population inthe molecular pathology of both the K-ras and p53 genes. Further studies are necessaryto clarify the differences in molecular pathways of pancreatic cancer in the Middle Eastand to investigate the role of environmental and/or genetic factors related to thosepathways

The main obstacle facing cancer preventive strategies worldwide is a lack of wellconducted epidemiological studies to guide local and international efforts for diseasecontrol. In Lebanon, long due political strain has added yet another obstacle to thedevelopment of methodologies aiming to collect data on cancer epidemiology.However, through several efforts dated from the 1960s the picture is becomingclearer. We herein review the outcome of all such efforts and their interpretation asa guide for future preventive strategies.

Meningioma is usually a benign central nervous system (CNS) tumor. Metastasisis rare; however if it does occur the most metastatic sites are the liver and lungs. Here,two cases of CNS meningioma with metastasis to cervical lymph nodes are reported.The first case, a 48 year-old man developed cervical lymph node metastasis nine yearsafter primary tumor diagnosis. The second case, a 23 year-old woman with parietallobe meningioma, developed lymph node metastasis in the neck nine months afterthe diagnosis of meningioma.

This report describes a rare intra-articular benign tumor, lipoma arborescens, ofthe knee joint in a 21 year-old female. The patient suffered from left knee joint swellingfor five years with occasional pain. Swelling was soft and boggy in the suprapatellararea. Motion of joint was complete. No abnormality was detected in any laboratorytests. MRI showed a large soft tissue density in the suprapatellar area with high signalintensity on T1 and T2 weighted images. Operative arthroscopy revealed a creamybrown hypertrophied synovium with diffuse papillary processes characterized byvillous proliferation of the synovium infiltrated by mature fat tissue, chronicinflammatory cells and vessels as seen in the pathologic slides. Lipoma arborescensor villous lipomatous proliferation of the synovial membrane should be distinguishedfrom other similar lipomatoid conditions such as synovial lipoma and Hoffa disease.Lipoma arborescens should be considered in patients with painless, slowly progressiveswelling of a joint, especially the knee.