Middle East Journal of Cancer
Volume:10 Issue: 3, July 2019

Odontogenic lesions range from simple cysts to benign tumors and carcinomas. Unicystic ameloblastoma is a monocystic lesion and a less aggressive tumor compared to multicystic ameloblastoma. Ameloblastic carcinoma is the malignant variant of the multicystic ameloblastoma and may arise de novo or from malignant transformation of a long-standing multicystic ameloblastoma.
We collected 54 tissue samples obtained from patients from 2000-2017 that were stored in the archives section of the Pathology Department of Taleghani Educational Hospital, Tehran, Iran. The specimens were processed for immunohistochemistry analysis. Immunostaining of the markers was assessed via quantitative methods. Statistical analysis was performed using one-way ANOVA and the chisquare test.
One-way ANOVA analysis and the chi-square test did not reveal any statistically significant differences between the expression levels of endocan, ET-1, and ETAR and lesion type. A positive correlation existed between ET-1 and ETAR expression levels in unicystic ameloblastoma and multicystic ameloblastoma (Pearson’s r = 0.506, P<0.002), and between ET-1 and ETAR expression levels in unicystic ameloblastoma and ameloblastic carcinoma (Pearson’s r = 0.376, P<0.024).
This study revealed a positive correlation between the histological degree of lesion and endocan, ET-1, and ETAR expression levels. Hence, it might suggest that multicystic ameloblastoma develops from unicystic ameloblastoma. Over time, multicystic ameloblastoma may undergo a malignant transformation to ameloblastic carcinoma. Possibly, a simple cystic neoplasm can progress to a cystic lesion with invasion to the connective tissue wall and a gradual development into a true neoplasm (multicystic ameloblastoma), with potential for malignant transformation (ameloblastic carcinoma). Endocan, ET-1, and ETAR can be used as prognostic biomarkers for different variants of multicystic ameloblastoma and possible new targets for cancer therapy.

Excess proliferation of blood cells may lead to leukemia, which is associated with structural and numerical chromosomal aberrations. Cytogenetic findings of acute lymphoblastic leukemia can be applicable in diagnosis, prognosis, and treatment selection for patients. In the present study we have evaluated molecular, cytogenetic, and immunophenotypic findings in acute lymphoblastic leukemia patients from Mashhad, a city in Northeast Iran.
This cross-sectional study enrolled 124 patients with acute lymphoblastic leukemia during 2015-2017. Two expert hematopathologists confirmed the diagnosis of acute lymphoblastic leukemia in patients’ peripheral blood and bone marrow smears. Molecular tests that included t(4;11), t (1;19), t (9;22)-190, and t (12;21) were done by reverse transcriptase real-time quantitative PCR. We performed karyotyping and immunophenotyping of the bone marrow samples. The data were analyzed by SPSS v.17.
Mean age of studied cases was 20.01 years. Participants consisted of 64% males and 36% females. Cytogenetic results showed that 23.37% of participants had a normal karyotype; the other participants had the following abnormalities: hyperdiploidy (12.06%), hypodiploidy (21.55%), pseudodiploidy (24.13%), and high hyperdiploidy (18.10%). Molecular analysis of karyotype patterns indicated that 14% of the acute lymphoblastic leukemia patients had the t(12;21), 9% with t(1;19), 2.5% with t(4;11), and 2.5% had the t(9;22).
The unique findings of the present study were the presence of previously unreported novel abnormalities. These findings might be useful for oncologists and hematologists in predicting outcome, remission, survival, and treatment response in acute lymphoblastic leukemia patients.

Combined treatment with radiotherapy and chemotherapy is the standard approach in non-metastatic anal carcinoma. Intensity-modulated radiotherapy and volumetric modulated arc therapy are currently the most accepted radiation techniques. We intend to report the clinical outcomes of patients that have been treated with volumetric modulated arc therapy concomitant with mitomycin C and capecitabine. This was a retrospective analysis of 11 patients diagnosed with anal carcinoma who received volumetric modulated arc therapy and a simultaneous integrated boost with concurrent chemotherapy. The chemotherapy protocol consisted of intravenous infusions of mitomycin C (12 mg/m2) on days 1 and 29, and oral capecitabine (825 mg/m2) twice daily with radiotherapy treatment. Most patients had stage IIIB (45.4%) disease. The majority of patients (63.7%) received a dose of 59.4Gy per 33 fractions to the primary tumor and enlarged lymph nodes (median dose: 59.4 Gy; range: 54 Gy-61 Gy). The overall treatment period ranged between 34-56 days. All patients received the planned chemotherapy protocol of two cycles with the exception of one patient who received one cycle due hematologic toxicity and intolerance. Grade 3 skin toxicity occurred in three (27.3%) patients followed by grade 3 gastrointestinal toxicities in 18.2% of patients. Grade 2 anemia (18.2%), neutropenia (27.3%), and thrombocytopenia (27.3%) were observed in eight patients. Complete response was achieved in 90.9% of patients. Patients had an overall one-year survival of 89% and overall 3-year survival of 71% (95% CI: 20.75%- 38.49%). After the median follow up period of 12 months, patients had a progression-free survival of 75% (95% CI: 21.29%-38.6%) and 2-year colostomy free survival of 68% (95% CI: 17.2%-32.1%). Volumetric modulated arc therapy is a safe and effective modality of intensity modulated radiotherapy when combined with chemotherapy (mitomycin C and capecitabine) in anal cancer patients.

Oral squamous cell carcinoma (OSCC) is the most common head and neck cancer with a continuing rise of incidence in developing countries. Despite the improvement in the clinical outcome of OSCC, the overall 5-year survival rate of patients is still disappointing. MicroRNAs (miRNAs) regulate gene expression in the post-transcriptional stage by targeting mRNAs. Advances in knowledge of the pathogenesis and molecular events lead to the improvement of OSCC treatments.
Human oral epidermoid carcinoma cells (KB), HGF1, and HEK 293T cell line were cultured. Lentiviral vectors were constructed and Western Blot analysis was performed. Then, immunocytochemistry staining was performed by using CD44 and vascular endothelial cadherin (VE-Cadherin) antibodies. All data were analyzed using the REST 2009 software. P values of ≤0.05 were considered statistically significant.
MiR-143, miR-145, and miR 590 were down-regulated in the oral cancer cell line. Following transfection of Lv miR 143, Lv-miR-145, and Lv-miR-590, the expression of CD44 was markedly decreased in KB cells. In addition, transfection of miR-143 and miR- 590 mimics into the oral cancer cell line significantly decreased the expresion level of VE-Cadherin; however, transfection of miR-145 mimic had no significant effect on the expression of VE-Cadherin. Western blot analysis and immunocytochemistry staining confirmed the results.
This study revealed that miR-143, miR-145, and miR-590 negatively regulate CD44 and VE-Cadherin (except miR-145) expression, which might play a crucial role in the induction of cancer stem cells proliferation and angiogenesis in OSCC cells. The knowledge about the involved factors may provide new insights for the clinical use of miR- 143, mR-145, and miR-590 in the treatment of patients with OSCC.

This study intended to measure radiation doses to various organs and calculate the risk of cancer incidence from neck computed tomography and head computed tomography scans of trauma patients by using a thermoluminescent dosimeter.
We assessed 93 patients who presented to the Emergency Department. Based on their health conditions, different computed tomography scans were performed. We used a fixed tube current of 200 mAs and tube voltage of 120 kVp for all patients. Next, we derived the effective radiation dose by multiplying the dose length product and conversion factor of each computed tomography scan based on the International Commission on Radiological Protection 103. Organ dose estimations were calculated from the dosimeter readout. We calculated the life attributable risk for cancer incidence based on the Committee on the Biological Effects of Ionizing Radiation VII preferred models.
Neck computed tomography scans had a mean effective dose of 2.18 mSv. The mean effective dose for head computed tomography scans was 1.53 mSv. The highest mean equivalent organ dose was for the thyroid with the neck computed tomography scan and the lenses of the eyes with the head computed tomography scan. There was no significant difference between scan lengths in each computed tomography acquisition. There was a noticeable correlation observed between effective radiation dose and tube current. As anticipated, young people had a higher life attributable risk of cancer compared to the elderly. This amount was less than 0.011 per 100 persons for both computed tomography studies.
Our data showed a significant organ radiation dose in both neck and head computed tomography scans, not only for the thyroid and the lenses of the eyes, but also for the chest.

High risk gestational trophoblastic neoplasia is considered a treatable malignancy due to recent advancements in chemotherapy. This report describes treatment outcomes as a predictor of prognosis in one institute.
We performed a retrospective analysis of the treatment results from 41 patients diagnosed with high risk and metastatic gestational trophoblastic neoplasia who received treatment at Mashhad University of Medical Sciences, Mashhad, Iran from January, 2008 to May, 2014.
Patients had a mean age of 31.31 years. Average treatment time was 3.5 months. Within the participants; 19 patients with World Health Organization scores over 7; received methotrexate at the first line of treatment. 11 cases (26.8%) of the 19 patients with single agent chemotherapy showed resistance. The patients who were resistant to treatment received a combination chemotherapy as the second line of treatment. The response rate of the etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin chemotherapy regimen as the first line of treatment was 93.7%, which decreased to approximately 83.3% when administered as the second line of treatment. There were 76.4% of cases in remission at the one year follow-up and a successful pregnancy rate of 17.5%. A statistically significant relation existed between chemotherapy response rate with disease stage, score, site, and number of metastases (P<0.05).
The World Health Organization/International Federation of Gynecology and Obstetrics staging-scoring system is appropriate for gestational trophoblastic neoplasia management. The etoposide, methotrexate, actinomycin D, cyclophosphamide, and oncovin regimen showed superior efficacy. The importance of accurate patient selection for adjuvant surgery in high risk gestational trophoblastic neoplasia cannot be emphasized.

This study sought to provide a comprehensive understanding of cancer treatment refusal based on the experiences of patients, caregivers, and health care providers.
In this qualitative research study, we enrolled 21 cancer patients, their caregivers, and health care providers. We conducted in-depth interviews of the participants to obtain the necessary data about treatment refusal. The data were coded, and data analysis was performed via the inductive analysis method.
There were three main categories in this study: “coexistence of hope and denial”, “treatment complexity and repeated complications”, and “treatment is in vain”. The first main category had five subcategories: ‘lack of symptoms, a way to denial’; ‘misconception’; ‘hope’; ‘hiding the disease’; and ‘insistence on maintaining one’s lifestyle’. Subcategories of the second main category included: ‘fear: shared experience’; ‘sign and symptom exacerbation; end of denial’; ‘duality in life quality’; ‘side-effects: a barrier to treatment’; ‘side-effect reliever’; and ‘tendency for alternative medicine’. Subcategories of the third category included: ‘degenerative course of cancer’; ‘acceptance of death’; and ‘remorsefulness: the shared experience’.
In this study, participants provided different explanations for forgoing or avoiding treatment. During the initial cancer stages, denial was an effective factor for patients to not seriously consider the appropriate diagnostic and therapeutic interventions. As the disease advanced, alternative treatments and complications were the main factors for treatment refusal. Identification of the main motives for treatment refusal during the course of the disease would be effective for cancer management.

Breast cancer is among the most prevalent types of cancers. Patients who suffer from cancer undergo many problems, including psychological complications. Acceptance and commitment psychotherapy can be used for psychological support and rehabilitation of patients with cancer. The present study investigates the effectiveness of acceptance and commitment group psychotherapy in improving the affective and psychological welfare of breast cancer patients in comparison with control cases. This study enrolled 30 female patients with breast cancer. The patients were equally randomized to an experimental group and a control group. Acceptance and commitment psychotherapy group intervention consisted of eight, 2-h sessions per month. The control group received non-therapeutic group intervention. We assessed psychological well-being at 2 time points, before and at the end of intervention. All data were analyzed by the Statistical Package for the Social Sciences. P-values less than 0.05 were considered significant. The results showed significant differences between the two groups in their mean scores of negative affect (F=18.91, P=0.000), positive affect (F=52.62, P=0.000), hope (F=59.10, P=0.000), and quality of life (F=22.12, P=0.001). Acceptance and commitment psychotherapy is a novel approach in group psychotherapy which can improve the psychological status of the patients who suffer from breast cancer.

Ethical problems routinely arise in the healthcare profession and more so in hospitals providing cancer diagnosis and care. Literature study indicates that almost all studies addressing ethical issues in cancer have been qualitative and reported from the developed countries, while there has been no study reported from developing countries. For the first time, we performed a questionnaire study to quantify the ethical issues plaguing the healthcare fraternity in the diagnosis and care of people with cancer. This prospective study was conducted under the aegis of UNESCO Bioethics Education and Research Unit of the UNESCO Chair in Bioethics, Haifa at Mangalore Institute of Oncology Mangalore, India. The investigators approached the healthcare professionals involved in diagnosis, treating, and caring for patients with cancer and ascertained various ethical issues they faced. Data were tabulated and subjected to frequency and percentage. The results indicated that discussing end-of-life issues with the patient and breaking bad news were the two most difficult ones while discussing end of life issues with family caregivers was the least. According to this study, oncology treatment involves a series of dilemmatic issues and breaking bad news. Based on the detailed studies and emphasis on handling these issues, it is possible to develop a teaching module for training the health care professionals and workers for managing the ethical issues effectively.

Thyroid nodules are frequent occurrences. This study aims to evaluate the risk of malignancy based on the 2015 American Thyroid Association Management: Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer.
In this cross-sectional study, ultrasonography and clinical manifestations were compared with pathology findings to predict the risk of malignancy in thyroid nodules. Assessment of the ultrasound findings was based on the criteria recommended by The 2015 American Thyroid Association Management Guidelines for Thyroid Nodules. For the evaluation of the association between clinical and ultrasound findings with histopathology results, we used the chi-square and Fisher’s exact tests. The relative risk and prediction of malignancy was assessed by multiple logistic regression analysis. Data analysis was performed by the SPSS19. The significance level was set at P<0.05.
From 130 patients with thyroid nodules, 110 (84.6%) were female. The mean age of participants was 46.1±11.5 years. Histopathology findings showed malignancy in 17.7% of the nodules, all of were papillary thyroid carcinoma. Multivariate logistic regression showed some of the ultrasonography parameters, absence of halo (P<0.001, OR=28), taller than wide shape (P=0.001, OR=18.3), nodule size more than 4 cm (P=0.04, OR=12.1), irregular margin (P=0.001, OR=10.06), solid or mixed composition (P=0.002, OR=8.1), hypoechoic (P=0.001, OR=4.5), lymph node positive  (P=0.002, OR=4.3), positive calcification (P=0.03, OR=2.08), positive internal vascularity (P<0.001, OR=1.05), and intermediate/high level of suspicion (P=0.001, OR=12) could predict malignancy in patients with thyroid nodules.
Based on increasing rate of thyroid cancer, in this study, the new and accurate ultrasound technique is recommended as alternative diagnostic method due non-invasive nature and lower cost used.

Cancer is among the most important causes of death worldwide. This disease is the third main cause of death in Iran. In the present study, mortality rates of Iranian men and women due to various cancers were analyzed using a database from 1990 to 2015 (in 5-year intervals), available in the Global Burden of Disease (GBD) study. For statistical modeling, Latent Growth Mixture Models (LGMMs) were used to determine the subgroups of cancers, in which cancers within each group had similar trends of mortality rates over the period of study. The LGMM identified 3 classes for both female and male data. For females, most cancers were allocated to the class with a slow increase in cancers mortality over time. Cancers in Class 2, including breast, stomach, trachea, bronchus and lung, colon and rectum, liver, brain, and nervous system, ovarian, and pancreatic had an increasing trend until 2000; then, they reached a fixed trend during 2000-2005, followed by showing an increasing trend once again. In the last class, leukemia showed a decreasing trend of mortality rate over time. For male data, most cancers were allocated to the class with a very slowly increasing trend in mortality rate over time. In both Class 2 (including bladder, brain and nervous system, liver, non-Hodgkin lymphoma, and pancreatic cancers) and Class 3 (including breast, larynx, leukemia, prostate, stomach, trachea, bronchus, and lung cancers), there was an increasing trend of mortality rate over time until 1995 and then it reached an almost stable trend during 1995-2005 followed by an increasing trend once again. Hence, the general status of cancer mortality rates shows an ascending trend. Therefore, it is necessary to provide programs for early detection, screening, preventing, public health program planning, and patient care improvement.

Myeloid or granulocytic sarcoma is an extramedullary tumor of immature granulocytic cells. This condition is rare and has a challenging diagnosis, relying on a high index of suspicion as well as radiology, histology, immunophenotyping, and molecular analyses. We herein report a case of a 25-year-old woman presented with vaginal bleeding and a large pelvic mass involving the vaginal and uterus. A biopsy and immunohistochemical examination of the mass revealed granulocytic sarcoma, and a subsequent bone marrow biopsy confirmed the diagnosis of acute myelogenous leukemia. The patient was treated based on the standard chemotherapy followed by allogeneic bone marrow transplantation from her full-matched sibling donor. After a 9-months follow-up, there was no notable complication, and the patient is now completely disease-free. Granulocytic sarcoma of the cervix is rare, and awareness of this entity is required for timely diagnosis and effective treatment.

Primary malignant sarcomas of the spine are not among common types of primary bone sarcomas. There are only few cases reported on the literature about this tumor. Ewing sarcoma occurring in the spine is divided into two types: 1) sacral spine Ewing sarcoma, which is very aggressive with poor prognosis and 2) non-sacral spine Ewing sarcoma, which is an extremely rare occurrence. The patient may present neurological deficit when the tumor extends into the spinal canal causing spinal cord compression; however, a sudden progressive paraplegia also is very rare. Here, we report a case of 8 years girl with sudden weakness and tingling in both lower limbs, inability to walk, progressive neck and upper dorsal pain, and urinary retention problem. Spinal MRI shows extradural mass from T2 to C7 with severe spinal cord compression. Urgent decompressive laminectomy and GTR of the lesion was done with excellent postoperative outcome

Oxytocin, due to its potential for modulation of cravings, is a possible alternative therapy for alcohol dependency. Management or cessation of alcohol use can increase the survival rates in cancers affected by alcohol abuse. The present study is an experimental single-case, reversal design study that has a multiple baselines and a 6- month follow-up. The study was conducted between January 2014 and November 2015. The patient was a 67-year-old man, known to abuse alcohol, who had a diagnosis of metastatic oropharyngeal squamous cell carcinoma and dysthymia syndrome. He was selected by a respondent-driven sampling method. The patient was treated with intranasal oxytocin in two stages and for six weeks. In the control phase, he used a placebo. The primary outcomes were the Addiction Severity Index results and changes to the Difficulties in Emotion Regulation Scale. The secondary outcome was the relationship between emotion regulation and addiction severity. The data were analyzed by the generalized estimation equation, linear mixed models (random effect model) with repeated measures, and correlation with repeated measures. Primary outcomes showed that intranasal oxytocin caused a significant decrease in addiction severity in its interaction with regulation of emotion. However, this reduction was not sustained until the follow-up stage. Secondary outcomes showed a direct relationship between the difficulty in controlling emotions and the severity of alcohol addiction. Oxytocin could decrease addiction severity by decreasing cue reactivity; thus, it could be considered an effective intervention in the field of addiction.