فهرست مطالب

  • Volume:10 Issue:4, 2019
  • تاریخ انتشار: 1398/07/09
  • تعداد عناوین: 14
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  • Hanaa A. Atwa, Hanan Lotfy Mohammed, Ihab Matar, Heba F.Taha, Salem Youssef Mohamed* Pages 281-291
    Background

    Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Pathologic differentiation between HCC from metastatic carcinoma and cholangiocarcinoma has critical therapeutic implications. However, it is occasionally challenging and sometimes requires immunohistochemical panels. Recently, Arginase1, MOC-31, and CDX2 have been introduced for the differentiation of these tumors. This study was conducted to determine the value of expression of Arginase-1, MOC31, and CDX2 in differentiating primary carcinoma of the liver from cholangiocarcinoma and metastatic adenocarcinoma to the liver.

    Methods

    50 cases of HCC, 20 cases of metastatic colonic carcinoma to the liver, and 10 cases of cholangiocarcinoma were evaluated for immunohistochemical expression of Arginase-1, MOC-31, and CDX2.

    Results

    Arginase-1 was positive in 45 (90%) of HCC cases and negative in metastatic carcinoma and cholangiocarcinoma cases. MOC-31 was positive in 19 (95%) of metastatic colonic adenocarcinoma cases and 10 (100%) of cholangiocarcinoma cases, while it was negative in HCC cases. CDX2 was positive in 18 (90%) of metastatic carcinoma cases while it was negative in cholangiocarcinoma cases. The sensitivity of Arginase-1 for HCC, MOC-31 for MC, and CDX2 for metastatic colonic carcinoma in the studied groups was 95%, 100%, and 98%, respectively, whereas its specificity was 100%, 96.7%, and 60%, respectively. The difference of Arginase-1, MOC31, and CDX2 expressions in HCC, cholangiocarcinoma, and metastatic colonic adenocarcinoma were statistically significant (P<0.001).

    Conclusion

    Our study revealed that Arginase-1, MOC-31, and CDX2 expression are suitable IHC markers in the differential diagnosis of HCC, cholangiocarcinoma, and metastatic colonic adenocarcinoma.

    Keywords: Arginase-1, MOC31, CDX2, Hepatocellular carcinoma (HCC), Cholangiocarcinoma (CC), Metastatic colonic carcinoma
  • Mohsen Farhangian, Frouzan Azarafrouz, Hossein Fallahi, Hassan Akrami* Pages 292-298
    Background

    Cancer stem cells (CSCs) harbor the self-renewal properties of the embryonic stem cells in addition to differentiation. While maintaining the balance between self-renewal and differentiation is required for homeostasis, dysregulation in the stem cell signaling pathways such as Notch signaling increases the proliferation of these cells. As a result, tumorigenic properties are obtained. Therefore, it appears that by targeting the CSCs, the generation of new cells could be reduced and the tumor could be contained. Ibuprofen is one of the nonsteroidal anti-inflammatory drugs that are in use to control pain and inflammation. They inhibit cyclooxygenase 1, 2 (COX1,2) activity and synthesis of prostaglandins. Recent studies have provided some evidence for the anti-tumor activities of NSAIDs through inhibition of cell proliferation.

    Methods

    In this study, we investigate the changes in the expression patterns of two key genes, i.e., DLL1 and NOTCH1, which are involved in the Notch signaling pathway in the MKN-45 derived gastric CSCs treated with ibuprofen.

    Results

    Our results showed that ibuprofen up-regulates the expression of the DLL1 gene (4.1 fold) and reduces 68% the transcript level of the NOTCH1 gene (Pvalue < 0.05). These findings show that in gastric CSCs, NOTCH1 gene may act as an oncogene and, conversely, DLL1 gene may act as a tumor suppressor gene.

    Conclusion

    Our findings suggest that ibuprofen, by targeting CSCs, may be used as an adjuvant chemotherapy drug to improve gastric cancer treatment outcomes.

    Keywords: Notch signaling pathway, Nonsteroidal anti-inflammatory drugs (NSAIDs), Gastric cancer, Cancer stem cells (CSCs)
  • Zahra Shiri, Reza Mansouri, Mohammad Reza Haghshenas, Abdolrasoul Talei, Nasrollah Erfani* Pages 299-304
    Background

    We investigated the possibility of an association between the C-2383T polymorphism (rs3761549) in the promoter region of the FOXP3 gene with breast cancer.

    Methods

    The study groups consisted of 250 women diagnosed with breast cancer (case group) and 250 healthy women (control group). Polymerase chain reactionrestriction fragment length polymorphism was performed for genotyping.

    Results

    Breast cancer cases had a C allele frequency of 455 (91%) and T allele frequency of 45 (9%). The control group had a C allele frequency of 468 (93.6%) and 32 (6.4%) for the T allele. The CC genotype was present in 206 (82.4%) patients, 43 (17.2%) patients had the CT genotype, and the TT genotype was observed in 1 (0.4%) patient. In the control group, 219 (87.6%) had the CC genotype, whereas 30 (12%) had the CT genotype, and 1 (0.4%) had the TT genotype. Statistical analysis revealed no significant differences in the distribution of alleles and genotypes between patients and controls (P>0.05). There was no significant association between genotype distribution and patients' clinicopathological factors.

    Conclusion

    Our results do not support an association between the FOXP3 -2383 C/T polymorphism and breast cancer in a population from southern Iran.

    Keywords: Breast cancer, FOXP3 gene, Single nucleotide polymorphism, PCR-RFLP
  • Mohammad Hadi Sadeghian, Hosein Ayatollahi, Seyyede Fatemeh Shams, Zahra Rezaei Dezaki♦ Pages 305-313
    Background

    Acute myeloid leukemia (AML) is a heterogeneous disease characterized by increasing immature blood cells in the bone marrow. Aberrant expression of specific genes is a common finding in AML. The proto-oncogene EVI1 is located in a 3q26 position that encodes a zinc finger protein. In the present research, we analyzed the expression of EVI1 gene in 88 Iranian patients with AML.

    Method

    This case-control study was performed in the Cancer Molecular Pathology Research Center of Mashhad University of Medical Sciences. Total RNA was extracted from the bone marrow or peripheral blood mononuclear cells of 88 AML patients and the same number of healthy cases. The expression level of EVI1 was investigated by real-time polymerase chain reaction (RT-PCR). Relative quantification analysis was performed by comparative CT (2−ΔΔCT) method.

    Results

    AML patients expressed a high level of EVI1 (32.95%). In addition, a statistically significant relationship was detected between t (8;21) and EVI1 expression (P=0.049). No correlations were found between EVI1 expression and FAB (French American British) classification, and also between FLT3-ITD mutation and white blood cell count (P =0.6). Furthermore, no correlations were found between the level of EVI1 expression and overall survival (P=0.72).

    Conclusion

    Although EVI1 is highly expressed in peripheral blood mononuclear cells of AML patient, it cannot be considered as an independent prognostic factor.

    Keywords: EVI1 Gene, Acute myeloid leukemia, Quantitative real-time PCR
  • Bahram Eshraghi, Mansooreh Jamshidian Tehrani*, Seyed Mohsen Rafizadeh, Hadi Ghadimi, Maral Mokhtari, Morteza Naderan, Fahimeh Asadi Amoli, Zohreh Nozarian, Abolfazl Kasaee Pages 314-318
    Purpose

    The present was conducted to measure the sensitivity and specificity of imprint cytology (IC) and frozen section (FS) in the evaluation of margin involvement of periocular basal cell carcinoma (BCC).

    Methods

    This cross-sectional study was conducted on 36 patients who underwent an excisional biopsy of periocular BCC. The surgical margins of each excised mass were tested for involvement by tumoral cells using three pathologic methods as follows. Samples were obtained for IC from the marginal territory of the tumor. Then, FS samples were obtained and the tissue was prepared for permanent histopathologic evaluation, the results of which were considered as the gold standard to compare two other methods. Sensitivity, specificity, positive predictive value, and negative predictive value of each method were calculated accordingly.

    Results

    Thirty-six patients (20 males and 16 females) with the mean age of 73±12 years who had periocular BCC were enrolled and a total of 121 samples were obtained from the margins. The sensitivity and specificity of FS were 94.3 and 97.7% and of IC were 51.4 and 84.9%, respectively. Also, Positive and negative predictive value for FS were 94.3 and 97.7 and for IC were 58.1 and 81.1%, respectively.

    Conclusions

    Although less expensive and more feasible than FS, IC lacks diagnostic accuracy for demarcating the extent of resection of eyelid BCC.

    Keywords: Basal cell carcinoma, Eyelid tumors, Frozen section, Imprint cytology
  • Negin Farshchian*, Maral Soleimani, Sahel Heydarheydari, Nazanin Farshchian Pages 319-323
    Background

    Neutrophil-lymphocyte ratio (NLR) is derived from the neutrophil and lymphocyte count obtained from routine complete blood count with the differential test (CBC/diff). The aim of the present study is to determine the relationship between NLR with prognostic factors in colorectal cancer.

    Material and Methods

    A total of 70 patients with colorectal cancer were studied according to the research objectives. Independent T-test and Mann-Whitney U Mann- Whitney test were used to compare the NLR with qualitative variables such as pathology type. Pearson or Spearman correlation coefficient was used for correlating the quantitative variables. The significance level was considered as P<0.05.

    Results

    Most of the enrolled patients were in the age group of 60-69 years (31.5%). The mean and standard deviation of NLR was 2.1 ± 0.1. Only 4.3% of the subjects had NLR greater than 5. The association between NLR with N-stage (P=0.005) and inflammatory factor (CRP) was statistically significant (P = 0.016). The correlation between NLR and these variables showed that Grade (P=0.091), PNI (P=0.093), LDH (P=0.20), diabetes (P=0.264), M-stage (P=0.282), ESR (P=0.386), LVSI (P=0.473), T-stage (P=0.527), CEA (P=0.582), and BMI (P=0.681) with NLR was not meaningful.

    Conclusion

    NLR can be associated with prognosis and risk of disease progression, especially in lymph nodes. Since NLR does not require additional testing and request and is quite easy and cost-effective, it is recommended considering this ratio during the initial assessment and the classification of the risk and stage of the disease.

    Keywords: Colorectal cancer (CRC), Neutrophil-lymphocyte ratio (NLR), PrognosticFactor
  • Veenita Yogi*, Om Prakash Singh, Pallavi Redhu, Bibin Francis Pages 324-332
    Background

    Extranodal non-Hodgkin lymphoma (ENL) occurs in 25-40% of non-Hodgkin lymphoma (NHL) patients. The objective of this study is to analyze the incidence, anatomical distribution, histopathological subtypes, prognostic factors, and the impact of the site on behavior and treatment response of extranodal lymphoma.

    Methods

    In this retrospective analytical study, 84 out of 379 NHL patients diagnosed with ENL were included. The patients were treated via predominantly chemotherapy and/or field external beam radiotherapy.

    Results

    The mean age of these 84 patients was 42.5 years (range 4-80 years). The leading site of ENL involvement was head and neck in 35 (41.66%) patients. Diffuse large B-cell lymphoma was the most common histological type in 46 (54.76%) patients. The median follow-up was 72.3 months (range 3.2-132.4 months). The CR was achieved in 40 patients (47.6%), PR was achieved in 22 (26.2%) patients, and NR was observed in 22 (26.2%) patients. Highest mean PFS, observed in GIT malignancies, was 68.4 months (54-82.8), overall mean progression-free survival (PFS) was 73.2 months (61.3-85.1) (P=0.369), and mean overall survival was 88.4 months (82-94.7) with a P-value of 0.014, which was statistically significant.

    Conclusion

    Based on the results of this study, it is concluded that extranodal NHL accounts for almost 25% of all NHL. Hence, before the initiation of treatment, all the NHL cases should be properly investigated and staged. Extranodal NHL responded well to chemotherapy as NHL. Furthermore, it was observed that treatment with field external beam radiotherapy results in an increase in the levels of progression-free survival and overall survival.

    Keywords: Extranodal non-Hodgkin’s lymphoma (ENL), Chemotherapy, Involvedfield radiotherapy, Site of involvement, Prognosis
  • Hourieh Ansari, Mohammad Nouranian, Ali Hajigholami*, Ahmad Mahmudian Pages 333-340
    Background

    Fatigue, as one of the most common side effects of cancer and its associated treatments, induces a distressing, persistent, and inward feeling. This study aimed to investigate the synergistic effect of the omega-3 supplement as an unconfirmed effect on conventional ginseng treatment with a possible effect on this side effect in cancer patients.

    Method

    This clinical trial was conducted in 2018 on 70 cancer patients referring to outpatient clinics affiliated to Isfahan University of Medical Sciences. Patients were included in the study by the convenience sampling method and were randomly divided into control and intervention groups. Patients in the treatment group received an omega-3 supplement and usual treatment. For patients in the control group, only the usual intervention was administered. Data were collected using the Multidimensional Fatigue Inventory questionnaire. The duration of intervention was 6 weeks. The primary outcome was the improvement of fatigue scores measured by the questionnaire.

    Result

    There was a significant difference in both groups concerning the mean total fatigue score in three times; i.e., 0, 3, and 6 weeks after the intervention (P <0.001). Mean value of total fatigue score at the beginning of the study was 77.8±6.6 in the intervention group and 76.8±9.7 in the control group. After 3 weeks of the study, it was 49.2±6.8 and 57.5±9.5 and after 6 weeks it was 25.3±7.8 and 37.2±8.4 in the intervention group and in the control group, respectively.

    Conclusion

    This study revealed that omega-3 supplement can reduce cancerrelated fatigue in outpatient cancer patients compared with the control group.

    Keywords: Cancer-related fatigue, Omega-3 supplement, Chemotherapy, RCT
  • Fahimeh Rezazadeh, Soleiman Mohammadi Samani, Fatemeh Talei, Mani Ramzi, Hajar Ashrafi, Zahra Emami* Pages 341-349
    Background

    Oral mucositis is one of the painful, debilitating and common complications in the patients under chemotherapy for which no certain and effective treatment has not been considered. The aim of this pilot study was to evaluate the efficacy of phenytoin mucoadhesive tablets on treating oral mucositis compared with phenytoin mouthwash.

    Methods

    In this clinical trial, after preparation and in vitro characterization of phenytoin mucoadhesive tablets, 27 patients were enrolled from oncology department of Nemazee Hospital, Shiraz, Iran. 21 patients with oral mucositis, who had the inclusion criteria due to chemotherapy, were divided into two groups of A (11 patients received phenytoin mouthwash 0.5%) and B (10 patients received phenytoin mucoadhesive tablet). Severity of oral mucositis (WHO grading), oral pain Visual Analogue Scale and the extension of lesions (number of involved sites) were assessed on three intervals (at the beginning and one or two weeks after beginning of the study).

    Results

    In the first visit, there was no significant statistical difference between the two groups regarding mean age, mucositis severity and visual analogue scale. However, on first and second weeks after beginning of the study, mucositis severity, extension of lesion and visual analogue scale in both groups were significantly lower than onset of the treatment; however, no significant difference between the two groups was observed.

    Conclusions

    Phenytoin mouthwash and mucoadhesive tablets used for oral mucositis care in patients after chemotherapy showed significant improvement in the lesions. Patients were more satisfied with mouthwash and all the patients in this group were free of lesion after two weeks.

    Keywords: Mucositis, Phenytoin, Mucoadhesive, Mouthwash
  • Parvaneh Abazari, Maryam Ehsani*, Fariba Taleghani, Simin Hematti, Azadeh Malekian, Fariborz Mokarian, Sayyed Mohammad Reza Hakimian Pages 351-361
    Background

    The present study was conducted to investigate the effect of implementing domestic truth-telling protocol on stress, anxiety, and depression in cancer patients.

    Method

    In this study, a semi-experimental design was used to examine the effect of truth-telling protocol implementation on psychological factors (i.e., stress, anxiety, and depression) in cancer patients. A total of 60 cancer patients participated in this study, 30 of them in the intervention group (who informed their disease with truth-telling protocol) and 30 others in the control group (who informed their disease with usual way and without protocol). Patients’ psychological factors were compared in intervention and control groups, three and eight weeks after the cancer disclosure by depression, anxiety, and stress scale-21.

    Results

    In this study, except higher stress level of patients in intervention compared to the control group, no statistically significant difference was seen in other variables three weeks after cancer disclosure (P=0.046, Z= -1.99). Eight weeks after the intervention, all variables were significantly lower in the intervention group (P=0.000, Z=-5.864; P= 0.000, Z=-0.651; P=0.000, Z=-5.351).

    Conclusion

    Exercising truth-telling practice through implementing a localized culture-based protocol, especially after passing the initial acute phase of hearing the bad news, can lead to improved psychological factors in cancer patients.

    Keywords: Truth-telling, Domestic protocol, Cancer, Breaking bad news
  • Elahe Askarzade, Amin Adel, Hosein Ebrahimipour, Shapour Badiee Aval, Elahe Pourahmadi, Akbar Javan Biparva* Pages 362-371
    Background

    Third leading cause of mortality in the world is cancer, with more than 12 million new cases and nearly 7.6 million deaths in 2007. The time estimation of healthcare costs of patients with cancer is an important component in developing national programs and policies of cancer. The present study aimed to investigate the epidemiology and costs of hospitalization of patients with cancer who were admitted to a regional referral center of the eastern Iran.

    Methods

    The present research was descriptive and had a cross-sectional and population-based design. It was conducted on all patients with cancer in a regional referral center in eastern Iran in 2018. The files of hospitalized cancer patients with disease codes of C0 to D48/9 and all patients who were admitted to the center for the treatment of cancer in 2018 and those who were discharged, were extracted and classified based on international codes of ICD10. Costs of the present study consisted of four categories including direct costs of cancer patients, direct costs of admission due to the cancer, direct outpatient costs, and indirect costs. Statistical data analysis was done by using criteria such as frequency, mean, and standard deviation through STATA Version 11.

    Results

    During the study, 1467 cancer patients were referred to Omid Hospital of Mashhad. Among them, 49.9% were males and 50.1% were females. 183 patients were in age range of 56-60 years. The highest prevalence and hospitalization were related to cancer of gastrointestinal organs (36%), and the highest hospital cost belonged to cancers involving bone, cartilage and joints (51.855 USD). The total cost of treating cancer patients was 1074990 USD and the average cost of cancer patients was 73278 USD per patient. Hoteling with a portion of 28% comprised the highest cost. The patients’ share of out of pocket payment for treatment cost was 7% and the governmental share was 6%. The highest cost of treatment for cancer patients was paid by insurance companies (87%).

    Discussion

    The research results indicated that cancer patients bore high direct and indirect costs during their treatment; hence, new policies for reducing costs in these cases are needed. The increasing number of cancer patients and their treatment costs requires the active participation of all responsible organizations along with continuing financial support by financial institutions such as banks or charities and the development of appropriate government policies on supporting these patients.

    Keywords: Epidemiology, Direct, indirect costs, Cancer
  • Sanjay Kumar Yadav, Chandan Kumar Jha, Saroj Kanta Mishra*, Ritu Verma, Abhishek Krishna Pages 372-377

    Adrenocortical carcinoma (ACC) is a very rare disease in the pediatric age group. The clinic-biological profile, histopathological criteria of diagnosis, and staging of this disease in this age group are different from those of adult ACC. In this paper, we report a case of pediatric ACC presenting as Cushing syndrome that was managed with complete surgical excision. Through this case presentation, we highlight the sequential protocol of investigations and management in a child suspected of having ACC.

    Keywords: Pediatric ACC, Cushing’s syndrome
  • Sant Prakash Kataria, Namita Bhutani*, Gajender Singh, Sanjay Kumar, Rajeev Sen, Sandeep Yadav Pages 378-383

    Most common sites of metastasis from breast cancer are the lungs, bones, liver, and brain. Although metastasis to the uterus from breast cancer is uncommon, there have been some case reports on uterine metastasis. Among them, myometrium is involved more frequently comparing to endometrium. The majority of breast cancer metastases to endometrium are lobular type, and there have been only 7 reported cases of ductal type since 1984. In this study, a new case of invasive ductal carcinoma with metastases to endometrium and isolated presentation of abnormal uterine bleeding is described. If an endometrial abnormality is detected, the differential diagnosis of whether the uterine tumor is metastatic or primary is very important to determine the course of treatment. Atypical bleeding in patients with known breast carcinoma should prompt screening for endometrial metastasis by a gynecologist. Metastasis to the uterus carries a grim prognosis. We herein report a case in which we detected a uterine tumor during followup after treatment with tamoxifen, and demonstrate that GCDFP-15 is useful in diagnosing metastatic uterine tumors arising from breast cancer.

    Keywords: Breast carcinoma, Invasive Ductal Carcinoma, Menorrhagia, Tamoxifen, Uterine metastases
  • Nasrin Namdari*, Negar Azarpira Pages 384-388

    Tumor lysis syndrome is caused by the massive lysis of tumor cells. It frequently occurs in rapidly proliferating malignancies and less often after solid tumor treatment. Spontaneous tumor lysis syndrome is extremely rare and only occurs in bulky, advanced, and metastatic tumors. Electrolyte abnormalities in tumor lysis syndrome could be life-threatening without prompt recognition and treatment. In this case, we present a spontaneous tumor lysis syndrome in a 22-year-old man with primitive neuroectodermal tumor. When managing bulky, advanced solid tumors, especially with liver metastasis, cautious observation should be sought because of the possibility of spontaneous tumor lysis syndrome.

    Keywords: Spontaneous tumor lysis syndrome, Solid tumors, PNET