Ovarian ectopic pregnancy misdiagnosed as gestational choriocarcinoma: A case report.

INTRODUCTION: and importance: Choriocarcinoma is a highly malignant epithelial tumor with often distant metastasis. The clinical presentation of choriocarcinoma depends upon extend of disease and location of metastasis. CASE PRESENTATION: A 35-year-old multiparous woman was presented with severe pelvic pain, fatigue and cough. She was diagnosed with positive pregnancy due to elevated B-hCG and hyperechoic mass in right adnexa. CLINICAL DISCUSSION: Exploration surgery showed a larger mass on the right ovary. She was diagnosed with choriocarcinoma however CT scan showed metastasis of lungs, brain and pelvis. She underwent multiple session of chemotherapy, nonetheless, after 8 months, she passed away. CONCLUSION: Timely diagnosis and prompt treatment of choriocarcinoma is necessary to prevent mortality and bad prognosis. It should be differentially diagnosed with all the types of pregnancies.

COVID19 Prevention & Care; A Cancer Specific Guideline.

On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.

Estrogen Receptor Expression in Glial Tumors of Iranian Patients: A Single Center Experience.

BACKGROUND & OBJECTIVE: Gliomas are the most common type of primary intracranial tumors in adults. The expression of estrogen receptors varies in different grades of glial tumors, and some studies have suggested that this expression might have a prognostic value. It seems that estrogen receptor expression negatively correlates with the histological grade of gliomas. In the present study, we aimed to determine the expression of estrogen receptor in different glial tumors in Iranian patients and to find a possible correlation between its expression and the grade of glial tumors. METHODS: The brain tumors pathology reports from 2014 to 2017 in the Pathology Department of Shohaday-e Tajrish Hospital in Tehran, Iran were evaluated and 104 different gliomas: 79 cases of astrocytoma and 25 cases of oligodendroglioma were selected. All the samples were re-evaluated by a neuropathologist in order to accurately determine the tumor grade. The immunohistochemistry was carried out to detect the expression of estrogen receptor alpha and beta on brain tumors. RESULTS: None of the samples expressed estrogen receptor alpha. In the case of estrogen receptor beta (ERß), all samples showed various degrees of positivity: 9% weak, 40% moderate, and 51% strong expressions. The level of ERß expression was found to be conversely correlated with tumor grade. CONCLUSION: Our study demonstrated that ERß is expressed in the majority (if not all) of the glial tumors and its expression was conversely related to the tumor grade. Because of well-tolerability and acceptable adverse effects, ER agonists might be considered as therapeutic agents for the patients with glial tumors.

Findings of DTI-p maps in comparison with T2/T2-FLAIR to assess postoperative hyper-signal abnormal regions in patients with glioblastoma.

PURPOSE: The aim of this study was to compare diffusion tensor imaging (DTI) isotropic map (p-map) with current radiographically (T2/T2-FLAIR) methods based on abnormal hyper-signal size and location of glioblastoma tumor using a semi-automatic approach. MATERIALS AND METHODS: Twenty-five patients with biopsy-proved diagnosis of glioblastoma participated in this study. T2, T2-FLAIR images and diffusion tensor imaging (DTI) were acquired 1 week before radiotherapy. Hyper-signal regions on T2, T2-FLAIR and DTI p-map were segmented by means of semi-automated segmentation. Manual segmentation was used as ground truth. Dice Scores (DS) were calculated for validation of semiautomatic method. Discordance Index (DI) and area difference percentage between the three above regions from the three modalities were calculated for each patient. RESULTS: Area of abnormality in the p-map was smaller than the corresponding areas in the T2 and T2-FLAIR images in 17 patients; with mean difference percentage of 30 ± 0.15 and 35 ± 0.15, respectively. Abnormal region in the p-map was larger than the corresponding areas in the T2-FLAIR and T2 images in 4 patients; with mean difference percentage of 26 ± 0.17 and 29 ± 0.28, respectively. This region in the p-map was larger than the one in the T2 image and smaller than the one in the T2-FLAIR image in 3 patients; with mean difference percentage of 34 ± 0.08 and 27 ± 0.06, respectively. Lack of concordance was observed ranged from 0.214-0.772 for T2-FLAIR/p-map (average: 0.462 ± 0.18), 0.266-0.794 for T2 /p-map (average: 0.468 ± 0.13) and 0.123-0.776 for T2/ T2-FLAIR (average: 0.423 ± 0.2). These regions on three modalities were segmented using a semi-automatic segmentation method with over 86% sensitivity, 90% specificity and 89% dice score for three modalities. CONCLUSION: It is noted that T2, T2-FLAIR and DTI p-maps represent different but complementary information for delineation of glioblastoma tumor margins. Therefore, this study suggests DTI p-map modality as a candidate to improve target volume delineation based on conventional modalities, which needs further investigations with follow-up data to be confirmed.

Investigating Esophageal Stent-Placement Outcomes in Patients with Inoperable Non-Cervical Esophageal Cancer.

Background: Esophageal stent insertion in patients with inoperable esophageal cancer is usually accompanied with relatively high adverse symptoms and even mortality. The current study aims at investigating the outcomes of esophageal stenting in patients with inoperable non-cervical esophageal cancer. Materials and Methods: The current descriptive-analytical research evaluates 25 patients with esophageal cancer. The stent was placed in esophagus based upon endoscopy analysis with or without fluoroscopy and then the stent position and its opening was investigated by making use of CXRand Gastrografin studies. Demographic characteristics, dysphagia scores, stent placement side effects and the dysphagia-related indices were recorded and examined by taking advantage of a questionnaire which was administered pre and post stent insertion. Results: The study population was comprised of 15 women and 10 men. The individuals' average age was 69.20 ± 11.25 years. Dysphagia mean score was lowered from a value of 4.32 ± 0.80 to 2.00 ± 1.22 (P-value<0.05). The prevalent side effects were chest pain (64%), dysphagia recurrence (40%), stent blockage (20%), stent migration (16%), GI bleeding (8%), and malposition (8%). Also, it was found out that 64% of the patients survived for 6 months. Conclusion: The results indicated that although esophageal stenting is accompanied with side effects in patients with inoperable esophageal cancer, but it is the most frequently used and the most reliable method in relieving dysphagia and improving dysphagia-related life indices.

An overview of neuro-oncology research and practice in Iran, three years with the NOSC initiative.

Research and practice of neuro-oncology compiles clinical neuroscience expertise from neurosurgery, radiation oncology, neuroradiology, medical oncology, neuropathology and related disciplines to optimize planning and therapy in central nervous system malignancies. Such an interdisciplinary context prompted health-care providers from all related disciplines to establish the Neuro-Oncology Scientific Club (NOSC) in Iran and let it flourish since 3 years ago. With the advent of advanced technologies and through continued share of experience, NOSC members have tried to provide more integrated diagnoses and therapeutic care to brain tumor patients across the country. NOSC activities revolve around some key tenets including dissemination of education and updates, facilitation of institutional collaborations; data registry and patients' awareness. By virtue of recent insights on molecular characterization of brain tumors such as codeletion of chromosomes 1p and 19q in anaplastic gliomas and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in glioblastoma, a range of translational research is being followed within NOSC. The most recent NOSC meeting which was held in Tehran, recapitulated main advances and dealt with the current debates on functional neurosurgery, biological markers and neuroimaging, risk prediction models in high grade gliomas and clinical issues in pediatric neuro-oncology. This article gives an overview of current hotspots in neuro-oncology research and practice which are pursued within NOSC.

Adaptation of a quality of life questionnaire for Iranian patients with esophageal cancer.

INTRODUCTION: Evaluation of quality of life is very important in cancer patients. Esophagus-specific quality of life questionnaire (QLQ-OES18) is a disease-specific questionnaire for assessing quality of life in esophageal cancer (EC). So we aimed to translate and evaluate the reliability and validity of the QLQ-OES18 when applied to Iranian patients. MATERIALS AND METHODS: This study was designed as cross-sectional study on 62 newly confirmed EC in two referral hospital in Tehran, Iran. Reliability of the subscales was evaluated by intraclass correlation coefficients. Pearson's correlations of an item with its own scale and other scales were calculated to assess convergent and discriminant validity. Clinical validity was also evaluated by known-group comparisons. RESULTS: Cronbach's alpha was higher than 0.7 in most subscales. All subscales met the standards of convergent and discriminant validity. Also QLQ-OES18 had discriminatory power for differentiation between patient's groups with different clinical status. CONCLUSION: Our results provide evidences that Persian version of QLQ-OES18 is a valid and reliable questionnaire when applied to a sample of Iranian patients with EC and is recommended for use in clinical research.

Metabolic syndrome and colorectal cancer: a cross-sectional survey.

INTRODUCTION: There is epidemiological evidence indicating that the metabolic syndrome increases the risk of colorectal cancer. Since there is little information about this issue in Iran, the present study was conducted to evaluate prevalence of metabolic syndrome and its components in patients with colorectal cancer. MATERIAL AND METHODS: This cross-sectional survey involved 200 patients with a new diagnosis of colorectal cancer. Demographic information of patients was collected through the interview with them. Components of metabolic syndrome including fasting glucose serum, triglyceride, high density lipoprotein, blood pressure and waist circumference were measured for all of the patients. RESULTS: A total of 72 colorectal cancer patients (36%) met metabolic syndrome criteria with rates of 76% for women and 24% for men. BMI in metabolic syndrome patients was higher than other colorectal cancer patients. Disease history including hypertension, diabetes and cardiovascular disease was most frequent in metabolic syndrome patients. Pathological characteristics of colorectal cancer were not significantly associated with the disease. CONCLUSION: The findings of present study indicated that the prevalence of metabolic syndrome in CRC patients is relatively high. Therefore, further analytical and multi centric studies are needed to better understand the role of metabolic syndrome in development of CRC in Iran. If this association is confirmed in future studies, metabolic syndrome patients should be considered in CRC screening programs.

Crude and age-specific incidence rate patterns for histopathologic subtypes of ovarian cancer in Iran.

BACKGROUND: The purpose of this study was to report age-specific incidence rates of histopathological subtypes of ovarian cancer in Iran. METHODS: Data published by the pathology-based Cancer Registry, Iranian Ministry of Health and Medical Education for the year 2004, was utilized. This study included 793 new ovarian cancer cases which were analyzed by SPSS software (version 13). RESULTS: There were 45 different histologies reported in 793 new cases which were categorized into ten major groups. Epithelial tumors displayed the highest age specific incidence rate, followed by germ cell tumors. Serous epithelial tumors were the most common in the epithelial group. CONCLUSION: The age-specific incidence rate of ovarian cancer varies based on histology.

Survival of ovarian cancer in Iran: 2000-2004.

OBJECTIVE: The aim of this study was to estimate the 5-year survival of ovarian cancer in Iran between 2000 and 2004, according to age and histology. METHODS: Cancer registry of Iran, 2000-2004, was used covering nearly 80% of all ovarian cancers and 100% of all pathologically diagnosed ovarian cancers. RESULTS: Of 1,246 new ovarian cancer cases, 451 were available for further follow-up, which revealed 169 deaths and 282 live cases. The 5-year survival was 61%; 85% for germ cell tumors and 59% for epithelial tumors. Survival of serous, mucinous, endometrioid and clear cell histologic subtypes of epithelial tumors was 41%, 62%, 76% and 78%, respectively. Young patients with epithelial tumors (below 45) displayed significantly better 5-year survival rates (63% versus 53%). CONCLUSION: we found that ovarian cancer had a better survival rate in Iran in comparison to other regions. We also reviewed all probable confounding factors or real causes. In this study, age and histology affected survival.