Ahmad Mosalaei | Shiraz University Of Medical Sciences (original) (raw)

Papers by Ahmad Mosalaei

Research paper thumbnail of Breast Cancer and its Radiotherapeutic Methods

Breast cancer is the most common cancer in women after skin cancer. In Iran, the presentation age... more Breast cancer is the most common cancer in women after skin cancer. In Iran, the presentation age of this cancer is younger than the global average. There are different therapeutic methods for treatment of breast cancer and the choice of treatment depends on the stage of the disease as well as its type and characteristics. Therapeutic methods include surgery, radiotherapy, and systemic therapies, each consisting of a variety of techniques. The two main surgical techniques are lumpectomy and mastectomy. The main systemic methods are biological therapy (immunotherapy), hormone therapy, and chemotherapy. Radiotherapy is mainly categorized into external-beam radiotherapy and brachytherapy. In this paper, we present a brief review of the different types of breast cancer and their treatments using conventional and modern radiotherapy methods, as well as the treatment efficacy and side effects of breast radiotherapy.

Research paper thumbnail of Paper: SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK: DRAMATIC RESPONSE TO CHEMORADIOTHERAPY

Research paper thumbnail of Rate and Time of Ovarian Function Restoration in Menopausal Breast Cancer Patients Who Received Letrozole Following Chemotherapy

Background: The present study aimed to investigate the rate and time of ovarian function restorat... more Background: The present study aimed to investigate the rate and time of ovarian function restoration in breast cancer patients between 40 and 60 years of age who were in menopause (biochemically documented) and received letrozole after chemotherapy. We intended to further clarify the management strategy for breast cancer patients with different menopausal status. Methods: We prospectively measured the effects of replacing tamoxifen with letrozole on ovarian function recovery in 90 women from two age groups (40-50 and 51-60 years). All had breast cancer and were treated by chemotherapy. Patients had laboratory documentation of menopause (FSH >40 mIU/ml and estradiol <20 pg/mL). Patients did not have menstruation for at least one year. Study patients received letrozole. At three month intervals, we checked their FSH and estradiol levels. Results: At three months after beginning letrozole, 12 patients in the younger age group had laboratory ovarian function restoration, among which three had vaginal bleeding. In the older group, 8 patients had increased estradiol levels; however, there was no evidence of vaginal bleeding in this group. At 6, 9 and 12 months, no ovarian function restoration was seen in the older group. However in younger patients, 4 had laboratory evidence of ovarian function restoration at 6 months, 2 at 9 months and 1 patient showed laboratory ovarian function restoration at 12 months of follow-up. Totally, there was a significant difference in the occurrence of ovarian function restoration between the two groups (P=0.03). Conclusion: A remarkable portion of women with chemotherapy-induced amenorrhea may develop ovarian function restoration. Therefore, endocrine therapy using aromatase inhibitors in patients with chemotherapy-induced amenorrhea should be followed by a regular hormonal study.

Research paper thumbnail of Patients with localized and disseminated tumors have reduced but measurable levels of ADAMTS-13 von Willebrand factor cleaving protease)

Journal of Thrombosis and Haemostasis, 2003

Patients with disseminated malignancies have been noted to have a deficiency of von Willebrand fa... more Patients with disseminated malignancies have been noted to have a deficiency of von Willebrand factor (VWF) cleaving protease, ADAMTS-13. The very low or undetectable plasma levels of this protease are said to be similar to those found in patients with thrombotic thrombocytopenic purpura (TTP). This observation, which challenges the paradigm that severe ADAMTS-13 deficiency is a specific diagnostic marker for TTP, remains so far unconfirmed. We measured the protease and VWF antigen (VWF:Ag) in parallel in 49 Iranian patients with solid tumors, which in 29 cases were localized (stages I and II) and in 20 disseminated (stage IV). Forty-nine healthy individuals matched with cases for sex, age and smoking habits were taken as controls. Patients with disseminated tumors had lower mean plasma levels of ADAMTS-13 than those with localized tumors, but these differences did not reach the level of statistical significance (p=0.059). However, in no patient was the level of ADAMTS-13 below 18% of normal, at variance with previous findings of lower or unmeasurable levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;15%). The level of ADAMTS-13 was significantly lower in patients with localized tumors than in controls ( p = 0.0003 ), but higher than in patients with disseminated disease (p=0.0001 vs controls). Malignancy, whether localized or disseminated, is another condition associated with low ADAMTS-13 levels not accompanied by signs and symptoms of TTP and other thrombotic microangiopathies.

Research paper thumbnail of Primary tonsillar lymphomas according to the new World Health Organization classification: to report 87 cases and literature review and analysis

Annals of Hematology, 2010

The present study aimed to define the natural history, World Health Organization (WHO) classifica... more The present study aimed to define the natural history, World Health Organization (WHO) classification, prognostic factors, and treatment outcome of 87 patients with primary lymphoma of the palatine tonsil and literature review and analysis. Between 1990 and March 2008, 87 consecutive patients diagnosed with primary lymphoid malignancy of the palatine tonsil. All pathologic specimens were reviewed and reclassified according to the recent WHO classification. To investigate the association of tonsillar lymphomas with Epstein-Barr virus (EBV), in situ hybridization was performed for 24 tonsillar lymphomas (23 diffuse large B-cell lymphoma (DLBC) and one classic Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27;s disease) and ten normal tonsils as control group. In literature review, we found 26 major related series including 1,602 patients with primary tonsillar lymphoma. The median age of our patients was 52 years (range 11-86 years). There were 39 women and 48 men with a median follow-up of 67 months for living patients. The vast majority (95%) of patients had B-cell phenotype. DLBC was the most frequent histology. In situ hybridization revealed none of 23 DLBC to be positive for EBV. The 5-year disease-free and overall survival rates were 78.9% and 86%, respectively. In the literature review and by analyzing the data collection from 26 major reported series, the median age was 55 years and male/female ratio was 1.3:1. Intermediate grade tumors consisted of 72% of all tonsillar lymphomas and B-cell lymphomas constituted 82% of all cell immunophenotypes. The 5-year disease-free and overall survival rates were 61% and 67%, respectively. The vast majority of tonsillar lymphomas are of B-cell origin and with intermediate to high-grade histology. These neoplasms tend to present in early stage disease and to have favorable outcome. WHO classification predicts more accurately treatment outcome of patients with tonsillar lymphoma. The association of DLBC in the palatine tonsil with EBV infection is infrequent.

Research paper thumbnail of Squamous Cell Carcinoma of the Head and Neck: Dramatic Response to Chemoradiotherapy

Research paper thumbnail of Breast Cancer and its Radiotherapeutic Methods

Research paper thumbnail of Efficacy of Ginger in Control of Chemotherapy Induced Nausea and Vomiting in Breast Cancer Patients Receiving Doxorubicin-Based Chemotherapy

Asian Pacific journal of cancer prevention : APJCP, 2016

Nausea and vomiting are among the most serious side effects of chemotherapy, in some cases leadin... more Nausea and vomiting are among the most serious side effects of chemotherapy, in some cases leading to treatment interruption or chemotherapy dose reduction. Ginger has long been known as an antiemetic drug, used for conditions such as motion sickness, nausea-vomiting in pregnancy, and post-operation side effects. One hundred and fifty female patients with breast cancer entered this prospective study and were randomized to receive ginger (500 mg ginger powder, twice a day for 3 days) or placebo. One hundred and nineteen patients completed the study: 57 of them received ginger and 62 received ginger for the frst 3 chemotherapy cycles. Mean age in all patients was 48.6 (25-79) years. After 1st chemotherapy, mean nausea in the ginger and control arms were 1.36 (±1.31) and 1.46 (±1.28) with no statistically significant difference. After the 2nd chemotherapy session, nausea score was slightly more in the ginger group (1.36 versus 1.32). After 3rd chemotherapy, mean nausea severity in cont...

Research paper thumbnail of A comprehensive approach in high-grade glioma management: position statement from the Neuro-Oncology Scientific Club (NOSC), Shiraz, Iran

German medical science : GMS e-journal, 2017

Establishing a robust teamwork model in the practice of neuro-oncology requires continued interdi... more Establishing a robust teamwork model in the practice of neuro-oncology requires continued interdisciplinary efforts. The Neuro-Oncology Scientific Club (NOSC) initiative is an interdisciplinary clinical forum promoting the comprehensive approach across involved disciplines in the management of central nervous system (CNS) malignancies. With its provincial founding panels and national steering board, NOSC has been operational in Iran since 2011. This initiative has pursued its mission through interval strategic meetings, tumor boards, case discussions as well as publishing neuro-oncology updates, case study periodicals, and newsletters. A provincial meeting of NOSC in Shiraz put together insights from international practice guidelines, emerging evidence, and expert opinions to draw a position statement on high-grade glioma management in adults. The present report summarizes key highlights from the above clinical forum.

Research paper thumbnail of Long-term pruritus as the initial and sole clinical manifestation of occult Hodgkin's disease

Indian Journal of Medical Sciences, Jun 1, 2004

Pruritus or itch is a frequent symptom of patients with Hodgkin's disease. It often occurs during... more Pruritus or itch is a frequent symptom of patients with Hodgkin's disease. It often occurs during the clinical course of the disease and rarely may precede the diagnosis of underlying disease. In this report, we present a 16-year-old patient who had history of generalized pruritus without any skin rash for 4 years before the diagnosis of Hodgkin's disease. Within that period, she had received symptom-oriented medications, with no significant effect. After the first cycle of chemotherapy, her pruritus resolved completely. This case suggests that long-term generalized pruritus may be indicative of a significant underlying problem like Hodgkin's disease.

Research paper thumbnail of Hemorrhagic cystitis in a patient receiving conventional doses of dacarbazine for metastatic malignant melanoma: Case report and review of the literature

Clinical Therapeutics, Jun 30, 2007

Introduction: Hemorrhagic cystitis is a potentially life-threatening complication in patients rec... more Introduction: Hemorrhagic cystitis is a potentially life-threatening complication in patients receiving cancer therapy. This urologic emergency is commonly associated with the chemotherapeutic use of oxazaphosphorine alkylating agents. This report describes a case of hemorrhagic cystitis associated with dacarbazine treatment. Case summary: A 63-year-old man with asymptomatic metastatic malignant melanoma received 3 cycles of dacarbazine (600-850 mg/m 2) monochemotherapy, each 3 weeks apart. Two weeks after the third cycle, he presented with gross hematuria and mild dysuria. Physical examination revealed no significant finding. Hematuria was confirmed by urinalysis, and urinary infection was excluded by repeated urine cultures. Ultrasonography revealed diffuse bladder wall thickening with no discrete mass or ulceration. Cystoscopy findings revealed generalized inflammation and edema of the mucosa of the bladder, confirming the diagnosis of hemorrhagic cystitis. The patient's gross hematuria continued for 2 weeks and then completely resolved with supportive care. Two weeks after complete resolution, the patient experienced 2 transient episodes of gross hematuria that lasted a few hours and subsided spontaneously. Discussion: Dacarbazine is currently considered the standard first-line treatment in patients with advanced malignant melanoma. At standard prescribed doses (a single dose of 850-1000 mg/m 2 or 250 mg/m 2 for 5 days per cycle), dacarbazine is a reasonably well tolerated chemotherapeutic drug; nausea, vomiting, and myelosuppression are the most common adverse effects. Association of dacarbazine with hemorrhagic cys-titis has not been reported previously (in a PubMed literature search from 1950-2006), and only 1 case report associates temozolomide (an analog of dacarbazine) with hemorrhagic cystitis. Based on the Naranjo adverse drug reactions probability scale, an objective assessment revealed dacarbazine to be a probable cause of hemorrhagic cystitis in this case. Conclusions: This case report suggests that dacarbazine at conventional doses was a probable cause of hemorrhagic cystitis. Regular urinalysis and early intervention are recommended, as a means of detecting early hematuria and subseqently reducing or discontinuing dacarbazine treatment. Adequate hydration before, during, and after dacarbazine administration may be useful in preventing this complication.

Research paper thumbnail of Bony Calvarium as the Sole Site of Metastases in Squamous Cell Carcinoma of the Uterine Cervix

Middle East Journal of Cancer, 2010

Research paper thumbnail of Osteopoikilosis: A Sign Mimicking Skeletal Metastases in a Cancer Patient

Middle East Journal of Cancer, 2011

Osteopoikilosis is a rare benign osteosclerotic bone disorder that may be misdiagnosed as skeleta... more Osteopoikilosis is a rare benign osteosclerotic bone disorder that may be misdiagnosed as skeletal metastases. Here we describe a case of coincidental breast cancer and osteopoikilosis mimicking skeletal metastases. A 41-year-old woman underwent right modified radical mastectomy in April 2007. Twenty-eight months after initial treatment, the patient complained of bilateral knee and foot pain. Plain X-rays of the feet and knees showed multiple well-defined osteosclerotic lesions. According to the radiographic appearance, the most likely differential diagnoses included skeletal metastases from breast cancer and osteopoikilosis. A whole-body bone scintigraphy showed no increase in uptake by the sclerotic lesions, and serum lactic dehydrogenase, carcinoembryonic antigen, alkaline phosphatase and cancer antigen 15-3 were not elevated. We therefore diagnosed the patient's skeletal lesions as osteopoikilosis. This case and our literature review suggest that the radiographic appearance of osteopoikilosis may mimic or mask skeletal metastases, potentially leading to misdiagnosis in patients with cancer.

Research paper thumbnail of Primary Pancreas Sarcoma, Optimal Treatment and Prognostic Factors

Reports of Radiotherapy and Oncology, 2015

Context: Sarcoma is a rare human cancer and pancreatic sarcoma is even rarer. Its treatment and c... more Context: Sarcoma is a rare human cancer and pancreatic sarcoma is even rarer. Its treatment and clinical history and prognosis are not well described. Evidence Acquisition: In this review, we collected all articles in the English language found in PubMed that were published between January 2000 to August 2015 to draw conclusions. We found 170 articles in total and 124 articles were excluded. The remaining 46 reports and information of 55 patients were collected and analyzed. Results: Mean age was 57.1 ± 16.7 years and male/female ratio was 27/28. The most common presenting symptom was pain. In 31 cases no adjuvant treatment was prescribed. Others received different chemotherapy agents and only two cases received radiotherapy. Mean tumor size was 9.0 ± 6.8 cm (1-27 cm) and the most common type was leiomyosarcoma (16 patients). Nine patients had carcinosarcoma and six cases had MFH. The most common site of metastasis was liver, 14 patients had liver metastasis at presentation. Median survival was 14 months. One, three and five year overall survival were 78.4, 48.5 and 48.5 percent, respectively. We found no effective clinical factor in survival. Conclusions: Pancreatic sarcoma is a rare disease and an optimal treatment, such as surgery, chemotherapy or radiotherapy is not well defined.

Research paper thumbnail of Sensitivity and specificity of CA 15-3 in detection of breast cancer recurrence

Research paper thumbnail of Experience with Adjuvant Therapy in 117 Patients with Locally Advanced Breast Cancer

BACKGROUND-Loco-regional recurrence and distant metastases are frequently disturbing events in pa... more BACKGROUND-Loco-regional recurrence and distant metastases are frequently disturbing events in patients with locally advanced breast cancer. This study was carried out to evaluate the role of postmastectomy conventional adjuvant treatment in such patients. MATERIALS AND METHODS-During the last five years, a total of 117 patients with locally advanced breast cancer (T3-T4 and/or more than four involved lymph nodes and/or fixed

Research paper thumbnail of Lack of Prognostic Impact of Adjuvant Radiation on Oncologic Outcomes in Elderly Women with Breast Cancer

Asian Pacific journal of cancer prevention : APJCP, 2015

Radiotherapy plays an important role as adjuvant treatment in locally advanced breast cancer and ... more Radiotherapy plays an important role as adjuvant treatment in locally advanced breast cancer and in those patients who have undergone breast-conserving surgery. This study aimed to investigate the prognostic impact of adjuvant radiation on oncologic outcomes in elderly women with breast cancer. In this retrospective study, we reviewed and analyzed the characteristics, treatment outcome and survival of elderly women (aged ≥ 60 years) with breast cancer who were treated and followed-up between 1993 and 2014. The median follow up for the surviving patients was 38 (range 3-207) months. One hundred and seventy-eight patients with a median age of 74 (range 60-95) years were enrolled in the study. Of the total, 60 patients received postoperative adjuvant radiation (radiation group) and the remaining 118 did not (control group). Patients in the radiation group were significantly younger than those in the control group (P value=0.004). In addition, patients in radiation group had higher node...

Research paper thumbnail of Primary Adenocarcinoma of the Appendix Presenting as a Buttock Mass

Archives of Iranian Medicine, 2009

Research paper thumbnail of Primary Mucosa-Associated Lymphoid Tissue Lymphoma of the Rectum

Annals of Colorectal Research, 2013

Introduction: Mucosa-associated lymphoid tissue (MALT) lymphoma most commonly involves the stomac... more Introduction: Mucosa-associated lymphoid tissue (MALT) lymphoma most commonly involves the stomach and its treatment is surgery, antibiotic therapy or radiotherapy. Rectal MALT is not only so rare, but also the treatment is not clear as gastric MALT. Case Presentation: Our patient was a 66 year-old man presenting with 5-6 months abdominal pain and anemia. In colonoscopy, a rectal ulcer was found and biopsy revealed MALT lymphoma. Physical examination and staging evaluations had normal results. Radiotherapy was started for him but he did not tolerate radiotherapy and instead received chemotherapy. After 38 months of follow up, he was fine. Conclusions: The incidence of rectal MALT is rare, and treatment is not so clear. The results on H. pylori eradication, radiotherapy and chemotherapy are more controversial.

Research paper thumbnail of Malignant Neoplasms of the Anal Canal

Annals of Colorectal Research, 2013

Background: Malignant neoplasms of the anal canal are rare accounting for approximately 4% of all... more Background: Malignant neoplasms of the anal canal are rare accounting for approximately 4% of all colorectal malignancies. Objectives: The present study aimed to report the clinicopathological characteristics and treatment outcomes of 41 cases with malignant neoplasms of the anal canal. Patients and Methods: Between 1999 and 2012, 41 consecutive patients were diagnosed with primary malignant neoplasm of the anal canal which were treated and followed up at Namazi hospital. Only primary malignant tumors arising from the anal canal were included. Patients with secondary anal canal involvement from rectal or perianal skin cancers and metastatic tumors were excluded. Results: There were 22 women and 19 men, age ranging from 33 to 83 years, with a median age of 57 years at diagnosis. Sixteen patients (39%) had localized disease, 21 (51%) had regional disease, and 4 (10%) had metastatic disease at diagnosis. Squamous cell carcinoma (61%) was the most frequent histologic subtype, followed by adenocarcinoma (27%), malignant melanoma (10%), and gastrointestinal stromal tumor (2%). After a median follow-up of 51 (11-169) months for surviving patients, 22 patients were alive and without disease, three were alive with disease, and 19 patients died due to the disease. Histological subtype (P = 001), and stage of disease (P = 0.002) were prognostic factors for overall survival. The 5-year local control, disease-free, and overall survival rates for all patients were 63.9%, 53%, and 59.4% respectively. Conclusions: This study indicated that squamous cell carcinoma, adenocarcinoma, and malignant melanoma are the most frequent malignant neoplasms in the anal canal. Histological subtype and disease stage are the most important prognostic factors for overall survival in this region.

Research paper thumbnail of Breast Cancer and its Radiotherapeutic Methods

Breast cancer is the most common cancer in women after skin cancer. In Iran, the presentation age... more Breast cancer is the most common cancer in women after skin cancer. In Iran, the presentation age of this cancer is younger than the global average. There are different therapeutic methods for treatment of breast cancer and the choice of treatment depends on the stage of the disease as well as its type and characteristics. Therapeutic methods include surgery, radiotherapy, and systemic therapies, each consisting of a variety of techniques. The two main surgical techniques are lumpectomy and mastectomy. The main systemic methods are biological therapy (immunotherapy), hormone therapy, and chemotherapy. Radiotherapy is mainly categorized into external-beam radiotherapy and brachytherapy. In this paper, we present a brief review of the different types of breast cancer and their treatments using conventional and modern radiotherapy methods, as well as the treatment efficacy and side effects of breast radiotherapy.

Research paper thumbnail of Paper: SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK: DRAMATIC RESPONSE TO CHEMORADIOTHERAPY

Research paper thumbnail of Rate and Time of Ovarian Function Restoration in Menopausal Breast Cancer Patients Who Received Letrozole Following Chemotherapy

Background: The present study aimed to investigate the rate and time of ovarian function restorat... more Background: The present study aimed to investigate the rate and time of ovarian function restoration in breast cancer patients between 40 and 60 years of age who were in menopause (biochemically documented) and received letrozole after chemotherapy. We intended to further clarify the management strategy for breast cancer patients with different menopausal status. Methods: We prospectively measured the effects of replacing tamoxifen with letrozole on ovarian function recovery in 90 women from two age groups (40-50 and 51-60 years). All had breast cancer and were treated by chemotherapy. Patients had laboratory documentation of menopause (FSH >40 mIU/ml and estradiol <20 pg/mL). Patients did not have menstruation for at least one year. Study patients received letrozole. At three month intervals, we checked their FSH and estradiol levels. Results: At three months after beginning letrozole, 12 patients in the younger age group had laboratory ovarian function restoration, among which three had vaginal bleeding. In the older group, 8 patients had increased estradiol levels; however, there was no evidence of vaginal bleeding in this group. At 6, 9 and 12 months, no ovarian function restoration was seen in the older group. However in younger patients, 4 had laboratory evidence of ovarian function restoration at 6 months, 2 at 9 months and 1 patient showed laboratory ovarian function restoration at 12 months of follow-up. Totally, there was a significant difference in the occurrence of ovarian function restoration between the two groups (P=0.03). Conclusion: A remarkable portion of women with chemotherapy-induced amenorrhea may develop ovarian function restoration. Therefore, endocrine therapy using aromatase inhibitors in patients with chemotherapy-induced amenorrhea should be followed by a regular hormonal study.

Research paper thumbnail of Patients with localized and disseminated tumors have reduced but measurable levels of ADAMTS-13 von Willebrand factor cleaving protease)

Journal of Thrombosis and Haemostasis, 2003

Patients with disseminated malignancies have been noted to have a deficiency of von Willebrand fa... more Patients with disseminated malignancies have been noted to have a deficiency of von Willebrand factor (VWF) cleaving protease, ADAMTS-13. The very low or undetectable plasma levels of this protease are said to be similar to those found in patients with thrombotic thrombocytopenic purpura (TTP). This observation, which challenges the paradigm that severe ADAMTS-13 deficiency is a specific diagnostic marker for TTP, remains so far unconfirmed. We measured the protease and VWF antigen (VWF:Ag) in parallel in 49 Iranian patients with solid tumors, which in 29 cases were localized (stages I and II) and in 20 disseminated (stage IV). Forty-nine healthy individuals matched with cases for sex, age and smoking habits were taken as controls. Patients with disseminated tumors had lower mean plasma levels of ADAMTS-13 than those with localized tumors, but these differences did not reach the level of statistical significance (p=0.059). However, in no patient was the level of ADAMTS-13 below 18% of normal, at variance with previous findings of lower or unmeasurable levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;15%). The level of ADAMTS-13 was significantly lower in patients with localized tumors than in controls ( p = 0.0003 ), but higher than in patients with disseminated disease (p=0.0001 vs controls). Malignancy, whether localized or disseminated, is another condition associated with low ADAMTS-13 levels not accompanied by signs and symptoms of TTP and other thrombotic microangiopathies.

Research paper thumbnail of Primary tonsillar lymphomas according to the new World Health Organization classification: to report 87 cases and literature review and analysis

Annals of Hematology, 2010

The present study aimed to define the natural history, World Health Organization (WHO) classifica... more The present study aimed to define the natural history, World Health Organization (WHO) classification, prognostic factors, and treatment outcome of 87 patients with primary lymphoma of the palatine tonsil and literature review and analysis. Between 1990 and March 2008, 87 consecutive patients diagnosed with primary lymphoid malignancy of the palatine tonsil. All pathologic specimens were reviewed and reclassified according to the recent WHO classification. To investigate the association of tonsillar lymphomas with Epstein-Barr virus (EBV), in situ hybridization was performed for 24 tonsillar lymphomas (23 diffuse large B-cell lymphoma (DLBC) and one classic Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#x27;s disease) and ten normal tonsils as control group. In literature review, we found 26 major related series including 1,602 patients with primary tonsillar lymphoma. The median age of our patients was 52 years (range 11-86 years). There were 39 women and 48 men with a median follow-up of 67 months for living patients. The vast majority (95%) of patients had B-cell phenotype. DLBC was the most frequent histology. In situ hybridization revealed none of 23 DLBC to be positive for EBV. The 5-year disease-free and overall survival rates were 78.9% and 86%, respectively. In the literature review and by analyzing the data collection from 26 major reported series, the median age was 55 years and male/female ratio was 1.3:1. Intermediate grade tumors consisted of 72% of all tonsillar lymphomas and B-cell lymphomas constituted 82% of all cell immunophenotypes. The 5-year disease-free and overall survival rates were 61% and 67%, respectively. The vast majority of tonsillar lymphomas are of B-cell origin and with intermediate to high-grade histology. These neoplasms tend to present in early stage disease and to have favorable outcome. WHO classification predicts more accurately treatment outcome of patients with tonsillar lymphoma. The association of DLBC in the palatine tonsil with EBV infection is infrequent.

Research paper thumbnail of Squamous Cell Carcinoma of the Head and Neck: Dramatic Response to Chemoradiotherapy

Research paper thumbnail of Breast Cancer and its Radiotherapeutic Methods

Research paper thumbnail of Efficacy of Ginger in Control of Chemotherapy Induced Nausea and Vomiting in Breast Cancer Patients Receiving Doxorubicin-Based Chemotherapy

Asian Pacific journal of cancer prevention : APJCP, 2016

Nausea and vomiting are among the most serious side effects of chemotherapy, in some cases leadin... more Nausea and vomiting are among the most serious side effects of chemotherapy, in some cases leading to treatment interruption or chemotherapy dose reduction. Ginger has long been known as an antiemetic drug, used for conditions such as motion sickness, nausea-vomiting in pregnancy, and post-operation side effects. One hundred and fifty female patients with breast cancer entered this prospective study and were randomized to receive ginger (500 mg ginger powder, twice a day for 3 days) or placebo. One hundred and nineteen patients completed the study: 57 of them received ginger and 62 received ginger for the frst 3 chemotherapy cycles. Mean age in all patients was 48.6 (25-79) years. After 1st chemotherapy, mean nausea in the ginger and control arms were 1.36 (±1.31) and 1.46 (±1.28) with no statistically significant difference. After the 2nd chemotherapy session, nausea score was slightly more in the ginger group (1.36 versus 1.32). After 3rd chemotherapy, mean nausea severity in cont...

Research paper thumbnail of A comprehensive approach in high-grade glioma management: position statement from the Neuro-Oncology Scientific Club (NOSC), Shiraz, Iran

German medical science : GMS e-journal, 2017

Establishing a robust teamwork model in the practice of neuro-oncology requires continued interdi... more Establishing a robust teamwork model in the practice of neuro-oncology requires continued interdisciplinary efforts. The Neuro-Oncology Scientific Club (NOSC) initiative is an interdisciplinary clinical forum promoting the comprehensive approach across involved disciplines in the management of central nervous system (CNS) malignancies. With its provincial founding panels and national steering board, NOSC has been operational in Iran since 2011. This initiative has pursued its mission through interval strategic meetings, tumor boards, case discussions as well as publishing neuro-oncology updates, case study periodicals, and newsletters. A provincial meeting of NOSC in Shiraz put together insights from international practice guidelines, emerging evidence, and expert opinions to draw a position statement on high-grade glioma management in adults. The present report summarizes key highlights from the above clinical forum.

Research paper thumbnail of Long-term pruritus as the initial and sole clinical manifestation of occult Hodgkin's disease

Indian Journal of Medical Sciences, Jun 1, 2004

Pruritus or itch is a frequent symptom of patients with Hodgkin's disease. It often occurs during... more Pruritus or itch is a frequent symptom of patients with Hodgkin's disease. It often occurs during the clinical course of the disease and rarely may precede the diagnosis of underlying disease. In this report, we present a 16-year-old patient who had history of generalized pruritus without any skin rash for 4 years before the diagnosis of Hodgkin's disease. Within that period, she had received symptom-oriented medications, with no significant effect. After the first cycle of chemotherapy, her pruritus resolved completely. This case suggests that long-term generalized pruritus may be indicative of a significant underlying problem like Hodgkin's disease.

Research paper thumbnail of Hemorrhagic cystitis in a patient receiving conventional doses of dacarbazine for metastatic malignant melanoma: Case report and review of the literature

Clinical Therapeutics, Jun 30, 2007

Introduction: Hemorrhagic cystitis is a potentially life-threatening complication in patients rec... more Introduction: Hemorrhagic cystitis is a potentially life-threatening complication in patients receiving cancer therapy. This urologic emergency is commonly associated with the chemotherapeutic use of oxazaphosphorine alkylating agents. This report describes a case of hemorrhagic cystitis associated with dacarbazine treatment. Case summary: A 63-year-old man with asymptomatic metastatic malignant melanoma received 3 cycles of dacarbazine (600-850 mg/m 2) monochemotherapy, each 3 weeks apart. Two weeks after the third cycle, he presented with gross hematuria and mild dysuria. Physical examination revealed no significant finding. Hematuria was confirmed by urinalysis, and urinary infection was excluded by repeated urine cultures. Ultrasonography revealed diffuse bladder wall thickening with no discrete mass or ulceration. Cystoscopy findings revealed generalized inflammation and edema of the mucosa of the bladder, confirming the diagnosis of hemorrhagic cystitis. The patient's gross hematuria continued for 2 weeks and then completely resolved with supportive care. Two weeks after complete resolution, the patient experienced 2 transient episodes of gross hematuria that lasted a few hours and subsided spontaneously. Discussion: Dacarbazine is currently considered the standard first-line treatment in patients with advanced malignant melanoma. At standard prescribed doses (a single dose of 850-1000 mg/m 2 or 250 mg/m 2 for 5 days per cycle), dacarbazine is a reasonably well tolerated chemotherapeutic drug; nausea, vomiting, and myelosuppression are the most common adverse effects. Association of dacarbazine with hemorrhagic cys-titis has not been reported previously (in a PubMed literature search from 1950-2006), and only 1 case report associates temozolomide (an analog of dacarbazine) with hemorrhagic cystitis. Based on the Naranjo adverse drug reactions probability scale, an objective assessment revealed dacarbazine to be a probable cause of hemorrhagic cystitis in this case. Conclusions: This case report suggests that dacarbazine at conventional doses was a probable cause of hemorrhagic cystitis. Regular urinalysis and early intervention are recommended, as a means of detecting early hematuria and subseqently reducing or discontinuing dacarbazine treatment. Adequate hydration before, during, and after dacarbazine administration may be useful in preventing this complication.

Research paper thumbnail of Bony Calvarium as the Sole Site of Metastases in Squamous Cell Carcinoma of the Uterine Cervix

Middle East Journal of Cancer, 2010

Research paper thumbnail of Osteopoikilosis: A Sign Mimicking Skeletal Metastases in a Cancer Patient

Middle East Journal of Cancer, 2011

Osteopoikilosis is a rare benign osteosclerotic bone disorder that may be misdiagnosed as skeleta... more Osteopoikilosis is a rare benign osteosclerotic bone disorder that may be misdiagnosed as skeletal metastases. Here we describe a case of coincidental breast cancer and osteopoikilosis mimicking skeletal metastases. A 41-year-old woman underwent right modified radical mastectomy in April 2007. Twenty-eight months after initial treatment, the patient complained of bilateral knee and foot pain. Plain X-rays of the feet and knees showed multiple well-defined osteosclerotic lesions. According to the radiographic appearance, the most likely differential diagnoses included skeletal metastases from breast cancer and osteopoikilosis. A whole-body bone scintigraphy showed no increase in uptake by the sclerotic lesions, and serum lactic dehydrogenase, carcinoembryonic antigen, alkaline phosphatase and cancer antigen 15-3 were not elevated. We therefore diagnosed the patient's skeletal lesions as osteopoikilosis. This case and our literature review suggest that the radiographic appearance of osteopoikilosis may mimic or mask skeletal metastases, potentially leading to misdiagnosis in patients with cancer.

Research paper thumbnail of Primary Pancreas Sarcoma, Optimal Treatment and Prognostic Factors

Reports of Radiotherapy and Oncology, 2015

Context: Sarcoma is a rare human cancer and pancreatic sarcoma is even rarer. Its treatment and c... more Context: Sarcoma is a rare human cancer and pancreatic sarcoma is even rarer. Its treatment and clinical history and prognosis are not well described. Evidence Acquisition: In this review, we collected all articles in the English language found in PubMed that were published between January 2000 to August 2015 to draw conclusions. We found 170 articles in total and 124 articles were excluded. The remaining 46 reports and information of 55 patients were collected and analyzed. Results: Mean age was 57.1 ± 16.7 years and male/female ratio was 27/28. The most common presenting symptom was pain. In 31 cases no adjuvant treatment was prescribed. Others received different chemotherapy agents and only two cases received radiotherapy. Mean tumor size was 9.0 ± 6.8 cm (1-27 cm) and the most common type was leiomyosarcoma (16 patients). Nine patients had carcinosarcoma and six cases had MFH. The most common site of metastasis was liver, 14 patients had liver metastasis at presentation. Median survival was 14 months. One, three and five year overall survival were 78.4, 48.5 and 48.5 percent, respectively. We found no effective clinical factor in survival. Conclusions: Pancreatic sarcoma is a rare disease and an optimal treatment, such as surgery, chemotherapy or radiotherapy is not well defined.

Research paper thumbnail of Sensitivity and specificity of CA 15-3 in detection of breast cancer recurrence

Research paper thumbnail of Experience with Adjuvant Therapy in 117 Patients with Locally Advanced Breast Cancer

BACKGROUND-Loco-regional recurrence and distant metastases are frequently disturbing events in pa... more BACKGROUND-Loco-regional recurrence and distant metastases are frequently disturbing events in patients with locally advanced breast cancer. This study was carried out to evaluate the role of postmastectomy conventional adjuvant treatment in such patients. MATERIALS AND METHODS-During the last five years, a total of 117 patients with locally advanced breast cancer (T3-T4 and/or more than four involved lymph nodes and/or fixed

Research paper thumbnail of Lack of Prognostic Impact of Adjuvant Radiation on Oncologic Outcomes in Elderly Women with Breast Cancer

Asian Pacific journal of cancer prevention : APJCP, 2015

Radiotherapy plays an important role as adjuvant treatment in locally advanced breast cancer and ... more Radiotherapy plays an important role as adjuvant treatment in locally advanced breast cancer and in those patients who have undergone breast-conserving surgery. This study aimed to investigate the prognostic impact of adjuvant radiation on oncologic outcomes in elderly women with breast cancer. In this retrospective study, we reviewed and analyzed the characteristics, treatment outcome and survival of elderly women (aged ≥ 60 years) with breast cancer who were treated and followed-up between 1993 and 2014. The median follow up for the surviving patients was 38 (range 3-207) months. One hundred and seventy-eight patients with a median age of 74 (range 60-95) years were enrolled in the study. Of the total, 60 patients received postoperative adjuvant radiation (radiation group) and the remaining 118 did not (control group). Patients in the radiation group were significantly younger than those in the control group (P value=0.004). In addition, patients in radiation group had higher node...

Research paper thumbnail of Primary Adenocarcinoma of the Appendix Presenting as a Buttock Mass

Archives of Iranian Medicine, 2009

Research paper thumbnail of Primary Mucosa-Associated Lymphoid Tissue Lymphoma of the Rectum

Annals of Colorectal Research, 2013

Introduction: Mucosa-associated lymphoid tissue (MALT) lymphoma most commonly involves the stomac... more Introduction: Mucosa-associated lymphoid tissue (MALT) lymphoma most commonly involves the stomach and its treatment is surgery, antibiotic therapy or radiotherapy. Rectal MALT is not only so rare, but also the treatment is not clear as gastric MALT. Case Presentation: Our patient was a 66 year-old man presenting with 5-6 months abdominal pain and anemia. In colonoscopy, a rectal ulcer was found and biopsy revealed MALT lymphoma. Physical examination and staging evaluations had normal results. Radiotherapy was started for him but he did not tolerate radiotherapy and instead received chemotherapy. After 38 months of follow up, he was fine. Conclusions: The incidence of rectal MALT is rare, and treatment is not so clear. The results on H. pylori eradication, radiotherapy and chemotherapy are more controversial.

Research paper thumbnail of Malignant Neoplasms of the Anal Canal

Annals of Colorectal Research, 2013

Background: Malignant neoplasms of the anal canal are rare accounting for approximately 4% of all... more Background: Malignant neoplasms of the anal canal are rare accounting for approximately 4% of all colorectal malignancies. Objectives: The present study aimed to report the clinicopathological characteristics and treatment outcomes of 41 cases with malignant neoplasms of the anal canal. Patients and Methods: Between 1999 and 2012, 41 consecutive patients were diagnosed with primary malignant neoplasm of the anal canal which were treated and followed up at Namazi hospital. Only primary malignant tumors arising from the anal canal were included. Patients with secondary anal canal involvement from rectal or perianal skin cancers and metastatic tumors were excluded. Results: There were 22 women and 19 men, age ranging from 33 to 83 years, with a median age of 57 years at diagnosis. Sixteen patients (39%) had localized disease, 21 (51%) had regional disease, and 4 (10%) had metastatic disease at diagnosis. Squamous cell carcinoma (61%) was the most frequent histologic subtype, followed by adenocarcinoma (27%), malignant melanoma (10%), and gastrointestinal stromal tumor (2%). After a median follow-up of 51 (11-169) months for surviving patients, 22 patients were alive and without disease, three were alive with disease, and 19 patients died due to the disease. Histological subtype (P = 001), and stage of disease (P = 0.002) were prognostic factors for overall survival. The 5-year local control, disease-free, and overall survival rates for all patients were 63.9%, 53%, and 59.4% respectively. Conclusions: This study indicated that squamous cell carcinoma, adenocarcinoma, and malignant melanoma are the most frequent malignant neoplasms in the anal canal. Histological subtype and disease stage are the most important prognostic factors for overall survival in this region.