Middle East Journal of Cancer
Volume:13 Issue: 1, Jan 2022

Adenoid cystic carcinoma (ACC) of breast is a rare type of breast cancer, which belongs to the triple-negative breast cancer associated with aggressive behavior and poor prognosis. Despite being classified as triple-negative breast cancer, ACC of breast is an indolent subtype with good biological behavior, less aggressive course, good response to treatment and clinical outcomes. It has generally a good overall survival with no propensity for metastasis. Thus, a correct diagnosis could be of great importance for providing proper and adequate treatment.

Published literature was reviewed to determine differentially expressed genes that could be used as biomarkers for this disease and to elucidate the biology and carcinogenesis of ACC of breast according to this genetic profile.

Several genes were differentially expressed and were found to belong to a wide range of biological processes. The most prevalent genetic alteration is a gene translocation that produces the MYB-NF1B fusion gene and the overexpression of MYB, which initiates tumorigenesis. This crucial genetic aberration is the hallmark of adenoid cystic carcinoma. The rest of the genes are involved in cell proliferation, apoptosis, stable epithelial phenotype, tumor suppression, and keeping an intact basement membrane, evasion of epithelial-mesenchymal transition, and prevention of metastasis.

This gene expression is responsible for various biological processes that reflect the biology of ACC of breast with an indolent course and good clinical outcomes. This genetic profile impacts biomarker research and could be used to refine patient diagnosis and selection for appropriate and less aggressive treatment options.

Autophagy means self-eating and is the degradation process of cellular proteins and organelles. In cancers, autophagy has a conflicting function. While it acts as a tumor suppressor by inhibiting the accumulation of damaged organelles and proteins, it functions as an oncogene and accelerates tumor progression. The related articles in the limited period of time of 2005 to mid-2020 were reviewed through searching PubMed, Google Scholar, and Scopus database. A total of 100 articles met all the selection criteria. The articles published in the last two decades related to the role of miRNAs in regulating autophagy and metastases were selected. Both miRNAs and autophagy involve in different signaling pathways that are activated in cancers. MicroRNAs and autophagy are critical factors for prediction of prognosis in cancer patients. Significant advancement has been achieved over the last decades. The development in therapeutic strategies has improved the survival rate of cancer patients. Metastasis is a multistep process; therefore, new detection biomarkers and treatment strategies are needed.

Gastric carcinoma, in India, is the second most prevalent cause of cancer-related deaths since most patients are asymptomatic until the disease progresses to advanced stages. Hence, there is a need for non-invasive and specific biomarkers for early screening and diagnosis. Human mitochondrial DNA (mtDNA) has 37 genes involved in oxidative phosphorylation pathway (OxPhos). There are several 100 to 1000 mitochondria in a human cell and each mitochondrion has two to 10 copies of mtDNA. There is a significant association between the mtDNA copy number and an increase in risk of various cancers. There is also a relation between the changes in the sequence of mtDNA in genes, such as MT-CYB, MT-ATP6 and gastric cancer, according to which the tumor cells switch to aerobic glycolysis for ATP production even in the presence of oxygen due to Warburg effect. Multiple factors have an adverse effect on mitochondrial gene expression and impairs the OxPhos pathway due to lack of sophisticated DNA repair mechanism in mitochondria. Techniques, such as Next Generation Sequencing and Whole Genome Sequencing, are capable of early detection of copy number variants and mtDNA mutations in blood sample essential for better prognosis of gastric cancer. Through the course of this study, various reports of a correlation between mtDNA damage and gastric cancer were analyzed and it was found that the increasing evidence of the role of mtDNA and its copy number in cancer indicates its significance as a potential biomarker for gastric cancer.

Colorectal cancer (CRC) is the third most prevalent cancer with approximately 9,000 annual deaths worldwide. However, early detection can provide a high survival rate. The fecal DNA, as a non-invasive method for detecting the genetic markers, such as the TP53 gene, can be conducive to disease diagnosis. In this study, we aimed to investigate the presence of the TP53 mutations in the stool samples and their relationship with somatic mutations in the tissue samples of CRC patients from northwestern Iran. In the present cohort study, tumor and stool samples were obtained from 64 CRC patients (mean age of 60), who were undergoing surgery. Total genomic DNA was extracted from the tissue and stool samples, and TP53 mutations were detected using the PCR-SSCP method, followed by direct sequencing. Differences between mutations were observed in the tumors, and the stools were examined using the McNemar method. Of 64 CRC patients, 19 individuals (30%) demonstrated 27 point mutations in exons 5-7 of the TP53 in the tumor samples. Furthermore, analysis of the stool specimens revealed that the 22 mutations (81.5%) identified in the tumor specimens were also present in the stool of 12 patients (P = 0.063). Based on the results, the DNA from the tissue could be replaced with fecal DNA in the mutation detections for CRC. Given the non-invasive nature of fecal sampling, it can be desirable and acceptable for patients in molecular screening tests as it increases the screening rates and improves timely CRC diagnosis.

Currently, combination therapy has become the cornerstone of cancer treatment. The combination of different anticancer mechanisms can induce tumor cell quiescence. However, toxicity to normal tissue is the major limitation of existing combined drugs.

In this experimental study, Ehrlich ascites carcinoma (EAC) inoculated into mice was targeted with just one dose of cisplatin and later doses of metformin, a safe antidiabetic drug with an anticancer effect, to maintain EAC cells in the quiescent state and secure a longer survival time without tumor recurrence.

The group that underwent dual therapy developed a delayed solid tumor instead of a malignant ascites. The induction of chemo-quiescence in the EAC cells was proven by the downregulation of mechanistic target of rapamycin and the upregulation of cyclin-dependent kinase inhibitor 1 (p21) expressions. Intriguingly, the conversion of free neoplastic cells into a solid tumor was associated with a significant decrease in ΔNp63 immunostaining in EAC cells.

Taken together, a single dose of cisplatin followed by metformin doses could overcome the aggressiveness of malignant ascites by the conversion into a solid tumor, induction of chemo-quiescence, and the extension of survival time.

Colorectal cancer (CRC) is known to be the third most frequently diagnosed cancer and the fourth leading cause of cancer death worldwide. In Egypt, colorectal carcinoma is considered the 7th prevalent cancer, accounting for 3.47% of male cancers and 3% of female malignancies. A localized CRC can be entirely cured via surgical resection. Metastasis remains the leading cause of cancer mortality. IMP3 is an independent prognostic biomarker that expects metastasis and poor prognosis in CRC. The upregulation of nuclear cyclin D1 plays an essential role in pathogenesis and metastases of CRC. We aimed to investigate the expression of IMP3 and cyclin D1 in colorectal carcinoma and their correlation with other clinicopathological features.
In this retrospective cohort study, 80 formalin-fixed and paraffin-embedded blocks of CRC were obtained from the subjects. The immunohistochemical expression of IMP3 and cyclin D1 were examined and found to be correlated with clinical-pathological parameters and the outcome of the patients.
Overexpression of IMP3 and cyclin D1 was noted in 68.75% and 56.25%, respectively. IMP3 expression was significantly correlated with tumor grade (P < 0.001), tumor, node, and metastases (TNM) stage (P = 0.040), and lymphovascular invasion (P = 0.005); cyclin D1 was significantly associated with TNM stage (P < 0.001), lymph node (LN) metastasis (P < 0.001), and distant metastasis (DM) (P = 0.004); cyclin D1 was significantly correlated with TNM stage (P < 0.001), LN metastasis (P < 0.001), and DM (P = 0.004).
IMP3 and cyclin d1 were associated with poor prognosis in CRC, w hich makes them attractive targets for anticancer drug development.

Malignant lesions of the cervix are the most frequent cause of mortality and morbidity and the third most common cause of cancer deaths in women worldwide. The incidence of cervical cancer is progressively reducing due to the routine use of Papanicolaou (Pap) smears to detect precancerous and early malignant lesions. Moreover, since it is based on subjective morphological assessment, false positive or negative reports are likely to be there. Using morphometric techniques, there have been attempts to use objective parameters to improve the accuracy of reports. In the present study, we used Image Morphometric Software and some of its plugins in order to create macro-images to analyze a large number of cells at a given time and study various nuclear parameters, useful in evaluating pre-malignant and malignant cervical Pap smears.
A retrospective study was done on abnormal Pap smears. Bethesda System was used for the categorization of cervical Pap smears into premalignant and malignant lesions. Nuclear parameters were calculated employing Image-Pro 2.0 Morphometric Software. The analyzed parameters included nuclear area, perimeter, radius, and compactness. The obtained results were statistically analyzed using SPSS software version 19.0.
Nuclear area, perimeter, radius, and compactness were found to be statistically significant parameters in differentiating premalignant from malignant cervical smears (P < 0.05).
Nuclear morphometry was found to be a useful objective way and an adjunct to conventional microscopy in differentiating premalignant from malignant cervical lesions.

Basal cell carcinoma (BCC) is the most prevalent type of skin cancer in Iran. The determination of subtype of BCC plays an essential role in the diagnosis, recurrence rate, and outcome of patients. The present study was conducted to investigate the relationship between histopathologic subtypes and demographic data, history of radiation exposure, and past medical history in the Iranian population.

This retrospective cross-sectional study evaluated the patients with BCC referred to Faghihi Hospital, Shiraz, Iran from 2012 to 2017. We examined all the patients with definite histologically diagnosed scalp BCC. The prevalence of different subtypes and its association with other variables were compared between the patients with and without chronic radio-dermatitis. A P-value of less than 0.05 was considered to be significant.

A total number of 161 patients with a cumulative number of 439 BCC lesions participated in the study. The mean age of the patients was 64.2 (± 12.38) years old. Among the patients, 113 (70.2%) were men and 48 (29.8%) were women. The total prevalence of macro-nodular, micro-nodular, and mixed aggressive was 70.2%, 49.1%, and 41.6%, respectively. Multivariate logistic regression analysis showed that excessive sun exposure increased the chance of developing micronodular and mixed aggressive lesions by 3.21 (P = 0.006) and 4.88 (P < 0.001) times, respectively.

BCC was more aggressive in chronic radio-dermatitis patients than that in non-radio-dermatitis patients. Moreover, it was significantly different regarding age, gender, appearance, and job distribution compared with non-radio-dermatitis patients. Thus, we could suggest that BCC in chronic radio-dermatitis should be regarded as a high-risk disease, unless proven otherwise.

The protective role of vitamin D in the occurrence of breast cancer is nowadays a controversial matter. Based on conflicting results of the studies in this field and also considering the prevalence of vitamin D deficiency in Iranian women, this work was conducted to evaluate the association between vitamin D and breast cancer.
This matched case-control study was conducted on 70 newly diagnosed breast cancer patients and 70 controls with the same age, menopause status, and time of blood sampling in Zanjan. Information regarding demographic, reproductive, history of diseases, medication, use of dairy products, and sunlight exposure was collected using a questionnaire. The serum level of vitamin D was measured with ELISA method. The data were analyzed utilizing chi-square test, independent t-test, and odds ratios using conditional logistic regression model.
The mean level of vitamin D was 39.04 and 63.34 ng/ml in the cases and controls, respectively (P=0.046). The proportion of the cases in the highest quartile of vitamin D was significantly smaller than that in the controls compared with the lowest quartile (Ptrend=0.028). Using conditional logistic regression model, an inverse and independent association was observed between vitamin D and breast cancer after controlling main confounders. The risk of breast cancer was independently associated with body mass index and low income.
In this study, an inverse association was confirmed between vitamin D and breast cancer. Prospective intervention studies should be performed to explore its role in the prevention of breast cancer.

The importance of extracellular matrix (ECM) components in the progression of hepatocellular carcinoma (HCC) has been shown in many studies. Although restoring or activating apoptosis in tumors is an active area of cancer research, little is known regarding the effects of collagen type I, the main ECM component in the liver, on apoptosis of HCC cells. Here, we investigated the apoptotic profiles of HCC cells in a microenvironment with collagen type I.
In this in vitro study, we assessed the effects of collagen type I on HepG2 cells in pre-confluent and confluent states. We determined the mRNA levels of 25 genes, which are the key players of apoptosis. Flow cytometry-based apoptosis detection was performed by use of Annexin V/PI staining. Confocal laser scanning microscopy was used to assess P53 immunofluorescence in the cells.
The microenvironment with collagen type I and the confluency state of HepG2 cells affected the expression of 13 genes involved in apoptosis. We observed no significant change in the number of cells undergoing apoptosis depending on the confluency state or the presence of collagen type I. P53 immunofluorescence demonstrated no significant changes.
We propose an apoptotic balance concerning overall cell survival, which might be caused by the counteraction of positive and negative mediators of apoptosis. This study might provide data for the involvement of collagen type I in apoptotic responses of HCC and contribute to a better understanding of cancer microenvironment.

Curcumin is a natural polyphenolic material with antioxidative, anti-inflammatory, and anticancer effects. In this study, we attempted to assay antiproliferative and apoptotic properties of polymeric micelles of curcumin on two colorectal cancer cell lines and normal human fibroblast cells.

In this experimental study, cancer cells HT29, HCT116 and normal human fibroblast cells (HGF) were subjected to concentrations of Nano- curcumin (1, 50, 100, 250, and 500 μg/ml). After incubation for 48 hours, cell viability was assessed with "MTT"(3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide) assay. Annexin V-FITC and Propidium iodide staining were done with flow cytometry for evaluation of apoptosis. The results were shown as mean ± standard deviation. Statistical significance was assessed utilizing ANOVA and Dunnetts t-test (P < 0.01).

According to MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay results, IC50 value of Nano- curcumin in HT29, HCT116, and HGF were 70.63, 123.9, and 168.53 μg/ml, respectively. We also discovered that Nano-curcumin can make indicative apoptosis in cancer cells, which could be compared with cisplatin <0.01.

These results revealed remarkable antiproliferative and apoptotic effects of polymeric Nano-micelles of curcumin in colorectal cancer cell lines.

The CXCR4 receptor along with CXCL12 is believed to have an effect on the onset, progression, migration, and treatment complications and improve acute myeloid leukemia (AML) treatment outcomes. In this study, we investigated the impact of (7+3) chemotherapy protocol on the expression of CXCR4 and its related ligand CXCL12.
In this case-control study, specimens were collected before and after the first cycle of chemotherapy of AML-M4 and AML-M5 patients. Reverse transcription polymerase chain reaction (RT-PCR) and flow cytometry techniques tested the CXCR4 expression. ELISA was used for measuring the serum level of CXCL12. Two samples, t-test and paired t-test, were utilized for data analysis.
We found that CXCR4 expression by lymphocyte cells after chemotherapy was approximately similar to the CXCR4 expression in the healthy subjects. Moreover, CXCR4 expression was high prior to chemotherapy. The serum level of CXCL12 considerably increased in the patients before chemotherapy. However, after chemotherapy, CXCL12 was found to reach the baseline level in comparison to the healthy control group.
The (7+3) current chemotherapy inhibited CXCL12. Therefore, controlling chemokines along with chemotherapy in AML patients might be conducive to the treatment process or even prevent the relapse of the disease.

Target therapy of apoptosis signaling has been previously shown to have a therapeutic role in the treatment of head and neck squamous cell carcinoma (HNSCC). The present study aimed to investigate the safety and maximum dose of Lovastatin (80 mg/day) in additional standard therapy with cisplatin.
The current study is a phase III randomized clinical trial, conducted to determine the effect of Lovastatin on HNSCC. To eliminate the interference effect of previous treatments and surgeries, newly-diagnosed HNSCC patients were included. A total of 45 patients from May 2017 to February 2018 were enrolled. The intervention group received Lovastatin/cisplatin chemoradiotherapy and the control group received only cisplatin. All the subjects were evaluated on a weekly basis during the treatment and three and six weeks after that for related adverse events (AEs). The response rate to the treatment was assessed eight weeks following the treatment.
No significant differences were found between the two groups concerning the objective response (OR) rate (95.8% vs. 95.2%, P = 1, 95% confidence interval). In the intervention group, tumors were entirely removed in 70.8% of the subjects and partial response was seen in 25% of them. No patient was excluded due to the AEs. The gastrointestinal AE (31.1%) was the most frequent one.
In the present study, comparing the intervention and control groups, no significant differences were observed concerning OR, but unlike previous investigations, the related cardiac AEs were not seen. This observation confirmed the hypothesis that there is a possible association of Lovastatin use with better OR compared with standard chemoradiation (cisplatin) in the initial point of the treatment. However, further research is needed to investigate different doses of Lovastatin with longer follow-ups and new diagnoses of HNSCC patients.

Gestational trophoblastic diseases are treated with chemotherapy, but some patients are resistant to it and require surgeries. The role of surgery in the management of these patients is not clearly defined. This study aimed to evaluate the role of surgery in the management of patients with gestational trophoblastic neoplasia (GTN).
This cohort study was performed on patients with GTN referred during June 2009 to June 2019. The patients receiving hysterectomy, hysterotomy to remove uterine lesion, pulmonary lobectomy, craniotomy, and other surgical procedures were included in the study. The surgery indications were resistant to chemotherapy or hemorrhage.
The survival rate of the 31 patients that entered the study was 100%. The mean age of patients was 36 years. The frequency of surgeries were as follow: hysterectomy in 21 patients (67.7%), hysterotomy in six patients (19.4%), removal of lung lesion in three patients (9.7%), and craniotomy in one patient (3.2%). Among the patients, 22 showed complete response to treatment and nine patients had relative response. The relation between response to surgery with variables, such as the type of previous pregnancy, disease pathology, the scoring of disease in World Health Organization (WHO) system, the severity of disease based on The International Federation of Gynecology and Obstetrics (FIGO) stage, and the need to chemotherapy sessions, were significant.
Surgery played an important role in the management of patients with GTD. Previous non-molar pregnancy, stage, and WHO score based on clinical factors affected the response rate of treatment.

The present study aimed to evaluate dosimetrically and correlate the lung and heart dose volume histogram (DVH) of the 4 field three-dimensional conformal radiotherapy (3DCRT) with 7 field intensity modulated radiotherapy (IMRT) in patients with oesophageal cancers.
This retrospective dosimetric study considered 20 oesophagus cancer patients treated with definitive chemoradiation with IMRT technique. In the 7 field IMRT technique, the first phase delivered a dose of 36Gy/18fr followed by 18Gy/9fr in two weeks in the second phase. In the 3DCRT technique, the first phase was planned with 4 field technique with two parallel opposed and two posterior oblique fields, followed by the 3 field technique in the second phase. The assessments of the techniques were performed using differential DVH analysis of the right and left lungs, heart, and the spinal cord. The values of the mean dose, V20 (volume receiving 20 Gy), and V30 (volume receiving 30 Gy) were assessed for any correlations.
The DVH of V20 in IMRT showed 5% less lung volume irradiation compared with the 3DCRT plans and over 20% less V30 for irradiated heart volume. The study demonstrated a statistical advantage of using 7 field IMRT over 4 field 3DCRT in reducing the mean percentage dose to both lungs, heart, and spinal cord.
7 field IMRT is superior to 4 field 3DCRT plans in significantly reducing the average percentage of irradiated volume of both the lung and heart in esophageal cancer radiation therapy.

Despite significant diagnosis benefits, the usage of ionizing radiation is not risk-free. The aim of this study was to determine the risk of thyroid cancer for children who exposed to brain computed tomography (CT) scan.
In this cross-sectional study, 90 patients under 20 years of age who underwent brain CT-scan were selected. Parameters such as age, sex, imaging technique, imaging characteristics, and thyroid absorbed dose were considered. We used SPSS software, version 21, at 95% confidence interval to analyze the absorbed dose and risk for each individual.
The mean and standard deviation of absorbed doses for girls and boys for the spiral technique were 3.954±0.393 and 4.72±0.000 mGy, and in sequential technique, were 2.282±0.461 and 1.985±0.431 mGy, respectively. The mean and standard deviation of the absorbed doses in <5 years age group were 5.65±2.00, 3.03±1.34 in 6 to 10 years, 2.63±0.98 in 11 to 15 years, and in 16 to 20 years were 2.57±1.04 mGy (P < 0.001). There was a significant negative correlation between the absorbed dose and field dimensions (r = -0.604, P < 0.001) and slice thickness (r = -0.777, P < 0.001). The mean and standard deviation of Lifetime risk for thyroid cancer induction (×105) in <5 years age group in spiral technique was 158.79±322.50 for female subjects and 16.5±42.90 for male patients, which was significantly more than those of other groups and techniques (P < 0.001).
The rate of thyroid absorbed dose during brain CT-scan was found to be noticeable, especially in spiral CT imaging, for female patients < 5 years. Based on our results, it was associated with an increased risk of thyroid cancer in this age group.

The multi-state models help more closely study of the factors affecting the survival of patients with breast cancer.

We conducted the present retrospective cohort study on 2030 Iranian patients with breast cancer in 2020. The patients’ follow-up period ranged from 1 month to 15 years. Accordingly, the initial treatment, metastasis, and death were considered as the first, second, and absorbing states, respectively. The multi-state model was utilized for modeling and analyzing the data at a 95% significance level using the MSM package in R software.

The mean age (± standard deviation) of the patients included at diagnosis time was 55.3 (±12.07) years old. The first one year and 5 years adjusted transition probabilities for transitions from the treatment to metastasis estimated as 0.85 (0.15 – 0.89) and 0.45 (0.21 – 0.61), and for metastasis to death transitions, they were estimated as 0.15 (0.1 – 0.21) and 0.55 (0.41 - 0.69), respectively. Moreover, the average sojourn times were estimated as 0.27 and 74.85 months for the treatment and metastasis states, respectively.

The obtained results revealed that over time, the transition probabilities of patients from surgery to metastasis state decreased, whereas the transition probabilities from metastasis to death state increased using the multi-state model.

Respect for human dignity has been the focus of various studies on patients’ health and treatment. Despite the increasing number of cancer patients, to date, the dimensions of dignity have not been fully identified for this group. This study was conducted with the aim of the development and psychometrics evaluation of a dignity assessment questionnaire for Iranian cancer patients.
This mixed-method design with a sequential exploratory approach was conducted in Iran. In the first phase, a purposive sampling method was used to recruit the participants and the sampling continued until data saturation. The data were collected through individual semi-structured interviews. In the second phase, the validity and reliability of this instrument were assessed among 300 cancer patients.
The dignity assessment questionnaire for cancer patients included four domains and 27 items. The domains of the questionnaire were “the performance of the treatment team”, “respect for patients’ personal space”, “family support”, and “adequate equipment and facilities”. The internal consistency of the questionnaire was assessed using Cronbach’s alpha coefficient and the split-half method. To confirm the stability, test-retest was utilized and the result of the interclass correlation coefficient for the entire questionnaire was 0.94.
A dignity assessment questionnaire has been developed based on the perception and understanding of cancer patients, their family caregivers, and oncology nurses. The findings of the present study could help healthcare providers to implement a scheme with the aim of strengthening support for and better treatment and care of cancer patients.

Chromogranin is a marker that can be detected in the tissue of the neuroendocrine tumors (NET) by immunohistochemistry and as a biomarker for the diagnosis and follow-up of NET. In this study, we evaluated the correlation of prognostic characteristics of NETs (Ki67, location, and size) with the chromogranin level.

In this case-control study, we measured the serum level of chromogranin in 50 cases of NETs from different locations of the gastrointestinal tract, liver, and pancreas as well as 30 healthy individuals for one year (2016). The correlation of this level was evaluated with Ki67, size, and location of the tumors (main prognostic predictors of NETs).

The level of chromogranin in the above-mentioned 80 tumoral and healthy cases was 37 to 2585 ng/ml (242.3±439.4). The level of chromogranin in NETs and normal cases was 326.3±525.3 and 51.5±16.7, respectively. This level showed a statistically significant correlation with the Ki67 percentage and the tumor grade (P-value <0.05). There was no correlation between size and chromogranin level, but the highest level was detected in liver NETs. The cut-off level of 61.2 ng/ml correlated with the presence of NET with a sensitivity of 80% and specificity of 70%.

Chromogranin level can be used as a prognostic biomarker that is correlated with the grade of NETs and very high levels of this marker can be indicative of liver involvement. The cut-off level of 61.2 ng/ml can be considered as one of the predictors of the NET in the gastrointestinal, liver, or pancreas.

Burn and wound care process for children is very painful and distressing. Hypnosis is used as a technique to reduce pain and anxiety caused by burns in adults. Acupuncture is also applied to reduce pain and improve psychological indices. However, the effectiveness of the two treatments in children has not been compared so far. In a single-case experimental design, from October 2015 to June 2016, an eight-year-old child with acute lymphoblastic leukemia and a severe left-hand burn was selected through the purposely sampling method and was treated in the form of a reverse A1B1A2B2 design in four time intervals, including sham, acupuncture, natural hypnosis, and clinical hypnosis, and was evaluated over a 24-week period. Data were analyzed via generalized estimation equation (GEE) and Repeated Measures Correlation (rmcorr) SPSS version 22. The primary outcomes showed that hypnosis had a significant effect on pain and anxiety (all P values < 0.05) and did not have any effect on the salivary cortisol level (P = 0.93). Additionally, acupuncture had a significant effect on reducing the pain, anxiety, and cortisol levels (all P values < 0.05). Secondary outcomes revealed a significant positive correlation between pain, anxiety, and cortisol (all P values < 0.01). The results of this study, consistent with the research background, indicated the effectiveness of each treatment on specific physical and psychological indices. These results can be considered in designing appropriate therapeutic programs although the explanation of the gap between the effectiveness of the two treatments requires further studies.

Leiomyosarcoma (LMS) is an uncommon malignant mesenchymal tumor. This tumor arises from smooth muscle cells and mostly occurs behind the peritoneum area, including pelvis and uterus. Oral LMS is exceedingly rare and occurs mainly in the bones and the soft tissues. It generally involves adults, without any considerable specific age or sex predominance. This tumor has a clinically aggressive growth pattern and is usually presented as a non-ulcerated, painless, destructive mass with a relatively firm consistency. LMS can be easily mistaken for other more common spindle cell lesions by only light microscopic evaluation; consequently, immunohistochemical study is helpful for the definitive diagnosis. The suggested treatment modalities include excision, radical surgery, radiation therapy, chemotherapy. Wide surgical resection is the most preferred treatment protocol. Herein, we report a clinically controversial case of gingival LMS in a 32-year-old female and also discuss the diagnostic procedures and treatment modalities in this malignancy.