Background: Although Wilms’ tumor 1 (WT1) mRNA overexpression is frequently observed in myelodysplastic neoplasms (MDS), its clinical and molecular significance remains incompletely defined across diverse populations; this study is the first to evaluate WT1 expression in Iranian patients with MDS.

Materials and Methods: WT1 expression was assessed in 58 MDS patients using an ELN-certified quantitative RT-PCR assay. Associations with clinical subtype, hematologic features, cytogenetic profiles, and molecular mutations were analyzed. Survival outcomes were evaluated using Kaplan–Meier and Cox regression analyses.

Results: WT1 overexpression was detected in 79.3% of patients and was significantly associated with advanced subtypes (MDS-EB1/EB2) and higher IPSS-R risk groups. Elevated WT1 levels correlated with an increased bone marrow (BM) blast percentage (P < 0.01). Although cytogenetic abnormalities were more frequent in patients with WT1 overexpression, the association did not reach statistical significance. No significant correlations were observed with peripheral blood (PB) cytopenias or mutations in RNA splicing genes. Importantly, WT1 overexpression was associated with shorter overall survival (OS) and progression-free survival (PFS). However, in multivariate analysis, ≥10% BM blasts and an abnormal karyotype remained independent predictors of poor outcome, whereas WT1 overexpression itself was not independently prognostic.

Conclusion: WT1 overexpression in MDS is associated with advanced disease features and poorer survival, though it is not an independent prognostic value. Its measurement may complement existing risk stratification, particularly in resource-limited settings.

Background: Acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) are rare blood cancers with poorer survival in adolescents and young adults (AYAs) than in children. Pediatric-inspired regimens like CALGB 10403 have improved outcomes in AYAs. This study evaluated the effectiveness, feasibility, and treatment-related toxicities of CALGB 10403 in AYAs with ALL/LBL treated at Seyed Al-Shohada Hospital, Isfahan, Iran, from December 2021 to May 2024

Materials and Methods: AYAs aged 17-39 with newly diagnosed ALL/LBL (excluding Burkitt, Ph+, and prior treatment) were included.  Baseline characteristics and outcomes of interest (induction response, event-free and overall survivals) were collected.  Induction response was assessed via bone marrow (ALL) or CT scan/biopsy (LBL). Minimal residual disease (MRD) was evaluated by flow cytometry. Treatment-related toxicities were monitored and graded per CTCAE criteria. The feasibility of implementing the CALGB 10403 protocol was evaluated by measuring treatment delays.

Results: Seventeen AYA patients with newly diagnosed ALL/LBL (median age 21) were enrolled, mostly male (14/17). Fourteen had ALL, and three had LBL. Extramedullary involvement was seen in 29%, including lymphadenopathy, bulky mediastinal masses, and CNS involvement. Sixteen patients (94%) achieved remission, with no deaths during the induction course. One-year EFS and OS were 77% and 100%, respectively. Common toxicities included hyperbilirubinemia, elevated transaminases, and infections. Treatment delays, mainly from non-adherence, occurred in 53%. Eight patients achieved MRD negativity after Course I.

Conclusion: This study provides insights into the first Iranian experience with the CALGB 10403 protocol for AYAs with ALL/LBL, a regimen that has demonstrated encouraging survival outcomes in U.S. trials.

caused by uncontrolled activation of macrophages and cytotoxic T cells. It is frequently underdiagnosed, leading to significant morbidity and mortality in pediatric populations. Early identification and treatment are critical to improving prognosis.

Materials and Methods: This retrospective study analyzed demographic, clinical, and laboratory data of pediatric patients aged 0 to 18 years diagnosed with HLH according to the HLH-2004 criteria. Patients admitted to our center between February 2021 and February 2023 were included. We aimed to describe common presenting symptoms, laboratory  abnormalities , treatment modalities, and patient outcomes.

Results: A total of 35 children diagnosed with HLH were included; 51% were female. The mean age was 6.1 years, with an age range from birth to 18 years. Fever was the most frequent presenting symptom, reported in 85% of cases. Hemophagocytosis in bone marrow aspirates was detected in 41% of patients. The overall mortality rate was 11%. Notably, 20% of patients tested positive for anti-COVID-19 IgG antibodies, suggesting a possible temporal association with the development of HLH, Comparative analysis indicated that deceased patients had significantly lower fibrinogen levels (p = 0.04) and higher triglyceride levels (p = 0.03). Treatment regimens varied according to clinical presentation and severity.

Conclusion: HLH remains a challenging diagnosis due to its variable presentation and potential to rapidly progress to life-threatening immune activation. Prompt recognition and timely initiation of appropriate therapy are vital for improving outcomes in affected children. Increased awareness among clinicians and early intervention can reduce morbidity and mortality associated with this condition.

Background: Osteoarthritis (OA) is a disease that causes disability, limited joint movement, and limitations in daily activities. No agreed-upon therapy or procedure has been proven to prevent the damage caused by osteoarthritis. However, research on the use of conditioned media in experimental animals demonstrated healing of cartilage defects, as proven by macroscopic, microscopic, and immunohistochemical analysis.

Materials and Methods: The research was conducted at Dr. Moewardi General Hospital, Surakarta, Central Java, Indonesia. This was a translational clinical trial that included patients with Kellgren-Lawrence grade 2-3 knee joint OA (n=10) treated with intra-articular injections of umbilical cord mesenchymal stem cell-conditioned media. Injections were administered five times at one-week intervals. Patients were evaluated at 2, 4, and 6 months. The data collected included KOOS, KSS, and WOMAC scores, as well as MRI T2 mapping sequence (CartiGram) examination.

Results: Functional score assessment using KOOS, KSS, and WOMAC showed significant differences between pre-treatment scores and those at the 2nd, 4th, and 6th months post-treatment. However, there were no significant differences between the scores at the 2nd and 4th months, or between the 4th and 6th months. MRI T2 mapping sequence (CartiGram) showed improvement in cartilage signal in all samples.

Conclusion: Allogenic umbilical cord mesenchymal stem cell-conditioned media therapy led to improvement in cartilage quality on MRI T2 mapping sequence (CartiGram) and in knee functional scores. No patients experienced direct side effects from the therapy.

Hepatocellular carcinoma (HCC) is a crucial health concern worldwide, representing a leading cause of cancer-related mortality and the most common form of primary liver cancer. The aggressive nature of HCC is mainly due to its high intention for invasion and metastasis, processes that are regulated by a complex network of genetic and molecular pathways. Among the critical regulators of these processes is microRNA-21 (miR-21), a small non-coding RNA that has been implicated in various oncogenic activities. This review provides a comprehensive analysis of the role of miR-21 in promoting HCC metastasis progression, with a particular focus on its interaction with key signaling pathways, including the PTEN/PI3K/AKT, PDCD4/AP-1, RECK/MMP, and TIMP-3 axes. By targeting tumor suppressors, miR-21 facilitates epithelial-to-mesenchymal transition (EMT), invasion, and metastasis of HCC cells. Understanding the molecular mechanisms regulated by miR-21 not only sheds light on the pathogenesis of HCC but also highlights possible therapeutic targets for combating this aggressive cancer.

Over the past three decades, stem cell therapy has undergone rapid development and has emerged as a novel treatment for many major disorders. This systematic review aims to analyze the current landscape of stem cell research publications in Iraq comprehensively. By identifying and critically evaluating existing progress, this review provides a robust overview of the field, informing the development of a well-designed national roadmap for future advancements. This analysis serves as a valuable scientific reference both within Iraq and internationally, fostering further progress in Iraqi stem cell research. Data on Iraqi stem cell publications were collected from scientific databases such as the Iraqi Academic Scientific Journals Database, Google Scholar, Scopus, PubMed, Science Direct and other search engines. These publications were classified and analyzed to evaluate their status in the field. In our systematic review, we analyzed 132 articles on Iraqi stem cell research, including 21 review articles, 9 cancer stem cell studies, and 102 methodological studies, spanning from 1977-2024. Our findings highlight a rapid increase in publications, particularly in recent years, demonstrating significant progress in stem cell research within Iraq. Key areas of focus include the therapeutic applications of stem cells, cancer stem cells, and methodological advancements, with the majority of studies utilizing human, mouse, and rat samples. This comprehensive analysis underscores the evolving landscape and the need for continued collaboration and strategic planning in Iraqi stem cell research. Our systematic review revealed a significant increase in Iraqi stem cell research publications over recent years. This growth reflects substantial progress and the critical need for continued collaboration and strategic planning to further advance the field.

Integrating supportive and palliative care into the oncology program is considered essential for effective cancer management. Despite the challenges that low- and middle-income countries such as Iran face in providing comprehensive supportive and palliative care services, continuous efforts are directed towards improving services and infrastructure. In this regard, the Iranian Cancer Control Center (MACSA) plays a fundamental role in providing supportive and palliative care with special emphasis on expanding services and ensuring equitable access for cancer patients in Iran. Through joint efforts with various organizations and hospitals, coupled with the implementation of effective leadership strategies, MACSA has tried to integrate its services into a referral hospital system in order to continuously improve and expand services and meet the multifaceted needs of patients and families affected by cancer. Indeed, MACSA's initiatives to embed supportive and palliative care within the framework of usual care in referral hospitals are critical in improving outcomes and quality of life for people battling cancer. The interdisciplinary nature of supportive and palliative care, involving a specialized team, is essential for efficient service delivery, cost-effectiveness, and overall quality of care.

Oral lichen planus (OLP) is a chronic, T-cell-mediated inflammatory disease of the oral mucosa, notable for its symptomatic burden and potential for malignant transformation. While corticosteroids and immunosuppressants remain the standard of care, their transient efficacy and adverse effect profile underscore a significant unmet clinical need. Mesenchymal stem cells (MSCs), with their multifaceted immunomodulatory and regenerative capabilities, are emerging as a compelling therapeutic alternative. This editorial synthesizes current evidence, positing that MSCs can fundamentally disrupt the immunopathogenic cycle of OLP. We explore the mechanisms by which MSCs re-establish immune tolerance and promote tissue repair, and we critically assess the translational pathway from preclinical models to clinical application. Despite promising results, the journey to clinical adoption necessitates overcoming hurdles in standardization, delivery, and safety profiling. We argue that MSC-based therapy represents not merely an incremental improvement, but a potential paradigm shift towards a curative strategy for this recalcitrant disease.

Paraneoplastic pemphigus (PNP) is a rare, severe autoimmune mucocutaneous disorder most commonly associated with lymphoproliferative malignancies. Here, we report the first documented case of PNP as a paraneoplastic manifestation of multiple myeloma (MM). A 61-year-old male with MM developed widespread mucocutaneous ulcerations shortly after his eleventh chemotherapy cycle, initially suspected to represent Stevens–Johnson syndrome. Clinical examination revealed diffuse skin peeling, mucosal involvement of the eyes, oral cavity, and genital region, and a positive Nikolsky sign. Laboratory evaluation demonstrated acute kidney injury requiring hemodialysis. Despite initial treatment with high-dose intravenous immunoglobulin, lesions persisted. Skin biopsy revealed lichenoid lymphocytic infiltration, basal vacuolar changes, subcorneal and suprabasal acantholysis, and keratinocyte dyskeratosis, confirming PNP. Viral serologies were negative, supporting the autoimmune etiology. The patient was subsequently treated with rituximab, resulting in significant improvement of cutaneous lesions over three months, with residual post-inflammatory hyperpigmentation. This case emphasizes the importance of early recognition and accurate differentiation of PNP from other blistering disorders in patients with underlying hematologic malignancies. Importantly, this represents the first reported instance of PNP presenting as a paraneoplastic manifestation of MM, highlighting the need for awareness of atypical autoimmune syndromes in this population

This case report describes the presentation for a 65-year-old patient with Sweet's syndrome (SS) presenting with systemic symptoms of general weakness, fever, and painful skin lesions on the right arm. He reported a history of weight loss with night sweats, while skin lesions manifested as erythematous plaques and painful papules. The diagnosis was confirmed by skin biopsy, which showed features of significant neutrophilic infiltrations on histopathology. Further investigations led to the diagnosis of AML associated with Sweet's syndrome. The study highlights the importance of prompt diagnosis of Sweet's syndrome as a paraneoplastic sign and using multi-disciplinary approach for diagnosis and management of patients with skin lesions and cytopenias.

Rhabdomyosarcoma (RMS) is a primitive mesenchymal malignancy of childhood and is very rare in adults. In the presence of a soft tissue mass, bone marrow metastasis of RMS is easy to diagnose. However, RMS can rarely present with extensive marrow replacement, without an obvious primary- a very challenging situation for the pathologist as well as the clinician. Owing to the classical round cell morphology, metastatic RMS is morphologically indistinguishable from acute leukemia, especially when the cells are singly scattered, rather than in clusters. We report a rare presentation of bone marrow metastasis of embryonal RMS in an adult, who presented only with pancytopenia and leucoerythroblastic blood picture. Bone marrow aspiration revealed near total replacement of the hematopoietic elements by atypical blast-like cells, which were singly scattered as well as arranged in loose clusters focally. The case was worked up as acute leukemia. Flow cytometric immunophenotyping ruled out acute leukemia. The trephine biopsy was more in favor of a metastatic tumor; hence, a PET-CT was performed. The scan revealed diffuse uptake in the axial and appendicular skeleton, along with enlarged supraclavicular lymph nodes. An excision biopsy of the lymph node clinched the diagnosis of metastatic RMS, which was confirmed by immunohistochemistry for desmin and Myo-D1. This report highlights a rare case of adult embryonal RMS and emphasizes the importance of a multidisciplinary diagnostic approach for metastatic disease in this population.

Supradiaphragmatic lymphadenopathy is a rare finding in prostate cancer. The occurrence of multiple lymphadenopathies forming a conglomerate that resembles lymphoma is also rarely encountered in prostate cancer diagnosis. We present the case of a 71-year-old man who has experienced bilateral leg swelling in the last four months. Multiple lymphadenopathies were detected in the intra-abdominal and supradiaphragmatic regions, along with several metastatic bone lesions. Histopathological and immunohistochemical evaluations confirmed a diagnosis of prostate adenocarcinoma, not otherwise specified (NOS), with a Gleason score of 4+3=7, classified as grade group III, indicating high-volume metastatic prostate cancer. The patient was treated with docetaxel and anti-androgen therapy. His condition was improved after eight cycles of chemotherapy, and his prostate-specific antigen (PSA) levels returned to normal.