فهرست مطالب ahmad mosalaei

Glioblastoma is the most prevalent and aggressive adult glial tumor. Patients who receive standard treatment have a mean survival of 12-14 months. Zinc is a micronutrient that has shown to have anticancerous effects. In the in vitro studies zinc had antineoplastic effects on gliobalstoma cells. This is a phase II randomized trial in which 60 patients in two groups were evaluated. The zinc group (29 patients) received zinc sulfate supplement 50 mg orally twice a day and the control group (31 patients) who were selected from historical case sreceived no supplements. Mean overall survival in the case and control groups were 9.93 (± 3.29) and 9.0 (± 3.56) months. In the case and control groups, the mean disease-free survival were 9.62 (SD ± 3.37) and 8.26 (SD ± 3.47) months. These differences were not statistically significant. Although overall survival and recurrence-free survival in patients in the case group was higher than the control group, there was no statistically significant difference (P = 0.485). Zinc consumption was associated with better survival, but these differences were not statistically significant, necessitating further studies.

Primary brain tumors, although not among the most common site of tumors, are considered an important pathology, due to their high mortality rate. Astrocytoma is a glial brain tumor with a high mortality rate. The predictors of the patients’ outcome is thus of great importance. In the present study, we investigated the results of 7–year follow–up of patients with astrocytoma in order to determine the prognostic factors associated with patients’ survival.

In this cross–sectional study, 115 patients suffering from astrocytoma grade II, who referred to radio–oncology department of Nemazee hospital between 2006 and 2013, were included. The patients’ overall survival (OS) and disease–free survival (DFS) were recorded and their difference according to demographic and clinical characteristics of patients, as well as the treatment used, was evaluated using SPSS v.25.

Mean age of patients was 35.34±15.17 years; most were younger than 40 years old (71%) and men (59%). Mean OS and DFS were 74.90±43.05 and 26.61±26.97 months, respectively. Patients younger than 40 had a significantly longer mean OS (84.04±37.93 vs. 53.04±47.41 months; P=0.004). Mean DFS was different according to chemotherapy and dose of radiotherapy (P=0.041 and 0.01, respectively), while OS was not (P>0.05).

Considering the difference in outcome of patients, specifically DFS, according to the performance of chemotherapy and the dose of radiotherapy, it is recommended to pay greater attention to appropriate choice of treatment strategy of patients with astrocytoma. Further randomized controlled studies are required to determine the predictors of patients’ outcome.

Squamous cell carcinoma (SCC) is the most prevalent malignancy of the larynx. Non-squamous cell carcinomas of the larynx are rare and consist of different pathology types. The present work is a retrospective study of non-SCC of the larynx in the south of Iran during a seven-year period. Among 517 patients with laryngeal cancers, seven (0.13%) had non-SCC. The mean age was 59.1 (39-71) years, and six were male. The main complaint of two of the patients was neck mass, five cases had hoarseness, and one had dyspnea. One subject had both dyspnea and hoarseness. Out of three cases of neuroendocrine tumor, two had radical surgery and afterwards, radiotherapy (RT) was given for one of them. Both cases are well and disease-free. The other patient was a 58-year-old man and was treated with chemoradiation. He died due to brain metastasis following 12 months. Our patient with osteosarcoma is well controlled with surgery, chemotherapy, and RT. We had two male cases of adenoid cystic carcinoma who had undergone total laryngectomy and supraglottic laryngectomy. Both of them received RT (60 or 70 Gy dose) and both are well after 60 and 48 months. A 51-year-old patient with chondrosarcoma had undergone total laryngectomy, who was well after 36 months. Treatment of non-SCC of the larynx is an extrapolation from the treatment of the more common site of each pathology type. Further studies are needed to draw a firm conclusion.

 The lack of breast cancer screening in young women leads to late disease diagnosis and worse outcomes in this age group. This study was designed to evaluate clinicopathological features and long-term outcomes of young breast cancer women in south of Iran.

 This is a retrospective study of breast cancer patients who were pathologically diagnosed during 2005 to 2017. Data from 284 breast cancer patients aged 40 years or younger were included in this study. Demographic, clinicopathological properties as well as treatment modalities including type of surgery, adjuvant radiotherapy, and adjuvant or neoadjuvant chemotherapy were recorded and analyzed.

 Median age of the patients was 36 (range 23-40) years. After a median follow-up of 68 months, 21 patients had died due to the disease, 59 patients were alive with the disease, and 204 patients were alive without the disease. The univariate COX regression demonstrated that the disease -free survival (DFS) was significantly low in patients who had undergone breast conservation surgery (BCS) and also patients with higher stages, estrogen/progesterone-negative and human epidermal growth factor receptor 2-positive (ER-/PR-/HER2+) status. Low overall survival (OS) was also significantly associated with stage. According to multivariate COX regression, BCS, stages II, III and also young age were independent predictive factors for low DFS.

 Given the aggressive features and worse outcome of young breast cancer patients, treatment remains tough and screening seems to be required at young age. Further studies are required to find best management and therapeutic protocols for these patients.

Papillary Serous Cervical Carcinoma (PSCC) is a very rare type of primary adenocarcinoma of the cervix. Herein, we report such a case of PSCC and describe its presentation and treatment.Our patient was a 65-year-old woman presented with vaginal spotting 14 years after menopause. Vaginal examination was not remarkable; however, transvaginal ultrasound showed cervical irregularity. A Pap smear was done for her that revealed atypical cells. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathologic examination and Immunohistochemical study disclosed PSCC. Metastatic evaluations including abdomen and pelvic MRI and chest CT scan were negative. Therefore, pathologic stage was IB1. Due to inadequate lymph node dissection, the patient received adjuvant external beam radiotherapy (45 Gy in 25 fractions). Subsequently, adjuvant endocavitary brachytherapy (3 fractions of 4 Gy) was delivered; however, she refused to receive any adjuvant chemotherapy. After 12 months she is well and is doing her regular daily life. PSCC is a rare case and although Radiotherapy is usually done for patients, its treatment is not well known.

Breast cancer is among the most prevalent cancers in women. Radiotherapy is an important part in treatment of breast cancer, associated with some side-effects, including skin dermatitis. Dermatitis may be severe and impair quality of life. Multiple agents have been studied, but no standard treatment is yet available. Silicone based gel (StrataXRT) was promising in some studies in reducing skin inflammation and also radiotherapy-induced dermatitis.
This was a randomized trial on 100 women with breast cancer who had undergone quadrantectomy for breast cancer. They received StrataXRT gel or best supportive care during radiotherapy. Dermatitis area and grade of dermatitis were measured.
Regarding the mean size of radiation-induced dermatitis area, there was a significant difference between the intervention (36.88 cm2 ± 69.93) and control (83.83 cm2 ± 79.34) groups (P = 0.002). During radiotherapy, except in the fourth week, dermatitis was significantly more severe in the control group.
It seems that StrataXRT is helpful in decreasing radiotherapy-induced dermatitis.

Glomus jugulare is known as a benign tumor that could involve in different parts of the body. The most prevalent site of involvement is head and neck area. This disease is rare and few of the cases are bilateral. However, in familial cases bilateral or multicenter lesions are even rarer, in which there is an autosomal dominant pattern of inheritance. The most efficient treatment is believed to be surgery or radiotherapy depending on the location and certain other factors, such as age and performance status. Sporadic bilateral lesion is rarely seen and most bilateral cases are familial. Herein, we reported a case of bilateral glomus jugulare of carotid with no history of this tumor in family or any other familial diseases. Our subject was a 67-year-old man. The diagnosis was made via Tru-cut biopsy. He was treated successfully by 3- dimensional conformal radiotherapy up to a dose of 60 Gy. The follow-up computed tomography scan revealed partial tumor responses. He had no family history of any systemic disease related to functional glomus jugulare, such as uncontrolled hypertention or mass in the neck. He also had no history of catecholeamine exceretion-related symptoms.

The variety of neoadjuvant treatments concerning rectal cancer has led to acute complications. The present study aimed to evaluate and compare the acute complications of short-course (SC) and long-course (LC) radiotherapy. We studied 100 patients suffering from rectal cancer, who referred to Nemazee Hospital before their surgery, in this cross-sectional study. The patients were divided into two categories: SC (25 grays radiotherapy at 5 fractions in 5 days) and LC (chemoradiotherapy with a dose of 45-50.4 grays in 25- 28 fraction in 5-6 weeks with concurrent Capecitabine (825 mg / m2) twice daily and five days a week). Subsequently, we evaluated them for acute complications in the SC group 10-14 days after the end of the treatment and in the LC group at intervals of the treatment, the end of it and 2 weeks afterwards. In the LC group compared to the SC group, the percentage of patients with grade 1 diarrhea, grade 2 colitis and grade 1 cystitis at the end of the treatment was statistically different (p <0.001, P=0.046, P=0.036 ). In addition, the total number of the patients with grade 1 and 2 dermatitis was higher in the LC group compared with that in the SC group (P=0.046). We observed no significant differences between the two groups concerning the severe acute complications (P>0.05). This study implied that there were no significant differences regarding severe acute complication between the two groups.

 Prostate cancer is the second most common malignancy among Iranian men after stomach cancer. To understand the nature of the disease and plan and develop a population-based cancer registry, it is essential to recognize the clinical and pathological characteristics of the tumors, as well as treatment results.

 The present study aimed to evaluate the clinical and pathological characteristics of prostate cancer and evaluate the routine practice, including treatment outline and results of treatment in six referral centers in Iran.

 This prospective observational pilot study recruited patients with prostate cancer between April 2015 and October 2015 at six referral centers in Iran. The participating physicians included consecutive patients according to inclusion criteria. Demographic, clinicopathologic, and treatment data were collected by the physicians using an electronic case report form (eCRF). The patients were followed for 18 months, and during this period, four visits were scheduled for each patient to collect the data.

 A total number of 102 patients from six centers in five different cities of Iran were included in the study. Sixty-seven (65.7%) patients were diagnosed by needle biopsy as the first diagnostic method, 23 (22.5%) by radical prostatectomy, and 12 (11.8%) by open prostatectomy. Total at-risk times of patients for overall survival (OS) and progression-free survival (PFS) were 1480.9 and 1437 months, respectively. Median (IQR) values of OS and PFS were 18.2 (9.2 - 20.5) and 18.2 (6.8 - 20.4) months, respectively. Forty (39.2%) patients underwent surgery, 58 (56.8%) underwent radiotherapy, and 13 (12.7%) received chemotherapy. Twenty-nine (28.4%) patients experienced adverse events over the follow-up period. Eight deaths were reported that were unrelated to treatment adverse effects.

 This pilot registry could serve as a valuable tool for the development of a comprehensive nationwide registry for patients with prostate cancer in Iran.

We report a case of colon cancer with pancreatic and interesting heart metastasis several months prior to disseminated metastases. The case was a 59-year-old man with a cecal cancer (T4N2); he received chemotherapy with XELOX regimen and then radiotherapy up to a dose of 45 Gy. He was under close and regular follow-up. After 42 months, he developed jaundice and computed tomography (CT) scan showed an isolated mass in the pancreas. We performed Whipple’s operation and the pathology report was pancreatic metastasis. He received chemotherapy and was relatively well until his CEA rose again and the chest CT scan indicated cardiac metastasis. We resected the metastasis and administered chemotherapy. Unfortunately, the case developed brain metastasis and passed away. We searched the literature and found 15 cases of colon cancer and cardiac metastasis. We found no cases with metastasis from colon cancer to the left side. Although cardiac metastasis has a poor prognosis, it might be more prevalent than what is generally believed.

Intraoperative radiation therapy (IORT) is the delivery of radiation at the time of surgery. Whereas the dose delivered by external beam radiation therapy (EBRT) is limited by the tolerance of the surrounding normal tissues, IORT allows exclusion of a part or all of the dose-limiting sensitive structures by operative mobilization and/or direct shielding of these structures. The aim of the present study was to report the non-breast cancer patientschr('39') outcomes after receiving IORT in Shiraz, Iran.

In this retrospective study, all cases who had received IORT and had non-breast malignancies were selected. Diagnosis was confirmed by biopsy. Additional imaging was done by sonography, magnetic resonance imaging (MRI) and computed tomography (CT). IORT was applied by self-shielded, LIAC 6-12 MeV Sordina mobile linear accelerator. Typically, a single dose of 10-21 Gy was given for maximally resected tumors. The statistical analyses were carried out using SPSS (version 21).

Twenty-six patients were treated with IORT alone or combined with EBRT. Different tumors were treated, including colorectal adenocarcinoma (10 cases, 38.4 %), Soft Tissue Sarcomas (STS, 11 cases, 42.3 %), head and neck cancers (3 cases, 11.5 %), one cervix malignancy case and one paravertebral fibromatosis case. Mean ± SD overall survival was 15±14.89 (0-38) and 34.3±15.72 (14-53) months for colorectal cancer and STS, respectively.

IORT is mostly useful for pelvic and abdominal malignancies where normal bowel limits the dose that can be delivered with EBRT. However, the dose delivered in a single fraction with IORT is rarely sufficient for tumor control; therefore, IORT is usually preceded or followed by additional EBRT which should be further evaluated preferably in prospective randomized trials.

Adenocarcinoma is the most common malignancy in pancreas. Normally there is no squamous cell in pancreas. Pancreas Squamous Cell Carcinoma (SCC) is a rare tumor and its presentation is like adenocarcinoma and no specific symptom and sign is reported. Tumor markers are not helpful for this disease.

We report a 55 year-old female patient who had pancreas SCC. All investigations were normal and no other site of SCC, as a possible source for metastasis, was found.  The tumor was not operable and she received 3 cycles of cisplatin and 5-fluorouracil. Then she received radiotherapy up to 44 Gy. Although she had partial response, operation was not again possible and then she received chemotherapy. Unfortunately she developed liver metastasis and passed away 9 months after diagnosis.

pancreas SCC is a rare tumor and the role of surgery and radiotherapy is not well studied. Chemotherapy is better to be administered according to SCC of other sites. Despite aggressive treatment, this malignant disease has a poor prognosis.

Breast cancer is among the most prevalent types of cancers. Patients who suffer from cancer undergo many problems, including psychological complications. Acceptance and commitment psychotherapy can be used for psychological support and rehabilitation of patients with cancer. The present study investigates the effectiveness of acceptance and commitment group psychotherapy in improving the affective and psychological welfare of breast cancer patients in comparison with control cases. This study enrolled 30 female patients with breast cancer. The patients were equally randomized to an experimental group and a control group. Acceptance and commitment psychotherapy group intervention consisted of eight, 2-h sessions per month. The control group received non-therapeutic group intervention. We assessed psychological well-being at 2 time points, before and at the end of intervention. All data were analyzed by the Statistical Package for the Social Sciences. P-values less than 0.05 were considered significant. The results showed significant differences between the two groups in their mean scores of negative affect (F=18.91, P=0.000), positive affect (F=52.62, P=0.000), hope (F=59.10, P=0.000), and quality of life (F=22.12, P=0.001). Acceptance and commitment psychotherapy is a novel approach in group psychotherapy which can improve the psychological status of the patients who suffer from breast cancer.

Solitary plasmacytoma is an uncommon type of plasma cell dyscrasia, which might occur in bone or soft tissue.  Soft tissue solitary plasmacytoma or extramedullary plasmacytoma is less frequent than bone plasmacytoma. The most common location for extramedulary plasmacytoma is nasopharynx and paranasal sinuses. Oropharyngeal plasmacytoma is very rare; hence we would like to share our experience. The patient was a 57 year-old man with 2 months history of dysphagia with a foreign body sensation. Total tumor resection was done and he received 40 Gy radiation. After 24 months of follow up the patient was well and disease free. according to the presented case, a plasmacytoma should be considered in patients with dysphagia and oropharyngeal lesion. These masses can be treated with surgical excision and radiotherapy.

Pineal region tumors are uncommon lesions in the central nervous system. Papillary tumor of the pineal region is recently recognized as a separate disease. Its incidence, treatment, and outcome are not well-defined. We have reported the case of a 6 yearold- boy with papillary tumor of the pineal region. He presented with headaches, nausea and vomiting and, after a biopsy, was referred for radiotherapy. The patient received 54 Gy irradiation to the pineal region followed by a chemotherapy regimen of cisplatin, vincristine, and lomostine. His tumor decreased slightly. After 4 years, the patient has remained well and attends school. He is under routine follow-up. We suggest radical radiotherapy as the main treatment for papillary tumors of the pineal region.

The pineal region is a rare site for primary tumors of the central nervous system. Papillary tumor of the pineal region (PTPR) is a relatively new phenomenon in this region. Considering the rarity of this tumor, the clinical course, treatment, and outcomes are not well studied. In the present study, we searched PubMed for relevant articles. A total of 72 articles were retrieved from PubMed. The exclusion criteria were autopsy and archive series, animal studies, and reports without clinical data. We had no access to the full - text of some articles; accordingly, 19 articles were excluded from the analysis. Data from 53 reports, including 50 case reports and three case series (a total of 73 patients), were collected and analyzed. The patients’ mean age was 33.5 (± 15.4) years. Forty - two cases were male and 31 were female. The most common symptom was headache in patients (80%). Other common symptoms included visual complaints (40%), nausea (31%), memory loss (7%), Parinaud’s syndrome (4%), and impaired gait (2%). Among 73 patients, 32 had undergone complete tumor resection. Twenty - nine patients had received conventional external beam radiotherapy, stereotactic radiosurgery (n, 10), brachytherapy (n, 5), and proton therapy (n, 1). Eight patients received no adjuvant therapy, and data presented in other reports were incomplete. Among the patients (n, 73), 11 received chemotherapy. Fifty patients had no evidence of recurrence at the time of report, while three patients had died. Local recurrence was the most common pattern of relapse (28%); nonetheless, parenchymal and meningeal involvement was also observed. The median disease - free survival (DFS) was 24 months, while five- and ten - year DFS rates were 50.1% and 25.0%, respectively. The median overall survival was 24 months. Generally, PTPR has an indolent course with a tendency towards local recurrence; nonetheless, an aggressive clinical course, associated with parenchymal and meningeal metastases, is well established.

Radiotherapy, as an adjuvant treatment, plays a well-known role in prevention of locoregional recurrence in breast cancer patients. This study aims to investigate the impact of radiotherapy in patients with N1 disease.
In this retrospective study, we reviewed the characteristics and treatment outcomes of 316 patients with a biopsy proven diagnosis of breast carcinoma and 1-3 positive axillary lymph nodes. The patients received treatment between 1995 and 2014. The patients had a median follow-up of 60 (range: 6-182) months.
This study was conducted on 316 patients with a median age of 48 (range: 26-86) years. Among patients, 215 underwent modified radical mastectomy and 101 had breast-conserving surgery before adjuvant treatment. Indeed, 259 patients received radiotherapy (radiation group) and 57 did not (control group). There was locoregional recurrence in one control group patient and two patients in the radiation group. Multivariate analysis results indicated hormone receptor status as an independent prognostic factor for the 5-year disease-free survival rate. Estrogen and progesterone receptor negativity (HR = 1.80, 95% CI: 1.02-3.19, P=0.043) also had a negative influence on the 5-year disease-free survival rate. However, radiotherapy had no significant effect on disease-free survival (P=0.446) and overall survival (P=0.058) rates.
The results showed that adjuvant radiotherapy had no prognostic impacts on locoregional and distant disease control in breast cancer patients with N1 disease.

Pancreatic leiomyosarcoma is a rare tumor and its clinical course and treatment is not well described.
This paper reports on a 57-year-old male, who presented epigastric pain and had a 12-cm pancreatic tail leiomyosarcoma. He received adjuvant radiotherapy after complete tumor resection. He developed local recurrence 11 months later and received no further treatment. He died after 3 months.
The literature search revealed that pancreatic leiomyosarcoma has a variable clinical course and behavior.

Most bladder tumors are epithelial in origin. Nonepithelial cancers are rarely located in the bladder. Sarcomas are the most common malignancies among nonepithelial cancers. Primary bladder lymphoma is rare and mostly low grade. Here, we have reported a case of diffuse large cell lymphoma of the bladder. The patient, a 64-year-old man, had urinary frequency for 18 months. Abdominal sonography indicated a thick bladder wall and transurethral biopsy showed diffuse large cell lymphoma. Immunohistochemistry (IHC) results showed that the tumor was positive for CD20, CD45, and Pax-5 and negative for BCL-2, cytokeratin, and S100. He had a normal bone marrow biopsy, abdominal, pelvic and chest CT scans. He had no B symptoms. The patient received 6 cycles of R-CHOP followed by radiotherapy (36 Gy) to the pelvis. Six months after treatment, the patient is well and has returned to work. We have searched PubMed for primary diffuse large cell lymphoma. Primary diffuse large cell lymphoma of the bladder is best treated according to treatment for diffuse large cell lymphoma of other sites, which includes chemotherapy and radiotherapy. As seen in our review, primary diffuse large cell lymphoma of the bladder has a similar clinical course to diffuse large cell lymphoma of other sites.

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.
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.
Pancreatic sarcoma is a rare disease and an optimal treatment, such as surgery, chemotherapy or radiotherapy is not well defined.

Although colon cancer is one of the most common human cancers, skin metastasis in this disease is rare and necessitates pathological confirmation. Report of the case: Herein we present a 33 year old man with rectal cancer with ascites. Six cycles of Oxaliplatin based chemotherapy were given. The ascites improved. After three weeks, skin lesions appeared in the upper trunk, both chest wall and back, with extension to the anterior neck Fine Needle Aspiration from the lesions showed malignancy and second line chemotherapy was started. Although the skin lesions showed partial response, unfortunately, the patient died after the fourth chemotherapy injection. Skin metastasis in colorectal cancer, although rare, is a devastating sign, and a careful dermatologic examination should be included in these patients’ follow up visits.

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. 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. 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). 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.

Drug-induced vasculitis following chemotherapy has been rarely reported. We report such a case of drug-induced vasculitis following chemotherapy in a breast cancer patient. Report of the case: A 52 year old woman with stage III breast cancer developed pathologically proven vasculitis presenting as bilateral severe erythema, edema and ulceration on both feet 10 days following the 4th cycle of adjuvant chemotherapy. Chemotherapy consisted of docetaxel, doxorubicin, and cyclophosphamide in each cycle that was preceded by premedication including dexamethasone, granisetron, and H1 and H2 blockers. Furthermore, filgrastim (5µg/kg) was administered following each cycle of chemotherapy during days 5-9. By discontinuing chemotherapy and starting high-dose intravenous methylprednisolone, vasculitis was resolved. The patient did not experience vasculitis following the re-challenge of chemotherapy excluding docetaxel and filgrastim. This case suggests that docetaxel and filgrastim might be added to the list of agents causing drug-induced vasculitis.

Thymomas are rare epithelial tumors arising from thymus gland. This study aims at investigating the clinical presentation, prognostic factors and treatment outcome of forty five patients with thymoma and thymic carcinoma. Forty-five patients being histologically diagnosed with thymoma or thymic carcinoma that were treated and followed-up at a tertiary academic hospital during January 1987 and December 2008 were selected for the present study. Twelve patients were solely treated with surgery, 14 with surgery followed by adjuvant radiotherapy, 12 with sequential combined treatment of surgery, radiotherapy and/or chemotherapy and 7 with non-surgical approach including radiotherapy and/or chemotherapy. Tumors were classified based on the new World Health Organization (WHO) histological classification. There were 18 women and 27 men with a median age of 43 years. Twelve patients (26.7%) had stage I, 7 (17.8%) had stage II, 23 (51%) had stage III and 2 (4.5%) had stage IV disease. Tumors types were categorized as type A (n=4), type AB (n=10), type B1 (n=9), type B2 (n=10), type B3 (n=5) and type C (n=7). In univariate analysis for overall survival, disease stage (P=0.001), tumor size (P=0.017) and the extent of surgical resection (P<0.001) were prognostic factors. Regarding the multivariate analysis, only the extent of the surgical resection (P<0.001) was the independent prognostic factor and non-surgical treatment had a negative influence on the survival. The 5-year and 10-year overall survival rates were 70.8% and 62.9%, respectively. Complete surgical resection is the most important prognostic factor in patients with thymic epithelial tumors.

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 treatment is not as clear as gastric MALT.. 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 were normal. Radiotherapy was started for him but he did not tolerate radiotherapy and instead received chemotherapy. After 38 months, he is fine.. 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..