Leila Farhadi^1,2, Farzad Soleimani¹, Shohreh Fakhari², Ali Jalili^1,2

Backgrounds and aims: Prostate cancer is the most common malignant cancer among men and is the second deadliest cancer in men after lung cancer. Understanding the molecular mechanisms involved in development and progression of prostate cancer is essential to improve both diagnostic and therapeutic strategies in this regard. In addition, using novel gene therapy-based methods for treatment of cancers has gotten increasing attention during the recent years. Accordingly, this study was aimed to evaluate the inhibitory effect of MAGE-A11 gene, as an important oncogene involved in the pathophysiology of prostate cancer invitro model. The study was also aimed to evaluate the downstream genes related to MAGE-A11.

Materials and Methods: First, MAGE-A11 gene was knocked out in PC-3 cell line using "Clustered regularly interspaced short palindromic repeats" (CRISPR)/ "CRISPR-associated genes 9" (CRISPR/Cas9) method. Next, the expression levels of MAGE-A11, survivin and Ribonucleotide Reductase Small Subunit M2 (RRM2) genes were determined by quantitative polymerase chain reaction (qPCR) technique. The levels of proliferation and apoptosis were also analyzed in PC-3 cells using CCK-8 and Annexin V-PE/7-AAD assays.

Results: The results showed that the disruption of MAGE-A11 by CRISPR/Cas9 method significantly decreased proliferation (P<0.0001) and enhanced apoptosis (P<0.05) in PC-3 cells compared to control group. Moreover, the disruption of MAGE-A11 significantly down regulated the expression levels of survivin and RRM2 genes (P<0.05).

Conclusion: Our results demonstrated that knocking out MAGE-11 gene by CRISPR/CAS9 technique could efficiently inhibit cell proliferation and induce apoptosis in PC3 cells. Survivin and RRM2 genes might also participated in these processes.

Keywords: Prostate Cancer, Apoptosis, CRISPR/Cas9, Mage-A11.

How does Linkage to the National Death Index Affect Population-Based Net Survival Estimates for Women with Cervical Cancer in Saudi Arabia?

Eman Alkhalawi^1,2, Claudia Allemani², Ali Saeed Al-Zahrani³, Michel P. Coleman²,

Background: Population-based cancer survival is a key metric for the assessment of cancer control strategies. Accurate estimation of cancer survival requires complete follow-up data for all patients.

Aim: To explore the impact of linking national cancer registry data to the national death index on net survival estimates for women diagnosed with cervical cancer in Saudi Arabia during 2005-2016.

methods: We acquired data on 1,250 Saudi women diagnosed with invasive cervical cancer during the 12- year period 2005-2016 from the Saudi Cancer Registry. These included the woman' s last known vital status and the date of last known vital status, but this was restricted to information from clinical records and death certificates that mention cancer as a cause of death (" registry follow-up" ). We submitted available national ID numbers to the National Information Center (NIC) of the Ministry of Interior, to ascertain the date of death, from any cause of death, for women who had died up until 31 December 2018 (" NIC follow-up" ). We estimated age-standardised 5-year net survival using the Pohar-Perme estimator under five different scenarios using the two sources of follow-up, and censoring at the date of last contact with the registry versus extending survival until the closing date if no information on death was obtained.

Results: 1,219 women were eligible for survival analysis. Five-year net survival was lowest when using NIC followup only (56.8%; 95%CI 53.5 - 60.1%), and highest when registry follow-up only was used and survival time was extended until closure date for those with no information on death (81.8%; 95%CI 79.6 - 84%).

Conclusion: Reliance solely on information from deaths certified as due to cancer and clinical records leads to a high proportion of missing deaths in the national cancer registry. This is probably due to low quality of certification of the cause of death in Saudi Arabia. Linkage of the national cancer registry to the national death index at the NIC identifies virtually all deaths, providing more reliable survival estimates, and it eliminates the ambiguity in determining the underlying cause of death. Therefore, this should become the standard approach to estimating cancer survival in Saudi Arabia.

Keywords: cancer registry, cervical cancer, survival, Saudi Arabia

Alawadhi E¹, Al-Awadi A², Elbasmi A², Coleman MP³, Allemani C³

Introduction: To assess progress against cancer, trends in incidence, survival and mortality need to be interpreted simultaneously.

Methods: Data were obtained from the Kuwait Cancer Registry (KCR) for all Kuwaiti children (0-14 years) and adults (15-99 years) diagnosed with one of 18 common cancers during 2000-2013, with follow-up for vital status to 31 December 2015. World-standardised average annual incidence and mortality rates were calculated for 2000-2004, 2005-2009, 2010-2013. Five-year net survival was estimated with the Pohar Perme estimator, corrected for background mortality using life tables of all-cause mortality. Survival estimates were agestandardised using the International Cancer Survival Standard weights.

Results: For liver cancer, five-year net survival increased from 11.4% to 13.4% for patients diagnosed between 2000-2004 and 2010-2013, while incidence and mortality rates fell from 5.5 to 3.6 and from 3.9 to 3.0 per 100,000, respectively. Similar patterns were seen for acute lymphoblastic leukaemia (ALL) and lymphoma in children. Survival and mortality remained stable for cancers of the lung, cervix and ovary, but incidence declined from 10.2 to 7.4, 4.9 to 2.4 and 5.8 to 4.3 per 100,000, respectively. For breast cancer, survival increased from 68.3% to 75.2%, while incidence and mortality rose from 45.6 to 58.7 and from 5.8 to 12.8 per 100,000, respectively. For colon cancer, incidence and mortality rates rose from 11.4 to 12.6 and from 2.3 to 5.4 per 100,000, respectively. Five-year survival fell from 64.8% to 50.2% between 2000-2004 and 2005-2009, before rising to 58.5% for 2010-2013.

Conclusions:Increasing survival, alongside falling incidence and mortality rates, represents progress in cancer control, attributable to effective prevention (e.g. tobacco control and lung cancer) and early diagnostic activity (e.g. mammography for breast cancer), or better treatment (e.g. childhood ALL). The increasing prevalence of obesity, linked to rising incidence for breast and colon cancers, suggests the need for public health prevention campaigns.

Keywords: Population-based cancer registries, cancer control, incidence, net survival, mortality, trends, Kuwait.

Oral Intake of Combined Natural Immunostimulants Suppresses the 7,12-DMBA/ Croton Oil Induced Two-step Skin Carcinogenesis in Swiss Albino Mice

Mohammed Abdellaoui¹, Assia Kadi¹, Yamina Abrazi¹, Yacine Kadi², Adnane Gary¹, Hind Kherfi³, ZinelaabidineCheraiet⁴, Mahfoud Messarah¹

Background: The immune system is critical in fighting cancer, so is it possible that the natural stimulation of this system can slow down or stop the evolution of cancer? Our in vivo study aimed to evaluate the protective effect of the combination of five types of immunostimulants, which are Beta-glucan and Arabinogalactan as polysaccharides and three mushroom extracts (Reishi, Maitake, and Shiitake), on 7,12-Dimethyl Benz[a]anthracene (DMBA)/ Croton oil-induced papilloma in Swiss albino mice.

Methodology: We used blood count analyses to estimate broadly the immunological reaction and biochemical techniques to determine the oxidative stress variations in the enzymatic activity of Superoxide dismutase (SOD), Catalase (CAT), and Glutathion peroxidase (GPx), which could have a preventive function against cancer development.

Results: The cutaneous application of the DMBA/Croton oil caused precancerous hyperplasia in squamous cells (papilloma) on the back of the mice. Tumor development was accompanied by a decrease in SOD and GPx activities. The treatment with the immunostimulants led to the total disappearance of the incidence of skin papillomas and also showed a nearly back to normal SOD activity but not CAT and GPx activities. The increase in the level of immune cells (lymphocytes, monocytes, and white blood cells) reflected a clear enhancement of the immune system activity.

Discussion: The healthy epidermis observed with treated mice simultaneously subjected to the cancerogenosis protocol suggests the inhibition of spinous cell proliferation leading to the total suppression of the hyperplasia. Moreover, the increase in the level of immune cells in this batch reflects an inflammatory reaction. Indeed, previous studies reported that immunostimulants, including Betaglucan involve a release of some inflammatory mediators who would be at the origin of its anticancer activity. Cancerogenesis has clearly disrupted the activities of the antioxidant enzymes, but the relationship between the two process is often complex. Bibliographic data led us to suggest that low catalytic activities of CAT and GPx observed in treated mice simultaneously subjected to the cancerogenesis protocol, would have induce an accumulation of H 2O2 which has often been described as an inducer of cancer cells apoptosis.

Conclusion: Immunostimulants used in our study could have an effective protective effect against skin carcinogenesis via the enhancement of the global function of the immune system and modulation of the antioxidant defense.

Keywords: Immunostimulants, Beta-glucan, Arabinogalactan, Reishi, Maitake, Shiitake, DMBA, Croton oil, Oxidative stress, Carcinogenesis.

Abbreviations: C, control group; Dc, drug control group; Pc, positive control group; St, sick treated group;DMBA, 7,12 Dimethyl Benz[a]anthracene; NK, natural killer; CAT, catalase; SOD, superoxide dismutase, GPx, glutathione peroxidase; IS, immunostimulants; WBC, White blood cells; LY, Lymphocytes; MO, Monocytes; ROS, Reactive oxygen species; ONAB, Office national des aliments de bètail.

Introduction With the introduction of neoadjuvant chemotherapy, increased expertise in surgical oncology, and advanced skeletal imaging techniques, limb salvage surgery is becoming the standard of care for treating malignant bone tumors. However, few studies have examined the outcomes of limb salvage surgery with relatively large sample sizes in developing countries.

Materials and Methods: Therefore, we conducted a retrospective study of 210 patients who received limb salvage surgery at King Hussein Cancer Center in Amman, Jordan, over a follow-up period of 1 to 14.5 years (2006- 2019).

Results: Negative resection margins occurred in 203 (96.7%) patients and local control occurred in 178 (84.8%) patients. The mean functionality outcome for all patients was 90%, and 153 (72.9%) patients did not experience any complications. The 10-year survival rate for all patients was 69.7%, and the rate of secondary amputations was 4%.

Conclusion: Therefore, we conclude that the outcomes of limb salvage surgery in a developing country are comparable to those in developed countries when adequate resources and trained orthopedic oncology teams are available.

Keywords: Osteo-oncology, Orthopedic cancer, Limb salvage surgery, Osteosarcoma, Ewing Sarcoma.

Dany Nassar¹, Claudia Chidiac¹, Elio Ibrahim¹, Karl Abou Zeid¹, Fady Haddad², Hampig Kourie¹

Background Lung cancer is the most frequent cause of cancer-related deaths worldwide. The discovery of acquired genetic alterations in the epidermal growth factor receptor (EGFR) gene involved in growth factor receptor signaling, has changed the way these cancers are diagnosed and treated. EGFR is more frequent in Asian, females, and non-smokers. Data regarding its prevalence in the Arab World remains limited. This paper aims at reviewing the data available for the prevalence of this mutation in the Arab patient population and comparing it with other international series.

Method: PubMed and ASCO databases were used to conduct a literature search and 18 relevant studies were included

Results: Overall, 1775 patients with non-small cell lung cancer (NSCLC) were included in this analysis. 15.7% had an EGFR mutation and 56% of the mutated patients were females. 66% of EGFR mutated patients were nonsmokers. Exon 19 and exon 21 were, respectively the most and the second most prevalent mutation.

Conclusions: The EGFR mutation frequency in Middle East and African patients lies between the frequency of Europe and North America. Like global data, it is more prevalent in females and non-smokers.

Keywords: Epidermal growth factor receptor; Arab World; prevalence; Non-small cell lung cancer

Afrah Aladwani¹, Faisal Alterkait², Alexander Mullen³, Emad Eldosouky⁴

¹ Clinical Pharmacy Unit, Jaber Alahmad Hospital, Kuwait.
²Department of Medical Oncology, Jaber Alahmad Hospital, Kuwait.
³Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
⁴ Department of Medical Oncology, Kuwait Cancer Control Centre, Kuwait.

Introduction: Worldwide statistics highlight that around 40% of breast cancer cases occur in patients aged 65 years and above, with expectations that this will increase as the population gets older. Cancer management in elderly patients is still unclear and depends primarily on individual oncologist decisions. The literature suggests that elderly breast cancer patients receive less intensive chemotherapy than younger patients, which is mainly attributed to a lack of effective individualized assessment or age bias. The current study explored the impact of elderly patient involvement in the decision-making process of breast cancer management and less intensive treatment allocation in Kuwait.

Methods: In an observational exploratory populationbased study, 60 newly diagnosed breast cancer patients aged 60 years and above and candidates for chemotherapy were included. Patients were grouped based on the treating oncologists' decision to receive either intensive first-line chemotherapy (standard treatment) or less intensive/ other than first-line chemotherapy (non-standard treatment) according to standardized international guidelines recommendations. Patients' attitudes toward the recommended treatment (accept/ reject) were documented through a short semi-structured interview. The prevalence of patients' interference with the treatment was reported, and individual causes were investigated.

Results: Data showed that 58.8% and 41.2% of elderly patients were allocated for intensive and less intensive treatment, respectively. Overall, 15% of patients interfered with the treatment plan against their oncologists' recommendations even though they were allocated for less intensive treatment. Among those, 6.7% of patients rejected the recommended treatment, 3.3% delayed initiating treatment, and 5% received <3 cycles of chemotherapy but refused to continue cytotoxic treatment. None of the patients requested intensive treatment. This interference was mainly directed by cytotoxic treatment toxicity concerns and targeted treatment preference.

Conclusion: In clinical practice, oncologists allocate selected breast cancer patients aged 60 years and above for less intensive cytotoxic treatment to enhance their tolerance; however, this was not always associated with patients' acceptance and compliance. Lack of awareness of targeted treatment indications and utilization directed 15% of patients to reject, delay, or refuse to continue the recommended cytotoxic treatment against their oncologists' recommendations.

Keywords: Breast Cancer, Elderly, Chemotherapy, Oncologists

Mohammed Tareq Mutar¹, Mustafa Majid¹, Mazin Judy Ibrahim², Abo-Alhasan Hammed Obaid³, Ahmed Zuhair Alsammarraie², Enam Altameemi⁵, Tara Farouk Kareem⁶

¹ Medical doctors, lectures at College of Medicine, University of Baghdad.
²Specialist Medical Oncologist College of Medicine University of Baghdad/ Department Of Medicine
³ Iraqi Ministry of health
⁴Specialist Medical Oncologist Medical Oncologist at Oncology Teaching Hospital Baghdad
⁵Specialist Radiologist leader of Breast Imaging Fellowship/ Arabic Board/ Baghdad teaching hospital /the national center for early detection of cancer
⁶ Specialist Radiologist at Baghdad teaching hospital /The national center for early detection of cancer

Background Breast cancer is the leading cause of cancer-related mortality among women worldwide. The incidence and mortality increased globally since starting registration in 1990. Artificial intelligence is being widely experimented in aiding in breast cancer detection, radiologically or cytologically. It has a beneficial role in classification when used alone or combined with radiologist evaluation. The objectives of this study are to evaluate the performance and accuracy of different machine learning algorithms in diagnostic mammograms using a local four-field digital mammogram dataset.

Methodology: The dataset of the mammograms was fullfield digital mammography collected from the oncology teaching hospital in Baghdad. All the mammograms of the patients were studied and labeled by an experienced radiologist. Dataset was composed of two views CranioCaudal (CC) and Mediolateral-oblique (MLO) of one or two breasts. The dataset included 383 cases that were classified based on their BIRADS grade. Image processing included filtering, contrast enhancement using contrast limited adaptive histogram equalization (CLAHE), then removal of labels and pectoral muscle for improving performance. Data augmentation was also applied including horizontal and vertical flipping and rotation within 90 degrees. The data set was divided into a training set and a testing set with a ratio 9:1. Transfer learning of many models trained on the Imagenet dataset was used with fine-tuning. The performance of various models was evaluated using metrics including Loss, Accuracy, and Area under the curve (AUC). Python v3.2 was used for analysis with the Keras library. Ethical approval was obtained by the ethical committee from the College of Medicine University of Baghdad

Results: NASNetLarge model achieved the highest accuracy and area under curve 0.8475 and 0.8956 respectively. The least performance was achieved using DenseNet169 and InceptionResNetV2. With accuracy 0.72. The longest time spent for analyzing one hundred image was seven seconds.

Discussion and conclusion: This study presents a newly emerging strategy in diagnostic and screening mammography by using AI with the help of transferred learning and fine-tuning. Using these models can achieve acceptable performance in a very fast way which may reduce the workload burden among diagnostic and screening units.

Keywords: Breast Cancer, Artificial intelligence, Transfer learning, Mammogram

Ekta A. Malvania^1,2, Shilpa J. Parikh³, Vaishanavi Pathak⁴, Pranay B. Nayi⁴, Tadrushi A. Gandhi⁴, Nidhi N. Patel⁴

¹ PhD Scholar, Gujarat University, Ahmedabad, Gujarat, India.
² Reader, Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India.
³ Professor, Department of Oral Medicine and Radiology,Government Dental College and HospitalAhmedabad,Gujarat, India.
⁴ Intern, Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India.

Background Oral submucous fibrosis (OSMF), a premalignant condition of oral cavity is associated with usage of smokeless tobacco. The growing prevalence and cultural acceptance of consumption of flavored arecanut and related products along with traditional smokeless tobacco products are confounding the scenario.

Objectives: To find out clinical staging of OSMF and correlate it with consumption of smokeless tobacco usage related factors among subjects with oral sub mucous fibrosis in Ahmedabad city.

Methods: A cross sectional hospital-based study was conducted on 250 randomly selected clinically diagnosed OSMF subjects. The data regarding various demographic details and habit related factors was recorded in a pre-designed study proforma. The data obtained was statistically analyzed.

Results: Among 250 OSMF subjects, 9% were having grade I, 32% were having grade II, 39% were having grade III and 20% were having grade IV OSMF. 81.6% of males and 18.4% of females were having OSMF. The youngest age when habit was initiated was around of 8 years which is alarming in nature. The lowest duration reported to develop OSMF was 6 months. Statistically significant difference was observed between gender, duration, chewing time, swallowing of tobacco juice and clinical staging of OSMF.

Conclusion: It is alarming that around 70% of the total subjects of OSMF were in the younger age group. The community-oriented outreach programs along with strict policy formulation and implementation should be developed to curb the usage of arecanut and smokeless tobacco derivatives.

Keywords: arecanut, smokeless tobacco, OSMF

Lokesh Kumar S¹, Zameera Naik², Vasanti Lagali-Jirge², Sridhar M ², Arun Panwar ², Vaishali Keluskar ²

¹ Department of Oral Medicine, Radiology, and Special Care Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), 162, Poonamalle High Road, Chennai- 600077, Tamil Nadu, India.
² Department of Oral Medicine and Radiology, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research (KAHER), JNMC Campus, Nehru Nagar, Belagavi- 590010, Karnataka, India.

Background The prognosis of head & neck cancer (HNC) depends on its early detection, diagnosis, and treatment, which has advocated a search for a simple, reliable, noninvasive, cost-effective tool to aid in the same. Salivary lactate dehydrogenase has gained interest in recent years, meeting the above requisite.

Objectives: To evaluate the levels of salivary lactate dehydrogenase in patients with oral potentially malignant disorders (OPMD), HNC, and in the healthy control group (CG); to find the correlation, grade-wise and genderwise difference between them; and to assess whether it can be used as a potent biomarker in OPMD and HNC.

Materials and Methods: A comprehensive search of the specialized 14 databases and 4 institutional repositories was performed for including the studies evaluating salivary lactate dehydrogenase in OPMD and HNC patients either comparing or not comparing to the healthy control group in the systematic review process. The meta-analysis was performed with the eligible study data with the STATA version 16, 2019 software with 95% CI and p = 0.05 in the random-effects model.

Results: Twenty-eight studies of case-control, interventional, or uncontrolled non-randomized design evaluating salivary lactate dehydrogenase were included. A total of 2074 subjects were included, involving HNC, OPMD, and CG. The salivary lactate dehydrogenase levels were significantly higher in HNC than in CG & oral leukoplakia (OL) (p=0.00); in OL & oral submucous fibrosis (OSMF) than CG (p=0.00); and higher in HNC than OSMF, however not significant (p=0.49). Also, the salivary lactate dehydrogenase levels had no significant difference between males and females in CG, HNC, OL, and OSMF groups(p>0.05).

Discussion: It is evident that the epithelial transformations in the various OPMD and HNC, and the proceeding necrosis in the case of HNC, raises the LDH levels. It's also worth noting that when degenerative alterations continue, the SaLDH levels rise correspondingly, which are higher in HNC than in OPMD. Hence, it is essential to determine the cut-off values for SaLDH for establishing that the patient may have HNC or OPMD. It would be easy to follow-up frequently and perform investigations such as biopsy for the cases with high SaLDH levels, thereby aiding in the early detection and improving the prognosis of HNC. Moreover, the increased SaLDH levels were indicative of a lower degree of differentiation and an advanced disease leading to a poor prognosis. Salivary sample collection is less invasive, simple, and more acceptable to the patient; however, saliva collection is a time-consuming procedure as it is mostly collected by the passive spit method. Also, it is more feasible to repeat the SaLDH analysis during the follow-up, but the method has recently gained interest for over a decade.

Conclusion: Salivary lactate dehydrogenase can be a potential biomarker for the screening, early detection, and follow-up of OPMD or HNC being simple, noninvasive, cost-effective, and readily acceptable modality. However, more studies with new standardized protocols are recommended to determine the precise cut-off levels for HNC and OPMD.

Keywords (MeSH): L-Lactate dehydrogenase; Saliva; Mouth Neoplasms; Squamous Cell Carcinoma of Head and Neck; Oral; Precancerous conditions.

Moath Alfentoukh¹, Abdulwahab Salih¹, Mukhtar E. Hassan², Osamah Alghamdi³, Khadija A. Alkhawaja³, Mustafa A. Ibrahim³, Elsanousi Ibrahim Sabir³

¹ Department Of Urology, Armed Forces Hospital, King Abdulaziz Air Base, Dhahran, Kingdom of Saudi Arabia
² Department Of Pathology, Armed Forces Hospital, King Abdulaziz Air Base, Dhahran, Kingdom of Saudi Arabia
³ Department Of Surgery, Armed Forces Hospital, King Abdulaziz Air Base, Dhahran, Kingdom of Saudi Arabia

Desmoid tumors (DTs) account for 3% of all soft tissue tumors. They are benign and have no malignant potential with a favorable prognosis, and predominantly occur in young women. The pathogenesis and clinical behavior of DTs are still uncertain. In addition, most cases of DTs were associated with abdominal trauma (including surgery), while genitourinary involvement seemed to be quite rare. Up to now, there has been only one DT case with urinary bladder involvement reported in the literature. We, Hereby, report a 67-year-old male patient with left lower abdominal pain while micturition. Computed tomography (CT) showed a mass located at the lower aspect of the left rectus muscle with an extension attached to the urinary bladder. Based on the pathological findings of tumor specimen, a diagnosis of benign desmoid tumor (DT) of the abdominal wall was made. Laparotomy with wide local excision was carried out. The patient had a smooth postoperative recovery and was discharged after 10 days.

Introduction: Historically, MacFarland first described these tumors in 1832. Etymologically, the word desmoid was first coined by Muller in 1838 and is derived from the Greek word desmos, which means band or tendon-like. Stout first used the term fibromatosis in 1961[1,2,3]. Desmoid tumors (DTs) are a kind of rare neoplasm, which represents 3% of all soft tissue tumors and 0.03% of all neoplasms with an incidence of 5 to 6 per million of the population per annum[4,5,6]. DTs predominantly affect young females with a median age of 30 to 40 years old and is more than twice in female than male patients. However, there is no gender preference in older patients [7,8]. Furthermore, the symptoms of DTs are not typical in general. Symptoms can occasionally occur due to the size and location of the tumor but usually are nonspecific. Because of its rarity and unusual behavior, DT is often associated with diagnostic and therapeutic challenges. Computed tomography (CT) and magnetic resonance imaging (MRI) is beneficial for the diagnosis of this tumor but pathological diagnosis is mandatory. Surgical resection is now considered as the most efficient treatment option for patients with DT, because it offers a good chance of long-term survival. Our case is of unusual presentation and finding of abdominal wall desmoid tumor with an extension to urinary bladder in a male patient who is 67 years old.

Keywords: desmoid tumor, fibromatosis, spindle cell tumor, urinary bladder

Raja Anand¹, Malik Kanuj¹, Sundersingh Shirley²

Introduction or Background Pilomatrix carcinoma is a rare malignant neoplasm arising from the root of hair follicles, with only 150 cases described in the world literature. It is most commonly seen in the head and neck region.

Case Presentation: We describe a case of malignant pilomatrix carcinoma in a 62-year-old gentleman presenting as a solitary globular mass over the right anterior chest wall along with a brief review of literature.

Discussion and Conclusion: Surgical excision with a wide margin is the current standard of care for chest wall pilomatrix carcinoma and is associated with the least recurrence. Role of radiation as definitive treatment of the primary or as adjuvant therapy has not been clearly established

Keywords: pilomatrix carcinoma, chest wall neoplasm, hair follicle neoplasm, wide excision

Sithara Aravind¹, Jasmin Jose¹, Sangeetha K Nayanar¹, Sajith Babu T P²

¹ Division of Oncopathology,Clinical Lab Services & Translational Research, Malabar Cancer Centre, Thalassery, Kerala, India
² Dept of Head and Neck Surgery, Aster MIMS Kannur, Kerala, India

Ghost Cell Odontogenic Carcinoma is a rare malignant odontogenic tumor that can appear as "de novo" or arises from malignant transformation of preexisting benign calcifying odontogenic cysts or dentinogenic ghost cell tumors after multiple recurrences. Ghost cell odontogenic carcinoma is histopathologically characterized by ameloblast-like islands of epithelial cells with aberrant keratinization, simulating a ghost cell, with varying amounts of dysplastic dentine. This article reports an extremely rare case of ghost cell odontogenic carcinoma with foci of sarcomatous change, involving maxilla and nasal cavity which arose from a previously existing recurrent calcifying odontogenic cysts in a 54-year-old man and reviews the features of this unusual and rare tumor. To the best of our knowledge, this is the first case of ghost cell odontogenic carcinoma with sarcomatous transformation to be reported till date. Owing to its rarity and unpredictability of clinical course, long -term follow up of patients with ghost cell odontogenic carcinoma, is mandatory for observation of recurrence and distant metastasis.

Keywords: Ghost cell odontogenic carcinoma, maxilla, sarcoma, calcifying odontogenic cysts, ghost cells, odontogenic tumour