Journal of the Egyptian National Cancer Institute - Articles in Press

Prevalence of androgen receptors in invasive breast carcinoma and its relation with estrogen receptor, progesterone receptor and Her2/neu expression - Corrected Proof

Hanan AlSaeid Alshenawy — 2012-05-17

Abstract: Background and aims: Although Breast carcinoma had many targeted biomarkers for its treatment, however, it is a heterogeneous disease with different outcomes and need new markers especially for the triple negative group when estrogen receptor, progesterone receptors and Her2/neu are negative. Androgen receptor is a new target with unclear role. The aim of this study was to examine the prevalence of androgen receptors in invasive breast cancer and tries to elucidate its relation to some well recognized clinicopathological and immunohistochemical markers.Materials and methods: One hundred and fifty cases of invasive breast carcinoma were evaluated for type, grade and stage and studied immunohistochemically for estrogen receptor, progesterone receptor, Her2/neu and androgen expression. Androgen receptor expression was correlated with histopathological factors and the three studied markers separately then the studied cases were classified into three groups according to estrogen, progesterone receptor and Her2/neu expression and correlated with androgen receptor expression.Results: Androgen receptor was expressed in 71% of breast cancer cases. Its expression is associated significantly with both the stage and the grade. Also it was significantly associated with estrogen receptor and Her2/neu expression. It was expressed in a significant number of triple negative breast carcinoma, in Her2/neu positive cases and in estrogen negative cases which indicate that androgen receptor could be a new target for the treatment of these groups.Conclusions: Although the impact of androgen receptor on breast cancer outcomes had not been clearly established, this result may provide evidence that androgen receptor is a good prognostic and predictive marker.

Retrosternal goiter: The need for thoracic approach based on CT findings: Surgeon’s view - Corrected Proof

2012-05-14

Abstract: Background and purpose: The incidence of retrosternal goiter (RSG) varies from 2% to 26% of all thyroidectomies, depending on the defining criteria. There are no clear guidelines to identify patients that require an intrathoracic approach. So, we tried to correlate, between the size and/or anatomical site of the RSG based on preoperative CT findings and the surgical approaches used, aiming at defining those patients with RSG who are in need for thoracic approach.Patients and methods: Out of 1481 patients underwent thyroidectomy at the National Cancer Institute (NCI), Cairo University, between January 2000 and December 2009, only 73 (4.93%) of them had retrosternal extension. Demographic, clinical, operative, anatomical, and pathological data of patients with RSG were recorded and analyzed.Results: The intraoperative extension of the goiter correlated with the extension seen in the CT in all except two patients. Laterality and longitudinal extension found in preoperative CT, correlated well with the surgical findings. The approach used was cervical in 66 cases (90.4%); combined approach in six patients (8.2%). Pure thoracic (full sternotomy) was used alone in one case (1.4%). Extension of the RSG down to or below the arch was associated with an increased risk of using a thoracic approach p<0.0001.Conclusion: Preoperative CT, can be used effectively to guide the indications for using a thoracic approach. Reaching the aortic arch or beyond and loss of fat planes in CT, recurrent and malignant disease, are significant risk factors for using a thoracic approach.

One stage reconstruction of the floor of the mouth with a subcutaneous pedicled nasolabial flap - Corrected Proof

Hamdy H. El-Marakby, Fouad A. Fouad, Ahmed H. Ali — 2012-04-09

Abstract: Background: Nasolabial flaps have been recognised as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity. Random pattern inferiorly based nasolabial flaps (NLF) have been utilised for covering small defects on the anterior floor of the mouth, but usually require a second stage procedure to divide the flap base. A subcutaneous pedicled inferiorly based nasolabial flap can provide a one stage repair of moderate sized defects of the floor of the mouth after de epithelialisation of the base of the flap.Aim: To evaluate the feasibility of a single stage reconstruction of intermediate sized defects in the oral cavity with an inferiorly based pedicled NLF. The study includes the indications of use of the flap, flap design, technique, and the complications rate. The incidence of secondary procedures and the final functional and the aesthetic results will also be evaluated.Materials and methods: A group of 20 patients presented with (T1–2) squamous cell carcinoma of the oral cavity have been treated at the Department of Surgery, National Cancer Institute, Cairo; in the period between January 2008 and September 2010. The pathology was confirmed with an incision biopsy and all metastatic work were carried out confirming that all patients were free from distant metastasis at presentation. Preoperative assessment also included assessment of the stage of the disease, the flap design and patient fitness for general anaesthesia. All patients underwent surgical excision combined with reconstruction of the defect with a subcutaneous inferiorly based pedicled NLF. The proximal part of the flap was routinely de epithelialised before it has been tunnelled through the cheek so a one stage procedure could only be required.Results: The mean age of the patients was 62.3±6years, range (52–69years). All patients were diagnosed with squamous cell carcinoma. The anterior floor of the mouth constituted 40% of the defects, the lateral floor of the mouth 20% and the inner surface of the cheek 40%. There was no reported major complication; and only one patient suffered a reactionary haemorrhage that required re-exploration to secure the bleeder. A single procedure was adequate in most patients (80%), only 20% of patients required revision of the scar at the donor site or release of the tongue. The overall aesthetic results were either very satisfactory or satisfactory in the majority of patients (90%). Two patients were not satisfied with the final aesthetic results, one suffered from ectropion and the other had a donor site wound healing problem. The functional results (deglutition, speech) were satisfactory in most patients (70%), all were edentulous.Conclusion: An inferiorly based pedicled NLF is a reliable flap for the reconstruction of small and medium sized defects in the oral cavity. The flap can be best utilised for old edentulous and high risk patients where it can be used as a single stage procedure which is particularly useful in those types of patients. The flap can be safely combined with neck dissection even when the facial artery was ligated.

Nucleophosmin (NPM1) gene variants in Egyptian patients with acute myeloid leukemia - Corrected Proof

Gehan H. Ibrahim — 2012-04-09

To the editor – Kassem et al. described a novel mutational deletion [del 1178 (A)] in the 3′ untranslated region of NPM1 gene detected in a heterozygous form in seven de novo acute myeloid leukemia (AML) patients of their study population. The described nucleotide deletion is an NPM1 gene polymorphism recorded in dbSNP database (rs34351976; g28027: GenBank accession number NG_016018.1) (http://www.ncbi.nlm.nih.gov/projects/SNP/) and was described previously by Döhner et al. and Chou et al. . This variant accounted for 60–70% of AML patients with normal karyotype . The putative deletion was also identified in healthy volunteers and persisted at complete remission and also at relapse of AML patients . This deletion had no effect on the predicted amino acid sequence and is not in linkage disequilibrium with any previously identified NPM1 mutations .

Corrigendum to “Novel mutations of the nucleophosmin (NPM-1) gene in Egyptian patients with acute myeloid leukemia: A pilot study” [Journal of the Egyptian National Cancer Institute 23 (2011) 73–78] - Corrected Proof

2012-03-30

The corrected affiliation ‘c’ is shown above.

Impact of lymphadenectomy in management of renal cell carcinoma - Corrected Proof

Ashraf Hamid Ibrahim, Abd ElHamid H. Ezzat — 2012-03-15

Abstract: Purpose: To evaluate the impact of regional lymphadenectomy as part of a management plan on morbidity, morbidity and survival in renal cell carcinoma (RCC).Patients and methods: A retrospective study reviewing 158 cases diagnosed as RCC at the National Cancer Institute, Cairo university, Egypt, during the time period from 2000 to 2007. Histopathological data and significant operative and postoperative events were retrieved to compare three lymphadenectomy groups; Group A, where more than 5 nodes were dissected, Group B where 5 or less nodes were dissected and Group C where no nodal dissection was done.Results: More positive lymph nodes were seen in group A (37.8%) compared to group B (9.6%) (p=0.002). Lymph node positivity was significantly associated with higher grade (p=0.005), but not with larger tumor size (p=0.221). There was no significant difference in overall survival between the three lymphadenectomy groups (p=0.163). Overall survival was not significantly affected by lymph node status (p=0.585).Conclusion: Regional lymphadenectomy in RCC has no impact on the mortality or morbidity.

Diagnostic accuracy of fine needle aspiration cytology in thyroid lesions - Corrected Proof

E.A. Sinna, N. Ezzat — 2012-02-27

Abstract: Purpose: Evaluation of accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of different thyroid lesions.Patients and methods: This is a retrospective study of 296 diagnosed cases of thyroid nodules referred to cytology unit, pathology department, NCI, who underwent FNAC for diagnosis. The results were categorized according to the recent Bethesda classification into: insufficient for diagnosis, benign, atypical follicular lesion of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant sampling. The final histologic diagnosis and/or clinico-radiologic follow-up assessment for non-neoplastic lesions were considered the gold standard.Results: The study included 296 cases presented with thyroid nodules who underwent diagnostic thyroid FNAC. Female to male ratio was 5.2:1, and the median age was 44years. Ninety-eight cases (33.1%) were diagnosed as benign, 40 cases (13.5%) as follicular lesion of undetermined significance, 49 cases (16.5%) as follicular neoplasm, 30 cases (10.1%) as suspicious for malignancy, 58 cases (19.5%) as malignant, and 21 cases (7.1%) as unsatisfactory. Nodular hyperplasia represented the majority of benign cases (89.8%), while papillary carcinoma was the most frequent malignant lesion (72.4%). Cytologic diagnoses were compared with their corresponding final histologic ones. FNAC achieved a sensitivity of 92.8, a specificity of 94.2%, a positive predictive value of 94.9%, a negative predictive value of 91.8%, a false positive rate of 7.2%, a false negative rate of 5.8%, and a total accuracy of 93.6%.Conclusion: FNA cytology is a sensitive, specific, and accurate initial diagnostic test for the evaluation of patients with thyroid swellings.