فهرست مطالب

  • Volume:9 Issue: 4, 2018
  • تاریخ انتشار: 1397/08/07
  • تعداد عناوین: 14
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  • Ebtsam R. Zaher, Abeer A. Ghazal, Wael A. Ellabban, Mona El, Deeb, Lamyaa Al, Ghaleed Pages 261-273
    Background
    Egypt has the highest prevalence of hepatitis C virus worldwide. Monitoring hepatitis C-infected patients for hepatocellular carcinoma development is an important clinical issue to diagnose these patients during the potentially curable early-stage of disease. This study aims to evaluate the role of N-terminal procollagen III, matrix metalloproteinase- 2, tissue inhibitor of matrix metalloproteinase-1, alpha-fetoprotein, and conventional liver function tests as predictors of hepatocellular carcinoma development upon long-term followup of non-responding hepatitis C virus patients.
    Methods
    The study included 850 treatment-naïve hepatitis C virus genotype 4a adult patients; after treatment, 360 achieved sustained viral response while 490 did not. Nonresponding patients had a 5-year rate for hepatocarcinogenesis of 8.4% and a 10-year rate of 27.5%. N-terminal procollagen III, matrix metalloproteinase-2, tissue inhibitor of matrix metalloproteinase-1, alpha-fetoprotein, and conventional liver function tests were evaluated in all patients before and after treatment, and after hepatocellular carcinoma development. The study also included a group of 50 hepatocellular carcinoma patients who were negative for hepatitis C and hepatitis B viruses, and a group of 50 healthy subjects as controls.
    Results
    The non-responders had significantly higher age, stage, grade, viral load, alanine aminotransferase, and aspartate aminotransferase than responders. Also N-terminal procollagen III, matrix metalloproteinase-2, tissue inhibitor of matrix metalloproteinase-1, and alphafetoprotein were significantly higher in non-responders; after treatment they decreased in responders. In non-responders they remained higher than the control. The most significant risk factors for hepatocellular carcinoma development in non-responding hepatitis C virus patients were male gender and increased age, stage, grade, aspartate aminotransferase, Nterminal procollagen III, and tissue inhibitor of matrix metalloproteinase-1. Patients with viral-hepatocellular carcinoma were of significantly lower age, higher grade, stage, γ-glutamyltransferase, N-terminal procollagen III, and matrix metalloproteinase-2 than non-viral hepatocellular carcinoma patients. Percent positive N-terminal procollagen III, tissue inhibitor of matrix metalloproteinase-1, and alpha-fetoprotein were significantly higher in viral hepatocellular carcinoma patients.
    Conclusion
    Data suggest that high N-terminal procollagen III and tissue inhibitor of matrix metalloproteinase-1levels after treatment might be particularly important as markers of hepatitis C virus-non-responding patients who are at higher risk of developing hepatocellular carcinoma, especially in older males with high stage and grade liver disease. However, studies of larger scale are needed to verify this suggestion
    Keywords: HCV, Hepatocellular carcinoma (HCC), PIIINP, MMP-2, TIMP-1, AFP, P redictive marker
  • Husam Khalil, Fawza Monem, Faizeh Al, Quobaili Pages 274-281
    Background
    The main goal of the present study was to investigate BRCA1 and BRCA2 mutations in a number of Syrian familial breast cancer cases. We included 50 early onset invasive breast cancer patients from different Syrian families (48 females and 2 males) and 20 healthy women (control group) in the study. All participants were matched for age (28 to 49 years). There were 64% of breast cancer patients who had a significant family history of breast cancer.
    Methods
    DNA was isolated from blood samples and we performed polymerase chain reaction on the isolated DNA to amplify specific target regions (hotspots): exon 2 of the BRCA1 gene and exon 11 of the BRCA2 gene. Polymerase chain reaction products were then sequenced to investigate possible genetic variations that could be present in the examined regions.
    Results
    The sequenced polymerase chain reaction products revealed 3 point mutations that included two deletions and one substitution. An exon 2 mutation was found in 2% of the breast cancer patients. Mutations of exon 11 were each found in 4% of the patient group. We detected no founder mutations. The detected exon 2 mutation was previously mentioned by other researchers and classified as a harmful mutation.
    Conclusion
    To the best of our knowledge, the detected mutations in exon 11 of the BRCA2 gene were not previously identified. A significant association existed between those mutations and the triple negative subtype of breast cancer in Syrian familial breast cancer patients
    Keywords: Familial breast cancer, BRCA1, BRCA2, Syria, Substitution
  • Rasha Hamdy Hamed, Hanem Sakr, Ahmed Lotfy Pages 282-287
    Background
    Anaplastic thyroid carcinoma is an extremely aggressive cancer that has a very poor outcome. We have analyzed predictive factors for overall survival and different therapeutic modalities that could help to determine the optimal therapy for this carcinoma.
    Methods
    We performed a retrospective analysis of data from 54 cases of anaplastic thyroid carcinoma to evaluate demographic, pathological, and clinical characteristics, along with therapeutic modalities that affected survival. The Kaplan-Meier curve was used to visualize the cumulative probability of survival and comparison among/between groups was performed with the log-rank test. A multivariate Cox proportional hazards model was used to examine overall survival.
    Results
    We observed overall survival percentages of 50% (one-year), 25% (2- year), and 5.6% (5-year). The 2-year overall survival was 41.7% for stage IVA, 31.5% for stage IVB, and 7.4% for stage IVC (P= 0.04). The 2-year overall survival rates were 59.3% for patients with negative margins, 30.1% for those with positive margins, and 0.0% in the group without thyroidectomy (P=0.005). Surgery plus postoperative radiotherapy indicated better 2-year overall survival (56%) compared to surgery alone (34.7%, Pone month, no reported metastasis at presentation, negative surgical margins, surgery, radiotherapy, and/or chemotherapy.
    Conclusion
    Anaplastic thyroid carcinoma is an aggressive cancer with a very poor prognosis. Multimodality treatment may improve overall survival in these patients. Duration of symptoms, primary tumor size, distant metastases, surgical treatment, surgical margin status, radiotherapy, and chemotherapy are independent factors that affect prognosis
    Keywords: Prognostic factors, Outcome, Anaplastic thyroid cancer
  • Parvin Mahzouni, Elham Aghili, Behnaz Sabaghi Pages 288-294
    Background
    Meningiomas are one of the most common primary brain tumors and the most common intradural spinal tumors. Vascular endothelial growth factor has been demonstrated to play an important role in the stimulation of angiogenesis in many types of cancers. Agents that block the vascular endothelial growth factor pathway, such as bevacizumab, have the capability to decrease vascular permeability. The aim of this study is to evaluate vascular endothelial growth factor expression in meningioma patients.
    Methods
    This retrospective, cross-sectional study used an immunohistochemical method to assess vascular endothelial growth factor expression in meningioma. We randomly chose 83 paraffin-embedded tissue blocks of meningiomas diagnosed during 2015 from the files of the Pathology Laboratory of Al-Zahra Hospital, affiliated with Isfahan University of Medical Sciences, Iran.
    Results
    All of the meningioma samples (100%) were vascular endothelial growth factor-immunoreactive. There was a vascular endothelial growth factor score of 1 in 6 (7.2%) cases, a score of 2 in 54 (65.1%) cases, and score of 3 in 23 (27.7%) cases. A correlation existed between vascular endothelial growth factor score and tumor grade. However, there was no correlation between vascular endothelial growth factor score and age and sex of patients.
    Conclusion
    Our study demonstrated a significant role of vascular endothelial growth factor expression in the pathogenesis of peritumoral brain edema in low- and high-grade meningiomas as well as in recurrence or malignant transformation. Thus, anti-vascular endothelial growth factor agents such as bevacizumab might be useful as a treatment of this condition.
    Keywords: Meningioma, VEFG expression, Stage
  • Ali Ariafar, Sabereh Davari, Shabnam Abtahi, Abbas Ghaderi Pages 295-299
    Background
    Bladder cancer is a prevalent disease with significant health care costs and high rates of recurrence. Results from numerous studies to associate bladder cancer with serum biomarkers have been analyzed for prognostic indicators, or to develop agents for diagnostic and therapeutic applications. Interleukin-35 is a suppressive cytokine that has a role in tumor immunity as a regulatory cytokine by suppressing T cell anticancer responses.
    Methods
    In the present study, we have investigated interleukin-35 serum levels in bladder cancer patients by ELISA, and compared these levels with a healthy comparison group, as well as among different clinicopathological subgroups.
    Results
    We observed no difference in serum levels of interleukin-35 in bladder cancer patients and healthy controls; however, bladder cancer patients diagnosed at lower stages (0a, I, II) had significantly higher levels of interleukin-35 in their sera compared to high stage (III, IV) patients (P=0.018).
    Conclusion
    Our results could indicate that interleukin-35 has no significant role in bladder cancer pathogenesis and progression. Interleukin-35 might not be a valuable biomarker for diagnosis or assessment of bladder cancer progression in clinical settings. However, further studies are needed in order to reach a definitive conclusion
    Keywords: IL-35, Bladder cancer, Serum biomarkers
  • Elham Asadinejad, Afshin Abdirad, Fatemeh Nili, Vahid Soleimani Pages 300-309
     
    Background
    Different studies have investigated the overexpression of human epidermal growth factor receptor 2 in ovarian cancers, in addition to the association between the level of its overexpression and tumor characteristics (tumor grade, subtype, stage, and prognosis). However, the prognostic significance of human epidermal growth factor receptor 2/neu dysregulation in epithelial ovarian tumors is controversial. The current study aims to assess human epidermal growth factor receptor 2 overexpression in different types and stages of epithelial borderline and malignant ovarian tumors in a population of Iranian patients.
    Methods
    We conducted this cross-sectional study on 100 patients diagnosed with epithelial borderline and malignant ovarian tumors who referred to the Cancer Institute of Imam Khomeini Hospital at Tehran between 2012 and 2014. After selection of the appropriate tissue block, we prepared slides for immunohistochemical staining with the human epidermal growth factor receptor 2 marker. Human epidermal growth factor receptor 2 positivity was evaluated and scored according to Ellis and Wolff recommendations. Cases with equivocal immunohistochemical results (score 2) also underwent chromogenic in situ hybridization.
    Results
    The most prevalent tumor in our study was serous carcinoma (54%). Human epidermal growth factor receptor 2 scores were: 0 in 69%, 1+ in 26%, 2+ in 4%, and 3+ in 1% of tumors. Chromogenic in situ hybridization examination of cases with human epidermal growth factor receptor 2 score of 2 showed negative results for human epidermal growth factor receptor 2 gene amplification. We observed no association between human epidermal growth factor receptor 2 and the level of tumor differentiation, histologic subtype, clinical stage, tumor size, and patient’s age.
    Conclusion
    Controversial results and wide range of prevalence in human epidermal growth factor receptor 2 overexpression in different studies could be due to several causes. Technical considerations, tumor heterogeneity, and lack of standard guidelines for interpretation could influence the results. We did not find any relationship between human epidermal growth factor receptor 2 overexpression and prognostic indices of grade, clinical stage or histologic subtype as many other reports. Future studies should be conducted on larger numbers of patients with different disease stages and adequate numbers of different histologic subtypes
    Keywords: HER2, Overexpression, Ovary, Borderline, Malignant, Tumor, Iran
  • Deborah Tolulope Esan, Ayodeji Akinwande Fasoro, Oluwaseun Elizabeth Olatoye, Elizabeth Funmilayo Ojo, Theophilus Olaide Esan Pages 311-317
    Background
    Breast cancer is a major global health problem in women from both developing and developed countries. As the leading cause of death among women, breast cancer has contributed 19.5% to the mortality rate among women in Nigeria. This study investigated the trend of breast cancer among women who attended Federal Teaching Hospital, Ido-Ekiti, Nigeria.
    Methods
    This retrospective study examined the trend of breast cancer over a period of eight years and determined the most affected age group. Participants consisted of patients registered in the cancer registry who had histologically confirmed breast cancer. Data of 362 patients were examined between March and April 2016. Data were analyzed and presented using descriptive (frequency, charts, and percentages) and inferential statistics (Fisher’s exact) for hypothesis testing.
    Results
    Findings of this study revealed that the mean age of the participants was 45.04±16.94 years and all patients involved were females. The age group 20-39 years was most affected by breast cancer with a proportion of 41.7%. This study revealed a relationship between breast cancer classification and age of patients (P=0.011). Almost all (94.3%) cases seen within this time period were malignant.
    Conclusion
    Healthcare professionals should place more emphasis on prevention of breast cancer across all age groups, especially young adults. These young adults constitute the larger percentage of the adult population. An increase in mortality rate in this age group will reduce the labor force and affect the nation’s economy.
    Keywords: Benign, Breast cancer, Trend, Malignant, Nigeria
  • Miganoosh Simonian, Sharifeh Khosravi, Deniz Mortazavi, Hadi Bagheri, Rasoul Salehi, Akbar Hassanzadeh, Meysam Mosallaei Pages 318-322
    Background
    Records from the cancer registry system of Iran indicate that colorectal cancer is the third most common cancer in Iranian men and fourth most common among Iranian women. In this study we have investigated the environmental factors associated with colorectal cancer in Isfahan, Iran.
    Methods
    In this case-control study, we randomly selected 187 patients with colorectal cancer who had positive results by colonoscopy and pathology (case group) and 250 persons who had negative colonoscopy results (control group) from the Colonoscopy Unit of Al Zahra Hospital and Colorectal Cancer Center of Seyed Al Shohada Hospital from 2014 to mid-2015. This study aimed to find the risk factors for sporadic colorectal cancer; therefore, we excluded patients with positive family history. Participants completed a self-administered questionnaire that asked about sex, age, body mass index, smoking status, job-related physical activity, and nonsteroidal antiinflammatory drug consumption.
    Results
    This study enrolled 187 colorectal cancer patients (98 males and 89 females) and 250 individuals without colorectal cancer (107 males and 143 females). Multiple analysis demonstrated a significant association of age (odds ratio: 1.04; 95% confidence interval: 1.02, 1.06) and body mass index (odds ratio: 1.09; 95% confidence interval: 1.03, 1.15) with colorectal cancer risk. Men had an almost two-fold risk compared with women (odds ratio: 1.85; 95% confidence interval: 1.14, 2.99). Subjects who did not use nonsteroidal anti-inflammatory drugs had an almost three-fold risk compared with nonsteroidal anti-inflammatory drug consumers (odds ratio: 0.34; 95% confidence interval: 0.19, 0.62). Analysis for job-related physical activity, also indicated an association between the no/low active group with colorectal cancer (odds ratio no activity: 36.09; 95% confidence interval: 10.94, 119 and odds ratio low activity: 2.96; 95% confidence interval: 1.43, 6.13).
    Conclusion
    Knowledge of the risk factors involved in colorectal cancer incidence makes it possible to identify people at risk and begin risk reduction strategies as well as screening programs.
    Keywords: Colorectal cancer, Risk factors, Environmental factors
  • Seyyed Alireza Golshani, Seyyed Ehsan Golshan, Mohammad Ebrahim Zohalinezhad Pages 323-327
     
    Background
    One of the great physicians in Iran who had expertise in medicine, surgery, and pharmacy was Sadid al-Din Kazeroni. He was a 14th century physician. No information is available on his birth and death – only “Al-Mughni”, a book, has been left to make him famous in surgical and medical knowledge.
    Methods
    We used desk and historical research methods in this research, with a historical approach. This commonly used research method in human sciences was used to criticize and study the birthplace and works of Sadid al-Din Kazeroni. Results and
    Conclusion
    Sadid al-Din Kazeroni discussed the exact issues in the field of anatomy, surgery, and gynecology. He was fluent in pharmacology. In his pharmacology book, for the first time, he named drugs considered necessary before and after surgery. In this study, we reviewed the biography and introduction of the works and reviewed “Al-Mughni”, a book on breast cancer.    
    Keywords: Sadid al-Din Kazeroni, Breast cancer, Anatomical illustration, Al-Mughni, Persian medicine
  • Leila Mousavi Seresht, Hamed Golmohamadzadeh, Zohreh Yousefi, Amir Hosein Jafarian, Ali Moghimi, Mojgan Soltani Pages 328-333
    Placental site trophoblastic tumor is a subtype of gestational trophoblastic neoplasm with unpredictable clinical behavior. Cytoreductive surgery is the cornerstone of treatment. The aim of this article is to present a case with an unusual site of metastases of placental site trophoblastic tumor. A 35-year-old woman was referred to the academic center of GTN as a persistent case gestational trophoblastic neoplasm for standard treatment. Based on pancreatic metastases in the patient’s work-up, she underwent cytoreductive surgery that resulted in significant improvement in her condition. Proper surgical approach of placental site trophoblastic tumor has a major role in the remission of this disease.
    Keywords: Placental site trophoblastic tumor, Gestational trophoblastic neoplasm, Pancreas metastasis
  • Malihe Hasanzadeh, Zohreh Yousefi, Amir Hosein Jafarian, Shohreh Saeed, Laya Shirinzadeh, Behrouz Davachi, Marjaneh Farazestanian Pages 334-338

    Squamous cell carcinoma is one of the common malignancies among women, especially in the third and fourth decades of life. Human papillomavirus is the most important cause of squamous cell carcinoma among women worldwide. Early diagnosis and treatment of this carcinoma can prevent disease progression. Herein, we present the case of a pregnant woman with squamous cell carcinoma. A 35-year-old pregnant woman referred to our clinic for cervical cerclage. During the procedure, the gynecological surgeon observed a suspicious lesion. Accordingly, cervical conization was performed and a squamous cell carcinoma lesion was confirmed by the pathology reports. Neoadjuvant chemotherapy was initiated for the patient during pregnancy. Radical hysterectomy and bilateral lymphadenectomy were conducted toward caesarean section. As the patient was a young fertile woman, the ovaries were saved. Although chemotherapy is not a standard treatment for cervical cancer in pregnancy, but neoadjuvant chemotherapy followed by radical hysterectomy and bilateral pelvic lymphadenectomy during cesarean section was a successful treatment in our patient.
  • Akbar Safaei, Ahmad Monabati, Maral Mokhtari, Mehdi Montazer Pages 339-343
    The emerging era of personalized medicine makes it increasingly important to consider intratumoral heterogeneity, which has been found in some breast cancer cases. However, its identification criteria, form of reporting, and subsequent effects on the clinical course of this disease remain controversial and not fully defined. Here, we report and discuss a case of breast invasive ductal adenocarcinoma with substantial intratumoral heterogeneity, discrepancy between Her2/neu immunostaining and in situ hybridization, and disparity between estrogen receptor status before and after neoadjuvant therapy.
  • Suvendu Maji, Indranil Ghosh Pages 344-347
    Non-islet cell tumor hypoglycemia (NICTH) is an exceedingly rare paraneoplastic condition and often its commonest presenting symptom is hypoglycaemia. Most cases of NICTH are associated with underlying mesenchymal or epithelial neoplasm. However our case is unique as NICTH was associated with well differentiated liposarcoma, which has never been described before. Most of the reported cases of NICTH were diagnosed on the basis of biochemical tests. However NICTH can also be a diagnosis of exclusion as highlighted by our case report. This case also highlights both the diagnostic dilemma and the surgical challenges in the management of such cases. The elderly lady presented with repeated episodes of loss of unconsciousness for which she was hospitalised twice. Her symptoms closely resembled that of a cerebrovascular accident patient. However CT brain did not reveal any brain lesion. However she also had spontaneous episodes of hypoglycaemia which led to further investigations. Ultrasonography abdomen revealed presence of huge retroperitoneal mass on FNAB which was malignant. Subsequently, she was put on dextrose drip and thorough investigations ruled out metastatic disease. She underwent laparotomy and the mass was excised enbloc. Postoperative recovery was smooth and the hypoglycaemia resoled spontaneously. Final histopathologic examination was suggestive of well differentiated liposarcoma. At the 6-month follow-up, she was free from hypoglycemic episodes. This case highlights that NICTH can be a difficult diagnosis given its propensity to mimic several other benign conditions. NICTH can also be caused by liposarcomas. Diagnosis by excluding all other causes of hypoglycaemia is also an option where costly biochemical tests are unavailable. Surgical excision is the main stay of treatment.
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