Context: Ewing's sarcoma (EWS) commonly involves long bones with a permeative pattern of bone destruction and aggressive interrupted periosteal new bone formation. However, radiological features show wide variation and some presentations are uncommon, leading to diagnostic confusion. This study is aimed at studying the imaging features of proven EWS and highlight the uncommon features and rare sites of presentation. Materials and Methods: The imaging findings of 100 consecutive histopathologically proven EWS were analyzed retrospectively. All uncommon presentations with respect to age and site and morphology of lesion were observed. Results: Most of the patients were below 20 years of age and 8% were younger than 5 years. Other than long bones, ribs, and pelvis, other sites considered to be rare and were noted in 25%. Extraosseous site involvement was 11%. Uncommon features included epiphyseal involvement (4%), sclerosis (4%), expansion of bone (8%), sunray spiculation (10%), calcification in soft tissue (8%), saucerization (4%), pathological fracture (5%), fluid–fluid level (2%), vertebra plana (2%), and lesion crossing the joint (13%). Conclusions: The uncommon observations included incidence in children <5 years (8%) and occurrence in craniofacial bones, spine, scapula, and clavicles and in extraosseous sites such as retroperitoneum, adrenals, or extremity. Uncommon findings included epiphyseal involvement, sclerosis, saucerization, calcification in soft tissue component, and pathological fracture and lesion crossing the joint.

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Context: Head neck cancer (HNCA) in North-East India accounts for 54.48% cancers at all sites, one of the highest in the country. Increased serum lactate dehydrogenase (LDH) activity is considered as a marker of cellular necrosis while serum alkaline phosphatase (ALP) is recognized as an important marker of induction of tumor cell differentiation. Considering the importance and need of biomarker in HNCA and there being no previous study on tumor markers from this highly prevalent region, we intended to examine the role of serum LDH and ALP in head and neck squamous cell carcinoma (HNSCC) and epithelial precursor lesions (EPLs) and also to find their correlation with the different histological grades of tumor. Materials and Methods: This is a prospective observational study on patients with HNSCC and precancerous lesions attending Department of ENT of a Teaching Hospital. Serum LDH and ALP was measured in HNSCC, EPL and control groups and the results were statistically analyzed and compared using analysis of variance, Pearson correlation coefficient, and sensitivity-specificity analysis. Results: Serum LDH was found to be a significant marker of HNSCC. Total serum LDH level was high in both premalignant and HNSCC cases. There was a significant correlation between serum LDH and grades of HNSCC showing highest levels of expression in moderately differentiated SCC. Elevated serum LDH was also seen in erythroleukoplakia, leukoplakia, and verrucous lesion, but serum ALP levels were not significant. Conclusions: This is the first study from this highly prevalent region of HNCA showing that serum LDH could be regarded as a biomarker for malignant and premalignant conditions of the head and neck.

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Background: Breast cancer is the most common malignancy among women leading to serious sequelae on the health-related quality of life (HRQOL). Materials and Methods: This is a cross-sectional study. The Arabic version of EORTC QLQ-C30 (version 3) and EORTC QLQ-BR23 questionnaire was administered to a random sample of 172 Egyptian women with breast cancer. One hundred and nineteen patients had modified radical mastectomy (MRM) and 53 had breast conservative surgery (BCS). Results: The mean age was 50.32 years (±standard deviation [SD] = 8.54) with a mean period of 4.75 years (±SD 3.33) from surgery. The global health was poor (28.38 ± 11.7, 95% confidence interval [95% CI]: 30.71). Among the functional scales of QLQ-C30, social functioning scored the highest (87.91 ± 17.92, 95% CI: 91.64) whereas emotional functioning scored the lowest (59.61 ± 24.96, 95% CI: 64.66). The most distressing symptom on the symptom scales of QLQ-C30 was financial impact followed by fatigue and pain (mean: 57.87, 39.43, and 36.44). Using the disease-specific tools, it was found that body image and sexual functioning scored the lowest (mean 74.51 ± 13.21 and 74.45 ± 14.89, 95% CI: 77.27 and 77.55), respectively. On the symptom scale, arm symptoms scored the highest with a mean of 32.35 ± 23.22 (95% CI: 37.19). MRM patients had more favorable global health status and body image among the functional scale (P = 0.011, 0.027) due to social and religious issues. The functional scale was better in BCS with significant role function (P = 0.004). In the symptom scale, fatigue, pain, systemic side effects, and arm symptoms were statistically significant better in the BCS (P = 0.004, 0.006, 0.002, and 0.003, respectively). Conclusion: Egyptian breast cancer survivors reported lower overall global QOL. HRQOL is better in BCS in spite of good global health and body image in MRM.

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Introduction: Screening and diagnostic efforts for breast cancer are critical because the disease has a high rate of successful outcomes with early identification and treatment. The mammography (MG) and Ultrasonography/ ultrasound (USG) are individually effective diagnostic modalities for detection of breast pathologies. Materials and Methods: This cross-sectional, prospective, hospital-based study was carried out with an aim to evaluate breast lesions using digital MG and ultrasonography (USG) independently and in combination with fine-needle aspiration cytology (FNAC) correlation. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MG in detecting carcinoma breast were 77.77%, 97.72%, 87.5%, and 95.55%, respectively. The sensitivity, specificity, PPV, and NPV of USG in detecting carcinoma breast were 55.55%, 97.72%, 83.33%, and 91.48%, respectively. In our study population, 83.01% of breast lesions were benign, and of them, 77.27% were diagnosed by MG alone and 72.72% were diagnosed by USG alone. When these modalities were combined, 97.72% of the lesions were diagnosed. The correlation coefficients of MG alone (0.792), USG alone (0.631), and MG and USG combination (0.884) with FNAC are all positive, and P values are significant of all the modalities. Conclusion: This study confirms that the MG and ultrasound (USG) when combined have significantly higher sensitivity and NPV than observed for a single modality in detecting the both benign and malignant lesions of the breast.

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Aims: The prognosis of acute myeloid leukemia (AML) in elderly patients is worse due to age and comorbidities. Lately, monotherapy with hypomethylating agents like azacitidine (Aza) has been used to prolong overall survival (OS) in AML patients. Herein, we present a retrospective study investigating treatment responses and OS of Aza in combination with etoposide (Eto) and cytarabine (ARA-C) in elderly. Materials and Methods: In this study, therapies and outcomes of 37 newly diagnosed AML patients, >60 years old, and ineligible for intensive chemotherapy were investigated retrospectively. Patients were grouped according to the treatments they received as follows - Group 1: low-dose conventional therapies as hydroxyurea, low-dose ARA-C, or best supportive care (n = 11); Group 2: Aza alone (n = 6); Group 3: Aza in combination with Eto and ARA-C (Aza + Eto + ARA-C, n = 20). Results: It was found that an Aza + Eto + ARA-C combination therapy had significantly better overall response rates (P = 0.002). Combination group had significantly better OS than Group 1 (8 months vs. 1 month, P < 0.001), the difference between combination and monotherapy was not significant. The OS was also associated with age and performance status, but the difference was still statistically significant after adjustment for these factors, especially for patients with younger age and better performance. Conclusions: We concluded that combination therapy of Aza with Eto and ARA-C increases response rates, and prolong survival for this poor prognosed patient group. We believe that larger controlled studies investigating Aza combinations with other antileukemic drugs will contribute to the development of tolerable treatment protocols for elderly AML patients.

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Background: Oral exfoliative cytology is a novel technique of using cells to detect dysplastic changes in the oral cavity in potentially malignant disorders and malignant oral lesions in resourced challenged areas. The aim of this study was to compare specimen adequacy and cellular clarity between oral rinse-based smears and conventional smears in normal controls, histologically confirmed and clinically diagnosed squamous cell carcinoma, and oral leukoplakia. For many years, oral rinse-based cytology has been used to detect candidal colonization in microbiology. Emphasis has been placed to detect changes in oral rinse-based cytology. From this research and development, oral rinse-based cytology has evolved as a method of preparing samples for examination in cytopathology. Materials and Methods: Oral exfoliated cells from 10 cases of smears of potentially malignant disorders (oral leukoplakia), 10 cases of histologically confirmed and clinically diagnosed squamous cell carcinoma, and 10 controls with healthy mucosa were taken. Smears were stained with the Papanicolaou stain and were examined independently by two different oral pathologists. The results were compared to assess four parameters such as nuclear cytoplasmic ratio, sample adequacy, cellular distribution, and cellular clarity in both the smears. The results were then analyzed with SPSS (version 20) software using the descriptive statistics such as mean and standard deviation and inferential statistics such as t-test and one-way ANOVA. The level of significance was set at 5%. Results: Oral rinse-based cytology was significantly more efficient than conventional exfoliative cytology in terms of cellular clarity (P < 0.001), cellular distribution (P < 0.001), and sample adequacy (P < 0.001). Conclusion: Oral rinse-based cytology shows overall improvement in cellular clarity, sample adequacy as compared to traditional exfoliative cytology.

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Tamoxifen plays a critical role in the treatment of hormone receptor-positive breast cancer. Despite these great benefits against breast cancer, tamoxifen increases the risk of endometrial pathologies such as endometrial hyperplasia, polyp, and neoplasms because of agonistic effect on endometrial tissues. Therefore, gynecologic follow-up should be carried out during tamoxifen treatment. Uterine tumors are frequently detected as the result of presentation with abnormal uterine bleeding. In addition, genital tract's metastases from distant primary tumors can present with abnormal uterine bleeding. Therefore, it is important to determine whether the uterine mass is metastatic or primary because different treatment modalities are used for them. In this context, breast carcinomas are the most frequent metastatic tumors, particularly invasive lobular carcinoma. Here, we report an invasive lobular carcinoma case that presented with abnormal uterine bleeding while receiving tamoxifen therapy and has metastasize in the uterus.

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Aims: Glioblastoma multiforme (GBM) shows the most aggressive invasion among primary brain tumors. In spite of the standard therapy methods such as surgery, radiotherapy, and chemotherapy, the mortalities are high in GBM patients owing to side effects. Some lichen secondary metabolites that have many bioactive functions exhibited anti-cancer efficacy toward many cancer types. The present study was undertaken to investigate proliferation change, oxidative status and DNA damage potentials of human U87MG-GBM, and primary rat cerebral cortex (PRCC) cells exposed to three lichen secondary metabolites. Materials and Methods: Different concentrations of lichen secondary metabolites including diffractaic acid (DA), lobaric acid (LA), and (+)-usnic acid (UA) were used for the treatments. PRCC cells were obtained from Sprague Dawley® rats. U87MG cell line was preferred as GBM cells. Results: The results showed that lactate dehydrogenase and 8-hydroxy-2'-deoxyguanosine levels increased in PRCC and U87MG cells in a clear dose-dependent manner. Inhibitory concentration 50% (IC₅₀) values of LA, DA, and UA were calculated as 9.08, 122.26, 132.69 mg/L for PRCC cells and 5.77, 35.67, 41.55 mg/L for U87MG cells, respectively. Concentration of 10 mg/L of DA and UA demonstrated high anti-oxidant capacity on healthy PRCC cells. Conclusions: Overall, obtained data indicated that LA was highly toxic on GBM and PRCC cells. However, DA and then UA had high anti-oxidant capacity on PRCC cells. These results suggest that further studies that will be held on LA may play a critical role in GBM treatment.

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Background: High-dose chemotherapy followed by autologous hematopoietic stem cell transplant (HSCT) is the treatment of choice for patients with relapsed and refractory (RR) lymphoma. We analyzed toxicity and long-term outcome with lomustine, cytarabine, cyclophosphamide, etoposide (LACE) conditioning in patients with primary refractory or relapsed lymphoma undergoing autologous transplant. Materials and Methods: One-hundred patients with primary refractory (23), chemotherapy sensitive relapse (74) or RR (3) Hodgkin lymphoma (HL - 70 patients), and non-HL (NHL - 30 patients) underwent HSCT with LACE (lomustine 200 mg/m ² day-7, etoposide 1000 mg/m ² day-7, cytarabine 2000 mg/m ² day-6 to day-5, and cyclophosphamide 1800 mg/m ² day-4 to day-2) conditioning between November 2007 and December 2013. At transplant, 68 patients were in complete remission (CR), 29 in partial remission, 2 had stable disease, and 1 had progressive disease. Patients were followed up for development of transplant-related toxicities and long-term survival outcome. Results: The incidence of grades 3–4 oral mucositis and grades 3–4 diarrhea was 8% and 4%, respectively. Median days to myeloid and platelet engraftment were 10 and 13. Transplant-related mortality was 7%. At median follow-up of 3 years, probability of overall survival (OS) and progression-free survival (PFS) at 3 years was 70% and 58% in entire cohort, 78% and 62% in HL and 51% and 46% in NHL subgroup, respectively. International Prognostic Score (IPS) >2 at relapse prognosticated for poor OS (P = 0.002) and PFS (P < 0.001) in HL subgroup. Positron emission tomography positivity pretransplant (HL subgroup) and at day + 100 (NHL subgroup) predicted for poor survival. Conclusion: We conclude that LACE is effective and well-tolerated conditioning regimen. IPS at relapse is the most important prognostic factor in HL transplant.

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Phyllodes tumor (PT) is an extremely rare tumor of the breast of mixed mesenchymal and epithelial origin. It may pursue a benign or malignant evolution with distant metastases in the latter case in 3–12% of patients. The most common sites of metastases are the lungs and bones. Although theoretically any organ may have metastasis, it is extremely rare that a PT will metastasize to the bilateral ovaries and present as Krukenberg tumor. Herein, we report such a case.

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Background: Uterine cervical cancer constitutes a major proportion of cancer in females of our population. The objective of this study was to conduct a clinical study of uterine cervical cancers including their survival from hospital-cancer registry data. Materials and Methods: Data of uterine cervical cancer patients diagnosed from January 1, 2010 to December 31, 2010 and that were treated at a regional cancer center in North East (NE) India was recruited. The cases were analyzed for age group distribution, stage, and treatment types. Survival from the date of first diagnosis and hazard ratios (HRs) was estimated. Survival probability and HRs were calculated by Kaplan–Meier method and Cox-proportional regression analysis, respectively. Active follow-up was done for the survival analysis. Results: One hundred and ninety-three patients (53.4%) were included for the analysis. Median age was 48 years, 56.5% (108/193) of patients were in the age group of 45–64 years, 56.5% (109/193) were Stage II patients, radiotherapy alone was the main treatment modality in 65.8% (127/193) of cases, 5-year overall survival (OS) was 40.7%, median survival was 44 months, early staged and advanced stage patients had 47.7%, and 29.4% 5-year OS (P = 0.002), respectively, and HR for advanced stages was 1.8 (P = 0.003, confidence interval (CI) = 1.2 to 2.7). Conclusion: Describing the clinical characteristics and survival of uterine cervical cancer patients is important for planning and identifying the gaps for its control in the NE India.

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Aims: Temozolomide (TMZ) is an alkylating agent used for glioblastoma multiforme (GBM) treatment. Nevertheless, resistance to TMZ is a major obstacle to successful treatment of this cancer. The aim of the present study was to investigate the effects of TMZ and thymoquinone (TQ) on U87MG cell line. Materials and Methods: The effect of TMZ and/or TQ on viability and invasion potential of U87MG cells was evaluated using various techniques including 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, lactate dehydrogenase activity, cell invasion, migration, and adhesion assays. Enzyme-linked immunosorbent assay and polymerase chain reaction were used to study the expression and secretion of matrix metalloproteinases (MMPs). Results: Combination of TMZ and TQ had a synergistic cytotoxic effect on U87MG cells. TMZ and/or TQ significantly reduced the potential of U87MG cells invasion. In addition, after treating with TMZ and/or TQ, there was a decrease in the levels of matrix matrix metalloproteinase 2 nad 9 (MMP 2 and 9) expression and secretion in U87MG cells. Conclusions: The combination of TMZ and TQ may emerge as a promising strategy for the successful treatment of GBM.

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Introduction: Oxaliplatin-induced neurotoxicity is the single main dose-limiting factor in the treatment of colorectal cancer. The degree of neurotoxicity may be either acute and reversible or observed as cumulative and chronic peripheral nerve damage leading to peripheral neuropathy (PNP), walking difficulties, extremity hypersensitivity, tingling and numbness, and increased pain sensation. Aim: The aim of this paper is to determine and compare the ratio of clinical versus subclinical PNP cases in colorectal patients who underwent oxaliplatin treatment. Materials and Methods: Thirty-two colorectal cancer patients were enrolled in the study. Patients received chemotherapy either as folinic acid and 5-fluorouracil and oxaliplatin or capecitabine and oxaliplatin regimen. Electroneurophysiological tests were performed before the treatment and after the 4^th cycle when the risk of peripheral nerve damage increases. All patients were subject to a standard neurological examination and a semi-structured questionnaire interview. Results and Discussion: Following oxaliplatin treatment, 21 (66.6%) of all patients presented neurological symptoms and/or electrophysiologically measured signs of PNP; of those, 7 patients (33.4%) displayed only electrophysiological changes and the remaining 14 patients (66.6%) presented fully symptomatic PNP – 4 patients were new neuropathy cases while the other 10 patients were previously diagnosed with PNP and showed signs of further neuronal deterioration and progressing sensory and motor dysfunction. Conclusion: Our study lays ground for further larger scale longitudinal studies on oxaliplatin neurotoxicity and its prevention. We believe that early diagnosis of oxaliplatin-induced neurotoxicity is essential in the prevention of irreversible nerve damage and should be prioritized when assessing and evaluating treatment so that adequate adjustment may be made.

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Objectives: To compare immunohistochemical expression of CD34 and CD105 in oral submucous fibrosis (OSF) and normal oral mucosa (NOM) and correlate with clinicopathological features of OSF. Materials and Methods: Total of thirty clinically diagnosed and histologically confirmed cases of OSF and 15 NOM were included in the study. Tissues sections were immunostained using CD34 and CD105 antibodies. Results: Twenty-eight cases (93.33%) were positive for CD34, and only 12 cases (40%) were positive for CD105 in OSF. In NOM all cases were positive for CD34 and only one case was positive for CD105. CD34 and CD105 significantly expressed in moderately advanced OSF when compared to very early, early, and advanced cases. It was found that the microvessel density (MVD) in NOM was significantly higher as compared to OSF and MVD decreased with advanced OSF. MVD was higher in CD34 when compared to CD105. MVD decreased with disease progression in OSF using both the markers. Conclusion: The role of CD34 in determining the premalignant nature of OSF could not be ascertained, since all endothelial cells were positive for CD34, whereas CD105 appeared to be more specific as it is associated with hypoxia-induced angiogenesis which is occurring in OSF due to hyalinization suggesting, CD105 to be more specific marker to determine neoangiogenesis in OSF. Thus further follow-up study of the cases positive for CD105 is required to determine the true nature of angiogenesis in OSF patients.

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Objective: Our study was undertaken to compare the dosimetric parameters of volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT) in postmastectomy patients with left-sided carcinoma breast. Study Design: This was a hospital-based cross-sectional study. Materials and Methods: Thirty plans were generated - VMAT with two partial arcs and field in field tangential 3DCRT plans. Results: In the 3DCRT plans, planning target volume (PTV) dose coverage was 2% higher compared with the VMAT plan 98.21 ± 1.79 versus 96.30 ± 2.62 (P = 0.028). The conformity index was better for the 3DCRT plan (0.97 vs. 0.95; P = 0.022), while the homogeneity index was worse for the VMAT plans (0.16 vs. 0.23; P = 0.057). However, the organ at risk sparing was better with the VMAT plans when compared to the 3DCRT plans. This was particularly relevant for the higher doses. The V20 Gy (34.94 vs. 24.42), V30 Gy (32.32 vs. 16.19), and V40 Gy (28.23 vs. 8.03) for the lung were significantly higher for the 3DCRT plans when compared to VMAT plans (P = 0.000). Similarly, the V20 Gy (29.88 vs. 12.79), V30 Gy (27.25 vs. 4.94), and V40 Gy (24.58 vs. 1.47) for the heart was significantly higher for the 3DCRT plans when compared to the VMAT plans (P = 0.000). The V5 Gy for lung (77.86 vs. 47.38) and heart (76.18 vs. 39.36) was significantly higher for the VMAT plans when compared to the 3DCRT plans (P = 0.000). Conclusion: VMAT is dosimetrically superior to the field-in-field 3DCRT for left-sided breast cancer patients owing to its comparable PTV coverage and better sparing of heart and lung.

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Aim: Tumor-associated macrophages (TAMs) play a decisive role in the regulation of tumor progression by manipulating tumor oncogenesis, angiogenesis, and immune functions within tumor microenvironments. Tumor progression is frequently associated with a phenotypic switch from M1 to M2 in TAM. Activation of signal transducer and activator of transcription 3 (STAT3) in TAM lead to tumor-induced immunosuppression. STAT3 is usually constitutively activated in a variety of malignancies. Consequently, STAT3 has emerged as a promising target for cancer immunotherapy. Materials and Methods: In this study, J774A.1 cell line which is an M2 macrophage and overexpress STAT3 was cultured in Dulbecco's Modified Eagle Medium supplemented by fetal bovine serum. Then, the STAT3 silencing was evaluated by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) using oligofectamine containing STAT3 short interfering RNA (siRNA). Oligofectamine containing STAT3 siRNA and control siRNA were added at a final concentration of 100 nM siRNA. The untransfected cells were considered as control group. Results: The semi-quantitative RT-PCR studies showed that J774A.1 cells express a high level of STAT3. Incubation of J774A.1 cells with oligofectamine containing STAT3 siRNA knockdown the STAT3 expression significantly both in 48 and 72 h study; however, the effect was more pronounced in 72 h study. Conclusion: The expression of STAT3 in J774A.1 cells confirmed that these cells are M2 macrophage. Moreover, silencing of STAT3 by siRNA delivery using oligofectamine delivery suggests that siRNA delivery using vehicles like nanoliposome could be a useful therapeutic agent in M2 macrophage therapy and its switch to M1 macrophages. This approach could be considered as a novel therapeutic agent for the treatment of all cancers.

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Background: Acute myeloid leukemia (AML) is a cytogenetically and molecularly heterogeneous diseases, and characterization of transforming genetic events is becoming increasingly important. Interleukins (ILs) are a diverse set of small cell signaling protein molecules. Single nucleotide polymorphisms (SNPs) of ILs alter their function, increasing susceptibility to different diseases. Patients and Methods: We investigated the association between polymorphism in IL-10 -819T/C (rs1800871) and the risk of AML in the Egyptian population. DNA was isolated from bone marrow of 80 newly diagnosed adult AML patients, and 85 age- and sex-matched controls. Genetic analysis of IL-10 SNPs at -819T/C was assayed by polymerase chain reaction-restriction fragment length polymorphism. Results: Genetic analysis of IL-10 revealed that the Egyptians have high -819T allele frequencies in apparently healthy controls, whereas -819CC genotype and the -819C allele frequencies in the AML group were higher than in the controls (P = 0.000086). The study suggested that subjects carrying the rs1800871CC genotype and C allele had a significantly increased risk for AML. Conclusion: IL-10 SNP at -819 was associated with enhanced AML risk, suggesting that rs1800871 provides clue for future studies and early detection of AML.

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Introduction: Breast cancer is the second leading cause of cancer-related mortality despite the staggering improvement in cancer therapeutics. So far, published data illustrate endocrine therapy as the cornerstone treatment for patients with hormone receptor-positive metastatic breast cancer. Unfortunately, most patients eventually develop resistance to this treatment. Methods: The purpose of this study is to evaluate the efficacy of mammalian target of rapamycin inhibition in reversing hormone resistance in the Lebanese breast cancer patients. Efficacy of the intervention according to the independent factors and notable side effects encountered were the primary points of the evaluation. Results: In total, fifty patients received the combination of everolimus and exemestane. The mean age of the study population was 61 ± 11 years. Sensitivity to hormonal therapy before the start of the combination treatment was estimated at 64%. Response rate was 14%, and all patients were partial responders. After regular interval evaluation, the median progression-free survival was 5.2 months since the initiation of therapy. The main toxicities associated with the combination were stomatitis (22%), myalgia (22%), skin toxicity (8%), and hyperglycemia (4%), all Grades 1 and 2. Conclusion: Everolimus has been shown to be effective in overcoming hormonal resistance in Lebanese breast cancer patients with results inferior to those reported in the BOLERO-2 population. The particular differences in molecular and pathological aspects of breast cancer in our region should stimulate the extensive research for a better understanding of the particular pattern of the disease.

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Aim of Study: While using F-18 fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT) for other than thyroid disease, an increased frequency of incidentally discovered areas of focally or diffuse increased uptake within the thyroid gland can be seen. We aimed to find the focal thyroid FDG uptake and compare the maximum standardized uptake value (SUV_max) results with cytology and histology results. Materials and Methods: We examined PET scan reports for all patients undergoing FDG PET/CT investigation over a 10-year period in a single center. Twelve thousand seven hundred and ninety-six patients underwent FDG PET/CT scanning in one PET/CT unit. Within this group, 526 patients had diffuse, focal, or multifocal FDG uptake. About 305 of 526 patients (57.9%) showed diffuse FDG uptake and 221 (42%) showed focal uptake on thyroid gland. Results: The malignant group thyroid nodule sizes were between 8 and 39 mm (21.1 mm average, standard deviation [SD] ±7.3) on ultrasonography (USG) examination. These nodules have SUV_max values between 2.3 and 31.2 (average 8.8 SD ± 5.7). Benign group thyroid nodule sizes were between 5 and 46 mm (average 18.3 mm, SD ± 5.8) on USG examination. There were no significant correlations between SUV_max of the incidental focal thyroid lesions seen on FDG PET/CT and fine needle aspiration biopsy results. Conclusion: There is a relatively high possibility of a malignant lesion in thyroid incidentaloma. FDG uptake of these lesions is not a useful tool in absolute discrimination between malignancy and benign lesion. The presence of primary or secondary malign lesion is diagnosed in 34.1% of the patients who are found to have incidental focal FDG uptake within thyroid gland in PET/CT scans, but we suggest that the thyroid incidentalomas detected on FDG PET/CT should be further examined with USG and scintigraphy.

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Aim of Study: Malignant pleural mesothelioma (MPM) is a highly lethal and refractory to multimodal treatment tumor. Numb is considered as a tumor suppressor playing critical roles in determining cell fate and has been shown to target the oncogenic transcription factor Gli1 for Itch-dependent ubiquitination, resulting in suppression of the oncogenic sonic hedgehog signaling in medulloblastoma. This study was designed to analysis the role of Numb and Gli1 in MPM. Materials and Methods: Tissues of 61 MPM patients and 22 normal pleura as control were investigated. Numb and Gli1 expression were evaluated by immunohistochemistry. The associations with clinical and pathological parameters of the two markers were statistically analyzed, and the correlation between them was also demonstrated. Results: The expression levels of Numb with nuclear Gli1 exhibited a significant inverse correlation (r = −0.361 P < 0.05). In addition, Numb has an inverse correlation with ki-67 labeling index (P < 0.05), and nuclear Gli1 was found in associated with the tumor International Mesothelioma Interest Group-stage (P < 0.05). The overall survival was influenced by the expression of Numb (P < 0.05) and histological subtype (P < 0.05), further regression analysis showed that only histological subtype has a prognostic influence on survival (P < 0.05). Conclusion: The results provide new evidence of Numb and Gli1 on the clinical characteristics of MPM, which may be helpful in clinical diagnosis and targeted therapy. Further research with larger sample size is needed.

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The well-being of young cancer survivors is hampered due to the toxic effects of chemotherapy on the ovaries, resulting in infertility. We report a case of a 42-year-old woman with a history of bilateral ductal carcinoma of the breast who underwent radical mastectomy with chemotherapy and radiotherapy was anxious to conceive. In vitro fertilization was performed with donor oocyte; the patient became pregnant and delivered a full term baby with no congenital anomalies. As very few have a background for providing guidance and treatment in this setting, this report highlights the possibility of improving the quality of reproductive life of young survivors by various assisted reproductive techniques, the importance of fertility preservation and a multidisciplinary team approach.

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Introduction: Cystosarcoma phyllodes of the breast, an uncommon sarcoma found primarily in women of the age group of 35–55 years, constitutes <1% of all breast neoplasms. These tumors are resistant to chemotherapy and hormonal therapies and often recur aggressively after initial surgery. Limited research is available about the role and effectiveness of adjuvant radiotherapy in reducing recurrences. Objectives: Surgery has been the primary treatment modality to date but with high recurrence rates. The purpose of this retrospective study is to highlight the role of postoperative time for adjuvant radiotherapy in aggressive borderline and malignant phyllodes tumor (PT). Materials and Methods: This retrospective study reviewed 13 histopathologically proven borderline and malignant PT, treated with radiation therapy to the dose of 50 Gray by external beam radiotherapy (EBRT) after primary surgical management. Results: The mean age at presentation was 33 years. Right laterality was more common (60% cases). Although all patients presented with lump, those who had pain as an added symptom turned out to be histopathologically malignant later on. Histopathologically, 66.6% patients were malignant, 20% borderline, and 13.3% benign. High mitotic index and stromal activity were observed in younger patients. Patients who received EBRT within a month of surgery had no local recurrence, whereas those who received EBRT after a month developed local recurrence (P = 0.012). Conclusion: Adjuvant radiotherapy is appropriate treatment for aggressive borderline and malignant PT. This study revealed that time interval between surgery to initiation of EBRT plays a significant role in the prevention of recurrence.

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Background and Objectives: TWIST is a transcription factor that plays a key role in the development of primary tumor to metastatic stage of cancer. It is an inhibitor of E-cadherin in epithelial-to-mesenchymal transformation process (epithelial–mesenchymal transition). Few studies are available on the use of TWIST as a goal in molecular-targeted therapy. The aim of this study was to evaluate of TWIST expression in oral squamous cell carcinoma (OSCC) and its correlation with clinicopathologic factors. Materials and Methods: In this cross-sectional study, immunohistochemical staining was for TWIST performed on 30 paraffin-embedded blocks of OSCC. Furthermore, thirty paraffin-embedded blocks of normal oral mucosa with minimum inflammation from the clinical and histopathologic aspects were selected. Staining intensity and percentage of stained cells from nuclear and cytoplasmic aspects were ranked in epithelial cells. TWIST expression and correlation with clinicopathologic factors were analyzed using Cox regression and Chi-square tests. Results: TWIST expression in OSCC was significantly increased compared to oral normal mucosa. Nuclear expression of TWIST in OSCC was significantly associated with clinical stage (P = 0.01) and lymph node metastasis (P = 0.007). Cytoplasmic expression of TWIST in OSCC was not associated with any clinicopathological factors. Conclusion: The results support the role of TWIST in carcinogenesis, development of OSCC, and its metastasis to lymph nodes.

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Hairy cell leukemia (HCL) is a rare, low-grade mature B-cell neoplasm with a characteristic clinical, morphological, immunophenotypic, and more recently described molecular (BRAF p.V600E mutation) profile. It typically affects middle-aged to elderly male who present with pancytopenia and massive splenomegaly. Lymphadenopathy is usually not seen. Atypical presentations such as absence of splenomegaly and presence of lymphadenopathy and leukocytosis, a hypoplastic marrow masquerading as aplastic anemia, pose a diagnostic challenge to both clinician and pathologist. A diligent morphological examination to look for the presence of hairy cells along with flow cytometric immunophenotyping showing consistent bright expression of CD200, in addition to well-described characteristic immunophenotype, helps in correctly diagnosing the case. This can be further confirmed by the consistent presence of V600E point mutation in BRAF gene. The correct identification of HCL in these unusual clinical presentations is of utmost importance owing to a different treatment approach in these cases. We present here four such cases with atypical presentation.

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Background: Cisplatin is one of the anticancer drugs used for head and neck cancers. Although some studies have shown that cisplatin can cause ototoxicity, periodic audiometric assessments have not been extensively studied in the Indian rural population. Hence, this study has been undertaken to evaluate the effects of cisplatin on hearing. Materials and Methods: Fifty-nine patients with squamous cell carcinomas of head and neck, who received cisplatin chemotherapy, were recruited. Serum creatinine, blood urea, serum proteins, and audiometry were assessed before and after the first, second, and third chemotherapy cycle. The cochleotoxic effect of cisplatin was assessed by pure tone audiometry. Hearing loss was graded accordingly. All patients were administered a quality of life questionnaire at baseline and at the end of the third cycle. Results: Hearing loss was observed in 12 patients at speech frequencies and those at higher frequencies were 12 (4000 Hz), 18 (6000 Hz), and 28 (8000 Hz). The hearing loss was symmetrical, sensorineural, and showed a strong correlation with the low serum albumin levels at the end of the third cycle. Dizziness was seen in eight patients, at the end of the study. The commonly observed adverse effects were nausea, vomiting, hair loss, fatigue, and tinnitus. Conclusion: The studies have shown hearing loss in higher frequencies, but in our study, we have observed hearing loss at speech frequency in 22.2% of patients receiving cisplatin, who also had low serum albumin levels. Periodic audiometric monitoring and serum albumin level may be helpful to provide timely intervention to prevent further hearing loss and deterioration in the quality of life.

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Aim of Study: Ovarian cancer (OC) leads to high mortality rate if diagnosed at late stage. The aim of the present study was to increase the survival rate by early disease diagnosis. Materials and Methods: A total of 21 females were divided into three groups. The control (n = 3), benign (n = 8), and malignant group (n = 10). We used flow cytometry to analyze cell cycle, caspase-3, -8, and annexin V. Results: The results showed that the annexin V expressed in malignant group more than benign and normal groups with (P = 0.000 and P = 0.007), respectively. Caspase-3 and 8 expression decreased in benign and malignant group than in normal group (P = 0.012 and P = 0.007), respectively. Furthermore, sub-G1 apoptosis level decreased statistically significant in benign and malignant group than in normal group (P = 0.012 and P = 0.007), respectively. These data showed that (S phase) level had statistically significant increase in malignant group (P = 0.007) than the control group and marked statistically significant decrease (P = 0.000) in benign group than malignant group. This study explained changes in sub-G1 apoptosis for benign group increase statistically significant (P = 0.003) than malignant group level. Conclusion: Caspase-3 and -8 and annexin V may serve as diagnostic markers in OC, also explained that the decrement in control of the S phase in the cell cycle may considered one of the significant factors in the development of ovarian tumors.

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Malignant thyroid tumors of follicular origin comprise a spectrum, with the indolent well-differentiated thyroid carcinoma (WDTC) at one end and lethal anaplastic thyroid carcinoma (ATC) at the other. Poorly differentiated thyroid carcinoma (PDTC) lies intermediately between WDTC and ATC in terms of morphology and prognostic standpoint. This thyroglobulin producing neoplasm accounts for 4–7% of all thyroid malignancies. PDTC has been controversial due to lack of defined diagnostic criteria. We hereby report a case of PDTC in a 42-year-old female presenting with neck swelling, pain, and dysphagia for 10 months. She was diagnosed as colloid goiter on fine-needle aspiration cytology. On imaging, a large complex thyroid with central neck nodes was seen. Total thyroidectomy and central neck node dissection were done. Based on the morphology, immunostaining, and the diagnostic criteria, a diagnosis of PDTC was made. PDTC is a diagnostic challenge due to its rarity and previous equivocal diagnostic criteria.

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Due to the cytotoxic effects of old chemotherapy regimens used in the islet cell tumors, capecitabine plus temozolomide combination has now become the first choice in the treatment of malignant insulinoma (MIoma). We present this case to emphasize and remind that a durable complete response in advanced stage MIoma may be achieved with a short course of streptozotocin plus doxorubicin combination.

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Introduction and Objectives: Nowadays, noncoding RNAs are of special significance to scientists. Among RNAs, long noncoding RNAs (lncRNAs) have an important role in gene expression regulation. Recent studies show aberrant lncRNAs expression in different types of cancer including blood malignancies. As such, lncRNAs could be a possible way for diagnosis and treatment of certain cancers. In the current study, the level of PCA3 gene expression in patients with chronic myeloid leukemia (CML) was compared with normal individuals to find out whether the level of PCA3 in CML patients is increased according to our hypothesis. Materials and Methods: The buffy coat was collected from peripheral blood of thirty untreated CML patients (BCR-ABL positive) and twenty normal volunteers. RNA was extracted from white blood cells and cDNA was synthesized. The level of PCA3 gene expression was measured using quantitative reverse transcription-polymerase chain reaction. Results: The results showed that PCA3 has expression in both normal and leukemic white blood cells. The data also revealed higher expression of PCA3 in leukemic patients, compared to the normal counterpart (P < 0.05). Conclusion: The unusual increase in PCA3 gene expression in CML patients suggests the need for more research on mechanisms of molecular pathways related to PCA3 which could help achieve better treatment.

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Objective: We aimed to demonstrate the effects of clinical evaluations as well as biopsy characteristics in terms of lymph node involvement (LNI) despite the small number of patients in our study. Materials and Methods: A total of 221 patients who underwent radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) in our clinic between 2010 and 2015 and who met the inclusion criteria were enrolled in our study group. All of the patients were evaluated in terms of age, prostate-specific antigen (PSA) value before transrectal ultrasound-guided prostate biopsy (TRUSPB), digital rectal examination, Gleason score (GS) on TRUSPB, percentage of positive cores on TRUSPB, total number of positive cores, highest percentage of cancer in positive cores, and number of lymph nodes removed at RP. Pathological examination of the data of RP specimens, PSA values in follow-up after surgery, and follow-up periods was recorded. The TNM 2009 classification was used for staging. Results: In the evaluation of LNI risk, as regards the assessment of predictors and outcomes with respect to the univariate and multivariate analyses, LNI was found in the univariate analysis to be associated with GS, clinical stage, number of lymph nodes removed according to the D'Amico risk classification. In the multivariate analysis, however, the number of lymph nodes removed was found significant. Conclusion: Risk stratification should be considered in patients with prostate cancer while selecting the patients who would undergo pelvic lymphadenectomy. In addition, ePLND should be performed to patients undergoing lymphadenectomy.

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Objectives: To investigate the correlation between tumor stage, Ki-67, Bcl-2, hypoxia inducible factor-1α (HIF-1α), cyclin D1 and metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUV_max) measured by ¹⁸F fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in patients diagnosed with laryngeal cancer. Patients and Methods: In this study, included 25 consecutive laryngeal cancer patients (2 women, 23 men) diagnosed and treated in the Otorhinolaryngology Department of our tertiary care center. All cases underwent ¹⁸F FDG PET/CT and SUV_max, mean standardized uptake value, MTV, and TLG values were calculated. Tumor staging was made and immunohistochemical staining was carried out for Ki-67, Bcl-2, HIF-1α and cyclin D1. Results: Eight (32%) patients had glottic laryngeal cancer, 6 (24%) had supraglottic laryngeal cancer and 11 (44%) had transglottic laryngeal cancer. Cyclin D1 was significantly correlated with MTV (r = 0.45, P = 0.03), TLG (r = 0.492, P = 0.01) and T-stage (r = 0.483, P = 0.02). Bcl-2 was significantly correlated with SUV_max (r = –0.41, P = 0.05) and tumor stage (r = –0.442, P = 0.03). MTV and TLG are significantly correlated with nodal stage (r = 0.422, P = 0.04, r = 0.419, P = 0.04), while TLG (r = 0.403, P = 0.05) and SUV_max (r = 0.440, P = 0.03) were correlated with tumor stage. Conclusion: Our results indicated that biomarkers such as cyclin D1 and Bcl-2 were correlated with measures such as MTV, TLG, and SUV in ¹⁸F-FDG PET/CT. Integrative and combined evaluation of biomarkers and imaging data derived from ¹⁸F-FDG PET/CT are important for staging and appropriate management of patients with laryngeal cancer.

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Malignant peripheral nerve sheath tumor (MPNST) is a rare variety as sporadic tumor but more common when associated with neurofibromatosis, and its usual site of origin lies in the extremities. MPNST of thoracic cavity is a rare site of origin with only anecdotal reports in literature. Progression to a large size without distant metastases is even rarer owing to its high metastatic potential. We present a case of thoracic MPNST highlighting its rarity and the treatment options available to provide a best possible outcome.

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Background: Esophageal squamous cell carcinoma (ESCC) is considered as the seventh most common cancer worldwide, and the second prevalent malignancy in the north of Iran. A subfamily group of tumor-specific antigens, commonly specified as cancer/testis antigens (CTAs), are expressed restrictedly in testis, ovary, and placenta. Melanoma-associated antigen A4 (MAGEA4) as a CTA is overexpressed in a variety of cancers. Expressional analysis of MAGEA4 protein in ESCC may be useful to investigate its clinical relevance leading to effective improvements in ESCC diagnosis and treatment. Materials and Methods: Fifty-six ESCC patients with no preoperative therapeutic circumstance such as radiotherapy or chemotherapy were analyzed to explore the protein expression level of MAGEA4 using immunohistochemistry assay. Results: MAGEA4 overexpression was detected in 66% of ESCC samples showing strong nuclear and cytoplasmic staining compared to the normal epithelium. There were significant correlations between MAGEA4 protein expression and depth of tumor invasion (P = 0.019), and the number of involved lymph nodes (P = 0.045). Conclusion: Because of the significant correlation of MAGEA4 and indices of poor prognosis, the role of this CTA may be confirmed in ESCC aggressiveness and metastasis. Therefore, MAGEA4 may be a promising therapeutic candidate for suppressing ESCC aggressiveness.

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The early diagnosis of very rare nasopharyngeal carcinoma (NPC) is so difficult, to surrounded by structures such as the orbital skull base. With the invasion of the disease, the symptoms are manifested in different ways so that it may be confusion and delay in diagnosis and treatment in this situation. Including otological symptoms (serous otitis media), Gradenigo's syndrome is a rare clinical condition. The majority of published cases involve children, and the most common etiology is otitis media. We report a case of a diabetic man who presented with repeating Gradenigo's syndrome symptoms due to NPC.

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Mature cystic teratoma is the most common type of ovarian germ cell tumor. The presentation ranges from its asymptomatic nature to various complications such as torsion, rupture, and malignant change. The present case summarizes the rarest complication in the form of superinfection in a young girl without preexisting risk factors.

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Background: Advancement in diagnostic and therapeutic modalities lead to increased cancer survivors who have 20% higher risk of developing second primary malignancy (SPM). Aim: To look for the incidence, epidemiological factors, treatment-related factors, and common risk factors responsible for the development of the SPM in Malwa region. Materials and Methods: Records of 7709 patients who visited the Department of Oncology between May 2008 and August 2015 were analyzed and looked for the presence of SPM based on Warren and Gates criteria for head and neck and International Agency for Research on Cancer definition for other sites. Data pertaining age at diagnosis of each tumor, gender, site, histology, the duration between primary and secondary tumors, treatment received for each malignancy, smoking and drinking habits, and metastasis sites were recorded. Results: Of 7709 patients, 56 developed SPM (11 synchronous and 45 metachronous) with an overall incidence of 0.726%. For metachronous SPM, the interval of 10–312 months was observed, with a mean time of 103.32 months (standard deviation 65.9 months). About 71.42% patients with SPM belonged to fifth, sixth, and seventh age decade. The median age of diagnosis for the second primary neoplasm was 57 years (range: 34–85 years). Maximum SPM were observed among head and neck tumors (33.93%) followed by breast (26.78%). The most common sites for SPM are head and neck (32.14%) followed by digestive system (19.64%). Breast as the first or the second location was seen associated with almost all systems. For the treatment of first primary, six received surgery, three received chemotherapy (CT), one received radiotherapy (RT) alone, and rest 46 patients received combined modality. For the treatment of SPM, 37 patients received combined modality, ten received CT, three with RT, and two with surgery while four patients received no treatment. Thirty-two patients had habits of tobacco, smoking and alcohol intake with twenty patients continued these after treatment for the first primary neoplasm. Conclusions: Patients with breast and head and neck cancer have a higher risk of developing SPM. The possibility of SPM should be considered and excluded during pretreatment evaluation and during follow-up of treated cancer patients.

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Background: Recent studies have shown pretreatment sodium level to be a predictive and prognostic marker in nonsmall cell lung cancer (NSCLC) patients treated with erlotinib. The objective of this study was to evaluate the prognostic significance of pretreatment sodium levels on progression-free survival (PFS) and overall survival (OS) in patients of NSCLC treated with pemetrexed-platinum doublet chemotherapy. Patients and Methods: Stage IIIb/IV NSCLC patients aged ≥18 years for whom baseline serum sodium level was available were included in this retrospective study. All patients received standard pemetrexed-cisplatin/carboplatin doublet for six cycles followed by maintenance pemetrexed till progression. Electronic medical record database of our hospital was used to retrieve demographic data, pretreatment sodium levels, and survival data. Normal serum sodium (NSS) was defined as serum sodium ≥136 mEq/L, and low serum sodium (LSS) was defined as serum sodium <136 mEq/L. The impact of sodium levels on PFS and OS after adjusting other prognostic factors was estimated using Cox proportional hazard model. Results: Data were available for 257 patients (male/female = 182/75) with median age of 55 (21–78) years. A total of 120 (46%) patients had LSS whereas 137 (54%) had NSS. Patients with NSS had significantly longer median PFS (7 months vs. 6 months; P < 0.05) and OS (16 months vs. 11 months; P < 0.05) compared to LSS group. Multivariate analysis showed LSS as an independent prognostic variable for poor survival (hazard ratio = 2.07, 95% confidence interval = 1.11–3.84). Conclusion: Pretreatment serum sodium level is an important prognostic marker in Stage IIIb/IV NSCLC patients. The simple possibility of testing coupled with low cost makes it an attractive biomarker.

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Background: Photon dose distribution of malignant pleural mesothelioma (MPM) in matched photon-electron technique is influenced by media inhomogeneity, lateral electronic disequilibrium at interfaces and narrow field. These may influence the dose calculation accuracy, calculated by treatment planning systems (TPS). This study aimed to evaluate the dose calculation accuracy of TiGRT TPS in radiation therapy of MPM. Materials and Methods: 18 MV photon beams of ONCOR Siemens linear accelerator was simulated using EGSnrc Monte Carlo (MC) code. Data of four patients were used to compare TPS and MC results in different regions included: Open and in-field, under shied and out of field regions. Results: Compared to MC results, the TPS overestimated the pleura dose coverage (90% of prescribed dose) about 3–12 mm, and also it overestimated the dose in under the shielded regions of lung (4–74%). While the TPS underestimated the dose profile width about 1–16 mm in low dose region (<50% prescribed dose) as well as the out of field region dose (4–100%). Conclusions: Results showed that TPS underestimated the dose in out of field and overestimated the dose in under the shielded regions. Unlike MC measurements, TPS calculation showed adequate pleural dose coverage. Based on the results, MC calculation can be used in matched photon-electron beam radiation therapy of MPM to modify the TPS photon dose calculations in the presence of heterogeneity, interfaces, and shield in MPM radiotherapy.

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Aim of Study: This review aims to highlight that bosutinib represents a valuable alternative for patients already treated unsuccessfully with one or more other tyrosine kinase inhibitors (TKIs). Chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm associated with a specific genetic abnormality resulting in a fusion protein with an active tyrosine kinase region. Therefore, TKIs were developed as a suitable treatment option. Methods: Full-text articles, abstracts, and meta-analysis comparing the efficacy and safety of the five TKIs were included in the review. Efficacy of these enhanced therapies is estimated on the basis of achievement of a complete cytogenetic response (CCyR) and this outcome is an important goal as a surrogate marker for improved survival. Results: Bosutinib's efficacy is comparable to that of imatinib in the first-line setting and with dasatinib and nilotinib as second-line therapy, while its safety profile is distinctly different. Most therapeutic guidelines for CML recommend an initiation of therapy with imatinib and application of dasatinib and nilotinib as subsequent lines. Conclusion: Bosutinib is generally not recommended despite its demonstrated efficacy and manageable toxicity. However, resistance, intolerance, specific mutations, as well as disease progression are often the reasons for the lack of sufficient response to therapy registered by the lower rates or complete absence of CCyR. Treatment options are limited for these patients.

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Nasopharyngeal carcinoma (NPC) metastasizing to urinary bladder is an uncommon site. We report an interesting case of NPC, on follow-up, presenting with unusual urinary symptoms and mimicking a primary bladder cancer. Subsequent bladder cold cup biopsy and immunohistochemistry unfolded a metastasis of NPC, highlighting unexpected and a rare presentation.

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Aim: Determination of boron neutron capture therapy in-phantom parameters by response matrix (RM) method. Materials and Methods: In this study, various in-phantom figures-of-merit including therapeutic gain, advantage depth dose rate, advantage depth, therapeutic depth, treatment time, skin dose rate, and skull dose rate have been analyzed using the RM method. This method is based on the division of neutron/gamma spectrum and calculation of various dose components of each energy group. Summation of these dose responses is equal to the total dose of the whole spectrum. Based on this method, in-phantom parameters could be calculated by a computer program in a very short time. Results: There is a good agreement between direct calculation and RM method. The maximum allowable contaminations of the thermal and fast neutrons in a neutron beam have been calculated by RM method. It was found that these values are 17.4% and 2.6%, for thermal and fast neutron, respectively. Conclusion: The results confirm that the RM method is a fast method to evaluate in-phantom parameters without repeating simulations due to change in neutron spectrum and treatment conditions.

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Background: Design of phantoms for use in radiotherapy should consider the complex geometry of breast tissue and inhomogeneity. The aim of this study is design of a slab phantom for breast dosimetry applications. Materials and Methods: In this study, an anatomical slab phantom was designed with cork lung inhomogeneity and plexi colored heart part, also describes the different size of breast and chest wall phantom that have been designed and constructed for dosimetry. Three size different phantoms have been manufactured that installed in one trunk, as “small,” “medium,” and “large,” two breast size fixed and one size was movable on a chest wall phantom. Two different dosimeters selected to dosimetry in this phantom, film was chosen for this dosimetry since it provides good spatial resolution and suitable for two-dimensional dosimetry also measure dose distribution used a point dosimetry with thermoluminescent dosimeter (TLD). Results: The results were shown near date due to either software or phantom calculation. Conclusion: Application include assessment dose in the junction region between the tangential fields and the supraclavicular fossa field, as well as assess dose in inhomogeneities, the phantom were formed from a variety of tissue substitute materials.

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Aims: This study aims to determine the diagnostic efficacy of microsatellite markers for screening bladder cancer in population at high risk. Materials and Methods: A population of 200 people was screened for bladder cancer using a set of microsatellite markers. Urine samples were obtained from four different types of population groups – Group 1 (healthy population group), Group 2 (current smokers with a smoking history of more than 10 years), Group 3 (bladder cancer group), and Group 4 (bladder cancer group who were former smokers with a history of more than 10 years). Polymerase chain reaction (PCR) was performed to amplify microsatellite sequences at D9S63, D9S156, and D9S283. PCR products were separated on 1.8% agarose gel and were scanned using ultraviolet transilluminator. Results: In Group 2 (high-risk population group, mainly current smokers with a history of more than 10 years), microsatellite alterations were found in 36 out of 50 people. We observed microsatellite alterations in 38 out of 50 people in Group 3 (bladder cancer group) and in 39 out of 50 people in Group 4 (bladder cancer group, mainly former smokers with a history of more than 10 years). The sensitivity of this test in Group 2, Group 3, and Group 4 was found to be 72%, 76% and 78%, respectively. The specificity of this test in each group was found to be 90%. Conclusion: Using these set of microsatellite markers, medium sensitivity and high specificity were reported for this test. The current findings suggest that a set of microsatellite markers (D9S63, D9S156, and D9S283) can be used to detect bladder cancer in high-risk population.

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Background: To determine the impact of concurrent chemoradiotherapy (CCRT) with or without induction chemotherapy over radiation alone for the treatment of patients of cervical lymph node metastasis from an unknown primary tumor. Materials and Methods: A total of 96 patients with squamous cell histology of cervical lymph node metastases from unknown primary tumor were retrospectively reviewed. About 12 patients were treated with radiation alone (RT alone), 45 with CCRT, and 39 with induction chemotherapy followed by CCRT (ICCRT). Results: Overall response rate (ORR) obtained with RT alone arm was 75%, whereas for CCRT, it was 86.7%. About 15.4% had a complete response (CR) after induction chemotherapy with 92.3% ORR after the completion of CCRT. At 2 years, the disease free survival (DFS) was 50% in RT alone, 73% with CCRT, and 62% with ICCRT, while the corresponding rates at 5 years were 50% for RT alone, 45% with CCRT, and 54% in ICCRT arm. Conclusion: Though we obtained a high ORR with concurrent or induction chemotherapy arm over RT alone, there is no clear advantage in the DFS. The nonrandomized nature of this trial and the potential for selection bias should definitely be taken into account while drawing comparisons from this trial.

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Objective: We studied CXCL12-related rs18011157 polymorphism in non-Hodgkin lymphoma (NHL) patients. We also determined the effect of this polymorphism on clinical features and outcome of NHL. Methods: We included 90 NHL patients (54 males, 36 females) and 88 healthy controls (54 males, 34 females). CXCL12-related rs18011157 polymorphism was determined by polymerase chain reaction. Results: rs18011157 polymorphism was significantly more frequent in NHL patients with GA genotype than in healthy controls (37.8% vs. 20.5%, P = 0.011). The frequency of patients with initially high lactate dehydrogenase (LDH) level (65.8% vs. 38.5%) and extranodal involvement (61.1% vs. 43.8%) was significantly higher in the GA plus AA genotype groups when considered altogether (P = 0.01 and 0.09). Poor prognostic factors in univariate analysis were the presence of B symptoms, initially high International Prognostic Index (IPI), splenomegaly, nonresponse to first-line therapy, the presence of early relapse, and carrying A allele (GA plus AA genotypes). The independent prognostic factors in multivariate analysis were only early relapse and an initially high IPI score. Discussion: CXCL12 rs1801157 polymorphism which was found to be associated with extranodal involvement and increased LDH in NHL might be a marker of poor prognosis in patients with GA and AA genotypes. Conclusions: CXCL12-related rs18011517 polymorphism was more frequent in NHL patients: it might be associated with NHL pathogenesis and outcome.

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Background: Renal cell carcinoma (RCC) is the most common kidney neoplasm and requires an early diagnosis because of poor response to conventional cancer treatments. However, till date, there is no reliable tumor marker available for the diagnosis of RCC. Objective: The aim of the study was to evaluate the expression of speckle-type POZ protein (SPOP) as a biomarker in patients with RCC. Materials and Methods: Blood samples were collected from fifty patients with RCC and ten healthy controls. Tumor tissue samples were obtained from nephrectomy specimen. Adjoining normal renal parenchyma of these fifty patients and eight normal renal tissue samples from normal kidney served as controls. Reverse transcriptase-polymerase chain reaction assay was performed for SPOP and mammalian target of rapamycin expression. Results: SPOP was significantly increased in blood of patients with RCC as compared to controls (0.754 ± 0.32 vs. 0.224 ± 0.14; P < 0.001). Twenty-two patients (44%) had SPOP value more than mean + 2 standard deviation (SD) of controls. In RCC tissue, 42 (84%) patients had increased expression of SPOP more than 0.523 (mean + 2 SD value of SPOP expression in controls). SPOP expression was high in blood of 60% patients and in tumor tissue of 90% patients with clear cell RCC. SPOP was higher in high grade and high stage of RCC. Conclusions: Our result suggests that SPOP expression in blood might have a sensitivity that is low for routine diagnostic use and for screening for RCC. However, SPOP could be a potential tissue diagnostic biomarker in RCC.

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Context: Computer-aided diagnosis (CAD) combining mammographic features from cranio-caudal (CC) and medio-lateral-oblique (MLO) views improve the diagnostic performance of breast cancer. This could help doctors incorrect diagnosis at the earlier stage thereby reducing mortality. Aim: The aim of this study is to propose a breast cancer diagnostic technique for improving the diagnostic accuracy and reducing the false positive rate by fusing mammographic features from CC and MLO views. Settings and Design: The MLO and CC view mammograms of same patients must be used to extract k-Gabor features and then fused to form a single feature vector. Subjects and Methods: Mammograms from the digital database for screening mammography (DDSM) and INbreast datasets are collected. k-Gabor features extracted from both MLO and CC view mammograms are fused serially and reduced by principal component analysis (PCA) or genetic algorithm. The reduced features are classified using a multi-layer perceptron feed forward neural network with backpropagation learning algorithm. Statistical Analysis Used: Various relevant performance metrics such as accuracy, sensitivity, specificity, discriminant power, Mathews correlation coefficient (MCC), F1 score and Kappa are used to analyze the classification results. Results: The accuracy, sensitivity, specificity, discriminant power, MCC, F1 score, and Kappa obtained as 92.5%, 93%, 91.8%, 1.198, 0.845, 0.936, and 0.845, respectively, for DDSM. For INbreast, the above specified metrics are 87.5%, 90.9%, 85.7%, 0.980, 0.741, 0.833, and 0.734, respectively. The results show 4.4%, 4.3%, and 9.4% improvements in accuracy, sensitivity, and specificity, respectively, compared to the previous works. Conclusions: Detailed analysis of the results implies that the serial fusion of k-Gabor features extracted from MLO and CC views with PCA reduction in CAD significantly improves the diagnostic performance.

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Background and Objectives: Human chorionic gonadotropin-β (hCGβ) is a hormone glycoprotein usually secreted by trophoblastic cells in early pregnancy and helps in growth and development of the embryo. While many trophoblastic and nontrophoblastic malignancies express elevated levels of hCGβ in serum, increased immunohistochemical reactivity has also been reported in malignant and aggressive tumors, thus serving as a marker. As limited studies exist on tumors of the oral- and para-oral region, it prompted us to observe the immunohistochemical expression of hCGβ in salivary gland tumors. Materials and Methods: A total of 21 cases of salivary gland tumors – 16 cases of mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ACC), and five cases of pleomorphic adenoma – were included in the study. The sections were subjected to immunohistochemical procedures using hCGβ antigen. The degree of intensity and distribution of hCGβ immunostaining was assessed. Results: One case of each (12.5%) MEC and ACC showed positive staining, and no staining was observed in the pleomorphic adenoma. Conclusion: The presence of hCGβ positive tumor cells appears to potentially reflect the aggressive behavior of MEC and ACC.

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