Ozlem Yavas

Correliation Between Osteopontin Protein Expression and Histological Grade of Astrocytomas

Osteopontin is a ligand for the integrin proteins, which are cell surface receptors that mediate the physical and functional interactions between a cell and the extracellular matrix. The expression of osteopontin is reportedly increased in a number of transformed cell lines and tumor tissues. Furthermore, increased expression of osteopontin results in some infiltrative features of tumors. The aim of the study is to demonstrate that expression of osteopontin in human astrocytomas correlates with histological tumor grade. The expression of osteopontin in human astrocytomas was determined with immunohistochemistry. Median osteopontin expression levels were 1%, 7.5%, 60%, and 50% in grade I, II, III, and IV tumors, respectively. Osteopontin staining was significantly higher in high grade (grade III–IV) than low grade (grade I–II) tumors. These findings indicate that osteopontin immunoreactivity in human astrocytomas may correlate with the grade of a tumor.

Chemotherapy-induced Hepatitis B virus reactivation in HbsAg positive cancer patients: a single center experience

Hepatitis B reactivation due to chemotherapy is a cause of serious morbidity and mortality in some of the patients with cancer. In this study, we retrospectively assessed the prevalence of hepatitis B reactivation among the patients undergoing cytotoxic chemotherapy. We investigated efficacy of lamivudine prophylaxis against hepatitis B reactivation as well.

Synchronous presentation of nasopharyngeal and renal cell carcinomas

We report a rare case of synchronous presentation of nasopharyngeal and renal cell carcinomas in a-50-year old male patient with long standing smoking history. The patient was initially presented with a diagnosis of nasopharyngeal carcinoma. During staging process, the abdominal computed tomography detected a right renal solid mass, 6.5 cm in diameter, originating from posterior portion of the right renal cortex. Right radical nephrectomy was performed and pathological examination revealed renal cell carcinoma. Smoking was thought to be a risk factor for both cancers. Systemic evaluation of kidney should not be discarded in patients diagnosed with nasopharyngeal carcinoma living in western countries with a smoking history.

Thymic malignancy in a breast cancer patient--is there an association with anti-estrogenic effects of tamoxifen?

With the increasing success of modern therapies in achieving longterm remissions in many cancer patients, the incidence of second primary tumors is rapidly increasing. Second tumors are closely related to the treatment of primary malignancy and to the effect of the curative therapy on pre-existing genetic susceptibility, predisposing the patient to a secondary malignancy. Adjuvant chemotherapy, hormonal therapy and radiation therapy have been shown to be effective in reducing cancer recurrence and death in women with early-stage breast cancer (1). However, as patients with breast cancer receive intensive treatment and survive longer, the risk of therapy-induced secondary malignancies is more than a clinical problem (2, 3). Specific risk factors cited include use of multiple alkylating agents and their cumulative dose, duration of treatment, use of combinations of radiotherapy and chemotherapy (4). Besides chemoand radiotherapy, tamoxifen is being increasingly blamed for increasing the incidence of new primary tumors (5). We present the case of a female patient who developed thymic cancer following successful treatment of breast cancer with adjuvant chemoand radiotherapy and who was currently receiving adjuvant tamoxifen therapy, and discuss the possible mechanisms underlying the development of secondary thymic cancer in breast cancer patients. It is a known fact that thymoma is associated with an increased risk of second malignancy (6), but to our knowledge this is the first published case of thymic cancer following the treatment of breast cancer. Case report . A 51-year-old premenopausal woman who underwent right modified radical mastectomy due to breast cancer in September 1999 was referred to our department in the postoperative period. The histopathological diagnosis was invasive lobular carcinoma. The patient had stage IIIA (T3N1M0) disease but there was no evidence of metastatic disease. She received six cycles of adjuvant cyclophosphamide (500 mg/m i.v. day 1), doxorubicin (50 mg/m i.v. day 1), 5-fluorouracil (500 mg/m i.v. day 1) combination chemotherapy (CAF) regimen and received radiotherapy after the third cycle of the CAF regimen (chest wall 2 Gy/day, total 46 Gy, and internal mammary chain 50 Gy). Adjuvant tamoxifen 10 mg twice daily was started in November 2001, as the patient’s tumor was shown to be progesterone receptor positive, although estrogen receptor negative. In routine follow-ups, a widening of the upper mediastinum was detected on a chest x-ray in the 8th month of tamoxifen treatment. Computed tomography of the thorax revealed multinodular goiter with retrosternal extension and a retrosternal lobulated mass, 3 /2 cm in diameter. Laboratory examinations including complete blood count, electrolyte count, liver function tests, thyroid function tests, tumor markers and bone scintigraphy were all within normal ranges. The patient complained of mild shortness of breath probably caused by multinodular goiter. She underwent left near total, right subtotal thyroidectomy and mediastinal tumor excision in September 2002. The pathology was consistent with nodular hyperplastic thyroid and well-differentiated thymic carcinoma according to the Muller-Hermelink classification (7) with capsular and vascular invasion (WHO Grade B 3). The thymic region was not treated with radiotherapy as the patient had already received the maximum dose of radiation to this area. Discussion . Adjuvant chemotherapy, hormonal therapy and radiotherapy, and a combination of these modalities are being administered to a growing proportion of breast cancer patients. In view of the proven therapeutic benefit of these treatments and the prolonged life expectancy of those treated, it has been important to evaluate the carcinogenic potential of adjuvant treatment (8). There is evidence that second primary malignancies may be associated with potentially carcinogenic treatment of the initial cancer, such as radiation therapy or chemotherapy (9). A combination of radiotherapy and chemotherapy may further increase the risk of these cancers. In any discussion of treatment-related second malignancies, it is of important to remember that not all second cancers are due to previous therapies. The occurrence of second primary malignancies may be a chance occurrence, and may result from host susceptibility factors such as genetic predisposition or immune deficiency, or may be linked to common carcinogenic influences, e.g. environmental factors or a clustering of different risk factors in the same individual. In relation to the general population, women with breast cancer have a significant, excess incidence for some cancers. However, thymoma is not included among them. In our case, the association between thymoma and breast cancer can be fully or partly explained by a common etiology such as genetic predisposition and hormonal risk factors. Sex hormones strongly influence the development of thymus tumors in spontaneous thymoma BUF/ Mna rats through their receptor within the tumor cells (10, 11). Thymic epithelial cells have cytoplasmic estrogen receptors and estrogen regulates a normal cellular differentiation process indirectly via its receptor in the thymus (12). Estrogens depress thymosin release from the thymus, leading to involution of the thymus. So, in CASE REPORT