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An official publication of the Middle-Eastern Association for Cancer Research
Clinical Cancer Investigation Journal
2021 Volume 10 - Issue 6
Table of Contents
Cervical minimal deviation adenocarcinoma (MDA) is an extremely well-differentiated adenocarcinoma. This tumor often imposes diagnostic dilemma among pathologists as it is confused with a variety of benign mimics and represents a diagnostic challenge in the field of gynecologic oncology. Since the microscopic features are subtle, it is frequently misinterpreted as benign and often misdiagnosed and inadequately treated. False positive as well as false negative reporting of MDA on cervical biopsy is commonly seen among pathologists, both of which have grave implications on the treatment of the patient. Immunohistochemistry has been found to be extremely useful in the diagnosis of MDA. In this review, based upon our experience and that of the literature, we highlight the salient clinicopathological features, discuss the benign mimics and review the immunohistochemical and molecular features that aid in the diagnosis.
Kavita Mardi
Objective: The objective of this study was to identify whether microRNA (miR)-21 and miR-191 could be used as a potential biomarker in patients diagnosed with oral leukoplakia (OL) and oral squamous cell carcinoma. The aim of this study was to evaluate the expression of miR-21 and miR-191 in patients diagnosed with OL and oral squamous cell carcinoma. Materials and Methods: Fifteen patients each diagnosed with OL and oral squamous cell carcinoma and 15 healthy controls were recruited for the study. The miR was extracted from the tissue samples for the evaluation of miR-21 and miR-191 using RT-qPCR. Results: The miR-21 (P = 0.0005) and miR-191 (P = 0.0094) were significantly expressed in oral squamous cell carcinoma in comparison with healthy tissues. The expression of miR-191 was also significantly overexpressed (P = 0.0460) in OL in comparison with healthy tissues. Conclusion: The profile miR-21 and miR-191 could be used as a novel biomarker for oral squamous cell carcinoma and miR-191 could be used as a biomarker for OL.
K Muth Lakshmi, Krithika Lakshmi, A Kannan, Yesoda Aniyan
Introduction: Radiotherapy for breast cancer has evolved over the years in terms of technique and dose fractionation. Hypofractionation for whole-breast radiotherapy has equivalent local control and toxicity profile compared to standard fractionation; however, evidence of the same for post modified radical mastectomy chest wall irradiation is scarce in terms of local control and complications. We undertook this study to determine whether hypofractionated (HF) chest wall irradiation gives comparable outcomes to standard fractionation in terms of locoregional control and late effects like arm and shoulder disability in resource-constrained setup. Materials and Methods: Breast cancer patients presenting at the outpatient department (OPD) from March to December 2015 who underwent postmastectomy chest wall irradiation were taken for the study. Radiotherapy was delivered by clinical planning using THERATRON 780c with cobalt 60, with tangential fields for chest wall and single anterior field for axilla and supraclavicular region. Patients were treated with either conventional fractionation of 50 Gy in 25# or HF to 42.5 Gy in 16 fractionation to both chest wall and regional nodes. Data were analyzed for patient profile, toxicity, and local and distant failure. Late complications in terms of upper limb morbidity was calculated using QuickDASH(short version of disabilities of arm, shoulder and hand questionnaire) score for patients presenting at OPD from June to November 2019 for follow-up. Results: The sample size in the HF and standard arm was 40 and 34, respectively. The hypo# arm had a significantly more number of patients with >3 lymph nodes positive (P = 0.044). The median follow-up of 41 months, the standard and hypo# arm had 6 and 7 failures respectively. The 3-year disease-free survival was 82.4% and 82.5% in the respective arms (P = 0.925). No Grade II or Grade III acute toxicity was noted in both the arms. No Grade II skin or subcutaneous toxicity was noted. The mean QuickDASH score was 5.84 in the standard arm and 6.54 in the HF arm (P = 0.727, Mann–Whitney U test, Nonsignificant). However, the QuickDASH score was found to be significantly more in patients who had a large interfiled distance or who had received axillary radiation. Conclusion: Postmastectomy HF chest wall radiotherapy may be a good alternative to conventional fractionation radiotherapy in terms of locoregional control with no difference in acute toxicity and late complications.
Anis Bandyopadhyay, Arnab Ghosh, Bappaditya Chhatui, Dhiman Das
Background: The aim of the study is to evaluate the role of fibrotic cancer stromal response and tumor budding in ectal adenocarcinoma development and progression. Materials and Methods: Fibrotic cancer stroma was classified into three distinct histological categories, i.e. mature, intermediate, and immature. The number of tumor-budding foci was counted in the low-power field (×10), and 0–5, 5–9 and ≥10 tumor buds were scored as I, II, and III, respectively. All histological and immunohistochemical assessments were made at the invasive front of the tumor. The distribution of T lymphocytes and myofibroblasts was assessed by immunohistochemical reactivity for the cluster of differentiation 3 and anti-smooth muscle antibody actin, respectively. Results: Among 25 cases of rectal carcinoma, 60% (15 cases) of patients had mature fibrotic cancer stroma, whereas 28% (7 cases) of patients had intermediate stroma and 12% (3 cases) of patients had immature stroma. The cancer-specific 5-year survival rate in the groups with mature stroma, intermediate stroma, and immature stroma was 53.34%, 42.8%, and 33.34%, respectively. There was a statistically significant correlation between the category of fibrotic cancer stroma and the tumor budding. Further, on immunohistochemical analysis and counting, the average number of T-cells was 302/400 μm diameter field in the region of mature fibrotic stroma, in comparison with 197/400 μm and 92/400 μm in the intermediate and immature fibrotic stroma, respectively (unpaired t-test with P < 0.05). Myofibroblasts were observed in 20% of tumors with mature fibrotic stroma compared with 65% in the intermediate fibrotic stroma and 100% of the tumors with immature fibrotic cancer stroma. Conclusions: The histological classification of fibrotic cancer stroma highlights the role of the stromal response with respect to host immune reaction and behavior in rectal adenocarcinoma and acts as a useful tool for predicting patient prognosis and outcome.
Navpreet Kaur, Sufian Zaheer, Preeti Sharma, Vaishali Rohilla, Sunil Ranga
Background: Adenocancer pathologic subtype, smoking history, and women gender have been known to predict the parameters such as the sensitivity to epidermal growth factor receptor tyrosine kinase inhibitors in advanced non-small cell lung cancer (NSCLC); however, we need new predictive markers as well as driver mutations for better treatment options. The aim of this study is to investigate the predictive role of sarcopenia in lung adenocancer patients treated with erlotinib. Materials and Methods: This study was designed as retrospectively. Skeletal muscle index (SMI) was measured with a single cross-sectional area of the muscle at the third lumber vertebra (L3, cm2)/(height × height)(m2). Sarcopenia was defined by median cutoff values of SMI of women (<28.2 cm2/m2) and men (<32.7 cm2/m2). The predictive role of sarcopenia and other parameters was assessed by the cox-regression model. Results: The median age was 56 years (range, 36–84). Median progression-free survival (PFS) was 38 (95% confidence interval [CI]: 21.3–54.6) weeks in the sarcopenic group and 49 (95% CI: 0–101.4) weeks in the nonsarcopenic group (P = 0.053). In multivariate analysis, the presence of sarcopenia and number of metastatis were the independent predictive factors for PFS. Disease control rate and overall survival were not significantly different between sarcopenic and nonsarcopenic groups. Conclusion: We found that the presence of sarcopenia and number of metastasis were a predictive marker in NSCLC patients treated with erlotinib. It is important to recognize sarcopenia early and manage patients accordingly.
Havva Cinkir, Tulay Kus, Gokmen Aktas, Umut Elboga
Background: Breast cancer (BC) is the most frequently diagnosed visceral cancer, with 13,400 new cases annually in Iranian women. A few studies in Western countries have indicated that BC patients with higher educational backgrounds have a better prognosis than patients with lower educational backgrounds. In a retrospective single-center study, we examined educational background and its relationship with pathological stage and treatment modalities in 3010 BC patients. Materials and Methods: The medical records of the patients from the database at the Cancer Research Center of the Shahid Beheshti University of Medical Sciences were reviewed. Univariate logistic regression analysis was used to link educational background to pathological BC stage and treatment modalities. Results: The average age at diagnosis was 49.1 ± 11.6 years. Regarding education level, 4.2% of the patients were illiterate, 7.8% had primary school level education, 7.5% had middle school level education, 21.8% had secondary school and diploma level education, 18.6% had university level education and higher, and 40.1% had unspecified level education. Based on the univariate logistic regression analysis, the illiterate group had 65.1% of early-stage BC (Stages I and II) and the university level education and higher group had 73.4% of early-stage BC (P < 0.001). The rate of receiving chemotherapy, radiotherapy, and endocrine therapy was 35.7%, 42.1%, and 50% in the illiterate group and 93.7%, 64.3%, and 71.1% in the university level education and higher group, respectively (P < 0.001). Moreover, the rate of breast-conserving surgery was 15.1%, 18%, 16.3%, 42.5%, and 73.2% in the illiterate, primary school level education, middle school level education, secondary school and diploma level education, and university level education and higher groups, respectively (P < 0.001). Conclusion: The study's findings showed that educational background had a significant impact on pathological staging and the selection of treatment modalities.
Amir Yousefi Kashi
Background: Gastric cancer is the third most common cause of cancer-related death worldwide. Tumor budding is an easy to detect histopathological feature associated with a poor prognosis in patients with several types of cancer. The present study aimed to determine the relationship between tumor budding and clinicopathological parameters in gastric adenocarcinoma patients. Materials and Methods: This study retrospectively analyzed the H and E-stained slides of 146 patients that were diagnosed with gastric adenocarcinoma between 2013 and 2017. Tumor budding, large cell invasion, mitosis, fibrosis, and peritumoral lymphocytic response were recorded in all cases. The relationship between tumor budding and clinicopathological prognostic parameters was statistically analyzed. Results: Increased tumor budding density (≥10 tumor buds) was observed in 62 (42.5%) of the patients. There was a significant relationship between increased tumor budding density and histological grade (P < 0.001), lymphovascular invasion (P = 0.016), perineural invasion (P < 0.001), lymph node involvement (P = 0.015), and tumor invasion depth (pT stage) (P < 0.001). There was also a significant relationship between a high fibrosis rate, and lymphovascular invasion (P < 0.001), lymph node involvement (P = 0.030), and pT stage (P = 0.002); however, there wasn't a significant association between prognostic parameters, and large cell invasion, the mitotic count, and peritumoral lymphocytic response. Conclusions: The present findings suggest that increased tumor budding density in gastric adenocarcinoma patients may be used to predict poor prognosis.
Gulfidan Ozturk, Aysun Gokce, Murat Alper
Background: P16/Ki-67 dual immunostaining has been confirmed as a sensitive and specific test for human papillomavirus positive women. In the present study, we evaluated cell blocks (CBs) with p16INK4A/Ki-67 biomarkers to detect high-grade cervical intraepithelial neoplasia (CIN). Materials and Methods: Samples for CB preparation were taken from females with abnormal Pap smears, who also underwent colposcopic guided biopsies, P16INK4A and Ki-67 staining were performed on CBs and tissue biopsies, histopathology with p16INK4A expression was considered the gold standard. Sixty-five specimens were included in the study. Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (AC) of CB + p16INK4A/Ki-67 in detecting CIN2 when considering only cytology specimens with the low-grade squamous intraepithelial lesion (LSIL) were 86.67%, 100%, 66.67%, 89.66%, and 82.93%, respectively. The sensitivity, specificity, PPV, NPV, and AC of CB + p16INK4A/Ki-67 in detecting CIN2 when considering only cytology specimens with atypical squamous cells of uncertain significance/LSIL were 75%, 85%, 60%, 91.89%, 82.69%, respectively. Rates of positive staining for p16 INK4A/ki-67 were enhanced according to increased pathologic grade and differed statistically between CIN1 and CIN2 as well as squamous cell carcinoma. Conclusion: CB preparation technique with p16INK4A and Ki-67 immunostainings have improved the diagnostic AC of Pap smear in detecting high-grade CIN.
Ghefar Omar, Ashraf Olabi, Fatima Alduihi, Lina Ghabreau
Background: Water-pipe smoking (WPS), a predominant method of tobacco consumption, is common amongst young females in the Middle East. WPS smoke consists of toxins analogous to the ones that exist in cigarette smoke and frequently correlates with the onset of several types of human cancers including breast. However, the potential target genes and their underlying mechanisms in the initiation and/ or progression of human cancers, especially breast, due to WPS exposure are still unknown. Materials and Methods: In this investigation, we explored the effect of WPS chronic exposure on human normal mammary epithelial cells and analyzed alterations in the differentially ex-pressed gene (DEG) targets using the NanoString nCounter PanCancer Pathways Panel consisting of 770 gene transcripts and a quantitative real-time polymerase chain reaction (PCR) analysis. Results: Our NanoString analysis identified 13 genes dysregulated under the effect of WPS exposure involved in regulating signal transduction, cell cycle, cell motility, proliferation and migration/invasion as well as the inflammatory response. We further performed an in silico analysis to investigate the effect of the identified genes in the prognosis of breast cancer patients and reported those DEGs that directly correlated with smoking and were upregulated in breast cancer in comparison with normal tissue. Moreover, the Kaplan–Meier curve analysis showed a significant correlation be-tween WPS-dysregulated genes (MX1, CCL8, GNGT1 and MMP9) and relapse-free survival in breast cancer patients. Conclusions: Our data clearly suggest that exposure to WPS can alter the expression of key regulator genes involved in the pathogenesis of breast cancer, thereby affecting the breast cancer prognosis.
Vanessa Lopez-Ozuna, Ishita Gupta, Ryan Chen Kiow, Emad Matanes, Amber Yasmeen, Semir Vranic, Ala-Eddin Al Moustafa
Over recent years, targeted therapy has become one of the most important innovations in cancer treatment. Agents targeting the epidermal growth factor receptor (EGFR) are administered in patients with advanced, recurrent or metastatic malignancy. We reported the case of a 74 year-old male patient with metastatic colorectal cancer who developed an SDRIFE and acneiform eruption during molecular target therapy with cetuximab and FOLFOX.
Rosa Coppola, Bianca Santo, Sonia Silipigni, Vincenzo Panasiti
Hepatoid adenocarcinoma of gallbladder: A mimicker of hepatocellular carcinoma
Kavita Mardi, Monica Sarohi
Platelet endothelial aggregation receptor 1 polymorphisms and idiopathic thrombocytopenic purpura
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
Challenges in pediatric radiotherapy requiring anesthesia during SARS-CoV-2 pandemic
Renu Madan, Shikha Goyal, Divya Khosla
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ISSN: Print -2278-1668, Online - 2278-0513