Solitary vertebral metastasis of unknown primary renal cell carcinoma treated with surgical resection plus tyrosine kinase inhibitor: A case report.

INTRODUCTION: Although 25-30 % of renal cell carcinomas (RCC) might be diagnosed in metastatic stage, occurrence of metastatic renal cell carcinoma (mRCC) as a cancer of unknown primary site (CUP-mRCC) is extremely rare. Here, we present a case of vertebral mass causing radicular pain that has been diagnosed to be mRCC through core needle biopsy while no renal mass has been found during serial imaging. CASE PRESENTATION: A 60-year-old woman presented with severe lumbar pain radiating to left leg. Lumbar X-ray suggested a mass in second lumbar vertebra which was confirmed by MRI. Biopsy showed that the mass was clear cell RCC. Abdominopelvic CT scan and other metastatic work-up found no primary source for the cancer -in kidneys- nor any other metastasis. Tumor resection was performed followed by sunitinib administration. 3 months after the surgery, she is symptom free with no signs of disease progression nor kidney tumor. DISCUSSION: 26 cases of CUP-mRCC has been reported in literature. Lymph nodes are the most commonly involved organ in CUP-mRCC. Exclusive bone involvement -similar to our case- have been reported in only 3 cases. No specific treatment guideline exists but surgery, systemic therapy, combination therapy, and radiotherapy have been used, with the first two items being the most commonly used ones. CONCLUSION: Tumor resection plus sunitinib seems to be a reasonable option in solitary CUP-mRCC involving vertebral column. Our patient is symptom free and there are no signs of disease progression nor kidney cancer in follow-up imaging after 3 months of surgery.

Association between selenium, cadmium, and arsenic levels and genetic polymorphisms in DNA repair genes (XRCC5, XRCC6) in gastric cancerous and non-cancerous tissue.

Gastric cancer is one of the most prevalent cancers in northern Iran. The DNA repair genes X-ray repair cross-complementing (XRCC) group 5, XRCC6, which are important members of non-homologous end-joining repair system, play an important role in repairing the DNA double-strand breaks. Chronic exposure to heavy metals has long been recognized as being capable of augmenting gastric cancer incidence among exposed human populations. Since trace elements could directly or indirectly damage DNA, and polymorphism in DNA DSBs-repair genes can alter the capacity of system repair, we assumed that XRCC5 VNTR and XRCC6-61C >G polymorphism also impress the DSBs-repair system ability and contribute to gastric cancer. Therefore, the objective of this research was to evaluate the tissue accumulation of Selenium (Se), Cadmium (Cd) and Arsenic (As), and XRCC5 VNTR, XRCC6-61C >G polymorphisms in cancerous and non-cancerous tissues in Golestan province. The study population included 46 gastric cancer patients and 43 cancer-free controls. Two polymorphisms of XRCC5, XRCC6 were genotyped using polymerase chain reaction (PCR) or polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Further employed was atomic absorption spectroscopy so as to determine the levels of Se, Cd and As. Finally, the data were analyzed by SPSS (version 16) statistical software. The Se level was significantly higher in tumors as compared to non-tumor tissues, but there was no significant correlation between As and Cd in cancerous and noncancerous tissues. Allele frequencies of the selected genes were not statistically different between groups regarding XRCC6 (-61C>G). XRCC5 0R/0R, 0R/1R, 1R/1R, and 0R/2R genotypes were more common in cancerous group. High levels of Se in cancerous tissues vs. non-cancerous tissues may be one of the carcinogenic factors; in Golestan province, unlike other regions of Iran and the world, the level of Se is high, hence the higher risks of gastric cancer.

Correlation Between HMGB1 and TLR4 Expression in Sinonasal Mucosa in Patients With Chronic Rhinosinusitis.

OBJECTIVES: Chronic rhinosinusitis (CRS) is one of the most common inflammations in the upper airway. Despite the wide prevalence of CRS, the pathogenesis of this disease is poorly understood. Several components of the innate immune system may play a significant role in CRS, including Toll-like receptor 4 (TLR4), TLR9, and high-mobility group box 1 protein (HMGB1). This study was conducted to determine the expression of TLR4, TLR9, HMGB1, and pNFκ-B p65 in paraffin-embedded blocks of patients with CRS with nasal polyps compared with those of the control group. METHODS: Twenty-six formalin-fixed, paraffin-embedded samples from patients with confirmed CRS and 26 patients undergoing septoplasty due to anatomic variations and no other inflammatory nasal diseases as the control group were assessed. Expression patterns of HMGB1, TLR9, TLR4, and pNFκ-B p65 genes were examined using real-time quantitative reverse transcription polymerase chain reaction (Real-Time qRT-PCR). Statistical analyses were performed with SPSS and analyzed using unpaired 2-tailed t tests or 1-way analysis of variance. RESULTS: Real-time PCR showed that the expression level of HMGB1 messenger RNA was significantly increased in the tissues of patients with CRS compared with controls (P < .05). The other 3 genes were also upregulated in the patients, but were not significant compared with control. Analysis of the Pearson correlation coefficient (r) revealed a significant positive correlation between HMGB1 and TLR4 (r = 0.79, P < .05) in patients and negative correlation between TLR4 and NfκB in the control group (r = 0.94; P < .05). CONCLUSIONS: Both HMGB1 and TLR4 are increased in the paranasal sinus mucosa of patients with CRS. These results suggest a possible contribution of HMGB1 and its internal receptor (TLR4) in the pathophysiology of CRS.

Temporal and geographical variations in colorectal cancer incidence in Northern Iran 2004-2013.

INTRODUCTION: Colorectal cancer (CRC) is one of the most common cancers in the Golestan province, Northern Iran. The purpose of this study is to describe colorectal cancer incidence patterns and trends in the province 2004-2013. METHODS: Data on CRC cases were obtained from the Golestan Population-based Cancer Registry (GPCR). The GPCR is a high-quality cancer registry that collects data on primary cancers according to internationally accepted standard protocols. Age-standardized Incidence rates (ASR) were calculated and the 10-year trend quantified using the average annual percentage change (AAPC) from Joinpoint regressions. RESULTS: The overall ASR of CRC were higher in men (14.8 per 100,000 person-years) and the urban populations (35.4), relative to women (11.5) and the rural populations (17.1), respectively. The overall incidence rate was observed to significantly increase 2004-2013 in men (AAPC = 7.3; 95%CI: 2.9-11.8) and women (AAPC = 6.6; 95%CI: 2.7-10.6). The analysis also showed that urban areas (AAPC = 8.1; 95%CI: 2.4-14.1) had a relatively more rapid increase in rates compared to rural areas (AAPC = 6.9; 95%CI: 2.2-11.7). CONCLUSIONS: CRC incidence rates in Golestan have been rising during the most recent decade, with a higher incidence and more rapid increases among men and the urban populations. The underlying risk factors should be assessed in the context of developing CRC prevention interventions in Golestan.

Extradural ganglioneuroma with T1-T2 involvement mimicking spondylodiscitis: a case report and a review of the literature.

Ganglioneuroma (GN) is a rare benign neural tumor, usually derived from the ganglia of the sympathetic system. This report describes a 36-year-old man who presented with back pain and local tenderness that closely mimicked the clinical and ima-ging findings of spondylodiskitis. However, histologic examination made the diagnosis of GN. To our knowledge, this is the first report presenting the pattern of a GN as a differential diagnosis of spondylodiskitis.

Massive malignant pleural effusion due to lung adenocarcinoma in 13-year-old boy.

A 13-year-old boy with no risk factors for lung cancer presented with a massive left-sided pleural effusion and a mediastinal shift on chest radiography and computed tomography. A chest tube drained bloody pleural fluid with an exudative pattern. A pleural biopsy and wedge biopsy of the left lower lobe revealed mucinous adenocarcinoma in the left lower lobe wedge biopsy and metastatic adenocarcinoma in the pleural biopsy. The patient is currently undergoing chemotherapy. Radiotherapy is planned after shrinkage of the tumor. Adenocarcinoma of the lung is very rarely seen in teenagers or children, especially in the absence of risk factors.

Can formaldehyde exposure induce histopathologic and morphometric changes on rat kidney? / ¿La exposición al formaldehído puede inducir cambios histopatológicos y morfométricos sobre el riñón de rata?

Formaldehyde is used traditionally for fixing the cadaver, and vaporized during dissection and practical studying on cadaver. This study was designed to determine the histopathologic and morphometric changes of rat kidney while all of the experiments were exposed to formaldehyde for 18 weeks. 28 male albino Wistar rats were divided into the following three experimental groups (E1: 2hrs/d, 2d/w; E2: 2hrs/d, 4d/w; E3: 4hrs/d, 4d/w) and one control group (C). when the exposure period was expired the animals were anaesthetized with chloroform. After cervical dislocation, the abdomen was dissected and the kidneys were taken. The kidney specimens were sectioned and stained with Haematoxylin and Eosin technique for histologic and morphometric study. Data were obtained from an Olympus light microscope and the analyzed with spss (version 11.5) and ANOVA test. In all histopathology sections of groups E1, E2 and E3, these similar changes were seen: mild glumerolar congestion, focal congestion, and vacuolar degeneration of tubular cells. There were no evidences of inflammatory cells infiltration or fibrotic changes of interstitial tissue. Only mild, non-specific congestion was seen in cortical vessels. Also there were not any abnormalities in the staining of nucleus and cytoplasm. According to Morphometric study, Mean +/- SD of glomerulus's area in control, E1, E2 and E3 group were 10802.66 +/- 1038.18, 10759.50 +/- 1971.88, 10434.73 +/- 1763.76 and 10077.64 +/- 2068.78 micrometer, respectively. Mean +/- SD inner proximal tubule diameter in control, E1, E2 and E3 group were 16.16 +/- 2.49, 16.92 +/- 2.90, 16.31 +/-2.79 and15.66 +/-4.11 µm, respectively. Mean +/- SD of inner distal tubule diameter in control, E1, E2 and E3 group were 15.96 +/- 4.47, 16.20 +/- 1.66, 16.96 +/- 1.63 and17.45 +/- 3.26 µm, respectively. These differences were not significant between cases and control. This study showed that formaldehyde inhalation in 1.5 ppm can not make specific...

El formaldehído se utiliza tradicionalmente para la fijación de cadáveres y vaporiza durante la disección y los estudios prácticos en el cadáver. Este estudio fue diseñado para determinar los cambios histopatológicos y morfométricos de riñones de ratas expuestos al formaldehído, durante 18 semanas. 28 ratas albinas Wistar se dividieron en tres grupos experimentales (E1: 2 h/d, 2d/s, E2: 2 h/d, 4d/s; E3: 4 h/d, 4d/s) y un grupo control (C). Cuando el período de exposición se cumplió los animales fueron anestesiados con cloroformo. Después de la dislocación cervical, el abdomen fue disecado y se obtuvieron los riñones. Los especímenes de riñon fueron seccionados y teñidos con técnica hematoxilina y eosina para el estudio histológico y morfométrico. Los datos fueron obtenidos con un microscopio óptico Olympus, el análisis con el software SPSS (versión 11.5) y la prueba de ANOVA. En todas las secciones histopatológicas de los grupos E1, E2 y E3, se observaron cambios similares: congestión glumerular leve, congestión focal y degeneración vacuolar de las células tubulares. No hubo evidencias de la infiltración de células inflamatorias o cambios de tejido fibrótico intersticial. Sólo una leve congestión no específica fue observada en vasos corticales. Además no hubo anormalidad en la tinción del núcleo y el citoplasma. De acuerdo al estudio morfométrico, la Media +/- DS del área glomerular en los grupos control, E1, E2 y E3 fue 10802,66 +/- 1038,18, 10759,50 +/- 1971,88, 10434,73 +/-1763,76 y 10077,64 +/- 2068,78 µm, respectivamente. La Media +/- DS del diámetro interno del túbulo proximal en los grupos control, E1, E2 y E3 fueron 16,16 +/- 2,49, 16,92 +/- 2,90, 16,31 +/- 2,79 y 15,66 +/- 4,11 µm, respectivamente. La Media +/- SD del diámetro interno de los túbulos distales en los grupos control, E1, E2 y E3 fueron 15,96 +/- 4,47, 16,20 +/- 1,66, 16,96 +/- 1,63 y 17,45 +/- 3,26 µm, respectivamente. Estas diferencias no fueron significativas entre los casos...

Fine needle aspiration of thyroid nodules in a general teaching hospital setting performing moderate number of biopsies: outcome of indeterminate cytologic results.

INTRODUCTION: Our aim was to assess the usefulness of fine-needle aspiration cytologic biopsy (FNA) of the thyroid in our general teaching hospital with average health care facility performing moderate number of such procedures and to evaluate the outcome of Indeterminate Cytologic Results. MATERIAL AND METHODS: We studied on all consecutive patients referred for FNA of the thyroid nodule. All samplings were performed primarily by one endocrinologist performing moderate number of samplings and interpreted by one pathologist. Cytological findings were classified as malignant, histologic control recommended (suspicious or indeterminate), benign, and unsatisfactory. RESULTS: Four hundred and seventy six biopsies were performed. Patient acceptance of this procedure was good and no complication was encountered. 64/476 of samples were considered as insufficient (13.4%). Of the remaining samples (355 F, 57 M), 321 specimens (67.4%) were reported to be non-neoplastic lesions, including 251 (52.7%) colloid nodules, 39 (8.2%) hemorrhagic nodules and 31 (6.5%) cases of thyroiditis. A neoplastic nodule was confirmed in 91/476 of cases (19.1%), of which 14 were cytologically malignant (3.0%). Follicular lesions were identified in the remaining 77/476 cases (16.1%). Excluding 21 patients who were lost to follow-up, the remaining 56 patients (72.7%) were surgically followed up. Upon excision, benign lesions were diagnosed in 47/56 (83.8%), of which 32 lesions (57.1%) were follicular adenoma and 15 cases (26.7%) of colloid nodules. Malignancy was confirmed histopathologically in 9 cases (16.2%), including 4 follicular variant papillary carcinomas and 5 follicular carcinomas. CONCLUSIONS: FNA is an inexpensive, safe, practical, well tolerated, and easily applied method, even in not fully-experienced hands and provides useful information. Based on our study findings, suspicious cytologic results (cytologically follicular neoplasms) are inconclusive and are associated with a remarkable chance of malignant involvement; hence surgical treatment is necessary for clarification.

Relationship between p53 expression and gastric cancers in cardia and antrum.

BACKGROUND: The mutations in p53 gene and accumulation of p53 protein are the most common genetic events in gastric carcinomas. The present study was conducted to compare the frequency of p53 gene overexpression in a consecutive series of adenocarcinomas arising from the cardia and the antrum. This study also evaluates the associations of this gene expression with demographic and clinicopathologic findings (age, sex, histology, and grade of tumor). METHODS: Retrospective analysis was performed on 111 patients with gastric cancer who had undergone upper gastrointestinal endoscopies in 5th Azar Medical Center (northeastern, Iran), during 1998-2005. The series comprised of 25 patients with cardia adenocarcinoma and 86 patients with antral adenocarcinoma. p53 alteration (nuclear p53 overexpression) was detected by immunohistochemistry. RESULTS: Nuclear p53 overexpression was found in 14 (56%) out of the 25 and 27 (31.3%) out of the 86 patients with cardia and antral adenocarcinomas, respectively. p53 gene overexpression was significantly more frequent in adenocarcinomas of the cardia than the antrum. There were no differences in the clinicopathologic characteristics of the tumors between p53-positive and p53-negative cases in both types of the cancer. CONCLUSION: This study shows that p53 alterations correlate well with gastric location, and they are more frequent in adenocarcinoma of the cardia than the antrum. This result reinforce the hypothesis that the cancers of the lower esophagus and upper stomach have distinct epidemiologic, pathogenesis, and molecular characteristics from that observed in cancers of the lower part of the stomach.

Histopathologic Changes of Rat Tracheal Mucosa Following Formaldehyde Exposure / Cambios Histopatológicos de la Mucosa Traqueal de la Rata Seguidos a la Exposición de Formaldehído

Formaldehyde is a chemical, which is used traditionally for fixing the cadaver. It is vaporized during dissection and practical studying on cadaver. Studies show that this vapor can cause some clinical symptoms such as throat, eye, skin and nasal irritation. This study was designed to determine the histopathologic changes of rat tracheal mucosa while all of the experiments were exposed to formaldehyde for 18 weeks. This study was performed on 28, 6-7 weeks postnatal albino Wistar rats. The rats were divided into 3 case groups (E1: 4h/d, 4d/w; E2: 2h/d, 4d/w; E3: 2h/d, 2d/w) and 1 control group. The tracheal specimens were sectioned and stained with H&E technique for histopathologic study. An epithelial disorganization, cilia disappearance, slight dysplastic changes and slight subepithelial lymphocytic infiltration were observed in the case of E1. Epithelial disorganization, irregular cilia and slight subepithelial infiltration were seen in E2 and E3 groups. The results of this study show that "the more exposure to formaldehyde vapor, the more intense epithelial changes".

El formaldehido es un producto químico que se usa tradicionalmente para la fijación de cadáveres. Éste se vaporiza durante la disección y los estudios prácticos en el cadáver. Investigaciones han mostrado que este vapor puede causar algunos síntomas clínicos como la irritación de garganta, ojos, piel y mucosa nasal. Este estudio tuvo como objetivo determinar los cambios histopatológicos en la mucosa de la tráquea de la rata para lo cual todos los animales fueron expuestos al formaldehído, durante 18 semanas. El estudio fue realizado en 28 ratas albinas Wistar, con 6-7 semanas de vida. Las ratas fueron divididas en 3 grupos (E1: 4h/día, 4días/semana; E2: 2h/día, 4días/semana; E3: 2h/día, 2días/semana) y un grupo control. Fueron seccionadasas las tráqueas de los especímenes y teñidas con H&E para su estudio histopatológico. Una desorganización epitelial, desaparición de cilios, leves cambios dispásticos y leve infiltración linfocítica subepiteial fueron observados en el grupo E1. Desorganización epitelial, cilios irregulares y leve infiltración subepitelial fueron observados en los grupos E2 y E3. Los resultados de este estudio muestran que a mayor exposición al vapor del formaldehido, más intensos son los cambios epiteliales de la mucosa traqueal.