Medical Journal of The Islamic Republic of Iran (MJIRI)

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Intraoperative radiation therapy (IORT) is a multidisciplinary approach in which residual tumors or tumor beds are directly irradiated during a surgical procedure. To evaluate its efficacy, from 1985, we conducted a prospective study including non-metastatic gastric adenocarcinoma treated by surgery, IORT (15 Grays) and postoperative external beam radiotherapy (44 Grays). Up to 1993, 51 cases of gastric adenocarcinoma (20 pN0 and 31 pN1-2) have been included in the study. Mortality and morbidity rates were not different from those of surgery alone. The overall 5 year survival rate was 59.1 %, and the pN1N2 5 year survival rate was 50.6'70. These promising results are comparable with those of Asian randomized studies which demonstrate the possible value of IORT in the treatment of gastric adenocarcinoma.

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156 Iranian patients with primary malignant tumors of the small intestine were reviewed. Malignant lymphoma was the most common tumor type, comprising 128 patients (82%), followed by adenocarcinoma (22 patients, 14.1 %), leiomyosarcoma (4 patients, 2.56%) and carcinoid tumor (2 patients, 1.28%). Lymphomas and adenocarcinomas were primarily located in the duodenum or jejunum, whereas leiomyosarcomas were more cornmon in the ileum. Abdominal pain (73%), weight loss (68%), diarrhea (41% ), and nausea or vomiting (35%) were the most common symptoms with these tumors. Among the lymphoma group 95 patients (74.2%) had non-IPSID (immunoproliferative small intestinal disease) lymphoma and 33 patients (25.8%) had IPSID related lymphoma. In contrast to the western world and far east countries in which malignant small intestinal tumors are a disease of middle and old age groups and adenocarcinoma is the most common tumor type, in our area, similar to some other middle east and north African countries, lymphomas are much more frequent. Although Iran is endemic for IPSID related lymphoma, the majority of these tumors are non-IPSID lymphomas and appear in a very young age group (mean age 27 y).

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A 70 year old male presented with right lower quadrant pain and anorexia for about 72 hours prior to hospital admission. He underwent laparotomy with impression of acute appendicitis. The operative finding was an inflamed tumoral appendix without appendicular base involvement, and appendectomy was done. The patient had an uneventful post-op course. Due to the pathology report of prostatic carcinoma he underwent cystoscopy and biopsy of prostate on the 4th post-op day. Histopathology of the appendix was consistent with metastatic adenocarcinoma of the appendix with prostatic origin. Histopathology of the prostatic specimen was consistent with high grade prostatic adenocarcinoma.

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 ABSTRACT

 Background: Gastric cancer is one of the most common cancers in our country. Recent studies have shown that adenocarcinoma of the cardia and distal stomach has increased in the past 25 years. However demographic data is lacking in this regard.

 Methods: This study is a retrospective case series study. All records from 460 consecutive patients who were documented pathologically to have gastric cancer and had been referred for diagnosis and follow-up to a private clinic from 1992 to 2002 in Tehran were evaluated.

 Results: 71 records were dismissed due to incomprehensive data. Among 389 remaining records 68.5% were males mean age was 59.4 years (range 13 to 92 years), 31.1% of patients were 40 years old or less (which is very high). Also 85% (331) of patients had adenocarcinoma and 5.9% (23) had lymphoma, 8.1% (31) had undifferentiated carcinoma while only 1% (4) of cases had gastrointestinal stromal tumor (GIST). 64% of tumors were located in the middle part of the stomach, 19% in the lower and 17% in the upper part. In our study the association between H. pylori and adenocarcinoma was 23.2% in cases younger than 40 years (P<0.001) and 56% in cases older than 40 years. Cases with lymphoma had the highest correlation with H. pylori. There was a significant difference between cancer pathology and sex (P< 0.001).

 Conclusion: Our data is somehow in conflict with the western data. We do not recommend blind H. pylori eradication based on positive serology (at least in Tehran) and we suggest conduction of larger multicenter studies in this field in our country.

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 Abstract

 Background: Esophageal cancer is one of the major malignancies, with various epidemiological aspects in recent years in developing countries, including increased prevalence and variations of pathologic patterns. This may be due to increasing rates of Barrett’s esophagus, gastroesophageal reflux, smoking and obesity. This study was performed from 1991 to 2005 in order to evaluate various clinicopathological aspects of esophageal cancer in patients referred to a gastroenterology clinic in Tehran.

 Methods: This retrospective cross-sectional study was performed according to data from clinical records, including demographic information, pathologic and endoscopic reports. We used SPSS/12 software for statistical analysis. Chi-square and ANOVAtests were used and a P-value less than 0.05 was considered significant.

 Results: 156 patients (87 males and 69 females) with an average age of 62.4±10.3 years (mean ± SD) were studied. 105 (67.3%), 39 (25%), and 12 (7.7%) patients had squamous cell carcinoma (SCC), adenocarcinoma and metastatic carcinoma, respectively. The location of tumors was 20.6 % (32 patients) in upper third, 35.2% (55 patients) in middle third and 44.2% (69 patients) in the lower third of the esophagus. There was no significant relation between sex and age of patients with the type of cancer and location of tumors. There was a significant relation between the location of tumors and cancer pathology (P<0.001).

 Conclusion: In our study, esophageal cancer had no significant epidemiological variations, so SCC was still more common than other esophageal cancers. Upper and lower thirds were the most common locations of SCC and adenocarcinoma of the esophagus, respectively.

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  Abstract

  Background: Gastric cancer is the second most common cancer and also the second

  cancer related death all over the world. In recent years recorded data for tumor

  has shown a rise in the incidence of gastric cancer in young individuals. The present

  study was designed to compare some of the epidemiologic characteristics of individuals

  suffering from gastric cancer aged below and above forty years.

  Methods: This cross-sectional study was performed on 389 patients suffering

  from gastric cancer referred to a referral private clinic in Tehran during the years

  1991 and 2001. The patients were divided into two groups, those older than 40 years

  and the younger ones. The demographic information, the tumor type and location as

  well as the prevalence of the H. pylori infection was compared in the two groups. The

  collected data were entered in SPSS version 13 and analyzed using chi-square and

  fisher exact test.

  Results: Fifty patients (12.9%) were reported to be lower than 40 years. The mean

  age of the patients in this group was 32.1±6.8years while the number was calculated

  to be 63.23 ± 9.7 years in the other group. The male to female ratio in the group

  younger and older than 40 years was 1.9: 1 and 2.6:1, respectively. Adenocarcinama

  and lymphoma compromised 70% and 12% of the individuals younger than 40 years

  whereas they were reported in 89.3% and 3.2% of the patients in the other group.

  While cancer in the middle third of stomach was the most frequent type in both

  groups, the prevalence of upper third gastric cancer was considerably higher in those

  younger than 40 years old (19.9% vs. 5%). H. pylori infection was seen in 23.2% of

  the younger group, while more than 56% of the older group suffered from H. pylori

  infection. There was a statistically significant difference between the two groups

  (P<0.017).

  Conclusion: gastric cancer is not rare among the individuals younger than 40

  years old. The disease is reported to be seen in the absence of H. pylori infection in

  the majority of these cases. There is a considerable difference between the prevalence

  of malignant lymphoma in this group of patients compared with the older patients.