Histologic Types of Chest Wall Tumors—Nine Years’ Single Center Experience

Background: Chest wall tumors are rare and mostly malignant. More than half of the malignancies are primary and the remainder are metastatic. Many studies have reported that metastatic lesions occur with about the same frequency as primary tumor. We evaluate common histological types of chest wall tumors in a tertiary center for respiratory and thoracic diseases (National Research Institute of Tuberculosis and Lung Disease). Method: We performed a retrospective study of chest wall tumors at National Research Institute of Tuberculosis and Lung Disease (NRITLD) from April 2001 to March 2010. The pathology slides of patients were retrieved from the pathology archive of NRITLD and reviewed by two pathologists. The lesions were classified as primary or metastatic according to the relevant clinical data and imaging findings. Result: A total of 124 chest wall tumors were identified in patients with a mean age of 47.7 years (range 4-90 years). The male/female ratio was 2:1. The most commonly affected side was the right (42.7%). There were 105 malignant tumors (84.7%), out of which 49 (46.2%) were primary and 57 (53.8%) were metastatic in origin. The majority of the metastatic lesions were epithelial tumors (36/57) (63.1%). The metastatic origin was clear in 51 cases, mostly arising from the lungs (35.7%). The most common types of primary chest wall tumors were primitive neuroectodermal tumor (15/49, 30.6%), chondrosarcoma (7/49, 14.3%), and malignant fibrous histiocytoma, undifferentiated pleomorphic sarcoma (5/49, 10.2%). The most common benign tumor was lipoma (5/18, 35.7%). Conclusion: Most common tumors of chest wall in this study were malignant, mostly metastatic epithelial neoplasms.

Expression of Mammaglobin and Carcinoembryonic Antigen in Peripheral Blood of Patients with Breast Cancer Using Real Time Polymerase Chain Reaction

Background and Objectives: Breast cancer is among the most common causes of cancer related mortality in women worldwide. Early detection and prompt diagnosis of tumor is the first step to prevent cancer-related morbidity and mortality, and a comprehensive understanding of the involved molecular mechanisms can greatly help in this respect. Breast cancer, like many other types of cancer, is caused by a combination of genetic and epigenetic changes such as inactivation of tumor suppressor genes. Materials and Methods: This study was performed on 40 breast cancer patients and 40 healthy controls. Quantitative real time reverse transcription polymerase chain reaction (real time qRT-PCR) was used to assess the expression of carcinoembryonic antigen (CEA) and mammaglobin mRNA in the peripheral blood of patients and healthy controls. The two groups were compared using t-test. Results: The two groups were not significantly different in terms of the mean age. Twenty-nine out of 40 cancer patients were positive for CEA mRNA and its sensitivity was calculated to be 72.5%. Twelve out of 40 healthy controls were positive for CEA mRNA. Twenty-six out of 40 patients were positive for mammaglobin mRNA indicative of 65% sensitivity while only five out of 40 healthy controls were positive for mammaglobin mRNA. Conclusion: Both CEA and mammaglobin mRNA had high sensitivity in cancer patients;thus, they can be used for screening and early detection of breast cancer patients. Further studies with larger sample sizes are required to confirm the current findings.

Invasive candidiasis in critical care setting, updated recommendations from “Invasive Fungal Infections-Clinical Forum”, Iran

Invasive candidiasis(IC) bears a high risk of morbidity and mortality in the intensive care units(ICU). With the current advances in critical care and the use of widespectrum antibiotics, invasive fungal infections(IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxil-iary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients' clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum(IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same(June 2014). The purpose of this review is to put together literature insights and Iranian experts' opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU.