Tehran University Medical Journal

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Background: Although postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach, curative surgery occurs in less than 50% of nonmetastatic gastric cancers. A regimen of docetaxel, cisplatin and infusional fluorouracil improves survival of patients with incurable locally-advanced gastric adenocarcinoma. So we assessed the perioperative regimen of docetaxel, cisplatin and infusions 5FU (TCF) and postoperative chemoradiotherapy to improve outcomes in patients with potentially resectable gastric adenocarcinoma.

Methods: Between March 2005 and March 2008, we 100 enrolled patients with stage II to IV (M0) adenocarcinoma of the stomach who had not been treated previously. Treatment consisted of three preoperative and one postoperative cycles of TCF followed by chemoradiotherapy. The primary end point was overall survival. The secondary end points were progression-free survival and toxicity of treatment.

Results: A total of 100 patients participated, 83 of whom received neoadjuvant and 17 received adjuvant chemotherapy. Seventy-five patients underwent at least D₀ gastrectomy. After chemotherapy, tumor stages were significantly lower than before beginning the protocol. Out of 100 patients, 44 had stage IV before chemotherapy versus 15 after the treatment. Three patients showed complete pathologic response. The median survival time was 25 months.

Conclusion: Docetaxel, cisplatin and 5FU combination chemotherapy is an active preoperative treatment in locally advanced gastric cancer. Perioperative chemoradio-therapy should be considered as an option to lengthen patient survival.

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Background: Treatment of cervical carcinoma is routinely performed with Low Dose Rate (LDR) brachytherapy, but Brachytherapy in our department is done with Medium Dose Rate (MDR) due to the technical characteristics of the machine available here. Thus we decided to evaluate the results of this treatment in our department in a prospective study.

Methods: Between March 2006 and July 2008, 140 patients with histologic diagnosis of cervical carcinoma referred to Tehran Cancer Institute were treated with external beam radiotherapy (44-64 Gy to whole pelvis) and MDR brachytherapy (8-30 Gy to Point A) with a dose rate of 2.2±0.3 Gy/h.

Results: 121 patients were followed up for a median time of 18 months (range: 9-39 m). There were 11%(6/54) local recurrence for surgery and adjuvant radiotherapy group 25%(16/65) for radical radiotherapy group, and 19%(23/121) for all patients. Rectal and bladder complications incidence for all patients were 10%(12/121) and 13%(16/121) respectively. High grade complication was shown only in one patient in radical radiotherapy group. In this study 3-years disease free survival and overall survival were 73% and 92% respectively, and disease stage (p=0.007) and overall treatment time (p=0.05) were the significant factors affecting disease free survival.

Conclusions: Results of this series suggest that the use of external beam radiotherapy and MDR brachytherapy with about 20% dose reduction in comparison with LDR can be an acceptable technique with regard to local control and complications.

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Background: Transitional Cell Carcinoma (TCC) of bladder is the second most common urogenital malignancy and because of its high rate of recurrence (two third of tumors recur) vigilant surveillance is necessary. There have been a lot of efforts to find a proper biomarker for detecting urothelial cancers because available methods are expensive and invasive (like cystoscopy) or have a low degree of sensitivity (like urine cytology). Urothelial malignancies, like other cancers tend to express a large amount of telomerase. The aim of this study was to evaluate the possible application of voided urine human telomerase reverse transcriptase (hTERT) mRNA assay in detecting low-grade bladder carcinoma in comparison with urine cytology.

Methods: Voided urine samples were collected from 49 patients who were supposed to go under operation. Samples were examined by both Quantitative Real-time RT-PCR (for measuring hTERT mRNA level) and cytology the results were then compared to the final pathologic studies.

Results: Regardless of clinical stage and or pathological grade of tumor, sensitivity of telomerase test and urine cytology was 74% and 16% respectively. There was a strong correlation between results of urine cytology and stage and/or grade of tumor however, sensitivity of telomerase test was acceptable regardless of stage and or grade of tumor. There was a statistically significant difference between sensitivity of urine cytology and telomerase test (p<0.001).

Conclusion: Detection of hTERT-mRNA can potentially be used as a non-invasive method for diagnosis and follow up of bladder carcinoma instead of urine cytology.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Neck lymph node metastasis has the prognostic role in SCC of the tongue and the importance of the biologic markers in tumor invasion and metastasis has been stated in the medical literature. The aim of this study was to evaluate the relationship between two biomarkers, p53 and EGFR (which had the main role in cell proliferation) and two other biomarkers, CD44 and E-cadherin, in lymph node metastasis.
Methods: In an analytic descriptive study fifty three patients with SCC (Squamous Cell Carcinoma) of the tongue who underwent the resection of tumor and dissection of neck lymph nodes were assessed during the year of 2002-2009. Histological samples from 53 patients were immunohistochemically stained and the analysis of these markers were performed due to clinicopathological variable and metastasis of the neck lymph nodes.
Results: The result showed that among the clinicopathological factors, the relationship between Age (p=0.01), history of having risk factors (p=0.002), clinical lymphadenopathy (p=0.002), the size of the tumor (p=0.001), decreasing of CD44 (p=0.02) and lymph node metastasis of the neck were statistically significant. No significant relationship were found between sex and other biomarkers including p53, EGFR, E-cadherin.
Conclusion: CD44 is an important indicator of prognostic markers that can also be used as an indicator of clinocopathological markers.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Gastric adenocarsinoma is the first leading fatal malignancy in Iran. Despite advances in novel therapeutics approaches for gastric cancer (GC) patient, tumor dissemination via blood stream to distant organ is still the major cause of death. Therefore, there is urgent need to establish sensitive methods for early detection of disseminated tumor cells in peripheral blood (PB) and bone marrow (BM) specimens of gastric cancer patients.
Methods: In the present study, we use Carcinoma Embryonic Antigen (CEA) as a tumor marker and Glyceraldehyde 3-Phosphate Dehydrogenase (GAPDH) as an internal control to detection and quantification of disseminated tumor cells in PB and BM specimens of affected individuals. Total RNA was extracted from AGS (gastric cancer) cell line and CEA and GAPDH fragments were generated by reverse transcription. The amplified fragments were cloned into pTZ57R/T vector separately. Double cloning of these genes has done into one pTZ57R/T vector. Serial dilution of this recombinant plasmid is used to construct standard curve, each containing a known amount of input copy number. Total RNA was extracted from BP and BM specimens of 35 GC patients. cDNA of the specimens were synthesized by reverse transcription and subjected to Quantitative Real-Time PCR (QRT-PCR).
Results: We developed a highly sensitive and specific quantitative PCR for CEA and GAPDH using Real-Time PCR based on TaqMan technology. CEA mRNA was detected in 23% of PB and 20% of BM specimens. There was no CEA mRNA detecting in control group.
Conclusions: The QRT-PCR for CEA can be a useful technique for detection of micrometastases in the PB and BM specimens of gastric cancer patients.

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Background: Primary clear cell adenocarcinoma of cervix (CCAC) is usually seen in women with a history of in utero exposure to diethyl acetyl bestrol (DES). We report two cases of clear cell adenocarcinoma of cervix with no history of exposure to DES in embryonic period. Case presentation: The first case was a 14-year-old women with complaint of painless vaginal bleeding. There was atypical cells in Pap Smear and a bleeding tumor with 1.5 cm in diameter was found in vagina. She was admitted with a diagnosis of CCAC of the uterine cervix stage Ib2 according to FIGO classification. The second case was a 23-year-old patient with complaint of painless vaginal bleeding. The results of cervical cytology was normal. Evaluation of the punch biopsy sample revealed CCAC. Her clinical exam showed stage IIb according to FIGO classification. Both patients had no history of exposure to DES during embryonic period. The first patient treated with radical abdominal hysterectomy and systematic pelvic lymphadenectomy and for the another one external beam radiotherapy and brachytherapy was performed. There was no any recurrence or metastasis after an 18-24 months follow-up Conclusions: Primary clear cell carcinoma of cervix could be unrelated to HPV infection or exposure to DES during embryonic period and in approach to these patients this subject should be considered.

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Background: Local recurrence in Nasopharyngeal Carcinoma (NPC) presents is a major challenge. Patients experience substantial morbidity as well as poor survival if no further treatment is offered. Residual or recurrent nasopharyngeal carcinoma is usually managed by chemotherapy, stereotactic radiosurgery, external beam radiation therapy (EBRT), interstitial, and intracavitary brachytherapy or salvage surgery. This case presents the treatment of two consecutive localized recurrences of NPC.

Case presentation: The patient was a 59-year-old man who underwent a course of radical external-beam radiotherapy for a primary NPC in 1999, then another course of external radiation in 2004 for his first recurrence, and finally a course of brachytherapy for the second recurrence in 2005. The patient is well now in 2010, with no signs of disease five years after the third radiotherapy.

Conclusion: Our experience of re-irradiation for this twice recurrent nasopharyngeal carcinoma has been promising with encouraging tumor control and acceptable treatment-related toxicity profile. This case indicates the efficacy of definitive re-irradiation for regional recurrence and the necessity for long-term observation for the salvageable early-stage local failure.

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Background: Surgery is the most effective treatment of well-differentiated endometrial cancer. But using systemic progestins, have been evaluated to treat the young patients with well-differentiated endometrial cancer who wish to preserve their fertility. The aim of this study was the evaluation of megestrol acetate on endometrial adenocarcino-ma with regard to the receptors.

Methods: This was a quasi-experimental study. In 16 infertile patients with stage Ia well-differentiated endometrial adenocarcinoma. The treatment initiated with 160mg/d of megestrol acetate and continued with 320mg/d for non-responsive cases. All of the patients followed with FD&C and hysteroscopy. The responsive patients were referred to IVF group and they were followed for three years.

Results: Of nine patient in the first step of the study, 4 (25%) became pregnant. Eight patients underwent Total Abdominal Hysterectomy (TAH), and one was retreated conservatively. Of seven patient of second step of the study, five are under treatment at the time of closing the paper (three cases candidate for IVF and two are under 320 mg/d megestrol acetate), one patient is a candidate for hysterectomy, and one exited of study because of male infertility. All of the patients were progesterone receptor positive, and only one was estrogen receptor negative.

Conclusion: Conservative treatment of early stage well-differentiated endometrial adenocarcinoma with progestins may be used in highly selected young patients who have not completed their family. Close long- term follow up in this special group of patients is necessary. The evaluation of estrogen and progesterone receptors assay may be useful in predicting response to the treatment.

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Background: Thyroid transcription factor-1 (TTF-1) is widely used in the diagnosis of lung and thyroid carcinomas. Although there have been reports of TTF-1 immunoreactivity in tumors other than those originating from the lung or thyroid, endocervical and endometrial adenocarcinomas have not been studied in large numbers in this regard.

Methods: Thirteen endocervical adenocarcinomas, 39 endometrioid endometrial adenocarcinomas and four uterine serous carcinomas which had no neuroendocrine component were retrieved, stained by TTF-1 and examined. A semiquantitative grading system was used to evaluate the distribution of TTF-1 staining (0= negative, 1+  5%, 2+= 5% to 25%, 3+= 26% to 50%, 4+= 51% to 75% and 5+  75%). A qualitative system was also used to evaluate the intensity of TTF-1 staining (weak, moderate and strong).

Results: TTF-1 expression was seen in 1 out of 13 (7.7%) endocervical adenocarcinoma samples, showing 1+ distribution rate and weak intensity. The positive sample was moderately differentiated. TTF-1 expression was present in 2 out of 39 (5.1%) endometrioid adenocarcinoma samples (one grade I and the other grade II) with 1+ distribution rate and weak intensity. There was no apparent correlation between the degree of differentiation and TTF-1 positivity in the studied adenocarcinomas. None of the four endometrial serous carcinomas were positive for TTF-1.

Conclusion: Although some recent studies cast doubt about the specificity of TTF-1 for lung and thyroid carcinoma, our study showed that TTF-1 was negative in endocervical and endometrial adenocarcinomas and established the specificity of TTF-1 for lung and thyroid carcinomas.

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Background: Fumonisins, a family of mycotoxins, are mainly found in wheat, corn and their products. Previous studies have shown that fumonisin B1 (FB1), the most abundant and toxic of known fumonisins, has been associated with many animal and human diseases including cancer. In the present study, the effects of FB1 were examined on the production of inflammatory cytokines in intestine and stomach cell lines.

Methods: This study was performed in the Cancer Research Center of Tehran University of Medical Sciences in 2010. The cell lines of colon adenocarcinoma (SW742) and gastric epithelium (AGS) were purchased from the Pasteur Institute of Iran. The cells were pretreated with different concentrations of FB1 (0 to 100 µM) for 3 days. The cells were later stimulated by lipopolysaccharides. Twenty-four hours after cell induction, the cytokines including tumor necrosis factor-alpha (TNF-α), interlukin-1 beta (IL-1β) and interlukin-8 (IL-8) were measured by ELISA.

Results: Treatment with FB1 induced a dose-dependent decrease in IL-8 production (P<0.05). This decrease was seen in both SW742 and AGS cell lines. Moreover, FB1 induced a dose-dependent increase in the production of TNF-α and IL-1β in both cell lines (P<0.05).

Conclusion: The results of this study indicated that FB1 could increase the inflammatory cytokines including TNF-α and IL-1β in gastric and intestinal celllines. These effects might result in the development of inflammatory responses and subsequent mucosal atrophy in in-vivo conditions.

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Background: Endometrial carcinoma (EC) is the most common gynecologic malignancy however, mechanisms underlying its pathogenesis remain obscure. Endometrial carcinoma has been classified into two major categories: type I (related to estrogen or endometrioid adenocarcinoma) and type II (unrelated to estrogen). Estrogen is the main trigger for the abnormal proliferation in the endometrial epithelium but progesterone can inhibit this process. The aim of this study was to analyze the expression of estrogen and progesterone receptors in all types of endometrial hyperplasia in comparison to endometrioid adenocarcinoma of endometrium.

Methods: Forty-seven specimens including 23 cases of histopathologically confirmed hyperplastic endometrium (12 simple hyperplasia, 5 complex hyperplasia without atypia, and 6 complex hyperplasia with atypia) and 24 cases of endometrial carcinoma were studied. Immunohistochemical staining of estrogen and progesterone receptors was performed in paraffin-embedded blocks and expression of estrogen and progesterone receptors were scored according to the proportion of positive staining cells.

Results: Overexpression of progesterone receptors was seen in 18 (75%) out of 24 cases of endometrial carcinoma and 23 (100%) of all types of endometrial hyperplasia. The aforesaid differences were statistically significant (P=0.023). 70.8% of cases with endometrial carcinoma were 3+ for immunohistochemical staining of progesterone receptors as were 85.7% of the cases with endometrial hyperplasia the difference being also statistically significant (P=0.02).

Conclusion: Considering the increased proportion of progesterone receptor expression in all types of hyperplastic endometrium in comparison to endometrial carcinoma, hormonal therapy by progestinal agents is recommended as a treatment of choice.

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Background: Transitional Cell Carcinoma (TCC) is the most common type of urinary bladder cancer. Cyclooxygenase-2 (COX-2), a key enzyme in prostaglandins biosynthesis, has been introduced as a new candidate for targeted therapy in this cancer. In this study, we investigated the expression of COX-2 in urinary bladder TCCs and its relationship with clinicopathological parameters such as tumor grade and stage.

Methods: This cross-sectional study was performed in the Pathology department of Sina Hospital in Tehran, Iran during 2006-2011. Pathology reports of patients with definite diagnosis of urinary bladder TCCs who had undergone Transurethral Resection (TUR) were reviewed and 40 cases were selected. Subsequently, COX-2 expression was assessed immunohistochemically by the examination of paraffin embedded tissue blocks. Staining in more than 5% of tumor cells was considered as positive expression.

Results: COX-2 was expressed in 52.5% of the patients. High-grade tumors revealed a higher (87.5%) COX-2 expression versus other grades of the lesions and there was a statistically significant difference in COX-2 expression between them (P<0.001). Patients' age was also related to the expression of this marker (P=0.03). In contrast, this marker did not correlate with other characteristics including gender, lymphatic invasion or tumor stage. In addition, perineurial or vascular invasions were not detected in any of the patients.

Conclusion: COX-2 expression was seen in more than half of our patients and it had a marked relation to tumor differentiation. Accordingly, this molecule may be a useful tumor marker in the assessment of urinary bladder cancers.

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Background: Warthin tumor- like papillary carcinoma of thyroid is a rare variant of papillary thyroid carcinoma. It is characterized by distinct papillary structures lined by oncocytic tumor cells with nuclear features of papillary carcinoma and marked lymphoplasmocytic infiltrate in the papillary stalks. This tumor derives its name from its resemblance to Warthin tumor of major salivary glands.
Case presentation: We report a 54- year- old man presented with bilateral thyroid masses. Histopathological study showed papillary structures lined by cells with eosinophilic granular cytoplasm and ground- glass nuclei with lymphoplasmacytic infiltration of the stalks.
Conclusion: Warthin tumor-like papillary thyroid carcinoma could be mistaken for benign lymphoepithelial lesions such as Hashimoto thyroiditis, Hurthle cell tumors and tall cell variant of papillary carcinoma. Follow- up information on the previously reported cases has suggested that these tumors behave similarly to usual papillary carcinoma.

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Background: Ovarian mucinous borderline tumors are divided into two morphologic groups: endocervical-like and intestinal type. Most endocervical adenocarcinomas exhibit mucinous and/or endometrioid differentiation, they infrequently metastasize to the ovaries but may simulate primary ovarian tumors (both atypical proliferative or borderline and carcinoma). In patients with mucinous adenocarcinoma in the abdominal cavity, caution should be exercised in interpreting the possible primary site of the tumor on the basis of the immunohistochemical profiles. The presence of human papillomavirus (HPV) DNA is assessed to determine whether the ovarian neoplasms were metastases or primary independent neoplasm. Approximately 90% of endocervical adenocarcinomas are related to high-risk human papillomavirus (hr-HPV) with the remainder being unrelated to HPV. Both types metastasize to the ovaries very infrequently. Ovarian endocervical-type (mullerian) mucinous tumors and tumors composed of a mixture of endocervical-type mucinous, serous endometrioid, squamous, and indifferent cells with abundant eosinophilic cytoplasm reported to date have been primarily limited to borderline and micro invasive types. We report a-36-yr old woman with adenocarcinomas of uterine cervix who also had ovarian mucinous borderline tumor.
Case presentation: The patient presented with abnormal uterine bleeding and lower abdominal pain. She had a history of uterine cervix polyps. Pelvic ultrasound showed a right adnexal mass and a large cervical size. Histological diagnosis in uterine cervix biopsy revealed adenocarcinoma of cervix. Radical hysterectomy type III with bilateral salpingo-oophorectomy was performed. Histological finding in adnexal mass revealed borderline mucinous tissue of ovarian tumor. Testing for HPV DNA in the tumoral tissue was negative. This confirms that the ovarian tumor is not metastatic from endocervical adenocarcinoma.
Conclusion: We conclude that in a patient with tumors that involve two organs, complete diagnostic investigation should be done to distinguish the primary origin. The factors that affect cell proliferation, can probably have synchronous effects on the two similar cells.

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Background: Gestational trophoblastic disease (GTD) is a heterogenous group of neoplastic lesions that is derived from placental trophoblastic epithelium. According to World Health Organization (WHO) classification they include: Hydatidiform mole (complete and partial), invasive mole, choriocarcinoma and placental site trophoblastic tumor. Hydatidiform mole is the most common and the diagnosis is achieved by pre-evacuation ultrasonographic evaluation, laboratory tests and finally histological assessment as gold standard. Since these disorders show varying potential for local invasion and metastasis, the accurate diagnosis, follow up and recommendations given to patients may differ.
Methods: Consecutive cases with diagnosis of GTD from archive of pathology department of women (Mirza Kochak Khan) hospital were reviewed in whom results of clinical presentation and pre-evacuation ultrasound examination were documented. There were overall 220 cases for which the following clinical features were determined: gravidity, parity, history of previous abortion and gestational trophoblastic disease, the clinical symptoms such as vaginal bleeding and hypertension. Finally concordance between pre-evacuation ultrasonographic and histological diagnosis by kappa test is calculated.
Results: Out of 220 cases with clinically gestational trophoblastic disease diagnosis, 197 cases were confirmed by histological diagnosis. The concluding histological diagnosis includes: 98 cases of complete mole (CM), 84 partial mole (PM), 4 invasive mole and 11 cases of choriocarcinoma. Outside 98 cases with histological diagnosis CM only in 4 cases misdiagnosed by ultrasonoghraphy (4.1%) and high degree of concordance between ultrasonography and histological diagnosis is seen.
Conclusion: Ultrasonographic examination accompanied with clinical examination, beside histological assessment as gold standard have high efficacy in diagnosing  complete mole. This study did not show this finding for partial mole.

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Background: Colorectal carcinoma is a common malignancy, in treatment of which pelvic radiotherapy plays an important role. But this may lead to azospermia. We designed a study to determine the delivered dose to the testis with thermoluminescence dosimetry (TLD) and compare it to the dose calculated by the Three-dimensional planning software. Methods: We measured the testicular doses by TLD the TLDs were fixed to the scrotum in six points anteriorly and posteriorly in two random fractions of the radiation course. All patients received a 50-50.4 Gy radiation dose to the pelvis in a prone position with standard fractionation and 3-dimensional planning, through three or four fields. The average dose of the TLD measurements was compared to the average of 6 relevant point doses calculated by the planning software. Results: In 33 patients with a mean age of 56 years, the mean testis dose of radiation measured by TLD was 3.77 Gy, equal to 7.5% of the total prescribed dose. The mean of point doses calculated by the 3-dimensional planning software was 4.11 Gy, equal to 8.1% of the total prescribed dose. A significant relationship was seen between the position of the inferior edge of the fields and the mean testis dose (P= 0.04). Also body mass index (BMI) was inversely related with the testicular dose (P= 0.049). Conclusion: In this study, the mean testis dose of radiation was 3.77 Gy, similar to the dose calculated by the planning software (4.11 Gy). This dose could be significantly harmful for spermatogenesis, though low doses of scattered radiation to the testis in fractionated radiotherapy might be followed with better recovery. Based on above findings, careful attention to testicular dose in radiotherapy of rectal cancer for the males desiring continued fertility seems to be required.

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Background: Thyroid carcinoma is the most frequent malignant tumor of the endocrine system in human body and accounts for nearly 1% of all cancers. Medullary thyroid carcinoma is the third frequent of thyroid cancer and accounts about 5-8% of thyroid cancer. Osteocalcin, known as a Bone Gamma-carboxyglutamic Acid-containing Protein (BGLAP), is the most non collagenous protein. Retinol binding proteins are the family of proteins that have diverse actions but mainly transport retinol in human body. In this study to evaluate effect of existence medullary thyroid carcinoma on metabolism of bone and adipose tissue, plasma level of two mentioned proteins had analyzed. Methods: Population in this study consists of 46 individuals with medullary thyroid carcinoma and 44 healthy subjects referred individuals to Research Institute for Endo-crine Sciences, Shahid Beheshti University of Medical Sciences. People with the disease after diagnosis of medullary thyroid carcinoma and pathologically confirmed by biopsy in the initial stages of the study were called. After informed consent, 10 ml of blood from the antecubital vein of left hand in sitting position obtained and after cen-trifugation, plasma was isolated from all samples until analyzed kept in the freezer. Plasma levels of hormones were measured by sandwich type ELISA method. Obtained results were analyzed by SPSS version 16 with independent t-test method. Results: Mean plasma level of osteocalcin in patients was 33.1±3.5 and in healthy sub-jects was 12.5±1.2 ng/ml (Mean±SD) and Odds Ratio (OR) value was 1.04. In patients, mean plasma level of retinol binding protein was 82.5±2.7 and in healthy subjects was 22.8±1.6 μg/ml and OR value was 2.1. The confidence level considered at 95%. These differences of plasma levels were statistically significant (P= 0.001). Conclusion: According to difference between plasma levels of osteocalcin and retinol binding protein-4 in patients suffered of medullary thyroid carcinoma comparison with normal subjects, it can be said that, probably medullary thyroid carcinoma has effect on bone and adipose tissue metabolism, so osteocalcin and retinol binding protein-4 hormones have potential to be used for confirmation of diagnosis or following treatment of medullary thyroid carcinoma.

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cBackground: Choriocarcinoma is a highly malignant form of gestational trophoblastic disease. It is characterized by metastatic potential, rapid growth and deeply invasion into blood vessel and then widespread dissemination metastasis. However, the most common sites of metastatic choriocarcinoma are lung, vagina, liver, and brain. But, metastatic choriocarcinomas rarely is extended to gastrointestinal system. It is im-portant to keep in mind that despite extensive metastasis, choriocarcinoma is very curable disease. Due to high responsibility of this disease, early diagnosis of choriocarcinoma and treatment with chemotherapy can prevent mortality and morbidity of these patients. In this case report, we present a rare case of metastatic choriocarcinoma in the small bowel after normal term pregnancy. Case Presentation: A 34-years-old woman G4, P4, L4 presented with abnormal postpar-tum vaginal bleeding (45 days) and unresponsive to usual medical and surgical therapy (oxytocine, metergene, antibiotic, and double curettage). The patient was admitted in the Ghaem Hospital, Mashhad University of Medical Sciences in April 2013. She suf-fered from rectal hemorrhage and severe weakness. Because of unsuitable condition (shock), laparotomy was performed and small bowel involvement was observed. Seg-mental resection of small bowel detected metastatic choriocarcinoma of the lesion. We couldn’t rescue our patient due to unresponsive to combination chemotherapy (actino-mycine, methotrexate, cyclophosfamide, vincrystine, etopuside). Conclusion: In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage.

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Background: Biosynthesis of nanoparticles has attracted the attention of the scientific community in nanotechnology and biotechnology due to their extensive application in the area of material sciences and medicine. Nowadays, despite a various application of nanomaterial’s, there is a little information about their impact on human health. In this study, we investigated the comparative study on cytotoxicity effect of biological and commercial synthesized nanosilver on human gastric carcinoma (AGS) and normal lung fibroblast (MRC-5) cell lines. Methods: The current experimental study was carried out in Islamic Azad University, East Tehran Branch, from April to November 2014. The biological synthesis of nanosilver was obtained from Eucalyptus plant extract as a reducing agent. Further to more analysis, morphological study on size and shape of developed biological nanosilver was characterized by performing scanning electron microscopy and dynamic light scattering. AGS and MCR-5 cell lines were treated with various concentration of nanosilver for 24, 48 and 72 hours. Finally, the cell viability was evaluated by using MTT assay. Results: The results show that the nanosilver exerts a dose-dependent inhibitory effect on viability of cells. At 100µg/mL of commercial and biological synthesized nanosilver, the viability of AGS was reduced to 7.47±0.002% (P=0.002) and 3.65±0.01% (P=0.003) after 72 hours, respectively. In addition, the viability of MRC-5 at the same condition was reduced to 10.27±0.19% (P=0.001) and 9.16±1.53% (P=0.002), respectively. Conclusion: Based on a thorough literature surveys, the present study is the first research about biosynthesis of nanosilver using Eucalyptus plant extract. This eco-friendly and cost effective method can be used for large scale production of silver nanoparticle. In addition, based on the current obtained data, commercial and biological synthesized nanosilver can more inhibitory effect on cancer cells compared to the normal cells. Hence, silver nanoparticles might be used as a new strategy for treating many human cancers. However, further studies are necessary to ascertain their potential as anticancer agents.

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Background: Breast cancer is the most common cancer in women around the world. It has been known for over a century that androgens and androgen receptor (AR) play a role in normal and neoplastic breast cells. The aim of this study was to determined the AR expression on tumor cells and its correlation with other prognostic and predictive factors as well as contribution of AR in patients overall survival (OS) and disease- free survival (DFS). Methods: This retrospective cross-sectional study performed on 189 patients who referred to Medical Oncology Ward of Cancer Institute, Tehran University of Medical Sciences, from April 2007 to February 2010. We performed an immunohistochemistry study for AR (AR441 clone, Dako, Germany) (10% cut-off point) and Ki-67 MIB-1 clone, Dako, Germany) on paraffin embedded blocks. Other data were extracted from patients’ documents. Results: Overall, AR expression was 49.1%. Mean age of the patients with and without AR was 47.86 and 48.49 years, respectively. AR positive tumors presented more in stage I/II than III/IV (P=0.02) and AR were more positive for estrogen receptor positive, lower grade of tumor (grade I/II versus III) and lower Ki-67 (P=0.01). AR positivity had neither correlation with progesterone receptor, HER2/neu, P53 expression or menopausal status. OS and DFS were higher in AR positive patients but did not reach statistical significance. In triple-negative breast cancer (TNBC) group, 25% of tumors showed AR expression. AR had non-significant positive correlation with OS in TNBC cancer patients. OS and DFS had significant statistic positive correlation with ER, PR and stage regardless of AR status. Conclusion: Based on this study, although androgen receptor expression showed correlation with other prognostic factors for survival in patients, we didn’t find statistically significant independent relationship between AR and overall survival in patients. As far as there isn’t any targeted therapy for triple-negative breast cancer (TNBC), prospective basic and clinical studies regarding AR inhibitors in the treatment of TNBC seems to be logical and valuable.