Publications by authors named "Ramesh Omranipour"

62 Publications

Bisphenol-A in biological samples of breast cancer mastectomy and mammoplasty patients and correlation with levels measured in urine and tissue.

Sci Rep 2021 Sep 16;11(1):18411. Epub 2021 Sep 16.

Toxicology and Poisoning Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

Endocrine disrupting chemicals (EDCs) are organic compounds that have estrogenic activity and can interfere with the endocrine system. Bisphenol-A (BPA) is one of these compounds which possess a potential risk for breast cancer. The aim of this research was to evaluate BPA concentration in both the urine and breast adipose tissue samples of breast cancer mastectomy and mammoplasty patients and study correlations of BPA levels in breast adipose tissue with urine samples in the both groups. Urine and breast adipose tissue samples from 41 breast cancer mastectomy and 11 mammoplasty patients were taken. BPA concentrations were detected using an ELISA assay. Urinary BPA concentrations were significantly higher in cancerous patients (2.12 ± 1.48 ng/ml; P < 0.01) compared to non-cancerous (0.91 ± 0.42 ng/ml). Likewise, tissue BPA concentrations in cancerous patients (4.20 ± 2.40 ng/g tissue; P < 0.01) were significantly higher than non- cancerous (1.80 ± 1.05 ng/g tissue). Urinary BPA concentrations were positively correlated with breast adipose tissue BPA in the case group (P < 0.001, R = 0.896). We showed that BPA was present in urine and breast adipose tissue samples of the studied populations. With regard to higher BPA mean concentration in cancerous patients than non-cancerous individuals in this study, BPA might increase the risk of breast cancer incidence.
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http://dx.doi.org/10.1038/s41598-021-97864-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446007PMC
September 2021

A Practical, Clinical User-Friendly Format for Breast Ultrasound Report.

Eur J Breast Health 2021 Apr 31;17(2):165-172. Epub 2021 Mar 31.

Breast Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Breast ultrasound (BUS) is often performed as an adjunct to mammography in breast cancer screening or for evaluating breast lesions. Our aim was to design a practical and user-friendly format for BUS that could include the details of the Breast Imaging Reporting and Data System.

Materials And Methods: As a team of radiologists and surgeons trained in the management of breast diseases, we gathered and carried out the project in four phases-literature search and collection of present report formats, summarizing key points and preparing the first draft, seeking expert opinion and preparing the final format, and pilot testing-followed by a survey was answered by the research team's radiologists and surgeons.

Results: It produced a list of items to be stated in the BUS report, the final BUS report format, and the pilot format guide. Then, the radiologists used the format in three active ultrasound units in university-affiliated centers, and reports were referred to the surgeons. At the end of the project, the survey showed a high degree of ease of use, clarity, conciseness, comprehensiveness, and well-classified structure of the report format; but radiologists believed that the new organization took more time.

Conclusion: We propose our design as a user-friendly and practical format for BUS reports. It should be used for a longer time and by various ultrasound centers in order to ascertain its benefits.
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http://dx.doi.org/10.4274/ejbh.galenos.2021.6344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025719PMC
April 2021

Solitary metastases of lower extremity myxoid liposarcoma to breast: A case report and review of literature.

Clin Case Rep 2021 Mar 18;9(3):1433-1437. Epub 2021 Jan 18.

Department of Pathology Tehran University of Medical Sciences Tehran Iran.

Solitary breast metastases from myxoid liposarcoma are extremely rare. Resection with negative margins seems as an effective treatment leading to improved survival.
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http://dx.doi.org/10.1002/ccr3.3793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981608PMC
March 2021

The effect of fibrin glue on the postoperative lymphatic leakage after D2-lymphadenectomy and gastrectomy in patients with gastric cancer.

BMC Surg 2021 Mar 21;21(1):155. Epub 2021 Mar 21.

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Disturbance in the lymphatic drainage during D2 dissection is associated with significant morbidity. We aimed to assess the effect of fibrin glue on the reduction of postoperative lymphatic leakage.

Methods: Prospective double-blinded randomized clinical trial with forty patients in each study arm was conducted. All patients diagnosed, staged, and became a candidate for D2 dissection based on NCCN 2019 guideline for gastric cancer. The intervention group received 1 cc of IFABOND® applied to the surgical bed.

Results: The difference between study groups regarding age, gender, tumor stage was insignificant. (All p-values > 0.05). The median daily drainage volume was 120 ml with the first and the third interquartile being 75 and 210 ml, respectively for the intervention group. The control group had median, the first, and the third interquartile of 350, 290, and 420 ml. The difference between daily drainage volumes was statistically significant (p-value < 0.001). The length of hospital stay was significantly different between the two groups. Notably, the intervention group was discharged sooner (median of 7 Vs 9 days, p-value: 0.001).

Conclusion: This study showed the possible role of fibrin glue in reducing postoperative lymphatic leakage after gastrectomy and D2 dissection. Registration trial number: IRCT20200710048071N1, 2020.08.16.
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http://dx.doi.org/10.1186/s12893-021-01168-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983227PMC
March 2021

Abnormal anti-Müllerian hormone level may be a trigger for breast cancer in young women: A case-control study.

Int J Reprod Biomed 2021 Feb 21;19(2):181-190. Epub 2021 Feb 21.

Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Anti-Müllerian hormone (AMH) is a known sensitive biomarker for fertility and ovarian reserve. The results of in vivo and human studies showed inconsistency with respect to the relation between AMH and breast cancer.

Objective: To compare the AMH level of young Iranian women with early breast cancer who have not received any treatment compared to that of healthy women.

Materials And Methods: In this case-control study, 58 breast cancer cases were recruited from the breast oncology clinic of two university hospitals. They were diagnosed with an in situ or invasive breast cancer before any anticancer treatment between August 2018 and April 2019. Healthy controls (n = 58) were selected from women referred to a gynecologic outpatient clinic without any symptoms of cancer or infertility. AMH was measured by the AMH enzyme-linked immunosorbent assay kits in one laboratory.

Results: Final analysis showed that the AMH means of case and control were not statistically significant (3.36 2.95 vs 3.13 1.79). However, the lower and higher AMH level categories are more prevalent in breast cancer compared to the control. Pearson's correlation test showed that the AMH level was negatively correlated with age (r = -0.44, p 0.001). The results of logistic regression analysis considering confounding factors showed the positive association between breast cancer and lower (Odds Ratio [OR] = 5.98, p = 0.02) and higher quartile of AMH level (OR = 4.95, p = 0.01).

Conclusion: Our results suggest that abnormal AMH level is more frequent in young breast cancer patients. Further investigation considering AMH determinants is required.
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http://dx.doi.org/10.18502/ijrm.v19i2.8476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922299PMC
February 2021

Study of therapeutic results, lymph node ratio, short-term and long-term complications of lateral lymph node dissection in rectal cancer patients.

Turk J Surg 2020 Jun 8;36(2):224-228. Epub 2020 Jun 8.

Tehran University of Medical Science, Cancer Institute, Tehran, Iran.

Objectives: This study aimed to assess disease free survival, lymph node ratio (LNR) and complication rate among advanced mid to low rectal cancer patients (stage 2-3) who underwent total mesorectal excision (TME) and lateral lymph node dissection (LLND) at the Iran Cancer Institute in 2016-2018.

Material And Methods: The study was carried out on 32 patients treated by curative surgery and lateral lymph node dissection at the Iran Cancer Institute from 2016 March to 2018 March. Chi-square test was used to assess the distribution of dichotomous clinical outcomes by sex. We also used Breslow test in Kaplan-Meier approach to estimate 1-year disease free survival and corresponding 95% confidence intervals (CI).

Results: Of the 279 dissected lymph nodes by TME, 42 nodes (in mesorectal) and of the 232 dissected lymph nodes by LLND, 7 nodes (in iliac, para-iliac and obturator) were positive for metastasis. Higher local recurrence was observed in men (three patients) compared to women (one patient) which was not statistically significant (p= 0.878). We also observed higher 1-year disease free survival rate in women (1-year disease free survival= 93.3%) compared to men (1-year disease free survival= 82.4%), which also was not statistically significant (p= 0.356). 1-year disease free survival rate in patient with negative lymph nodes was 95.5% while respective number in patients with positive lymph nodes was 70% (p= 0.047).

Conclusion: TME with LLND could prolong survival and reduce local recurrence in patients with advanced low rectal cancer. However, large-scale clinical trials are required to evaluate such procedure as a standard in Iran.
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http://dx.doi.org/10.5578/turkjsurg.4593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7515638PMC
June 2020

Evaluation of the treatment strategies on patient-derived xenograft mice of human breast tumor.

Eur J Pharmacol 2020 Dec 24;889:173605. Epub 2020 Sep 24.

Radiation Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Since only a minority of patients may respond to single-agent therapies, methods to test the potential antitumor activity of rational combination therapies are still needed. This study aimed to characterize the efficacy of antitumor combination therapies in vivo within the primary tumor using patient-derived xenograft (PDX) models by gamma-irradiation-induced immune suppression. We employed four Luminal A PDX models obtained from human mammary tumors grown in mice. PDX models were implanted into the right flank of mice, and treatments have ensued once tumor volume reached ~150 mm. Four of the active drugs- Adriamycin, Cyclophosphamide, Taxotere, and Tamoxifen-were tested in vivo to treat mammary tumors. The tumor volume was measured during the study. The mice's immune system was inherently suppressed by gamma irradiation, thus allowing human tumors to grow. The results showed that the tumorigenesis rate of the PDX model was from 65 to 80%. PDX models were successfully established with a high frequency of tumor engraftment. Humanized mice treated with a two-drug regimen, that is, adriamycin + cyclophosphamide exhibited an increased antitumor response than a three-drug regimen, that is, adriamycin + cyclophosphamide + taxotere that correlated with tumor growth inhibition. Combination therapies with adriamycin + cyclophosphamide in PDX mice reduced tumor growth in four Luminal A PDX models. These preclinical results suggest that a two-drug regimen than a three-drug regimen can be useful for breast cancer patients. This study provides insights for future studies combining chemotherapeutics with targeted therapies using PDX models by gamma-irradiation-induced immune suppression.
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http://dx.doi.org/10.1016/j.ejphar.2020.173605DOI Listing
December 2020

Association study of miR-22 and miR-335 expression levels and G2 assay related inherent radiosensitivity in peripheral blood of ductal carcinoma breast cancer patients.

Neoplasma 2021 Jan 27;68(1):190-199. Epub 2020 Aug 27.

Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.

Identifying patient's cellular radiosensitivity before radiotherapy (RT) in breast cancer (BC) patients allows proper alternations in routinely used treatment programs and reduces the adverse side effects in exposed patients. This study was conducted on blood samples taken from 60 women diagnosed with Invasive Ductal Carcinoma (IDC) BC (mean age: 47±9.93) and 30 healthy women (mean age: 44.43±6.7). The standard G2 assay was performed to predict cellular radiosensitivity. To investigate miR-22 and miR-335 expression levels in peripheral blood mononuclear cells (PBMCs), qPCR was performed. The sensitivity and specificity of the mentioned miRNAs were assessed by plotting the Receiver Operating Characteristic (ROC) curve. Binary logistic regression was performed to identify the miRNA involvement in BC and cellular radiosensitivity (CR) of BC patients. The frequency of spontaneous and radiation-induced chromatid breaks (CBs) was significantly different between control and patient groups (p<0.05). A cut-off value was determined to differentiate the patients with and without cellular radiosensitivity. miR-22 and miR-335 were significantly downregulated in BC patients. miRNAs expression levels were directly associated with CR. ROC curve assessment identified that both miRNAs had acceptable specificity and sensitivity in the prediction of BC and CR of BC patients. Binary logistic regression showed that both miRNAs could also predict BC successfully. Although only miR-22 was shown potent to predict CR of BC patients, both miR-22 and miR-335 might act as tumor suppressor miRNAs in BC. miR-22 and miR-335 may be promising potential biomarkers in BC prediction along with other important biomarkers. Moreover, mirR-22 might be a potential biomarker for the prediction of CR in BC patients.
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http://dx.doi.org/10.4149/neo_2020_200225N185DOI Listing
January 2021

Surgery for Pregnancy-Associated Breast Cancer.

Adv Exp Med Biol 2020 ;1252:95-99

Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.

Surgery in the form of both mastectomy and breast conservation is the main step in the treatment of breast cancer. Numerous studies have shown an equivalent long-term survival for breast conserving surgery (BCS) and mastectomy . Patients desire and tumor characteristics, especially size and multicentricity, are the key factors that affect the decision between these two types of surgery . Patients with any contraindication for radiotherapy or previous history of radiation to the breast field are not suitable for BCS . There are few absolute contraindications for BCS , and early pregnancy is listed among them; mastectomy is preferred in the first trimester of pregnancy to avoid the impact of delaying radiation therapy on outcome of the cancer.
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http://dx.doi.org/10.1007/978-3-030-41596-9_12DOI Listing
September 2020

Premalignant Disorders of the Breast in Pregnancy and Lactation.

Adv Exp Med Biol 2020 ;1252:63-72

Brigham and Women's Hospital, Department of Surgery, Harvard Medical School, Boston, MA, USA.

Papillomas, atypical hyperplasias, and lobular carcinoma in situ of the breast are not malignant tumors, but present serious management challenges when they are diagnosed in a breast biopsy . Upgrading after excision and increased possibility of future cancer are risks that accompany these lesions. While some features have been defined as high-risk for upgrading, many practitioners now recommend conservative non-surgical treatment and vacuum-assisted biopsy . However, the challenge gets worse when the patient is pregnant or breastfeeding because of the limitations in imaging and treatment in relation to the fetus. This chapter deals with these problems, although the best management strategy cannot be defined because of lack of evidence at present.
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http://dx.doi.org/10.1007/978-3-030-41596-9_8DOI Listing
September 2020

Mastitis, Breast Abscess, and Granulomatous Mastitis.

Adv Exp Med Biol 2020 ;1252:53-61

Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.

Breastfeeding is immunoprotective and World Health Organization recommends exclusive breastfeeding for about six months with continuation of breastfeeding for one year or longer as mutually desired by mother and infant. But the target for duration of exclusive breastfeeding has not been reached in a significant number of women. It may be due to inflammatory breast disease such as milk stasis or lactational mastitis.In this chapter we discuss the most common complications of breastfeeding including milk stasis, mastitis, and breast abscess. Also idiopathic granulomatous mastitis, a less common condition, is discussed due to its confusing characteristics and not universally-accepted treatment strategies .Breastfeeding mastitis is inflammation of the breast that can be infectious or non-infectious. With proper diagnosis and treatment of this condition, more severe complications like breast abscess could be avoided, so that breastfeeding could be continued in some circumstances.
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http://dx.doi.org/10.1007/978-3-030-41596-9_7DOI Listing
September 2020

Higher dietary acid load is not associated with risk of breast cancer in Iranian women.

Cancer Rep (Hoboken) 2020 04 15;3(2):e1212. Epub 2019 Aug 15.

Community Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: Dietary acid load (DAL) may play a key role in certain cancers, including breast cancer (BC); however, evidence showing a causal relationship is lacking.

Aim: We examined the relationship between DAL, assessed with both the potential renal acid load (PRAL) and the net endogenous acid production (NEAP) scores, and BC risk.

Methods: We identified 150 women who had a diagnosis of BC recently and 150 age-matched apparently healthy controls. Data from dietary intake and anthropometric measures were collected from participants and eventually, PRAL and NEAP scores were obtained from nutrient intakes. Multivariate odds ratios (OR) with 95% confidence intervals (CI) were used to evaluate the relationship of BC risk with PRAL and NEAP scores.

Results: The odds ratios (OR) of BC according to tertiles of PRAL and NEAP scores by multivariate logistic regression models revealed that both PRAL (P-trend = 0.8) and NEAP (P-trend = 0.1) scores were not significantly associated with BC risk. After controlling confounders, multiple logistic regressions still remained non-significant which indicated no significant associations between PRAL (P-trend = 0.9), NEAP (P-trend = 0.4) scores and risk of BC.

Conclusion: The results of our study suggested that there is no significant relationship between DAL and BC incidence among Iranian women.
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http://dx.doi.org/10.1002/cnr2.1212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941541PMC
April 2020

Study of pregabalin effect on postsurgical pain in breast cancer patients: A double-blind randomized clinical trial using placebo.

Breast J 2020 11 13;26(11):2286-2288. Epub 2020 Jul 13.

Department of General Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1111/tbj.13979DOI Listing
November 2020

Evaluation of Pathologic Complete Response (pCR) to Neoadjuvant Chemotherapy in Iranian Breast Cancer Patients with Estrogen Receptor Positive and HER2 Negative and impact of predicting variables on pCR.

Eur J Breast Health 2020 Jul 1;16(3):213-218. Epub 2020 Jul 1.

Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.

Objective: The pathologic complete response (pCR) in the breast and axillary lymph node after neoadjuvant chemotherapy (NAC) would improve outcomes and it is used as a surrogate marker for survival. Our objective was to evaluate the breast and nodal pCR in breast cancer patients with estrogen receptor-positive (ER) and HER2 negative subtypes. Meanwhile, we sought to examine the impact of predicting factors on the rate of pCR.

Materials And Methods: In this multicenter retrospective study, medical records data of 314 women with ER+/HER2- breast cancer subtype who received neoadjuvant chemotherapy was extracted from oncology centers' data between 2011 and 2018. Breast and axillary lymph node pCR were assessed. Meanwhile, receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value for proliferative index (Ki-67%) expression.

Results: Breast pCR was seen in 25.2% (n=79) of the 314 cancer patients and partial response was seen in 47.8% (n=150), too. Nodal pCR was reported in 30.9% (n=97) of the 249 node-positive patients. The overall pCR (both breast & node) was observed in 14.6 % (n=46) of the 272 patients in which the data of breast and nodal were available. We identified 22.5% as the best cut-off value for ki-67 expression in predicting complete response to NAC.

Conclusion: The pCR rate after NAC in ER+/HER2- subtypes of breast cancer is low. Therefore, the optimal therapy for these patients should be further investigated.
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http://dx.doi.org/10.5152/ejbh.2020.5487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337920PMC
July 2020

Invited commentary on "Initial surgical versus non-surgical treatments for advanced hypopharyngeal cancer: A meta-analysis with trial sequential analysis".

Int J Surg 2020 08 11;80. Epub 2020 Jun 11.

Department of Surgical oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.ijsu.2020.06.010DOI Listing
August 2020

Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients.

Breast J 2020 07 5;26(7):1358-1362. Epub 2020 Apr 5.

Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.

Idiopathic Granulomatous Mastitis (IGM) is an uncommon inflammatory disease of the breast, with similar presentations as breast cancer and a relatively high recurrence rate. We reviewed the demographics, clinical presentations, and treatment modalities of a large cohort of patients in Iran. Most of the patients had history of pregnancy and breastfeeding. The most common clinical finding was pain and a palpable mass, respectively. Most of the patients received medical treatment, and about half of the patients had surgery. The recurrence rate was 24.8%, and breast skin lesions were associated with a significantly higher odds of recurrence.
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http://dx.doi.org/10.1111/tbj.13822DOI Listing
July 2020

An Overview of Oncology Researches in Iran: A Scientometric Approach (1974 - February 2019).

Arch Iran Med 2020 03 1;23(3):181-188. Epub 2020 Mar 1.

Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran.

Background: With the growing rate of tumors, cancer has become one of the most important health concerns in Iran. The urgency with which Iranian researchers and health professionals address this challenge leads to a load of scientific materials.

Methods: To reveal gaps in produced knowledge and suggest future research directions, applying well-validated scientometric tools, we assessed the trends of Iranian published scientific articles and citations in the field of oncology. The inclusion criteria consisted of all oncology-related articles that were data-based, and peer-reviewed; with at least an abstract published in English; and authored by at least one researcher affiliated with Iranian institutions.

Results: Amongst 5063525 oncology research records indexed in at least one of PubMed, Scopus, or Web of Science Core Collection (WoS) from the start to February 2019, Iranian researches accounted for about 24867 (0.49%). Published articles on all cancers by Iranian researchers had a sharp continuously ascending trend, with the same pattern for citations received. Some important topics such as complementary and alternative medicine (CAM) therapies have been missing and some such as diagnostic and pharmaceutical innovations have been less investigated. The most collaborative country was the United States, while no close collaboration was observed with China that was introduced as the most productive country in the field of oncology over the past decades.

Conclusion: Despite the progressive trend in most oncology fields, some significant practical topics are still missing. Systematic reviews of produced theoretical innovations and translating them to functional knowledge can be of importance to fulfill the mentioned gaps.
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March 2020

Atypical Lesions of the Breast and Lobular Carcinoma in Situ in Pregnancy - Surgeons' Practice.

Eur J Breast Health 2020 Jan 1;16(1):16-21. Epub 2020 Jan 1.

Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.

Objective: Approach to precancerous and high-risk breast lesions occurring in pregnancy has received little attention in the literature. We carried out a study to investigate the practice of surgeons in the management of these cases.

Materials And Methods: A short survey was sent to surgeons, including a multiple-choice questionnaire about their practice for atypical hyperplasia or lobular carcinoma in situ presenting in each trimester of pregnancy or at time of breastfeeding. Answer options included observation, immediate vacuum biopsy, immediate surgery, surgery in next trimester, surgery after delivery, and surgery after end of breastfeeding; based on the time of presentation.

Results: Out of the 671 practitioners invited, 97(14.5 %) responded to the survey. Participants were from 23 countries. Answers showed that management of gestational Atypical Ductal Hyperplasia (ADH) and Lobular Neoplasia (LN) was readily postponed by surgeons in favor of fetus safety while being cautious about risks of conservative management alone.

Conclusion: Various methods of treatment are selected by surgeons for managing high-risk breast lesions during pregnancy. In the absence of relevant literature, decision making in a multidisciplinary team would be the best approach in these cases.
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http://dx.doi.org/10.5152/ejbh.2019.5158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939716PMC
January 2020

A Case-Control Study of Breast Cancer in Northeast of Iran: The Golestan Cohort Study.

Arch Iran Med 2019 07 1;22(7):355-360. Epub 2019 Jul 1.

Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.

Background: The incidence and survival of breast cancer (BC) vary across countries. This study aimed to determine risk factors for BC and estimate the overall survival rate in BC patients of the Golestan Cohort Study (GCS).

Methods: This case-control study was performed among participants of the GCS. Cases (N = 99) consisted of women who were diagnosed with BC and controls (n = 400) were selected out of women participating in the same cohort and had not developed any cancer during the follow-up period. Controls were frequency matched to case on both place of residency and 5-year categories of age.

Results: Considering confounding variables, logistic regression analysis manifested a reverse association between parity and BC (OR [odds ratio] = 0.87, 95% CI: 0.80-0.95, P = 0.001). In addition, we found women who had family history of any cancer (OR = 1.63, 95% CI: 1.02-2.60, P = 0.04) and long term oral contraceptive (OCP) use (≥10 years) (OR = 3.17, 95% CI: 1.27-7.95, P = 0.01) were at higher risk of BC. Of the total patients, 23 (23.2%) were died due to BC after a mean follow-up of 102.4 ± 5.31 months. Using the Kaplan-Meier analysis, the 5-year survival in these patients was 74%.

Conclusion: In the Golestan Cohort population, long term OCP use and family history of cancer were risk factors for BC, while parity was a protective factor. The 5-year survival of BC patients in the GCS is still lower relative to Europe and the United States.
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July 2019

Idiopathic granulomatous mastitis: Looking for the most effective therapy with the least side effects according to the severity of the disease in 374 patients in Iran.

Breast J 2019 07 13;25(4):672-677. Epub 2019 May 13.

Kaviani Breast Disease Institute, Tehran, Iran.

The goal of this study is to compare the response rate and the recurrence rate of available therapeutic modalities in the treatment of Idiopathic Granulomatous Mastitis (IGM). 374 patients with pathologically confirmed IGM, were included. They were subdivided into three levels of severity. Close observation had the best response rate with the lowest recurrence rate in mild to moderate cases. Severe cases were mostly treated by prednisolone or underwent surgery. The outcome of prednisolone use in severe cases was comparable to NSAIDs. Overall 9% were resistant to treatment and surgical intervention is still an option among them.
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http://dx.doi.org/10.1111/tbj.13300DOI Listing
July 2019

A randomized, controlled, phase II clinical trial of β-D-mannuronic acid (M2000) in pre-surgical breast cancer patients at early stage (T1-T2).

Clin Exp Pharmacol Physiol 2019 06;46(6):527-532

Department of Immunology, School of Public Health, Tehran University of Medical Science, Tehran, Iran.

Following the potent efficacy of β-D-Mannuronic acid in a breast cancer murine model, we evaluated the efficacy of this novel non-steroidal anti-inflammatory drug in breast cancer patients in the present clinical trial. The study was an 8-week randomized, controlled, phase II clinical trial (IRCT: 2017012213739N7 (in 48 pre-surgical breast cancer patients. Patients who had breast cancer at early stage, with invasive ductal carcinoma, were placed on a waiting-list for surgery and were allocated to the study. β-D-Mannuronic was administrated at a dose of two capsules (1000 mg/d) orally during a period of 8 weeks. The end point of this study was when the patients were admitted for surgery. Moreover, the patients' well-being status was followed up on for safety. There were no statistically significant differences between treatment and non-treatment groups at baseline. β-D-Mannuronic acid therapy, from 20 patients, showed that in one patient (5%) tumour size was decreased; in five patients (25%) tumour growth was stopped; and in 14 patients (70%) the growth rate in the treatment group did not show significant change, compared to the non-treatment group. Evaluation of two tumour markers (carcinoembryonic antigen and cancer antigen 15-3) showed that there was no significant difference between before and after treatment. Although the use of some non-steroidal anti-inflammatory drugs in a long time period has shown a prophylactic effect in breast cancer, their therapeutic efficacy in a short time period is unknown, whereas treatment with β-D-Mannuronic acid during 8 weeks could show 30% therapeutic effects in pre-surgical breast cancer patients.
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http://dx.doi.org/10.1111/1440-1681.13086DOI Listing
June 2019

The Anti-tumoral Effect of β-D-Mannuronic Acid (M2000) as a Novel NSAID on Treg Cells Frequency and MMP-2, MMP-9, CCL22 and TGFβ1 Gene Expression in Pre-surgical Breast Cancer Patients.

Iran J Allergy Asthma Immunol 2019 Feb;18(1):80-90

Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran AND Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

With respect to the role of chronic inflammation in the induction and progression of breast cancer (BC). The relationship between tumor and tumor microenvironment may be a hopeful strategy for BC therapy. According to the effect of β-D-Mannuronic acid (M2000) as a novel non-steroidal anti-inflammatory drug (NSAID) on BC murine model and 4T1 cell line, we started to study that was a phase II, randomized, controlled clinical trial. 24 women with BC were included in this study and were followed by fixed oral doses of M2000, 500 mg two times a day (6-8 weeks). Blood samples were collected at baseline and weeks 6-8. To compare the patterns of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), C-C motif chemokine ligand 22 (CCL22) and The transforming growth factor-beta 1 (TGFβ1) gene expression and T regulatory cells (Tregs) frequency of healthy women normal controls with BC patients, a set of 10 blood samples of  women healthy volunteers was collected. The gene expression was evaluated by quantitative Real-time PCR (qRT-PCR) and the frequency of Tregs was assessed by flow cytometry. Our results showed, reduction in MMP-2 (p=0.08), MMP-9 (p=0.03), CCL22 (p=0.003) and TGFβ1 (p=0.1) gene expression and Tregs frequency (p=0.01) which play a main role in the development of chronic inflammation, angiogenesis, tumorigenesis and metastasis. Our findings demonstrated that M2000 therapy as a novel designed NSAID had valuable therapeutic effects on BC. No adverse effects were observed following the use of M2000 after 6-8 weeks.
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February 2019

Plasma miR-21, miR-155, miR-10b, and Let-7a as the potential biomarkers for the monitoring of breast cancer patients.

Sci Rep 2018 12 19;8(1):17981. Epub 2018 Dec 19.

Breast Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

There is a pressing need for further studies to categorize and validate circulating microRNAs (miRs) in breast cancer patients that can be one of the novel strategies for cancer screening and monitoring. The present study is aimed to investigate the expression of the circulating candidate microRNAs after the operation, chemotherapy, and radiotherapy in the non-metastatic breast cancer patients. Tumor tissue and plasma samples were collected from the 30 patients with recently diagnosed Luminal A breast cancer. Control plasma samples were collected from the 10 healthy subjects. A panel of four miRs including miR-21, miR-55, miR-10b, and Let-7a were selected and their expression levels were measured before and after the operation, chemotherapy, and radiotherapy by using Real-Time PCR technique. The plasma expression of the miR-21, miR-155, and miR-10b was significantly increased and the Let-7a plasma expression decreased in the breast cancer patients compromised to the control ones. There was a similar expression pattern of the miRs between the tissue and plasma samples. The plasma levels of the miR-21, miR-155, and miR-10b were significantly down-regulated and the Let-7a plasma level was up-regulated after the operation, chemotherapy, and radiotherapy compromised to the pre-treatment. There was a significant difference in the miR-155 plasma level after the operation, chemotherapy, and radiotherapy compromised with each other. Moreover, there was no significant difference between the plasma levels of the miRs after the radiotherapy compromised to the control cases. The operation, chemotherapy, and radiotherapy led to a more reduction in the oncomiRs and an increase in the tumor suppressor-miRs. It seems that monitoring miRs during treatment might be considered as a respectable diagnostic tool for monitoring of breast cancer patients.
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http://dx.doi.org/10.1038/s41598-018-36321-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299272PMC
December 2018

Duodenal Metastases From Renal Cell Carcinoma Presented With Melena: Review and Case Report.

Iran J Pathol 2017 1;12(3):272-276. Epub 2017 Jul 1.

Cancer Institute of Tehran University of Medical Science, Tehran, Iran.

Renal cell carcinoma (RCC) metastasis to duodenum is very rare and only a few case reports are available in the literature. We here reported a patient with solitary duodenal metastasis presented with melena six years after right nephrectomy. The patient underwent upper gastrointestinal endoscopy showing ulcerative mass at the second portion of duodenum and biopsy of this mass was consistent with metastatic RCC. Metastasis work up did not find any other site of malignancy, thus Whipple's operation (Pancreaticoduodenectomy) was performed. In conclusion metastasis from RCC should be considered in mind in patients with history of nephrectomy presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835376PMC
July 2017

The Core Needle and Surgical Biopsy Concordance to Detect Estrogen, Progesterone, and Her-2 Receptors in Breast Cancer: A Comparative Study.

Iran J Pathol 2017 1;12(3):202-208. Epub 2017 Jul 1.

Dept. of Oral and Maxillofacial Pathology, Tehran University of Medical Sciences, Tehran, Iran.

Background &objectives: Evaluation of estrogen receptor (ER), progesterone receptor (PR), and (human epidermal growth factor receptor-2) Her-2 on core needle biopsies (CNBs) is increasingly in use to diagnosis early breast cancer, but its concordance with surgical excision (SE) is not well documented.

Methods: The study included 100 formalin fixed, paraffin-embedded specimens of invasive breast carcinoma archived in Pathology Department of Cancer Institute, Tehran, Iran, from 2011 to 2014. Immunohistochemistry was applied to detect ER, PR, and Her-2.

Results: The current study findings indicated a significant correlation of 90% between CNB and SE specimens for expression. The correlation between CNB and SE specimens was estimated as 81% and 97.3% for PR and Her-2, respectively.

Discussion: CNB can be performed confidently to determine ER and Her-2. For PR, results obtained from CNB should be considered
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835367PMC
July 2017

Naja Naja Oxiana Venom Fraction Selectively Induces ROS-Mediated Apoptosis in Human Colorectal Tumor Cells by Directly Targeting Mitochondria

Asian Pac J Cancer Prev 2017 08 27;18(8):2201-2208. Epub 2017 Aug 27.

Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email:

Objective: To investigate the selective effect of Naja naja oxiana crude venom and its fractions on human colorectal cancer mitochondria to activate apoptosis signaling. Methods: Cells and mitochondria isolated from human cancerous and normal colorectal tissues exposed to N. oxiana crude venom and its fractions obtained from size-exclusion chromatography and then mitochondrial parameters related to up-stream cell death signalling such as reactive oxygen species formation, MMP, mitochondrial swelling, cytochrome c release and ATP content as mitochondrial parameters and activation of caspase3 and finally apoptosis/necrosis % were then assayed as cellular parameters. Result: Our findings indicated that crude venom (15, 30 and 60 μg/ml) and fraction 3; F3; (10, 20 and 40 μg/ml) of N. Oxiana venom induced a significant (p<0.05) increase of reactive oxygen species level, swelling of mitochondria, collapse of mitochondrial membrane potential (MMP), release of cytochrome c, activated caspase3 and decrease ATP content only in colon cancer tissue group but not from the healthy colon tissue group. Our results also showed that fraction 3 of venom decreased the percentage of viable cells and induced apoptosis in cancerous colorectal cells. Conclusion: F3 fraction of N. Oxiana venom is a suitable candidate for further studies as a new drug treatment of colorectal cancer due to its high capacity for induction of apoptosis signaling via mitochondrial pathway.
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http://dx.doi.org/10.22034/APJCP.2017.18.8.2201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697481PMC
August 2017

Persian Gulf Jellyfish (Cassiopea andromeda) Venom Fractions Induce Selective Injury and Cytochrome C Release in Mitochondria Obtained from Breast Adenocarcinoma Patients

Asian Pac J Cancer Prev 2017 01 1;18(1):277-286. Epub 2017 Jan 1.

Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email:

Objective: This study was conducted to investigate whether fractions of jellyfish Cassiope andromeda venom, could selectively induce toxicity on mitochondria isolated from cancer tissue of patients with breast adenocarcinomas. Methods: Firstly, we extracted two fractions, (f1 and f2) from crude jellyfish venom by gel filtration on Sephadex G-200.Then different dilutions of these extracted fractions were applied to mitochondria isolated from human breast tumoral- and extra-tumoral tissues. Parameters of mitochondrial toxicity including generation of reactive oxygen species (ROS), mitochondrial membrane potential (MMP) collapse, swelling, cytochrome c release, activation of caspase3 and apoptosis were then assayed. Result: Our results demonstrate that fraction 2 of Cassiopea andromeda crude venom significantly (P<0.05) decreased mitochondrial succinate dehydrogenase activity, increased mitochondrial ROS production, induced mitochondrial swelling, MMP collapse and cytochrome c release, activated caspase3 and induced apoptosis only in tumoral mitochondria, and not in mitochondria obtained from extra-tumoral tissue (P<0.05). Conclusion: In conclusion this study suggested that fraction 2 of Cassiopea andromeda crude venom selectively induces ROS mediated cytotoxicity by directly targeting mitochondria isolated from human breast tumor tissue.
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http://dx.doi.org/10.22034/APJCP.2017.18.1.277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563113PMC
January 2017

Bilateral Simultaneous Pseudoangiomatous Stromal Hyperplasia of the Breasts and Axillae: Imaging Findings with Pathological and Clinical Correlation.

Case Rep Radiol 2016 27;2016:9084820. Epub 2016 Oct 27.

Department of Pathology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a pathology that is usually diagnosed by accident during pathological examination of other breast lesions. PASH is an uncommon and benign tumoral lesion of the mammary stroma that can be pathologically mistaken for other tumours, such as phyllodes, fibroadenoma, and sometimes even angiosarcoma. We report the case of a 45-year-old woman with complaints of huge bilateral breast enlargement. This is a rare case of PASH presenting with gigantomastia and involving bilateral breasts and axillae simultaneously. Mammography, ultrasonography, and MRI features are illustrated with histopathological correlation.
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http://dx.doi.org/10.1155/2016/9084820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102722PMC
October 2016

Comparison of the Accuracy of Thermography and Mammography in the Detection of Breast Cancer.

Breast Care (Basel) 2016 Aug 25;11(4):260-264. Epub 2016 Aug 25.

Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Science, Tehran, Iran.

Background: Benefits and harms of screening mammography have been disputed in recent years. This fact, along with the limitations of mammography as well as its unavailability in all our medical centers, tempted us to evaluate the accuracy of thermography in detecting breast abnormalities.

Patients And Methods: All patients who were candidates for breast biopsy were examined by both mammography and thermography before tissue sampling in a referral center between January 2013 and January 2014. We defined sensitivities and specificities, and positive predictive values (PPVs) and negative predictive values (NPVs), of the 2 modalities in comparison with histologic results as the gold standard.

Results: 132 patients were included. The median age of all patients was 49.5 ± 10.3 years (range 24-75 years). The sensitivity, specificity, PPV, NPV, and accuracy for mammography were 80.5%, 73.3%, 85.4%, 66.0%, and 76.9%, respectively, whereas for thermography the figures were 81.6%, 57.8%, 78.9%, 61.9%, and 69.7%, respectively.

Conclusion: Our study confirms that, at the present time, thermography cannot substitute for mammography for the early diagnosis of breast cancer.
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http://dx.doi.org/10.1159/000448347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040931PMC
August 2016

Applicability of Radioguided Occult Lesion Localization for NonPalpable Benign Breast Lesions, Comparison with Wire Localization, a Clinical Trial.

Asian Pac J Cancer Prev 2016 ;17(7):3185-90

Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran Email :

Background: This study was designed to compare radioguided versus routine wire localization of non palpable nonmalignant breast lesions in terms of efficacy for complete excision, ease of use, time saving, and cosmetic outcome.

Materials And Methods: Patients with nonpalpable breast masses and nonmalignant core biopsy results who were candidates for complete surgical lumpectomy were enrolled and randomly assigned to radioguided or wire localization groups. Radiologic, surgical, and pathologic data were collected and analyzed to determine the difficulty and duration of each procedure, ease of use, accuracy, and cosmetic outcomes.

Results: This prospective randomized study included 60 patients, randomly divided into wire guided localization (WGL) or radioguided occult lesion localization (ROLL) groups. The mean duration of localization under ultrasound guidance was shorter in the ROLL group (14.4 min) than in the WGL group (16.5 min) (p<0.001). The ROLL method was significantly easier for radiologists (p=0.0001). The mean duration of the surgical procedure was 22.6 min (±10.3 min) for ROLL and 23.6 min (± 9.6 min) for WGL (p=0.6), a nonsignificant difference. Radiography of the surgical specimens showed 100% lesion excision with clear margins, as proved by pathologic examination, with both techniques. The surgical specimens were slightly heavier in the ROLL group, but the difference was not significant (p=0.06).

Conclusions: The ROLL technique provides effective, fast, and simple localization and excision of nonpalpable nonmalignant breast lesions.
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February 2017
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