Tehran University Medical Journal

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Tumor angiogenesis shown by Microvessel Count (MVC) or Microvessel Density (MVD), is assessed by several studies as prognostic factor in some types of tumors, and also in colorectal carcinoma. This article is payed to correlation between clincopathologic factors and tumor angiogenesis. In this study, immunohistochemical techniques are used for vascular evaluation in specimens from twenty-nine colorectal carcinoma, and stained for Factor VIII-Related Antigen (F8RA) by using monoclonal antibody. Uni and multivariate analysis disclosed that total MVC was higher in tumor [76.3±33 (×100=2.5 mm²/field) and 29.8±11 (×200=0.785 mm²/field)] than in normal tissue [37.7±15.8 (×100) and 17.6±7.8 (×200)], (P=0.022, P=0.000009). Microvessel quantification was significantly higher in stage D (115±36.6, ×100 and 26.7±6.4, ×200, P=0.002 and P=0.04). In this study MVD has correlation with vascular invasion (P=0.024, ×100 and P=0.007, ×200), the mean tumor vessel count although was increased with clinicophatologic findings such as age<60 years, male, right colon involvement, infiltrating type, mucinous carcinoma, transmural penetration, grade III, lymphatic and perineural invasion, but was not statistically significant. Lymph node and hematogenous metastasis and size of tumor also, was not important. As a conclusion, MVD was increased in tumor and has shown correlation with metastasis, and vascular invasion. Resulting angiogenesis increase risk of metastasis.

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Testicular germ-cell tumors are the most common malignancy among men aged 20-40 years, and 60 percent of them are seminomas. These tumors are now an important socio-economic problem, considering their growing incidence. Thus we undertook to evaluate the results of curative irradiation in our testicular seminoma patients and compare them to literature results considering the use of cobalt-60 systems in our department (in contrast to the use of linear accelerators). All testicular seminoma cases referred after orchiectomy to Radiation-Oncology Department of Tehran Cancer Institute and treated curatively during the 12-years period of 1987-1998 were reviewed. These included 147 patients. The results showed a mean age of 34.5 years. Eighty-six patients (58.5 percent) were in stage I, 57 (38.8 percent) in stage II and 4 (2.7 percent) in stage III. With a mean follow-up time of 53.5 months (range 2-158 months) after radiotherapy, there were 12 (9 percent) local relapses and 8 (6.5 percent) distant metastases among the 122 patients who came back for follow-up. The 10-years overall survival was 97.9 percent and disease-free survival 79.7 percent (life-tables). Mean overall and disease-free survival time was 155 and 133 months respectively, with a median survival time of more than 158 months (Kaplan-Meier). The only significant prognostic factor was stage of the disease (P=0.01), though lactate dehydrogenase (LDH) was significant only in multi-factorial analysis (P=0.02). In conclusion, our survival figures were all favorably comparable to literature results, considering the higher ratio of stage II in our patients. We recommend training of young men for testicular self-examination and a greater attention to LDH measurement, and hope for installation of linear accelerators in our department to further improve the treatment results with less side effects.

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Background: Osteoid osteoma is a well-known benign tumor of bone. It occurs in children and young adults and is rarely seen above the age of 40. It is uncommon in hand and wrist. If it occurs in hand and wrist, its diagnosis is difficult because of its unusual presentations both clinically and radiologically.

Materials and Methods: We encountered ten patients with osteoid osteoma of hand during the last ten years in orthopedic department of Emam university hospital from 1970 to 1979.

Results: The average age of ten patients with osteoid osteoma of the hand and wrist that were treated in Imam hospital from 1369 to 1378, was 22.9 years (range, 14 to 33 years). Five lesions were in proximal phalanx, one in middle phalanx, and one in distal phalanx. In the wrist, one lesion was in the capitate, one in the lunate, and one in the hamate. The average time from onset of symptoms to successful treatment was 20 months (range, 4 months to 60 months). Three of ten patients had had treatment elsewhere, all of them had had unsuccessful operative procedures related to incorrect diagnosis. All patients had a minimum follow-up of 6 months (range, 6 months to 9 years, mean: 4.6 years). The operative treatment were successful in all ten patients without any signs or symptoms of recurrence. Only limitation of proximal interphalangeal joint range of motion was remained in one patient due to 60 months delay in diagnosis and treatment.

Conclusion: High index of suspicion is necessary for diagnosis of osteoid osteoma of hand because of unusual presentation of it. The most important factors for successful treatment of osteoid osteoma of hand are accurate diagnosis and exact preoperative planning.

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Primitive Peripheral Malignant Neuroectodermal Tumor is a malignant neoplasm of neural origin with high mortality which occurs mostly in children and adolescents. The most common site of involvements are chest wall and paraspinal regions. Head and neck involvement is rare. The diagnosis is based upon histopathologic and immuno-histochemical studies. Treatment is combination of surgery, radiotherapy and chemotherapy. In this article we present a rather rare case of PNET which occurred in the neck area of a child.

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The development of testicular masses in male patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency has been recognized for many years. We present here the eighth and ninth reported patient with bilateral testicular tumors associated with 11 hydroxylase deficiency. They were two brothers aged 7.5 and 5 yr. who had bilateral testicular tumors and diagnosed because of signs and symptoms of true precocious puberty and high blood pressure. The patients testicular enlargement is suggestive of bilateral testicular adrenal rest.

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Background: Wilm’s tumor is the most frequent primary renal neoplasma in pediatric age group. Classically it is composed of three histologic parts: Blastemal, Epithelial and stromal. Different factors are implicated as prognostic determinants. Nowadays special attention is paid to proliferation markers for determining the biologic behavior of tumors. In this study we tried to ascertain the proliferative index of 22 cases of Wilm’s tumor in our center who have had rather good follow up (at least two years).

Materials and Methods: After reviewing the H and E slides, we stained sections with PCNA and ki67 and scanned them by image cytomertry. Then the proliferative indices for each histological part was determined.

Results: We resuted that proliferative indices of blastemal and epithelial parts have significant (P< 0.0002) difference (increment) from that of stromal part. Also the patients were divided into those with recurrence (within two ys of primary surgery) and recurrence. The profileration indices of PCNA for those recurring tumors was significantly higher (PCNA= 22.3%) (P= 0.0015).

Conclusion: Finally we concluded that using proliferative markers in Wilm’s tumor is useful as an effective prognostic factor.

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Background: Mediastinum includes the vital organs like the heart the major respiratory passages and the major vessels due to this vicinity, the masses of this area with malignant or benign etiology or cause systemic diseases such as metastatic malignancies or granulomatous reactions can be potentially fatal.

Materials and Methods: According to the priority of the problem, a ten years comprehensive retrospectively study of mediastinal masses in children was conducted In children medical Center (Tehran University) from the points of view of incidence, clinical manifestations and diagnostic and treating ways. Results &

Conclusion: In our study there were 34 patients from 1992-2002 who were reviewed. No differences between boys and girls with mediastinal masses were observrd. The most prevalence age for mediastinal tumors was form 5-10 years (38%). The most prevalent sign was fever (53%) and the most common symptom was coughing (44.4%). Basesd on this research, mediastinal masses have been the most prevalent finding in chest radiography (53.8%). CT-Scan with double contrast was recognized as the most common and easiest ways for diagnosing masses. Anterior masses were the most common finding in our study (41.7%). Most of these masses were removed by surgery and the most common operation in our patients was thoracotomy and removing the masses (61.7%). Lymphoma was the most common masses (35.2%) and masses with neural orgins occupy the second grade. According to available documents and with regard to mean follow up of patients in 3.2 years the rate of survival was 54%.

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Background: In this study we evaluated the treatment of giant cell tumor (GCT) of long bones using cryosurgery combined with curettage and polymethylmetacrylate (PMMA) cementing.
Material and methods: From January 1999 to December 2004, twenty patients (mean age at the time of surgery 29.2 years) 13 females and 7 males were included in the study. Cortical disruption were presented in 7 patients 4 with soft tissue extension, but none of them had intra-articular extension of tumor, 3 patients presented with pathologic fracture of distal femoral lesions. These tumors were located in distal femur in 6 patients, proximal tibia in 7, distal radius in 3, proximal femur in 2, and each of proximal humerus and distal ulna in one patient. In each case diagnostic biopsy was done and surgical procedure performed including curettage, power burr of the wall, cryosurgery with liquid nitrogen and finally filling the space with PMMA cementing. The mean follow-up was 34 months (7 to 61 ).
Results: During follow-up, we observed one recurrence of GCT of proximal tibia. Secondary Aneurysmal bone cyst was reported at the site of one primary distal femoral lesion, without any finding in favor of a recurrence. Neurapraxia of the proneal nerve was occurred in one patient with proximal tibia tumor improved after 8 months.
Conclusion: Cryosurgery combined with power burr and PMMA cementing in the treatment of GCT could be an effective approach in tumor eradication. This method obviates the need for extensive resections and reconstructive procedure.

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Background and Aim: Osteoblastoma is one of the rarest primary bone tumors. Although, small bones of the hands and feet are the third most common location for this tumor, the hand involvement is very rare and few case observations were published in the English-language literature.                     

Materials and Methods: In this study, we report five cases of benign osteoblastoma of the hand, 3 in metacarpals and two in phalanxes. The clinical feature is not specific. The severe nocturnal, salicylate-responsive pain is not present in patients with osteoblastoma. The pain is dull, persistent and less localized. The clinical course is usually long and there is often symptoms for months before medical attention are sought. Swelling is a more persistent finding in osteoblastoma of the hand that we found in all of our patients. The radiologic findings are indistinctive, so preoperative diagnosis based on X-ray appearance is difficult. In all of our 5 cases, we fail to consider osteoblastoma as primary diagnosis. Pathologically, osteoblastoma consisting of a well-vascularized connective tissue stroma in which there is active production of osteoid and primitive woven bone. Treatment depends on the stage and localization of the tumor. Curettage and bone grafting is sufficient in stage 1 or stage 2, but in stage 3 wide resection is necessary for prevention of recurrence. Osteosarcoma is the most important differential diagnosis that may lead to inappropriate operation.

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Background: TPS is one of the tumor markers which has specially been considered due to its exclusive physiological characteristics like its easy measurement in serum of cancer patients. This study has been due to evaluate the efficiency of this tumor marker in the prognosis, treatment control and follow up of patients with gastrointestinal cancers including esophagus, stomach and colorectal.
Methods: TPS has been measured in 109 persons including 28 healthy people and 81 patients with different gastrointestinal malignancies which were composed of 38 patients with esophageal cancer, 20 ones with stomach cancer and 23 ones with colorectal cancer. Sampling has been done in three times depending on treatment methods. TPS has been measured with ELISA in samples which contend of 2 to 3 ml of serum from patients and the health.
Results: The obtained results, demonstrate the obvious changes in TPS serum level in patients underwent various treatment procedures.
 Conclusion: The results have revealed that the serum TPS is not only as a measure of prognosis but also would be helpful in follow up and treatment control of the disease. Moreover the results has shown that serological analysis can be settled in the diagnosis and follow up with production of polyclonal antibody against TPS gene family and planning appropriate pattern.

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Background: Meningiomas are common benign tumors of the brain. Meningioma patients have optimal functional recovery after surgical removal of their tumors. Some patients experience recurrence months or years after surgical resection. In this study, we try to determine the prevalence of recurrent meningioma and the correlation between recurrence and certain factors.
Methods: This retrospective descriptive-analytical study included all patients with recurrent meningioma at Shiraz University of Medical Sciences-affiliated hospitals during a 20-year period (1983 to 2003). We evaluated a series of data for each patient including age, gender, tumor volume, tumor shape, bone changes, brain edema, tumor location, histological subtypes, degree of tumor resection and duration between operation and recurrence. Finally, correlations between these factors and recurrence were investigated using SPSS software version 11.5, by the descriptive method.
Results: Among the 644 patients enrolled in this study, the recurrence rate of intracranial meningioma was determined to be 9.6%. Multivariate analysis revealed a statistical correlation between edema, bone changes, tumor volume, tumor volume, tumor shape and histological subtype, but no relationship was found between age, gender and tumor location. Our study shows a statistical correlation between radiotherapy and reduced chance of recurrence. Patients with malignant and atypical meningiomas have shorter periods between surgery and recurrence than those with benign types.
Conclusion: We recommend that all patients with these prognostic factors receive adjuvant therapy and closer follow-up. In consideration of the statistical correlation between the degree of tumor removal and recurrence in this study, we suggest more complete tumor resection to decrease the risk of recurrence.

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Background: The aim of this study was to review the frequency, histopathology and outcome in children with tumors of the liver.
Methods: Included in this retrospective/descriptive study were 30 children treated for liver tumors from 1375-1384 (ca. 1996-2005), at Children’s Hospital Medical Center, Tehran, Iran. We included the clinical, radiologic, and pathologic data of our patients, focusing on the frequency, etiology and outcome.
Results: Patient ages ranged from three months to 12 years (median 3.8 years), with 18 males (60%) and 12 females (40%). Of these, 17 patients had hepatoblastoma (55.66%), including 13 males and four females, with an age range of six months to five years. Four cases (13.33%) had neuroblastoma. Hepatocellular carcinoma (HCC) was found in three cases (10%), all of whom were carriers of hepatitis B. Two cases (6.66%) were diagnosed with mesenchymal hamartoma, two cases (6.66%) with hemangioendothelioma and two cases (6.66%) with rhabdomyosarcoma and leiomyosarcoma of the biliary tract. Abdominal swelling and hepatomegaly were seen in all of patients. Jaundice was observed in two cases. Serum alpha-fetoprotein levels greater than 500 ng/ml were seen in 17 cases (56.66%). All patients were receiving specific treatment. The three-year survival rate was 65% for hepatoblastoma and 2% for HCC
Conclusion: With the introduction of specific treatment, the survival rate for children with tumors of the liver has significantly increased. Further improvement can be achieved using diagnostic biopsy for hepatoblastoma, although it may result in complications, and preoperative chemotherapy followed by complete surgical excision (per International Society of Pediatric Oncology guidelines), yielding an outstanding survival rate of 80%.

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Background: Tumor diathesis (TD) refers to the granular proteinaceous precipitates on the slide surface of cytologic (Pap) smears. Found in the background of smears from some, but not all, invasive carcinoma cases, TD is present in the majority of smears from large cell nonkeratinizing carcinoma. It is more pronounced than keratinizing SCC also is almost always present in small cell carcinoma.  Smears from patients with adenocarcinoma are frequently associated with dense inflammatory and fresh blood exudates and less often there is a recognizable tumor diathesis.

Methods: To determine the prevalence of TD in cervicovaginal smears from patients with uterine cervix carcinoma, cytologic smears and histologic slides of 46 patients with histologically-confirmed uterine cervix carcinoma were reviewed for the presence or absence of TD, red blood cells and neutrophils on cytologic smears, as well as depth of invasion, histologic types and grade of differentiation of tumor on histologic slides.

Results: TD was identified in 28 smears (60.9%), 18 patients with squamous cell carcinoma (62.1%), seven patients with adenocarcinoma (58.3%), two patients with adenosquamous carcinoma (66.7%) and one patient with endometrial carcinoma that involved the uterine cervix. TD was seen in smears from four (33.3%) patients with uterine cervix carcinoma with invasion <5 mm and 17 (65.4%) carcinomas with invasion >5mm. However, some of the patients with invasive carcinoma lacked TD on the cytologic smears. Red blood cells were identified on 16 (34.8%) smears.

Conclusions: Although TD is the hallmark of invasive carcinoma of the cervix on cytological smears, there have been few studies performed on it. We found that tumors with greater depth of invasion and reduced differentiation are associated with TD cytologic smears. TD was absent in some cases, particularly in micro-invasive carcinoma. This study reinforced what has been recognized from other studies.

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Background: Headache is one of the most common problems that bring patients to doctors' offices. Many physicians order neuroimaging studies after taking the history of the patient and performing a physical examination. These neuroimaging studies are often requested due to the probable existence of an intracranial lesion. However, at times they are requested to allay the fears of patients or even doctors. Most of these studies are normal and the question arises whether there is any indication for requesting neuroimaging studies for a patient with an isolated headache.

Methods: We studied 146 patients with headache who had been referred for CT scan to the imaging center of Imam Khomeini Hospital during 2004-2005. For each patient, a questionnaire, including the medical history and accompanying neurological symptoms, was filled out and CT scan results were gathered.

Results: The mean of age of the patients was 37.8 years, and 69% were female. Only 10 patients (6.8%) had a brain lesion in the CT scan. Accompanying neurological symptoms were more frequent in patients with abnormal rather than normal CT scans. There was a meaningful correlation between abnormal CT scan and paresthesia, ptosis, paresia, diplopia, visual loss, convulsion, vomiting and vertigo. A statistical correlation existed between gender and positive CT scan.

Conclusions: Many patients with headache have normal brain CT scan results. Thus, better criteria are warranted for requesting neuroimaging including accurate patient history and neurological examination in order to prevent unnecessary radiation exposure. MRI instead of CT scan would be a better first step toward the evaluation of the possible existence of brain lesions.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Stromal tumors of the gastrointestinal tract (GISTs) are uncommon and the cell of origin is actually mesenchymal. Stemming from smooth muscle, 90% of GISTs, or leiomyomas, are found in the lower two thirds of the esophagus. Typically solitary, multiple tumors (leiomyomatosis) are occasionally reported. Remaining intramural during their growth, most of their bulk protrudes toward the esophageal outer wall, with a freely-movable, normal-looking overlying mucosa. In this study, we report a rare case of esophageal leiomyomatosis treated by esophagectomy.
Case Report: A 70-year-old man presented with discomfort upon swallowing, dysphagia, nausea, belching and weight loss. After a barium swallow, only dilatation of the esophagus from the retained food and saliva was seen. CT scan revealed a 10-cm dilatation of the thoracic esophagus. An endoscopy and upper GI series was performed, but no pathology was found. Esophageal manometry and pH monitoring for gastroesophageal reflux were normal. Upon endoscopic ultrasonography, a thickening of the esophageal wall was identified 20-30 cm from the dental arch. The patient was diagnosed with a GIST, referred to surgeon and a transhiatal esophagectomy was performed. The patient was discharged from the hospital in good condition and has had no problem during the one-year period of follow up. 

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Background: Epithelioid sarcoma is a malignant soft tissue tumor of uncertain histogenesis, categorized as a morphologically distinct neoplasm that characteristically affects the distal parts of the extremities in young adults. In fact, epithelioid sarcoma is the most common soft tissue sarcoma in the hand and wrist.

Case report: This 32 year-old male presented with an inguinal swelling, for which he underwent surgery with the initial intent of inguinal hernia repair. With this uncommon manifestation and site, among the differential diagnosis were abscess and GI malignancies. However, after a supplementary evaluation that included biopsy of the ulcer margin, the diagnosis focused on undifferentiated high-grade epithelial tumor, highly suggestive of epithelioid sarcoma. Immunohistochemical studies revealed CD34 and cytokeratin positivity, which confirmed this diagnosis.

Conclusion: Due to the malignant nature, invasive behavior and high recurrence rate of this tumor, as well as its unknown response to chemotherapy and radiation, extensive resection and hepatectomy are recommended for treatment.

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Background: Inhibin is a dimeric glycoprotein that has a depressive effect on the anterior hypophys secretion. The level of this tumor marker is undetectable in menopause women. In patients with gynecological cancer, especially granulosa and epidermal-type (mucinous), ovarian cancers considerable increase in the serum level of inhibin has been reported. The increased level of inhibin has been reported in patients with recurrent ovarian cancer. Methods: We measured total serum inhibin and CA125 tumor marker level in 38 postmenopausal women with pathologically confirmed ovarian cancer before and after surgery out of 51 suspected women. Our control group were postmenopausal women that attended to our clinic for routine gynecologic check up. Both tumor markers were measured in these patients too. Results: Among 38 women with ovarian cancer, 13(34.2%) had elevated serum levels of total inhibin. Among the 16 women with serous adenocarcinoma, 3 patients (18.8%) had elevated serum levels of inhibin. All the three women with granulosa cell tumor had elevated serum levels of inhibin (100%) and 3 of 4(75%) women with mucinous ovarian cancer had the same result. three out of 38 women in control group had elevated serum levels of inhibin. Among all 38 patients, 6(15.7%) showed tumor recurrence, that all were concomitant with rising of both serum CA125 and Inhibin levels (p=0/001). Conclusions: Serum inhibin level is a usefull tumor marker in granulosa cell and in mucinous tumor of ovary. In this study combined inhibin and CA125 assay showed better results in early detection of ovarian cancer in comparison to either CA125 or inhibin alone

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Background: Colorectal cancer is the third common cancer world wide and the forth in Iran. Neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer. In this study we evaluate the efficacy a cox-2 inhibitor on pathologic response, sphincter preservation and acute toxicity during neoadjuvant chemoradiation.

Methods: Thirty-six patients that have adenocarcinoma of rectum was enrolled (up to 15 cm of anal verge). The patients were undergone Endometrial Ultrasound (EUS), abdomino-pelvic and chest CT for staging. Then received neoadjuvant concurrent chemo radiation (xeloda 825 mg/m2 bid in combination with celecoxib 100 mg qid and 50-50.4Gy/25-28f). Surgery was done 4-8 weeks after chemoradiation. During the chemoradiation the patients was observed for the probable complication one year. Tumor regression grade was reported.

Results: From 36 surgery patients, Total Mesorectal Excision (TME) was done in 30 patients. Pathologic complete response was seen in eight of 30 patients (26.7%). Tumor regression grade was calculated in three and five grade system: in three grade system 17 patients had grade 1 (60.7%), eight patients had grade 2 (28.6%) and three patients had grade 3 (10.7%). In five grade system of tumor regression eight patients had grade 1 (28.6%), nine patients had grade 2 (32.1%), eight patients grade 3 (28.6%), three patients had grade 4 (10.7%). T down staging was 43.3%. N downstaging was 30.8%. No patient had skin reaction or cardio-vascular complication.

Conclusion: Based on our study results, Celecoxib in combination with neoadjuvant chemoradiation is safe and is associated with low complications. This combination can promote pathologic complete response, TRG and T and N downstaging in Rectal adenocarcinoma.

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Background: Osteochondroma is a common tumor of the skeletal bone and is a common benign tumor of the bone constitutes 10-15% of all and 20-50% of the benign bone tumors. The lesion is an exophytic bony protrusion covered by a cartilaginous cap. It is most commonly found in long bones, and especially at the epiphysis. Nearly 40% of cases are seen around the knee joint. Osteochondroma rarely affect skull bones, occurrence of an intracranial osteochondroma is a rarity in the neurosurgical literature and only anecdotal reports are available in the literature. To our knowledge no case arising from foramen magnum has been reported.
Case presentation: We present a 73 years old male with gait problem and limb paresis. Imaging investigation showed a bony mass in the foramen magnum, that compresses neural elements. The patient also complained of persistent headache in his occipitocervical region. There was no history of previous trauma. The patient underwent surgery and histopathological examination confirmed the lesion to be osteochondroma.
Conclusion: Many types of lesion may be seen in foramen magnum area, and in differential diagnosis of such lesion rare, osseous tumors such as osteochondroma should be considered.

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Background: Female genital tract sarcomas are rare but most aggressive tumors of mesodermal origin. Little is known about the pathogenesis, risk factors, optimal treatment and outcome of these diseases. Therefore, we aimed to evaluate the clinicopathologic characteristics of patients with genital sarcoma.

Methods: This is a retrospective, cross-sectional study. The medical records of 43 female patients with genital tract sarcoma, hospitalized during a 16-year period (from 1991-2007) were retrieved from the medical records office of Ghaem Hospital in Mashad, Iran. The demographic data extracted from the records.

Results: The mean age of the patients was 46.95 years (ranging from 3-77 years). The chief complaint of the patients was abnormal vaginal bleeding (69.8%). The mean interval between the onset of symptom to the pathological diagnosis of sarcoma was 8.53 months (ranging from 1-36 months). Histologically, the tumors included: leiomyosarcoma (79.1%), endometrial stromal sarcoma (18.6%) and embryonal rhabdomyosarcoma (2.3%). Three patients (7%) were in International Federation of Gynecology and Obstetrics (FIGO) stage I, 20(46.5%) in stage II, 6(14%) in stage III and 14(32.6%) in stage IV. 48.8% of the patients had undergone chemoradiotherapy.

Conclusions: In most cases, our patients were referred so late or the disease was recognized very late due to being rare. We should consider this disease for every patient with unusual vaginal bleeding especially in post menopause women who their sonography has reported uterine mass.