Ectopic Cushing's syndrome secondary to lung and mediastinal tumours -- report from a tertiary care centre in Iran

INTRODUCTION

Ectopic Cushing`s syndrome (ECS) secondary to neuroendocrine tumours (NETs) of the lung and mediastinum are rarely encountered. In this study, we present our experience in Iran on 15 patients with ECS secondary to lung and mediastinal tumours over a period of 27 years.

MATERIAL AND METHODS

Since 1985, 15 patients with ECS secondary to lung and mediastinal tumours have been diagnosed and prospectively followed by the endocrinology team of Taleghani Hospital, Tehran, Iran. The clinical signs and symptoms, laboratory findings, radiological features, immunohistochemical characteristics, management strategies and outcome data are here presented.

RESULTS

There were six women and nine men, aged 26-70 years, all presenting with typical features of Cushing's syndrome. Based on histopathologic evaluations, four patients had small cell lung cancer (SCLC) and seven patients had pulmonary NETs, one patient had a thymic NET, and one case was diagnosed as a lung tumourlet. The mean ± SD serum cortisol, 24h urine free cortisol and plasma ACTH were 47.2 ± 20.5 μg/dL, 2,702 ± 5,439 μg/day, and 220 ± 147 pg/mL, respectively. Pulmonary lesions ranged in diameter from 1.1 to 4 cm (mean 1.9 ± 1.1 cm). One patient had a 10 cm mediastinal mass. The duration of follow up in these cases was between one month and seven years (mean 29.9 ± 27.5 months). The four patients with SCLC died within three months of diagnosis.

CONCLUSION

Our data demonstrates the protean clinical and laboratory manifestations of ECS secondary to lung and mediastinal tumours, the problems encountered in diagnosis, and the need for a multidisciplinary approach. This study confirms other series from Western Europe and North America that, unlike the SCLC patients who show a poor outlook, ECS secondary to lung carcinoids has a more favourable prognosis.

Multiple endocrine neoplasia type 2A in an Iranian family: clinical and genetic studies

Multiple endocrine neoplasia (MEN) type 2A, a dominant inherited syndrome caused by germline activating mutations in the RET protooncogene, is characterized by association of medullary thyroid carcinoma, pheochromocytoma and primary hyperparathyroidism. There is limited data on this disease in the Middle East region. In this paper, we present clinical and genetic studies of an Iranian patient and her family members. The patient was a 49-year old Iranian woman who presented with hypertension due to bilateral pheochromocytoma. She had history of a medullary carcinoma of thyroid which had been operated 28 years ago. Analysis of the RET gene in the family revealed a C634R mutation in codon 11 and 3 polymorphisms, G691S, S836S and S904S in codons 11, 14 and 15, respectively, that might have been important in modifying the clinical picture. Due to paucity of information on MEN type 2 in the area, this study can be helpful in portraying the clinical and cytogenetic characteristics of the disease in the region.

A study on the relationship between clinical features with Ki67 expression and eosinophil cells infiltration in oral squamous cell carcinoma

BACKGROUND

Cell proliferation is one of the most critical factors in metastasis and prognosis of the malignant tumors.Recent investigations show that the eosinophil granolosytes have an important role in developing of malignant tumors. The relation between cell proliferation and eosinophilic infiltration in oral squamous cell carcinoma (OSCS) with prognosis is unclear. The aim of this study was to investigate the relationship between the Ki67 expression and eosinophilic infiltration with the clinical features on OSCC.

METHODS

This study was cross sectional in which 24 paraffined embeded block of OSCC selected from the Imam Khomeini hospital; cancer institute's archive. 4 micron sections were prepared and studied for Ki67 antigen immunohistochemically. The labeling index (LI: positive epithelial cells/1000 epithelial cells) of Ki67 positive cells were obtained. In each section eosinophilic cells were counted in 10 fields with 400 (HPF). The relations between the eosinophil cells and Ki67 positive cells counts with clinical features and histopathological differentiation were achived by the linear regression and spirman statistical tests.

RESULTS

There were no any significant relationship between gender, histopathological differentiation and the number of eosinophils and Ki67 positive cells counts (p= 0.33 and p=0.73). A significant relationship between lymph node involvement and the number of eosinophils and the Ki67 positive cells counts was found (p=0.04).There was a positive relationship between the number of Ki67 positive cells and the number of eosinophil cells (p= 0.05).

CONCLUSION

A significant relationship between lymph node involvement with eosinophilc cells and Ki67 positive cells counts were exist.

Ectopic acromegaly due to growth hormone releasing hormone

Acromegaly secondary to extra-pituitary tumors secreting growth hormone releasing hormone (GHRH) is rarely encountered. We review the literature on ectopic acromegaly and present the index report of ectopic acromegaly secondary to GHRH secretion from a mediastinal paraganglioma. Clinical and pathological manifestations and therapeutic management of 99 patients with ectopic acromegaly are reviewed. Acromegaly secondary to ectopic GHRH secretion is usually caused by a neuroendocrine tumor in the lung and pancreas. We report an additional cause of ectopic acromegaly from a mediastinal paraganglioma. Diagnostic criteria of ectopic GHRH syndrome include biochemical and pathologic tumoral confirmation of GHRH secretion and expression. Management of ectopic acromegaly consists of surgical resection of the primary tumor and biochemical normalization, with possible adjuvant use of somatostatin analogs. The review demonstrates that there are several tumor types, including paragangliomas which may secrete GHRH, leading to acromegaly. Clinical and laboratory manifestations of the syndrome and challenges in diagnosis and management of these rarely encountered patients require early diagnosis and appropriate treatment to prevent long-term morbidity and mortality with ectopic acromegaly.

Vascular endothelial growth factor and ki-67 antigen expression in relation to age and gender in oral squamous cell carcinoma

BACKGROUND AND AIMS

Vascular endothelial growth factor (VEGF) and Ki-67 antigen are contributing factors in this process cell proliferation and new blood vessels formation in tumor progression. This study was conducted to examine the relationship between the expression of VEGF and Ki-67 and gender and age of patients with oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

Twenty-three archival samples of well-differentiated OSCC were examined immunohisto-chemically and assessed by obtaining Total Score (TS = proportion score × staining index). For statistical analysis, t-test and Pearson's correlation were employed. P≤0.05 was considered statistically significant.

RESULTS

The differences in VEGF expression between males and females (P = 0.43) and different ages (P = 0.88) were not significant. The differences in Ki-67 expression was between males and females (P = 0.67) and different ages (P = 0.88) were also not significant. A positive correlation of VEGF and Ki-67 expression was observed in males and females in addi-tion to ≤ 60 years age group (r = 0.22, r = 0.008, and r = 0.58, respectively; P < 0.05). The expression of VEGF had a nega-tive relation to Ki-67 in > 60 years group (r = -0.48, P < 0.05).

CONCLUSION

The expression of VEGF and Ki-67 between males and females and different ages were not significant among oral squamous cell carcinoma cases evaluated.

Postpartum hypercalcemia secondary to a neuroendocrine tumor of pancreas; a case report and review of literature

Parathyroid hormone-related protein producing pancreatic neuroendocrine tumors have been infrequently reported. Herein, we report a case of an Iranian woman who had such a tumor during pregnancy, and gave birth to a female neonate with esophago-tracheal fistula and imperforated anus. Hypercalcemia was diagnosed at postpartum because of elevated serum calcium levels in the neonate and neurologic deterioration of the mother. Extensive literature review revealed 42 cases with pancreatic neuroendocrine tumors and hypercalcaemia. The clinical and laboratory findings of such patients are reviewed in this manuscript.

Lymphoma of mucosa-associated lymphoid tissue in common variable immunodeficiency

Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency characterized by reduced levels of all major immunoglobuline classes and recurrent c infections. The risk of non-Hodgkin's lymphoma (NHL) among patients with CVID was found to be increased in different studies. Mucosa-associated lymphoid tissue (MALT) lymphomas are a recently recognized sub-set of low-grade B-cell NHL composed of marginal zone-related cells. MALT lymphomas appear in the lymphoid tissues as a result of chronic inflammatory or autoimmune stimulation. This study briefly reviews previously published cases and reports a patient suffering from CVID with a history of chronic diarrhea and recurrent sinopulmonary infections. Despite treatment with intravenous immunoglobulin, chronic cough and wheezing progressed. Open lung biopsy showed a MALT lymphoma. Although a rare complication, pulmonary low grade B-cell lymphoma is a diagnosis that must be kept in mind in CVID patients with chronic pulmonary symptoms unresponsive to conventional therapies.

Comparative genomic hybridization (CGH) analysis of chromosomal aberrations in Iranian patients with invasive ductal carcinoma breast cancer

INTRODUCTION

Breast cancer is one of the most common cancers in women; however, due to the complexity of chromosomal changes, limited data are available regarding chromosomal constitution.

MATERIALS AND METHODS

In this study, Comparative Genomic Hybridization (CGH) was used on 16 Iranian patients diagnosed with invasive ductal breast carcinomas.

RESULTS

12 samples had abnormal CGH results (75%), including 21 types of chromosomal imbalance. The most prevalent were chromosomal gain of +1q, +17q, +8q and chromosomal loss of -13q. All three cases with DNA loss at chromosome 13q (-13q) had lymph node metastasis.

CONCLUSIONS

CGH is able to detect chromosomal abnormalities which are difficult to identify by conventional cytogenetic techniques. More studies on a larger sample size may help to confirm or rule out any possible correlation between 13q monosomy and lymph node metastasis, which could result in establishing new strategies for prevention and early detection of invasive breast tumors.

Combining mammaglobin and carcinoembryonic mRNA markers for early detection of micrometastases from breast cancers--a molecular study of 59 patients

INTRODUCTION

As many as 30% of node-negative breast cancer patients relapse within five years, suggesting that current histological detection methods are inadequate for identifying metastatic disease. Detecting small number of cancer cells in the breast tissue or lymph node by reverse transcription-polymerase chain reaction (RT-PCR) assays using a combination of tissue and cancer specific markers might be very useful in the early detection or monitoring of the treatment. Mammaglobin is a member of the uteroglobin gene family and appears to be expressed only in breast tissue. Carcinoembryonic antigen has been the preferred molecular marker for detection of micro metastases in lymph nodes in almost all carcinomas.

MATERIALS AND METHODS

Samples were collected from randomly chosen breast cancer patients undergoing modified mastectomy or breast conserving surgery between September 2003 and July 2004. RT-PCR was applied to study the expression of MMG and CEA markers. Breast cancer micrometastases in axillary lymph nodes were also assessed.

RESULTS

The MMG marker was positive in 9/10 normal breast tissues, 3/3 breast fibroadenomas and 37/39 of breast carcinoma tissues, giving an overall sensitivity of 94%. The sensitivity was 80% for metastatic lymph node samples. On the other hand CEA showed 95% sensitivity for malignant breast tumors and 100% sensitivity for metastatic lymph nodes.

CONCLUSIONS

RT-PCR using a combination of MMG and CEA markers is a powerful tool to complement current routine histopathology techniques for detection of breast cancer metastasis in axillary nodes.

Immunohistochemical evaluation of p27 (kip1) in pleomorphic adenomas and adenoid cystic carcinomas of the minor salivary glands

BACKGROUND

p27(kip1), a universal cyclin-dependent kinase inhibitor, is a useful marker for predicting clinical aggressiveness with various human tumors. In this study, p27 expression was investigated in pleomorphic adenomas (PAs) and adenoid cystic carcinomas (ACCs) of minor salivary glands to evaluate its utility for differentiation purposes. At the same time, the correlation between p27 and ACC grading was evaluated.

MATERIALS AND METHODS

Clinicopathological features of 22 patients (11 ACCs, 11 PAs), including age, sex and size of tumor were obtained from medical records. Immunohistochemical staining with p27(kip1) was performed for each specimen and p27 labelling indices were determined with a computer-assisted image-analyzing system (CAS 200). Pearson's correlation coefficient, Spearman's correlation coefficient, Students t-test, Kruskal-Wallis test and ANOVA were applied for statistical analyses using SPSS 11.5.

RESULTS

p27 LIs for all PAs were above 25% whereas for ACCs they were under 25% (except one case). p27 expression (LI and intensity) was significantly lower in ACCs than PAs. The correlation between p27 expression and ACC grading was not significant.

CONCLUSION

Overall, these findings suggest that reduced expression of p27 might be correlated with the development of ACC and could be an indicator of malignant behavior.