kazem anvari

Oral squamous cell carcinoma (OSCC) is the most common oral cavity cancer and may occur following oral epithelial dysplasia (OED). Cancer stem cells (CSCs) can self‑renew and multi‑directionally differentiate to promote tumorigenesis with high expression of cluster of differentiation (CD) 24 and CD44 markers. CSCs play a pivotal role in tumor development, drug resistance, and relapse after treatment. We aimed to evaluate the correlation between both marker expressions and clinicopathological indices in OED and OSCC patients.

In this follow‑up study, we could access 37 patients, including 12 OEDs and 25 OSCCs (Grade I: n = 9, Grade II: n = 8, and Grade III: n = 8). Data were analyzed using SPSS software (version 26) and log‑rank tests, Fisher’s exact test, Chi‑square, and one‑way ANOVA. P < 0.05 was considered statistically significant.

There was no significant difference in the expression of CD24 and CD44 markers between the study groups (P > 0.05) and the expression of both markers and clinicopathological indices in the study groups (P > 0.05). The mean and standard deviation of overall survival (OS) were 54.46 ± 43.08 with a range of 6–193 months, and they were 8.24 ± 15.34 months with a range of 0–70 months for disease‑free survival (DFS) in patients, respectively. The average of DFS in Grade I was significantly lower than the OED (P = 0.002) and Grade II (P = 0.039) groups. The OS average in the Grade I (P = 0.014) and Grade III (P = 0.004) groups was statistically lower than the OED group.

Although more than half of the patients demonstrated high expression of both markers, there was no statistically significant difference between them and clinicopathological indices. 

Papillary tumor of the pineal region (PTPR) is an infrequent neoplasm arising from the ependymal cells of the sub-commissural organ. This tumor entity was incorporated into the World Health Organization (WHO) classification of central nervous system tumors in 2007. Given the propensity for local recurrence observed in PTPR cases and the documented instances of leptomeningeal seeding in previous case reports, it presents a substantial risk of significant morbidity. Due to its rarity, there is no established standard for its management. Surgical intervention constitutes the primary treatment modality, while the role of adjuvant radiotherapy remains ambiguous. In this case report, we present the clinical course of a 46-year-old male diagnosed with PTPR who underwent surgical resection followed by adjuvant radiotherapy. 14 months post-initial treatment, the patient manifested intracranial and spinal metastases in the form of leptomeningeal dissemination. Subsequently, systemic chemotherapy utilizing vincristine and carboplatin was initiated, and the patient exhibited no evidence of disease progression over the last six months.

This study aimed cohort study aimed to evaluate the relationship between the depth of invasion (DOI) and the lymphocytic host response (LHR) in oral squamous cell carcinoma (OSCC) biopsies with various clinicopathological characteristics of the disease.

Eighty-seven OSCC biopsy samples were obtained and key patient data such as clinical stage, grading, nodal involvement, overall survival (OS), and disease-free survival (DFS) were collected. DOI was measured from the basement membrane to the deepest invasion point, classifying samples into low risk (DOI < 4 mm) and high risk (DOI > 4 mm) categories. Additionally, LHR in the DOI was categorized as mild, moderate, or severe. The Chi-squared and Fisher’s exact test and Kaplan-Meier analysis were used for data analysis. The significance level was set at 0.05.

The findings revealed that 43.7% of patients fell into the low-risk DOI category, while 56.3% were in the high-risk group. LHR levels varied, with 36.8% mild, 18.4% moderate, and 44.8% severe. Most patients were in stage IV (31%) and grade I (60.9%). A significant relationship was found between the high-risk DOI group and several factors: disease stage (p < 0.001), grading (p = 0.021), five-year OS (p=0.001), five-year DFS (p < 0.001), and lymph node involvement (p < 0.001). Moreover, a significant relationship existed between LHR and the disease stage (p = 0.003) and lymph node involvement (p = 0.001).

Incorporating DOI into routine histopathological reports could be beneficial in predicting OSCC prognosis, especially in early stages. This underscores the importance of histopathological evaluations in OSCC treatment planning, highlighting the value of DOI and LHR in understanding the disease's clinicopathological aspects.

Context: 

During a literature search, we found data indicating how lactate affects cancer patients.

Evidence Acquisition: 

This review discusses metabolism in tumors, the lactate production pathway, and its effects on the host body.

Research has described high lactate concentration as an undesirable clinical condition, and lactic acidosis contributes to the death of patients or some metastatic cancers.

Lactate can lead to angiogenesis, metastasis in the tumor, and resistance to radiation therapy and chemotherapy, especially immunosuppression. It may be possible to reduce the mortality of this disease by affecting treatment worldwide.

[68Ga] Ga-labeled C-X-C motif receptor4 as a novel radio-ligand using PET/CT has been investigated for tracing various kinds of solid and hematopoietic malignancies in recent years. High-grade Glioma (WHO classification 2016 grade III and IV) shows elevated levels of CXCR4 ligand expression in the affected tumoral cells. Healthy and non-affected organ cells express low-level CXCR4 ligands density. We performed [68Ga] Ga-Pentixafor (Pars-Cixafor™) PET/CT in a patient with high-grade Glioma (anaplastic oligodendroglioma WHO grade III) with no other documented medical condition and history. In addition to the Pentixafor-avid tumor remnant in the PET/CT images, we observed mild symmetrical bilateral uptake in the fibro glandular tissue of the breasts and moderate CXCR4(Pentixafor) avidity in both adrenal glands without any discernable pathology and abnormal density changes in the CT component of the study. Attention should be paid to the interpreting [68Ga] Ga-Pentixafor PET/CT examination and its normal uptakes and variants.

Brain glioblastoma multiforme with leptomeningeal metastasis is a rare medical condition. Although autopsy series have demonstrated a higher incidence of leptomeningeal metastasis, it is usually a late complication in the course of the disease. The disease progression is almost always rapid, resulting in a poor performance status and short survival. There is no single standard treatment but different individualized choices including chemotherapy (standard, anti-angiogenic, intrathecal, immunotherapy), and radiation have been utilized. In this manuscript, we report a male patient with glioblastoma multiforme of left prefrontal lobe that presented with concomitant cervical leptomeningeal metastasis. Because of poor performance, he received hypofractionated radiotherapy of brain and cervical spine which consisted of a total dose of 45 Gy in 10 fractions with 300c Gy per fraction and 30 Gy local boost to the areas of enhancement. Despite this treatment, there was no response and the patient died three days after the completion of the treatment.

Breast cancer is among the leading causes of cancer death in women. Despite extensive efforts to identify novel prognostic and predictive clinical biomarkers, a very small number of markers have been reported as risk stratification biomarkers (e.g., BRCA1/2 and HER2). The substitution of arginine with lysine in codon 497 of HER1 497 has been suggested as a potential marker in breast cancer. This study attempted to explore the association between HER1 497 gene polymorphisms with pathological and clinical information of breast cancer patients.

110 breast cancer patients were recruited followed by genomic DNA extraction and genotyping using Taqman-PCR and sequencing. The associations of this genetic variant were evaluated with breast cancer risk and pathological information of patients.

Our data showed that 9.43% of cases had AA genotype, while these frequencies in AC and CC genotypes were 77.35% and 13.20%, respectively. Moreover, we found that 78.4% of breast cancer patients with M0 had AA+AC genotypes, while 21.6% of CC cases had M0 status. Furthermore, 22.7% of these cases with CC genotype had N0/1. Interestingly, we observed that most of the patients with CC genotype had lower HER2 expression.

Our finding showed the potential association of CC genotype of HER1 497 with the prognosis of patients with breast cancer. Further studies are warranted to explore the prognostic value of this marker in a larger and multi-center setting in breast cancer.

This study aims to investigate the effectiveness of mindfulness-based cognitive therapy in depression and serum cortisol levels in women with breast cancer and depressed women.

In this clinical trial, 30 women with breast cancer who referred to Omid Hospital, Mashhad-Iran and 30 women with depression who referred to counseling clinics of Mashhad in 2020-2021 were selected by the convenience sampling method and were randomly assigned to four equal groups (2 experimental groups and 2 control groups). The experimental groups received mindfulness-based cognitive therapy during eight 90-120 minute sessions per week, while the control group did not receive any intervention. Research instruments included the Depression Inventory (BDI-II) and the blood samples to evaluate the cortisol levels. Data were analyzed through descriptive statistics, and the covariance analysis.

The results of depressed people demonstrated that mindfulness-based cognitive therapy is effective to reduce depression and serum cortisol levels within the normal laboratory range (P< 0.001). Further, the findings of breast cancer women indicated that mindfulness-based cognitive therapy reduced depression and increased serum cortisol from low to moderate levels within the normal laboratory range (P< 0.001).

Mindfulness-based cognitive therapy can be effective in neurobiological mechanisms in addition to improving psychological symptoms in depressed individuals and cancer patients.

Exquisite soft tissue contrast of magnetic resonance images (MRI) and the new combined radiotherapy system of MR-Linac have been the main impetus for applying MR imaging in radiotherapy. One limitation of MR-based radiotherapy is the geometric distortion of MR images that can generate errors in the contouring and dosimetry stages. This study aimed to evaluate and correct geometric distortion for radiotherapy applications.
A large field of view (FOV) phantom develop using Perspex sheets and 325 plastic pipes. The quantification and correction of MR images' system-related geometric distortion are conducted for HASTE protocol by MATLAB and 3D slicer software in phantom and patient images. The effect of MRI images geometrical distortion was evaluated for ten patients undergoing body radiotherapy treatment.  CT images were used as a primary dataset to estimate the distortion map.
The phantom investigation results indicate that in radial distances of < 13 cm (or FOVs < 25 cm), the amount of distortion is under 2 mm. Still, at more considerable radial distances, distortion may increase up to about 3.5 cm. MR images of Patients with lateral (LAT) and anterior-posterior (AP) diameters of more than 38 cm and 25 cm respectively, need to be corrected for geometric distortion.  
MR images' geometric precision in large FOVs is not sufficient for MRI only treatment planning of radiotherapy and further corrections are required. The B-spline deformable registration method can correct the MR geometric distortion until an acceptable range of 2 mm for radiotherapy applications.

The oral squamous cell carcinoma (OSCC) composes about 90% of all head and neck cancers. The toll-like receptor (TLR)+ immune cells have potential of invasion and malignancy transformation. The aim of this study was assessment of possible associations between clinicopathological indices and TLR2 and TLR9 gene expression in OSCC.

Forty-two OSCC samples with related healthy margins including 25 early and 17 advanced stages were gathered. The samples were classified histologically from grade I to II. The expression of TLR2 and TLR2 was evaluated by Real-time PCR. The patient’s disease-free survival (DFS) and overall survival (OS) were analyzed using SPSS V.23 software.

The expression of TLR2 and TLR9 genes in tumor tissues (especially in grade I and II) were higher than healthy surgical margin tissue (p< 0.001). TLR9 expression in grade II was statistically significant than grade I in tumor tissue (p< 0.001). TLR9 expression in advanced stage was statistically significant in compare to early stage (p= 0.012). In advanced stage both overall survival (p= 0.029) and disease-free survival (p= 0.012) were statistically lower than early stage. The follow-up time to recurrence in advanced stage was statistically lower than early stage (p= 0.007).

Overexpression of TLRs 2, 9 play role in the pathogenesis and tumor development of OSCC and can be applied as biomarker in prognostic approaches.

Atypical teratoid/rhabdoid tumor (AT/RT) is a very rare tumor, mostly found in the posterior fossa of children aged under three years. Combined modality treatment appears to improve the results. Herein, this report aimed to present a case of intramedullary intradural AT/RT of the anterior thecal sac in a 17-year-old girl with subtotal resection by undergoing adjuvant radiotherapy and sequential chemotherapy.

Depression is now a common chronic illness in most communities all over the world that may disrupt normal functioning, cause depressive thoughts, and negatively affect the quality of life (QoL). The aim of this study was to assess the effectiveness of mindfulness-based cognitive therapy on quality of life (QoL), depression and cortisol levels in people with depression. Thirty women with depression were selected voluntarily and randomly assigned to experimental (n = 15) and control (n = 15) groups. For the experimental group, treatment sessions were held for eight 90-minute sessions per week and the control group did not receive any treatment. To measure the variables, Beck Depression Inventory (BDI-II and SF36 Quality of Life Questionnaire) was used twice (before and after treatment) and to measure cortisol levels, blood samples were taken between 8 and 10 am before the onset of first and last treatment sessions and analysis of covariance (ANCOVA) was employed to analyze the data. The results showed that mindfulness-based cognitive therapy in the pretest-posttest phase reduced depression and cortisol rate from 23.87 and 14.48 to 10.13 and 11.95, respectively and increased quality of life from 32.90 to 83.52 in the experimental group (p < 0.001). Based on the findings of the present study, it can be concluded that mindfulness-based cognitive therapy can improve the mental status and quality of life of patients with depression.

AbstractBreast cancer is the most common type of cancer among women. Diagnosis and treatment can all be extremely stressful. This study aimed to review mindfulness-based cognitive therapy on quality of life, depression, and serum cortisol levels in women with breast cancer.This study is a quasi-experimental research project of pre test-posttest with the control group. The statistical society contains 30 women with breast cancer referred to Omid Hospital in Mashhad that they were selected by sampling method and they were randomly divided into two groups of 15 people of the experimental and control group. To do the therapy, a trained clinical psychologist held 8 sessions of 90 minutes per week for the experimental group, while the control group received no treatment session. To measure variables from Beck depression questionnaires (BDI-II), quality of life SF36, and to evaluate cortisol levels, the blood samples were taken between 8 and 10 am before the first and last treatment sessions were started. In the statistics section, while describing the data descriptively and examining the assumptions of analysis of covariance (Shapiro-Wilk test,,Levin test, regression line homogeneity test and ..)statistical test of analysis of covariance was used. The results showed that mindfulness-based cognitive therapy is effective in reduced depression and enhanced quality of life and increased serum cortisol from low to moderate levels within the normal laboratory range (P <0.001). The results showed that mindfulness-based cognitive therapy can be used as an effective intervention to promote mental health in patients.

Glioblastoma primary brain tumor.Immunotherapy is a promising therapeutic adjuvant in fighting against this cancer.  Cancer/testis antigens (CTAs) are a group of tumor-associated antigens that are typically restricted to adult testis, but they are aberrantly expressed in several types of cancers, especially in advanced cancers with stem-like characteristics. These tumor-associated antigens are immunogenic in different cancers. Finding of frequently expressed CTAs in GBM can provide effective immunotherapeutic targets to use in translational researches on this cancer. The aim of this study was conduct an extensive expression analysis of ADAM29, HORMAD1, FTHL17 in GBM to determine whether these antigens can be appropriate target in immunotherapy of GBM.

fifty pathologically confirmed GBM paraffin embedded tissue sample were conducted into this experiment. Total RNA was extracted from these samples and TaqMan based RealTime PCR technology was used to evaluation of HORMAD, ADAM29 and FTHL17 gene expression.

according to our results HORMAD1 is the most frequent expressed gene in these tissue samples. Forty-four percent of samples (22 out of 50 samples) expressed HORMAD1 in various levels. Either FTHL17 and ADAM29 were expressed in only one of samples .On the other hand, according to statistical studies of patients' demographic findings and the expression of genes, HORMAD1 has had a much higher level of expression in glioblastoma samples than other genes, which, based on these results, we can consider this gene as a therapeutic target in immunotherapy

CT46/HORMAD1 is a single-copy gene on chromosome 1q21.3, A review of carcinoma showed that 31% of carcinomas express this antigen in high numbers. In 2006, the gene had a high expression in gastric cance. so far no precise and thorough study has been done on the existence (expression) of these gene in glioblastma samples,
 
HORMAD1 can be a promising target in immunotherapy research targeting GBM.
multiform (GBM, World Health Organization grade IV) is the most common and aggressive

The present study investigated the relationship between invasive front (IF) of tumors and clinicopathological parameters including stage, grade, nodal involvement, lymphocytic host response (LHR), recurrence, overall survival (OS), and disease-free survival (DFS).

A total of 87 oral squamous cell carcinoma (OSCC) biopsies were evaluated. Clinical stage, grading, nodal involvement, time of recurrence, OS, and DFS were assessed. The number of tumor budding cells in the IF was measured by two pathologists with an optic microscope. IF was graded to low risk (<5) and high risk (>5), according to the counting of tumor budding as a single cancer cell or cluster cells. Also, LHR was reported in the IF as mild, moderate, and severe.

IF was reported in 43.7% of patients as a low-risk group and 49.4% as a high-risk group. LHR was also mild in 31%, moderate in 25.3%, and severe in 43.7% of the patients. Most of the patients were in stage IV (31%) and grade 1 (60.9%). The high risk IF group had a significant statistical relationship with stage (P=0.001), grade (P=0.039), five years OS (P=0.03), five years DSF (P=0.01), and lymph node involvement (P=0.007). The relation between LHR and stage of disease was significant (P=0.034).

Considering the important role of histopathological reports in the treatment plan of patients and the relationship between IF and clinical parameters, IF evaluation in routine histopathological examinations, especially in the early stages of OSCC, seems to be necessary.

Pre-operative chemoradiotherapy (NACRT) of patients with proximal gastric and esophagogastric junction (EGJ) adenocarcinoma may result in increased local control and improved patients’ survival rate. This study aimed to investigate the effect of NACRT on resectability of tumor in patients with proximal gastric and EGJ adenocarcinoma.

In this single-arm clinical trial, patients with locally advanced proximal gastric and EGJ adenocarcinoma were included. Two courses of paclitaxel/carboplatin chemotherapy alone followed by NACRT with a similar treatment regimen and a total radiation dose of 45-50.4/1.8-2 Grays were prescribed. After surgery, patients were evaluated for resection rate, pathologic response rate, and post-surgical complications.

A total of 61 patients with a mean age of 65.9 years participated. Grades 1 and 2 were the most prevalent side effects, with grade 3 being the worst grade and exhibiting as leukopenia (4.9%) and thrombocytopenia (1.6%). 25 (41%) patients underwent surgery after NACRT. Post-surgery complication was reported in 20% of cases (including 8% mortality and 12% morbidity). R0 and R2 resection was observed in 88% and 12% of cases, respectively. Complete pathologic-response was achieved in 24% of patients.

Paclitaxel/carboplatin based neoadjuvant chemotherapy was associated with potential resectability and appropriate pathologic response in patients with locally advanced proximal gastric and EGJ adenocarcinoma. However, by reducing patient tolerance to complete courses of weekly chemotherapy, induction chemotherapy lowered the effectiveness of concurrent chemotherapy and radiotherapy (as a sensitizing agent). Hence, induction chemotherapy proved to be more unbeneficial causing delayed treatment and reducing concurrent chemoradiotherapy tolerance.

Glioblastoma is the most common primary malignancy of the brain, the prognosis of which is poor. Immunotherapy with cancer/testis (CT) antigens is a novel therapeutic approach for glioblastoma. This study aimed to investigate the expression rate of MAGE-E1, GAGE, and SOX-6 in glioblastoma tumors using the immunohistochemistry (IHC) method.

Expression of MAGE-E1, GAGE, and SOX-6 were determined by IHC in 50 paraffin blocks of glioblastoma. The results were compared between variables including age, gender, tumor location, and Karnofsky performance status (Kps) score. Survival analysis was also performed.

The expression levels of SOX-6, MAGE-E1, and GAGE were 82%, 78%, and 76%, respectively. The relationship between CT antigens and age, gender, and tumor location was not significant, while the association between MAGE-E1 expression and age was statistically significant (p =0.002). High expression levels of SOX-6 and MAGE-E1 were associated with low Kps scores (p =0.034 and p <0.001, respectively). Survival analysis showed that age >40 and Kps score p =0.005 and p =0.018, respectively). Expression of MAGE-E1 and GAGE was negatively associated with overall 2-year survival (p =0.001 and p =0.021, respectively).

The expression of all the three CT antigens, especially MAGE-E1 and SOX-6, was high in patients with glioblastoma. It can be concluded that these markers are ideal targets for immunotherapy in these patients. MAGE-E1 and SOX-6 can be considered as important markers in determining the prognosis of glioblastoma.

Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity. Despite some improvements in treatment, the survival rate is still very low, mainly due to the possible development of secondary malignancy or metastasis. Clinical and pathological features as well as molecular biomarkers might predict the recurrence.In recent years, many studies have been carried out on molecular biomarkers that can predict the prognosis of OSCC. One of these markers is the epidermal growth factor receptor (EGFR), which has led to different results. The aim of this study was to determine EGFR level in OSCC and to analyze its correlation with clinicopathological features.

A total of 62 paraffin-embedded samples from OSCC patients treated in the oncology department of the Omid Hospital in the city of Mashhad, Iran were selected and EGFR staining was performed. The clinical and histopathological data were extracted from the medical records.

EGFR expression was positive in 98.4% of the cases. There was a significant difference between EGFR expression in the tumor and control cases in terms of cellularity and intensity (p˂0.001 and p=0.004, respectively). No statistically significant correlation was observed between EGFR and clinicopathological parameters. There was also no significant relationship between the cellularity and intensity expression of EGFR and patient survival (p=0.92 and p=0.42, respectively).

In view of the high EGFR expression in squamous cell carcinoma, further studies on the role of EGFR in cell processes such as proliferation, angiogenesis and differentiation of the tumor are recommended.

Nutritional dysfunction with or without aspiration is a common complication following head and neck cancer (HNC) surgery and patients frequently present with weight loss secondary to dysphagia and malnutrition.

The aim of this study was to investigate the incidence of weight loss and malnutrition in patients with HNC following surgery through the Malnutrition Universal Screening Tool (MUST) scale.

A total of 28 patients with a confirmed diagnosis of head and neck cancer mainly of the oral cavity referring for surgery for the first time were enrolled. A researcher-designed questionnaire was used for data collection. Further, a single nutritionist evaluated each patient’s nutritional status before and 6-8 weeks' post-surgery according to MUST to measure the level of malnutrition. Significance level was set at p<0.05.

Among the subjects, 57% were younger than 70 years; 61% were in stage II of cancer while the rest were in stage III. Weight, body mass index (BMI), serum hemoglobin, and albumin levels showed a significant reduction following surgery (p<0.05). Specifically, 18% had less than 5%, 36% had 5-10%, and 46% had >10% weight loss. According to MUST scale, 18% of Patients with HNC had low, 25% had moderate, and 57% had high risk of malnutrition. A significant relationship was found between severe malnutrition and patients older than 70 years of age.

In head and neck cancer patients, weight loss increases the morbidity and mortality, therefore nutritional interventions should be initiated before cancer treatment begins and these interventions need to be ongoing after completion of treatment to ensure optimal outcome.

The present study was conducted to implement a simple practical independent quality check of depth dose and isotropy of the Intrabeam™ therapeutic X-ray machine using radiochromic EBT2 film. Theindependent quality check of 1.5, 3.5, and 5-cm spherical Intrabeam™ applicators was accomplished using particular EBT2 film cutting pieces with internal rounded edges in a water phantom. Prior to this measure, the film was calibrated at three distances from the 5-cm applicator in water to clarify the effects of beam spectrum and dose rate alteration on film response. To this end, three calibration curves were plotted. The results of the one-way analysis of variance showed a critical difference between film pieces receiving equal doses at various distances (P<0.05). Therefore, depth dose curves were designed using all three calibration curves. Smaller applicators represented steeper dose fall-off, compared to the larger sizes. In this regard, 14.97%, 17.59%, and 30.92% of the relative mean doses were measured at 1 cm depth of 1.5-cm, 3.5-cm, and 5-cm applicators, respectively. A 10%/1mm gamma index was satisfied for the lateral dose evaluation of corresponding depth relative to Z-direction. The approach implemented in this study could be carried out as a rapid monthly quality check method for the dose distribution evaluation oftheIntrabeam device.

Breast cancer is the first leading cause of cancer-related deaths in women. Ki-67 is being used for evaluation of the prognosis of patients with breast cancer. The aim of the current study was to explore the association of the involvement of axillary lymph nodes status with the expression of Ki-67 in patients with breast cancer. A total of 449 patients were enrolled followed by evaluation of the association of Ki67 levels with demographic, pathologic, and survival data of patients, using Chi-square, logistic regression models, student t test and Mann-Whitney. We observed a significant relationship between the expression level of Ki-67 and stage of tumor (P = 0.012), positive progesterone receptor (P = 0.003), and subtype pathologic features (P < 0.05). Also, a significant difference was detected between Her2 and expression level of Ki-67 (P = 0.015). Survival analysis showed the association for Ki-67 (P = 0.02), age (P = 0.005), stage of tumor (P < 0.05), lymph node involvement (P = 0.001), and the Her2 (P = 0.024) with clinical outcome (e.g., overall survival or disease free survival) of patients with breast cancer. The results of this study demonstrated that the overexpression of Ki-67 was associated with large tumors, progesterone receptor expression, and stage of tumor, but it was not related with lymph node involvement.

Melanoma is a neoplasm derived commonly from melanocytic cells of skin. Although coetaneous presentation of malignant melanoma is easily recognizable, the presentation of melanoma in other organs is so confusing. In particular, when it metastasizes to other organs, many bizarre figures and unusual organs may be involved. In this report, we present a case of primary duodenal malignant melanoma.
A 68-year-old man presented with a history of iron deficiency anemia. The upper gastrointestinal endoscopy showed a prominent papilla of duodenum along with an ulcerative lesion adjacent to second part of duodenum. Histopathologic evaluation showed a high-grade malignant neoplasm involving the bowel wall which was labeled for S100 protein and markers of melanocytic differentiation; Melan-A indicating the definitive diagnosis of malignant melanoma of the second portion of duodenal mucosa.
In patients with a history of iron deficiency anemia, any GI symptom should be evaluated carefully. However, the diagnosis of primary GI melanomas in patients without any history of melanoma is possible. Full medical investigations are recommended in these patients with primary mucosal lesions.

The standard of care for glioblastoma is concurrent chemoradiotherapy and adjuvant chemotherapy with Temozolomide. In this trial, we have investigated the impact of MGMT promoter methylation on prognosis and benefit from Temozolomide based chemotherapy in a group of patients with glioblastoma in our region.
This retrospective study included glioblastoma patients treated in our institute between 2006 and 2011. We used methylation specific PCR to detect methylation in the promoter region of the MGMT gene. The Kaplan-Meier technique was used to calculate overall survival from the time of diagnosis to the time of death. We utilized the log-rank test and Cox-regression model for univariate and multivariate analyses of potential prognostic factors.
There were 78 patient participants with a median age of 50 (range: 20 to 75) years and a male to female ratio of 56/22. All patients underwent minimal surgical resection which was considered as a biopsy. All patients received adjuvant radiotherapy with a median dose of 60 Gy (54-60 Gy) and 25 patients received concomitant Temozolomide. The MGMT promoter methylation was found in 19 (24.4%) patients and was relatively more frequent in men (28.6%) compared to women (13.6%; P=0.16).This genetic change was associated with a significantly higher 2-year survival in men (57.2%) compared to women (16.8%; P In our series, MGMT promoter methylation was a significant independent prognostic factor. The finding of sex as an independent prognostic factor would need further validation.

Malignant melanoma (MM) usually present with metastases to unexpected regions of the body. Metastatic MM is a highly lethal condition, and the median survival in this setting is 6 to 7.5 months; however, few reports rarely describe long-term after chemotherapy. Case Report: We describe a 31-year-old man with MM, which got metastatic (to paranasal sinuses) after local and systemic therapy showed complete responses with long-term survival after endonasal endoscopic metastasectomy and radiotherapy of the nasal cavity, paranasal sinuses, and base of the skull. Although long-term survival is rare, few reports describe cases after chemotherapy. MM could be associated with metastasis to any regions and clinicians should be aware of its behavior and perform complete investigation in the presence of any suspicious symptoms, and this should be reinforced periodically. However, the survival is poor in the metastatic setting, and the treatment of choice is debatable, some patients may benefit from metastasectomy and local radiotherapy.

Esophageal squamous cell carcinoma (ESCC) is a common malignancy in gastrointestinal tract.
This study was conducted to investigate the frequency of human epidermal growth factor receptor 2 (HER2), over-expression in patients with ESCC, and its correlation with pathologic response in cases undergoing neo-adjuvant, chemoradiation, and survival.
In this cross sectional study, 68 patients with non-metastatic esophageal SCC, who had undergone neo-adjuvant chemotherapy containing cisplatin and 5FU in conjunction with radiotherapy between 2007 and 2014 were evaluated. HER2 expression assessed by Immunohistochemistry and HER2 score was also calculated for each specimen. Tumor response to neoadjuvant chemoradiotherapy was evaluated in surgical blocks according to tumor regression grading (TRG) system. Patients were followed up every 3 months in first 2 years and every 6 months afterwards.
The result of Hercep test was positive in 42.8% of cases, among whom 33.8% were 2 and 8.8% were 3. Her2 score was above 100 in 38.3%. Complete pathologic response was observed in 32.3%. There was no significant difference in the rate of complete response between patients with positive and negative HER-2 over-expression (P = 0.71). There was also no significant correlation between Her2 score among groups with favorable and unfavorable response to chemoradiation (P = 0.796 and 0.743). There was no difference in overall survival in Her2 positive and negative groups (3 years survival was 45 and 54 months, P = 0.32). Overall survival significantly reduced in patients with Her2 score above 100 (P = 0.045).
Her2 positive in ESCC had no effect on tumors biologic behaviors and its response to chemoradiation. Although no correlation was observed between Her2 expression and survival; Her2 score above 100 was associated with shorter survival.