Prognosis and survival study in patients with gastric adenocarcinoma and its relationship with pRb expression alteration: A retrospective IHC-based study.

Background and Objective: Among cancers, gastric cancer has the fifth highest incidence worldwide and is the third most common mortality factor, which may have been due to inadequate knowledge of its molecular pathogenesis. The retinoblastoma gene (RB1), a tumor suppressor gene, may have a role in gastric cancer. This research aims to assess Rb expression as a prognostic marker to obtain more insight regarding gastric cancer. Methods: This retrospective analytical study was done on 61 patients (45 males and 16 females) with gastric adenocarcinoma admitted from 2010 to 2012 in Shahid Sadoughi and Mortaz hospitals, Yazd, Iran. Demographic data, including age, gender, clinical signs and symptoms, and pathology reports, were retrieved from patients' hospital folders. Then, the altered Retinoblastoma gene expression was evaluated by immunohistochemistry studies. Acquired data were analyzed by SPSS software v.16. p < 0.05 was statistically considered meaningful. Results: In this study, the ratio of men to women was higher (2.81:1), and the mean age of patients was 62.44 years. About 90.2% of patients died during the study. There was no meaningful relationship between the presence of pRb, the intensity of staining, the percentage of staining with patients' age, gender, tumor grading, and survival rate (p > 0.05). There was only a meaningful relationship between the grade of tumors and survival rate (p = 0.039). Conclusion: Altered pRB expression is not common in gastric cancer and does not impact the survival and grading of tumors. Poorly differentiated tumors had an ominous outcome with the lowest survival time.

Dietary trans fatty acids and risk of colorectal cancer: a systematic review and meta-analysis of observational studies.

PURPOSE: Although trans fatty acid has been associated with diabetes and cardiovascular disorders, studies gave conflicting results when examined their impact on colorectal cancer (CRC). The present systematic review and meta-analysis aimed to summarize the current evidence regarding the association between dietary and tissue trans fatty acids and the risk of CRC. METHODS: We searched PubMed/MEDLINE, EMBASE, Scopus, Web of Science (ISI), and Google Scholar without date and language limitation up to May 2022 and included the eligible studies. The quality of included studies was assessed using the Newcastle-Ottawa scale. The overall odds ratios (ORs) were derived using a random-effects model. RESULTS: In assessment of dietary trans fatty acids 18 studies, including eight cohort, 10 case-control, and observational data from one randomized control trial were included. Although Dietary trans fats were associated with higher risk of CRC (OR = 1.093, 95% CI 1.017, 1.176, P = 0.016; I2 = 61.3%), Subgroup analysis by study design yielded an insignificant effect for case-control (OR = 1.152, 95% CI 1.000, 1.328, P = 0.050; I2 = 77.2%) and cohort (OR = 1.027, 95% CI 0.976, 1.081, P = 0.299; I2 = 0%) studies. Although there was no significant association of trans fatty acids with rectal cancer (OR = 1.093, 95% CI 0.984 to 1.215, P = 0.098; I2 = 0%), there was for colon cancer (OR = 1.91, 95% CI 1.062 to 1.335, P = 0.003; I2 = 37.6%).The analysis of four studies that evaluated the relation between tissue trans fat and CRC revealed meaningful result (OR = 0.745, 95% CI 0.619, 0.896, P = 0.002; I2 = 42.6%). While subgroup assessments for colon cancer (OR = 0.804, 95% CI 0.583, 1.109, P = 0.183; I2 = 0%) and plasma trans fatty acids OR = 0.853, 95% CI 0.633, 1.150, P = 0.298; I2 = 0%) were insignificant. CONCLUSION: Dietary trans fatty acids increased the risk of CRC, whereas tissue trans fatty acids had a protective effect on CRC. Nonetheless, neither type of trans fatty acid increased the risk of colon or rectal cancer; thus, more prospective studies are needed to determine the validity of these associations.

Comparative study of breast core needle biopsy (CNB) findings with ultrasound BI-RADS subtyping.

<b> Introduction:</b> Given the high prevalence of breast cancer, developing quick and accessible diagnostics solutions is critical. The BIRADS classification is a reliable method for assessing and estimating the risk of malignancy in breast lesions. </br></br> <b>Aim:</b> The aim of this study was to compare the results of core needle biopsy of breast lesions and sonographic findings based on the BIRADS category in Yazd. </br></br> <b>Materials and methods:</b> This retrospective analytical study was done on all core needle biopsy specimens referred to Mortaz hospital, Yazd, Iran from 2010 to 2019. Demographic data such as age, laterality of the lesion, BIRADS category, and pathology reports were extracted from patients' hospital folders. Data were analyzed by SPSS version 21. P < 0.05 was considered statistically significant. </br></br> <b>Results:</b> In total, 514 cases with a mean age of 43.9 9.4 years were studied. Among them, 104 cases (20.2%) were malignant and 410 cases (79.8%) were benign. The most common benign and malignant lesions were fibroadenoma (24.9%), and infiltrative ductal carcinoma (83.7%) respectively. The most common BIRADS was class 4A (54.9%). Patients with benign lesions were mostly in the 3rd and 4th decade of life, while malignant lesions were more in the 4th and 5th decades, and this difference was statistically significant (P = 0.001). The correlation between ultrasound diagnoses (BIRADS) and pathology findings was statistically significant (P < 0.001). </br></br> <b>Conclusion</b>: Based on the results, there is a significant correlation between ultrasound outcomes according to BIRADS and pathology results, and the radiology-pathology accordance, owing to its high accuracy, can be very helpful in correctly diagnosing, monitoring, and managing the lesion.

Neuroblastoma Soft Tissue Metastasis in a 10-Month-Old Infant with a Right Thigh Mass.

BACKGROUND: Neuroblastoma is a solid tumor that occurs more frequently in pediatric populations. It may originate from any part of the sympathetic nervous system, but it most commonly arises from the paraspinal sympathetic ganglia in the abdomen or mediastinum. Local lymphadenopathy and distant metastasis to the central nervous system, orbit, and liver might be detected; however, it rarely includes soft tissue or musculoskeletal involvement. Case Report. Here, we report a 10-month-old infant presented with a right thigh mass with an otherwise benign physical exam and medical history. MRI of the lower extremities suggested tumoral infiltration in the soft tissue of both thighs, predominantly on the right side. Surgical pathology of the lesion confirmed neuroblastoma. A large subhepatic mass and paraaortic lymphadenopathy in the abdominal CT scan and metaiodobenzylguanidine scan findings favored primary abdominal neuroblastoma that had spread to lower extremities. The patient has been in remission since the completion of chemotherapy. CONCLUSION: Neuroblastoma should be considered in infants with an abnormal mass in extremities. Due to its aggressive nature, most patients struggle with distant and local tumor spread at diagnosis. Therefore, any abnormal signs and symptoms, especially in younger pediatrics, warrant immediate evaluation to avoid tumor expansion.

Malignant Melanoma Metastasis to the Appendix as the First Presentation of Lentigo Maligna Melanoma.

Malignant melanoma is a malignant neoplasm of the skin and mucosal tissues, and its behavior is not predictable. Thus, it could metastasize via mysterious routes. Here, we report a rare case of acute abdomen and acute appendicitis which involved metastatic malignant melanoma in a 63-year-old man without a history of previously treated malignant melanoma.

Can the prophylactic quadrivalent HPV vaccine be used as a therapeutic agent in women with CIN? A randomized trial.

BACKGROUND: Human papillomavirus (HPV) is one of the most significant risk factors for cervical cancer. The HPV vaccine has a very significant impact on the incidence of cervical cancer. The present study aimed to investigate the impact of prophylactic quadrivalent HPV vaccine in the treatment of women with cervical intraepithelial neoplasia (CIN 1-3). METHODS: This randomized controlled trial was conducted in the Shahid Sadoughi University of Medical Sciences (SSUMS), Yazd, Iran, from October 2011 to November 2015 in women with histologically confirmed residual/recurrent CIN 1 or high-grade CIN (CIN 2-3). Eligible women were assigned randomly to an intervention and a control group. Women in the intervention group were given HPV vaccinations while those in the control group were not. Participants were followed up for 24 months. Primary and secondary outcomes, and adverse effects of the treatment in the two groups were compared using Student's t test, the chi-square test, or Fisher's exact test. P values < 0.05 or less were considered statistically significant. RESULTS: Three-hundred and twelve women were randomized to the two groups; the data of 138 in the intervention group and 104 in the control group were analyzed. The mean age of the women was 32.59 ± 4.85 years. Differences in age, marital status, and grades of CIN weren't significant between the two groups. At the end of the two-year follow-up period, the number of women with CIN 2-3 in the intervention and control groups was reduced by 75% (from 93 to 23) versus 40% (from 69 to 41). The efficacy of the HPV vaccine in women with CIN 1-3 was 58.7% (p = 0.018). No serious adverse effects related to the vaccines were reported. CONCLUSIONS: The prophylactic quadrivalent HPV vaccine after treatment may have a therapeutic effect in women with residual/recurrent CIN 1 or high-grade CIN (CIN 2-3). TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20190603043801N1. Registered 24 July 2019 - Retrospectively registered, http://www.irct.ir/user/trial/40017/view.

Prognostic Factors and Survival Time in Patients with Small Bowel Tumors: A Retrospective Observational Study.

This study examines survival time in patients with small bowel tumors and determines its contributing factors. In this retrospective analytical study, the medical records of 106 patients with small bowel cancer (from 2006 to 2011) were investigated. The patients' data were extracted, including age, gender, clinical presentation, location of tumor, histological type, grade of tumor, site of metastasis, and type of treatment. The Kaplan-Meier test was used to estimate the overall survival time and the Log-rank test to compare the survival curves. The Cox regression was also used to evaluate the effect of the confounding variables on survival time. This study was conducted on 106 patients with a median age of 60 years (Min: 7, Max: 87). The tumor types included adenocarcinoma (n=78, 73.6%), MALToma (n=22, 20.8%), neuroendocrine tumors (n=4, 3.8%), and sarcoma (n=2. 1.8%). Grade 3 adenocarcinomas had a significantly lower survival time (HR: 1.48, 95% CI: 0.46-2.86; P=.001). Combined therapy (chemotherapy and surgery) vs. single-therapy (only surgery) had no significant effects on the survival of the patients with MALToma (5 vs. 3 months, 95% CI: 1.89-5.26; P=.06). There were no significant differences between the survival time in adenocarcinoma and MALToma (12 vs. 20 months, 95% CI: 6.24-24.76; P=.49). Tumor grade was the only independent prognostic factor that affected survival in adenocarcinoma. The patients diagnosed with MALToma in the study also had a poor prognosis, and the type of treatment had no significant effect on their survival.

Aggressive Adenoid Cystic Carcinoma of Maxillary Sinus in a 43-Year-Old Male: Rare Case Report and Review of Literature.

Adenoid cystic carcinoma (ACC) is a rare malignant tumor, mostly involving the minor salivary glands. Herein, we present a case of ACC in a 43-year-old man with symptoms of dental abscess as the initial presentation of the tumor. In spiral computed tomography (CT) scan, soft tissue mass with the erosion of maxillary sinus wall on the right side of the alveolar ridge was evident. Histopathological examination of the excised tumor with immunohistochemical studies (C-kit, Vimentin, pan-cytokeratin, p53, p63, and ki67 positive reaction) confirmed grade 2 ACC in the maxillary sinus. The patient underwent hemimaxillectomy and right-neck dissection. Due to the extension of tumor cells excessively into the surrounding tissues and involvement of orbital bone, complete and total resection of the tumor with safe margins could not be done. After surgery, adjuvant radiotherapy was considered for the patient. At the end of treatment, the patient lost his eye vision. Seventeen months from initial diagnosis, he was still alive without lung or distant metastasis.

Metaplastic breast carcinoma with chondroid differentiation: a rare variant of infiltrative carcinoma in a 38-year-old woman.

Metaplastic breast carcinoma (MBC) is a rare type of invasive breast carcinoma, and chondroid differentiation is even rarer. Here we report a case of MBC with extensive chondroid differentiation in a 38-year-old woman who presented with a lump in her left breast. Ultrasound findings were most compatible with those of giant fibroadenoma. A histopathological examination revealed a malignant lesion comprising neoplastic epithelial cells arranged in solid nests, with large areas of chondroid differentiation. Neoplastic chondroid cells exhibited a positive reaction for S-100, patchy positive reaction for pan-cytokeratin (AE1/AE3) and negative reaction for epithelial membrane antigen. Both carcinomatous and chondroid cells exhibited p53 overexpression. Sentinel lymph node biopsy revealed no tumorous involvement.

Chondromyxoid Fibroma of Two Cervical Vertebrae with Involvement of Surrounding Soft Tissue: Radiologic Diagnostic Dilemma.

Chondromyxoid fibroma is a rare benign cartilaginous neoplasm that mostly affects the metaphyseal region of the long bones. The tibia, small tubular bones of the foot, the distal femur and pelvis are common locations, but involvement of the vertebral bones, especially the cervical vertebra, is very rare. Radiographic features show typical characteristics and this tumor often presents as a lobulated, eccentric radiolucent lesion with no periosteal reaction. In addition, geographic bone destruction is seen in all cases. We present an adult female with a one-year history of neck pain, and ultrasound findings that suggest a right paravertebral muscular lesion due to inflammatory or neoplastic origins. The histopathological studies confirmed that the biopsied specimen was a chondromyxoid fibroma of the cervical vertebrae laminae and spinous processes (C3 and C4) with abutting soft tissue. Despite the unusual location and soft tissue presentation, a chondromyxoid fibroma should be considered in the differential diagnosis of a cervical bone lesion.

Comparison of Pap Smear and Colposcopy in Screening for Cervical Cancer in Patients with Secondary Immunodeficiency.

INTRODUCTION: Cervical cancer is the second most common cancer among women worldwide. The sensitivity of conventional Pap smear in detecting cervical lesions before cervical cancer is 51%, which means the false negative value is 49%. The aim of this study was to compare two methods for screening for cervical cancer in patients with secondary immunodeficiency, i.e., the conventional Pap smear and colposcopy. METHODS: This cross-sectional study was conducted on 101 immunodeficient patients who were referred to the Gynecologic Clinic at Shahid Sadughi Hospital in Yazd from March 2011 to August 2012. All patients underwent the Pap test, a colposcopy, and a cervical biopsy, with the latter being considered as the gold-standard test. RESULTS: The most frequency of immunodeficiency was noted among patients with rheumatoid arthritis (53.3%), and this was followed by patients who were undergoing chemotherapy (30.7%), patients with lupus erythematosus (12.9%), and patients with AIDS (3%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Pap smear were 18.2, 98.5, 85.5, 71.3, and 72.2%, respectively. The respective values for colposcopy were 66.7, 98.94, 80, 97.9, and 97%, respectively. CONCLUSION: In this study the accuracy, sensitivity, specificity, and negative predictive values of colposcopy were higher than those for the Pap smear in detecting high-grade, cervical, pre-malignant lesions (cervical intraepithelial neoplasia: CIN ≥ 2). Therefore, an annual colposcopy is advised for secondary immunodeficient patients instead of a Pap smear.

Primary breast angiosarcoma: pathological and radiological diagnosis.

Primary breast angiosarcoma is a very rare aggressive mesenchymal tumor, which may represent only 0.04% of all breast malignant tumors. We report a case of primary angiosarcoma in the breast of a 22-year-old woman who presented with a mass in her right breast. Ultrasonography revealed a large heterogeneous lobulated mass lesion consistent with a fibroadenoma or phyllodes tumor. After a period of six months, she presented with nipple retraction, so a core needle biopsy was performed. Histopathology revealed a well differentiated angiosarcoma (grade I/III), but in the mastectomy specimen, numerous neoplastic multinucleated giant cells were evident, which resembled those found in other sarcomas, such as malignant fibrous histiocytoma or extra skeletal osteogenic sarcoma, and this caused difficulty making the diagnosis. Using immunohistochemical (IHC) studies, neoplastic cells were positively stained for CD31, CD34, and factor VIII-related antigens, which confirmed that the tumor was a high grade, poorly differentiated angiosarcoma (grade III/III). In conclusion, angiosarcomas may have different grade patterns in the same tumor, and as a result it is necessary to examine the whole tumor for definite grading. Imaging findings in angiosarcomas are non-specific, therefore they may misdiagnosed, frequently by other benign lesions.

A rare case of rib osteoblastoma: imaging features and review of literature.

Osteoblastoma is a rare benign, but locally aggressive bone tumor with rare malignant transformation. It mostly affects the vertebral column and long bones. Radiographically, it is seen as an expansile, oval, sclerotic or lytic mass-like lesion with well-defined borders, although sometimes it may mimic a malignant tumor such as osteogenic sarcoma by its irregular borders. Herein, we report a case of osteoblastoma in a 22 year-old man with a long history of back and neck pain accompanied with neck stiffness. On the routine chest X-ray, the salient lesion appeared as an expansile, oval, sclerotic mass with well-defined borders and speckled calcification without any internal lucency and periosteal reaction, involving the posterolateral aspect of the first left thoracic rib, a rare anatomical site. Despite the unusual location, osteoblastoma should be considered in the differential diagnosis of a solitary rib lesion.

Leiomyosarcoma of the maxilla in a 24-year-old man who initially presented with odontalgia, and suffered from tumour mismanagement.

Leiomyosarcoma is an uncommon malignant soft tissue tumour originating from smooth muscle cells. It generally occurs in the female genital tract, especially in the uterus, gastrointestinal tract, retroperitoneum and rarely in the head and neck. Here we report a case of leiomyosarcoma in a 24-year-old man with a 6-month history of toothache and extraction of three right upper molar teeth, that was complicated by fistula tract formation and facial swelling. Imaging studies demonstrated tumoural lesions involving the right maxillary sinus, nasal cavity, hard palate and orbit. The histopathological and immunohistochemical studies confirmed that it was leiomyosarcoma.

Malignancy risk assessment in patients with thyroid nodules using classification and regression trees.

Purpose. We sought to investigate the utility of classification and regression trees (CART) classifier to differentiate benign from malignant nodules in patients referred for thyroid surgery. Methods. Clinical and demographic data of 271 patients referred to the Sadoughi Hospital during 2006-2011 were collected. In a two-step approach, a CART classifier was employed to differentiate patients with a high versus low risk of thyroid malignancy. The first step served as the screening procedure and was tailored to produce as few false negatives as possible. The second step identified those with the lowest risk of malignancy, chosen from a high risk population. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the optimal tree were calculated. Results. In the first step, age, sex, and nodule size contributed to the optimal tree. Ultrasonographic features were employed in the second step with hypoechogenicity and/or microcalcifications yielding the highest discriminatory ability. The combined tree produced a sensitivity and specificity of 80.0% (95% CI: 29.9-98.9) and 94.1% (95% CI: 78.9-99.0), respectively. NPV and PPV were 66.7% (41.1-85.6) and 97.0% (82.5-99.8), respectively. Conclusion. CART classifier reliably identifies patients with a low risk of malignancy who can avoid unnecessary surgery.

Dermatomyositis sine myositis with membranoproliferative glomerulonephritis.

Dermatomyositis (DM) is an autoimmune disease that is characterized by involvement of proximal musculature and skin. We report a 52-year-old woman with a 6-year history of dermatomyositis sine myositis, who developed lower extremity edema and proteinuria. Pathological examination of renal biopsy showed membranoproliferative glomerulonephritis. She received steroid, cyclophosphamide, and mycophenolate mofetil. Over the 9 to 10 months after the beginning of treatment, the proteinuria was improved.

A localized sclerosing osteomyelitis at the periapex of a vital tooth: report of a misdiagnosis.

Osteomyelitis is an inflammatory infectious condition of bones, occurringeither acutely or chronically. The clinical course of the disease leads to destructive or sclerosing patterns of the involved bone. This report presents a case of chronic focal sclerosing osteomyelitis in a 19-year-old male with a history of an uncontrolled convulsive condition. The lesion was first diagnosed as an osteoblastoma. Chronic trauma or traumatic occlusion has the potential to induce osteomyelitis and should be considered a possible diagnosis in differentiating periapical radiopacities, even in relation with vital teeth.