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Abstract Background Biomarkers that can predict outcome will improve the efficacy of treatment for HNSCC patients. In this regard, we retrospectively evaluated the prognostic effect of PD1, PD-L1, and CD45RO in tongue and larynx squamous cell carcinomas. Methods FFPE tissue blocks of 63 larynx and 40 tongue squamous cell carcinoma samples were selected, cut into 3 µm sections, and immunohistochemically stained for PD1, PD-L1, and CD45RO. The slides were evaluated by an expert pathologist, and results were analysed using Chi-square, univariate, and multivariable Cox regression methods. Results TC-PD-L1 expression (P = 0.001) and its expression intensity (P = 0.002) were significantly correlated with a higher percentage of PD-1 + tumor infiltrating lymphocytes. In univariate survival analysis, TC-PD-L1 and its expression intensity had a significant impact on both DFS (HR: 0.203; P = 0.003 and HR: 0.320; P = 0.005) and OS (HR: 0.147; P = 0.002 and HR: 0.322; P = 0.005). Based on the multivariate analysis, PD1 (DFS: HR: 3.202; P = 0.011, OS: HR: 2.671; P = 0.027) and TC-PD-L1 (DFS: HR: 0.174; P = 0.006, OS: HR: 0.189; P = 0.009) were found to be independent prognostic markers. In the second part, scoring systems were defined based on the expression status of PD1 and PD-L1. Patients with higher scores were expected to have longer DFS and OS. In multivariate analysis, the PD1/TC-PD-L1 (DFS: P = 0.001, OS: P = 0.003) scoring systems showed superior prognostic effects. Interestingly, at the highest levels of this score, none of the patients experienced recurrence or cancer-caused death. Conclusion Collectively, this study suggests negative prognostic behaviour for TC-PD-L1 protein and introduces the PD-1/TC-PD-L1 scoring system as a strong prognostic marker in OS and DFS prediction of tongue and larynx HNSCC patients.

Background: This study aimed to evaluate serum vitamin D levels in patients with oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC) in comparison to healthy controls in an Iranian population. Method: A cross-sectional study was conducted, which included 69 patients with OLP, 40 patients with OSCC, and 60 healthy controls. Serum vitamin D levels were measured using the ELISA method. The data were analyzed using Mann-Whitney and T-tests, and statistical significance was set at P < 0.05. Results: The study found that 17.9% of OLP patients, 27.25% of OSCC patients, and 25% of the control group had normal vitamin D levels. The mean vitamin D level in OLP patients (17.00 ± 14.16 ng/mL) was significantly lower than that in the control group (22.99 ± 14.46 ng/mL) (P = 0.003). However, in OSCC patients, the mean vitamin D level (24.63 ± 16.19 ng/mL) was not significantly different from that of the control group. Conclusion: The study revealed a high rate of vitamin D deficiency and insufficiency in OLP, OSCC, and control group patients. Vitamin D deficiency was more common in patients with OLP. Vitamin D deficiency may potentially increase the risk of OLP and OSCC development and progression.

Introduction:The active vitamin D metabolites have anticancer effects on many human neoplasms. The vitamin D receptors have been detected in salivary glands tissue. This study aimed to evaluate the serum level of vitamin D in patients with malignant and benign salivary gland tumors.Materials and Methods:In this retrospective and cross-sectional study, 151 participants, including 42 patients with benign, 42 malignant salivary gland tumors, and 67 healthy subjects, participated. The serum level of vitamin D was measured using an enzyme-linked immunosorbent assay (ELISA).Results:The mean serum level of vitamin D was 42.7 ng/mL in patients with benign tumors, 40 ng/mL in malignant tumors, and 36.7 ng/mL in the control group. There was no significant difference between the mean vitamin D level and vitamin D status in patients with salivary gland tumors and normal controls (P=0.2). There was a significant positive correlation between vitamin D level and age in the control group (P=0.04).Conclusions:The results showed a high prevalence rate of vitamin D deficiency/insufficiency in salivary gland tumors and normal subjects, with no significant difference. Therefore, the serum level of vitamin D might not play a significant role in the pathogenesis of these tumors, similar to many human cancers. However, further prospective studies are recommended focusing on specific tumors and considering other interventional factors.

Abstract Introduction Oral Squamous cell Carcinoma (OSCC) is the most common oral cancer and is treated with surgery, radiotherapy and chemotherapy. Various complications of treatment include xerostomia, mucositis, and trismus, which affect patients’ quality of life. The aim of this study is to evaluate the mortality, recurrence rate and prevalence of oral complications in treated patients. Method and materials This cross-sectional study reviewed 326 cases of patients with OSCC who were referred to public health centers in Shiraz (Khalili Hospital and Dental School) from 2010 to 2020. All patients were contacted, and the survivors were called and examined by an oral physician. A medical record was created for them, including demographic information, location of the lesion, type of treatment, history of recurrence, metastasis and oral complications. Results 53.5% of patients were male and 46.5% were female. The mean age of patients was 58.68 years. Mortality and recurrence rate was respectively 49.8% and 17.8%. The most common location of the lesion was tongue (64%). Surgery was done for all patients. 97.4% of patients complained of xerostomia, 46.2% of mucositis and 44.3% of trismus. Conclusion The most common complications of treatment are xerostomia, mucositis, and trismus, respectively. Frequent and regular follow-ups and supportive therapies reduce these complications and improve patients’ quality of life.

Abstract Background A crucial role for the immune system has been proposed in the establishment and progression of head and neck squamous cell carcinoma (HNSCC). In this study, we investigated the cytokine and regulatory profiles of T cells in tumor draining lymph nodes (TDLNs) of patients with HNSCC. Results The frequencies of CD4+TNF-α+ and CD4+TNF-αhi negatively were associated with poor prognostic factors such as LN involvement (P = 0.015 and P = 0.019, respectively), stage of the disease (P = 0.032 and P = 0.010, respectively) and tumor size (P = 0.026 and P = 0.032, respectively). Frequencies of CD8+IFN-γ+ and CD8+IFN-γ+ TNF-α+ T cells showed negative relationship with tumor grade (P = 0.035 and P = 0.043, respectively). While, the frequencies of CD4+IL-4+, CD8+IL-10+, CD8+IL-4+T cells were higher in advanced stages of the disease (P = 0.042, P = 0.041 and P = 0.030, respectively) and CD4+IFN-γ+TNF-α−, CD8+IL-4+ and CD8+IFN-γ+TNF-α− T cells were higher in patients with larger tumor size (P = 0.026 and P = 0.032, respectively). Negative associations were found between the frequencies of CD4+CD25+Foxp3+ and CD4+CD25+Foxp3+CD127low/− Treg cells and cancer stage (P = 0.015 and P = 0.059). Conclusion This study shed more lights on the changes in immune profile of T cells in TDLNs of HNSCC. Larger tumor size and/or LN involvement were associated with lower frequencies of CD4+TNF-α+, CD8+IFN-γ+ and CD8+IFN-γ+TNF-α+ but higher frequency of CD4+IL-4+ T cells. Moreover, Foxp3+Tregs correlated with good prognostic indicators.

Statement of the Problem: Heat shock protein 27 (HSP27) plays important roles in many cellular processes and has been implicated in different types of diseases such as cancers.Purpose: This study aimed to evaluate the serum level of HSP27 in patients with salivary gland tumors and to determine its possible correlation with the prognosis of the disease.Materials and Method: This cross-sectional study was performed on 60 patients with salivary gland tumor including 16 pleomorphic adenoma, 33 adenoid cystic carcinoma, 6 mucoepidermoid carcinoma, 5 acinic cell carcinoma, and 28 healthy control subjects. The control cases were healthy blood donors who matched the study group in age and sex. Serum samples were obtained from the clotted blood and HSP27concentrations were measured with sandwich enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed by using one-way ANOVA, post Hoc test, independent sample t-test, and ROC analysis. A p value of less than 0.05 was considered as significant.Results: The mean serum level of HSP27 was 3956.1±3830.1 (pg/ml) in patients with malignant salivary gland tumor, which was significantly higher than that in benign salivary gland tumor (752.2±485.6) and healthy controls (602.3±575.8) (p< 0.001). However, there was no significant difference in the HSP27 serum levels between the patients with benign salivary gland tumors and healthy controls (p= 0.2). No association was detected between the mean serum levels of HSP27 and clinicopathologic factors such as age, sex, stage and nodal metastasis (p> 0.05), except for the tumor size (p= 0.04).Conclusion: The HSP27 concentration increased in patients with malignant salivary gland tumors. Moreover, the HSP27 level was correlated with tumor growth, invasiveness, and diagnosability. Yet, larger clinical studies are required to explore its prognostic value.

Aims. Salivary gland tumors (SGTs) are a rare and diverse group of tumors that account for 3 to 10% of all head and neck malignancies. We aimed to conduct a comprehensive epidemiological analysis of SGTs in the south of Iran and compare the findings with previous reports from Iran and other parts of the world. Methods. Using a retrospective study, 405 patients diagnosed with SGTs were observed over an eight-year period between April 2013 and October 2021 in Shiraz, Iran. Patients’ demographic and clinicopathological features were obtained from patients’ records. Quantitative and descriptive data analysis was performed using SPSS software. Results. There were 302 benign (74.5%) and 103 (25.4%) malignant SGTs. Pleomorphic adenoma and Warthin’s tumors were the most common benign SGTs (70.5% and 21.5%, respectively). The most common malignant SGTs were mucoepidermoid carcinoma and adenoid cystic carcinoma (26.2% and 22.3%, respectively). There was a statistically significant association between tumor origin and its malignancy status (p

Aim. Long noncoding RNAs (lncRNA) ANRIL and its genetic polymorphisms are shown to be associated with the risk of several cancers. However, the single nucleotide polymorphisms (SNPs) of lncRNA ANRIL are not thoroughly assessed in oral squamous cell carcinoma (OSCC) which is the most prevalent cancer in the head and neck area. Thus, this study aimed to assess the association of SNP of lncRNA ANRIL rs4977574 in patients with OSCC. Methods and Materials. 106 blood samples from the patients with OSCC were obtained with a gender- and age-matched control group to evaluate the SNP of rs4977574 of lncRNA ANRIL. The DNA was extracted using the salt-out technique and DNA genotyping was undertaken using specific primer pairs in the tetra-primer ARMS-PCR technique. Eventually, the frequency of wild-type (A) and the mutated allele (G), as well as the genotypes were estimated between the groups of patients with OSCC and healthy individuals. Results. The results of our study indicated no statistically significant difference in the frequency of rs4977574 A/G of lncRNA ANRIL among the patients with OSCC and healthy individuals (p>0.05). Likewise, no significant difference was found in the genotypes’ frequencies (p>0.05). Nevertheless, the marked association of GG with smaller tumor size and the high level of differentiation of OSCC cells in the presence of AA or AG genotypes were interesting outcomes of this study (p0.05). Conclusions. The results of our study indicate that rs4977574 A/G and its genotypes do not have any direct correlation with the presence of OSCC; however, its association with the smaller tumor size and the level of the cancer cells differentiation could imply its possible indirect role.

Introduction: Submandibular gland resection is a controversial issue in patients with oral tongue squamous cell carcinomas (SCC). This study aimed to determine the frequency of submandibular gland involvement in patients who had undergone elective submandibular gland resection following oral tongue SCC. Materials and Methods: This cross-sectional retrospective study was performed between 2001 and 2017 on patients with oral tongue SCC who had undergone glossectomy in a referral center for otorhinolaryngology surgery, Shiraz, Iran. Results: In this study, 131 patients were included. Their mean age was 59.84 years (range: 19-86). The mean tumor size was 2.83 cm (range 0.3-7). The vast majority (92%) of the patients were at stage III-IVa and had well (55%) to moderate (31%) differentiated tumor. The mean diameter of the submandibular gland was 3.87 cm (range: 1.5-6 cm). There was only one (0.76%) patient with submandibular involvement. She was an 80-year-old woman with a T2 well differentiated tumor without cervical lymph node involvement in the neck node dissection. Conclusion: In patients with oral tongue SCC, submandibular gland involvement is rare and its elective resection in not recommended.

Abstract Background Orbital mucormycosis is a rare but potentially severe and troublesome invasive fungal infection that could be occurred even in healthy individuals. The initial clinical presentation is similar to bacterial pre-septal or septal cellulitis, especially in early stages. Case presentation Herein, we describe the successful management of a series of five cases presenting with orbital mucormycosis in previously healthy children. Conclusions Orbital mucormycosis is extremely rare in healthy children and maybe life-threatening when diagnosis delayed given a similar clinical presentation with bacterial septal cellulitis. Intravenous antifungal therapy with amphotericin B and timely surgical drainage is live-saving.

Background and Objectives: Despite a low prevalence, salivary gland tumors (SGTs) represent a diverse set of tumors with a broad range of biologic behaviors. Implementation of early detection programs has significantly improved the outcome of treatment and patients' survival. High mobility group box 1 protein (HMGB1) may likely be a candidate for the detection of SGTs due to its background in other human tumors. This study, for the first time, aimed to investigate the clinical value of HMGB1 in patients with benign and malignant SGTs and analyze its correlation with clinicopathologic outcomes. Material and Methods: Using an enzyme-linked immunosorbent assay (ELISA), the serum level of HMGB1 was measured in 85 patients with SGTs (30 benign and 55 malignant cases) and 85 age- and sex-matched healthy individuals. Results: HMGB1 levels had a significant difference between patients with SGTs and healthy controls (2041.4±787.1 pg/ml versus 536.3±374.6 pg/ml, p

Abstract Background The European Organization for Research and Treatment of Cancer QOL Core Questionnaire 30 (EORTC QLQ-30) and the Assessment of Cancer Therapy-General (FACT-G) are the two most widely used measures of cancer-specific health-related quality of life (HRQOL). This study aims to assess whether the two instruments measure the same constructs of HRQOL in patients with total laryngectomy. Methods The EORTC QLQ-30 and the FACT-G was completed by 132 patients with total laryngectomy. Convergent, discriminant, and construct validity of the EORTC QLQ-C30 and the FACT-G were assessed by Spearman’s correlation and explanatory factor analysis. Results The results of factor analysis showed that the EORTC QLQ-C30 and the FACT-G measure different aspects of HRQOL. Moreover, both instruments showed excellent convergent and discriminant validity, except for nausea and vomiting symptom subscale in the EORTC QLQ-C30 questionnaire. The internal consistency was close or greater than 0.7 for all domains of both instruments except for functional wellbeing in FACT-G. Conclusions This study revealed that neither of the two instruments can be replaced by the other in the assessment of HRQOL in Iranian patients with total laryngectomy. Accordingly, clinicians should exactly define their research questions related to patient-reported outcomes before choosing which instrument to use.

Introduction: Endostatin is a C-­terminal proteolytic fragment of collagen XVIII and, as with angiostatin and thrombospondin, is known as an anti­angiogenic agent. The aim of this study was to assess the level of serum endostatin in patients with oral squamous cell carcinoma (SCC), and its association with the clinicopathological characteristics of the tumor. Materials and Methods: Using an enzyme-linked immunosorbent assay (ELISA) kit, we investigated the circulating levels of endostatin in the blood serum of 45 patients with oral SCC and 45 healthy controls. Results: The mean level of serum endostatin in patients was significantly lower (68.8±85 ng/ml) than in healthy controls (175.6±73 ng/ml) (P

Statement of the Problem: Squamous cell carcinoma (SCC) is the most frequent oral cancer whose 5-year survival rate is 80% for early-detected lesions and nearly 30-50% for advanced lesions. Early detection of oral cancers and precancerous lesions can improve the patient’s survival and decrease the morbidity. Purpose: This study aimed to evaluate and compare the Ki-67 and MCM3 expression in cytologic smear of oral SCC (OSCC). Materials and Method: We examined 48 oral brush biopsies including 28 OSCC and 20 healthy non-smoking samples. Immunocytochemistry staining was performed for Ki-67 and MCM3 by using an EnVision-labeled peroxidase system, and labeling index (LI) was calculated. Results: Out of 28 OSCC cases, 27(96.4%) cases contained MCM3 positive cells and 22(78%) cases contained Ki-67 positive cells. All normal mucosa were Ki-67 and MCM3 negative. MCM3 and Ki-67 LI were significantly higher in OSCC than normal mucosa (p< 0.001). MCM3 LI was significantly higher than Ki-67 LI in OSCC group (p< 0.001). Conclusion: Immunocytologic evaluation of Ki-67 and MCM3 can be used for early detection of OSCC. Furthermore, MCM3 may be a more sensitive cytologic biomarker than Ki-67 in SCC patients.

Introduction: Cyfra 21 is a serum-soluble fragment of cytokeratin19. Increased Cyfra 21 serum levels and their benefit as a tumor marker have been shown in some malignancies. This study aimed to evaluate the serum levels of Cyfra 21 in patients with benign and malignant salivary gland tumors. Materials and Methods: In this cross-sectional study, the serum level of Cyfra 21 in 44 patients with malignant salivary gland tumors and 16 cases of pleomorphic adenoma were compared with 28 healthy controls using enzyme-linked immunosorbent assay (ELISA). Data were analyzed statistically using the Kruskal Wallis test, analysis of variance (ANOVA) and Spearman’s correlation tests. Results: Mean serum levels of Cyfra 21 were 0.135 ± 0.285 ng/ ml in the control group, 0.167 ± 0.142 ng/ ml in patients with pleomorphic adenoma and 1.059 ± 3.251 ng/ml in patients with malignant salivary gland tumors. There was no significant difference among groups. Cyfra 21 levels did not correlate with location of tumor, clinical stage or cigarette smoking. Conclusion: Results of the present study showed no significant difference in Cyfra 21 serum level in salivary gland tumors compared with normal individuals. In addition, Cyfra 21 serum level was not sufficiently sensitive to function as a tumor marker in salivary gland tumors.

Background and objective: Oral tongue Squamous Cell carcinoma (SCC) commonly involves males between the sixth to eighth decades of life. Major risk factors are tobacco usage and alcohol consumption. The increasing number of patients developing oral tongue cancer without these well-known risk factors suggests that a viral infection, such as Human Papillomavirus (HPV), may be responsible for this increase, by acting as an oncogenic agent. This study investigated the prevalence of HPV infection and its clinicopathologic significance in oral tongue SCCs. Material and methods: Tissue blocks from a total of 50 cases (patients with oral tongue SCC) and 50 controls (palatine tonsillar tissues with benign diagnosis) were selected. DNA was extracted from tumoral and non-tumoral tissue blocks. Detection of common HPV DNA by nested Polymerase Chain Reaction (PCR), and high-risk genotypes, HPV 16 and HPV 18, by conventional PCR, was achieved and the results correlated with clinicopathological parameters. Results: Of the 50 patients (18 males and 32 females with a mean age of 57.36±12.18 years, and age range of 27 to 86 years), 7 (14%) had HPV positive results. None of the control group subjects had HPV DNA positive results (P-value of 0.012). The HPV genotype 16/18 was not detected in positive cases. No statistically significant association was found between HPV status and gender, age, tumor grade, tumor stage or lymph node involvement. Conclusion: Although there was a significantly higher prevalence of HPV in oral tongue SCC, its association with carcinogenesis in this area requires further studies.

Background: Because of its effect on speech and swallowing, laryngeal squamous cell carcinoma is a devastating disease which has been shown to have a poor survival rate. Abundant research is being carried out in search of novel biomarkers that can aid the process of diagnosis and treatment of this disease. FXYD3, a modulator of Na/K-ATPase, is presented as a biomarker in some cancers. FXYD3 expression has been shown to be effected reversely by tumor necrosis factor alpha. Tumor necrosis factor alpha is a pro-inflammatory cytokine proposed to play an important role in tumor promotion and progression. In our study we examined FXYD3 and tumor necrosis factor alpha mRNA expressions, their correlation with each other and with clinicopathologic parameters in tumor tissues and lymph nodes. Methods: We assessed 75 tissue samples and 30 lymph node samples of laryngeal squamous cell carcinoma patients and compared them to 9 adjacent normal tissue samples by quantitative real-time polymerase chain reaction. Results: FXYD3 mRNA expression showed no significant difference among different tissues. We observed significantly lower tumor necrosis factor alpha mRNA expression in laryngeal tumor tissues compared to adjacent normal tissues. FXYD3 showed significant correlations with node metastasis (N factor), differentiation grade, and regional metastasis in lymph nodes. FXYD3 and tumor necrosis factor alpha mRNA levels significantly correlated in tumor and normal tissues. Conclusion: FXYD3 might be involved in the dedifferentiation and metastasis process of laryngeal squamous cell carcinoma. This biomarker has contributed to the aggressiveness and progression of the tumor. Verification of the observed results will need evaluation in a larger group of patients.

Background: Salivary gland tumors are among malignancies that have high recurrence rate. Immune responses in salivary gland tumors have not been well elucidated. T helper type 1 (Th1) and Th2 cytokines have been reported to play a role in the outcome of head and neck cancers. Objective: To evaluate the serum levels of interferon gamma (IFN- γ), as the hallmark of Th1 cytokines, and interleukin-4 (IL-4), as the hallmark of Th2 cytokines, in patients with benign and malignant salivary gland tumors in comparison with healthy controls. Methods: Fifty patients with benign and 14 patients with malignant salivary gland tumors, as well as 23 healthy individuals were recruited. Serum levels of IFN-γ and IL-4 were measured using ELISA method. Nonparametric tests were used for data analysis. Results: Serum levels of IFN-γ and IL-4 were found not to be significantly different in patients compared to the control group (0.68 ± 0.29 vs. 1.03 ± 0.57 pg/ml, p=0.58 for IFN-γ, 4.57 ± 1.57 vs. 4.41 ± 1.31 pg/ml, p=0.28 for IL-4). IFN-γ and IL-4 serum levels were also not significantly different between patients with benign and malignant salivary gland tumors (p=0.54 and p=0.86, respectively). Conclusion: The systemic levels of IL-4 and IFN-γ seem not to be associated with salivary gland tumor in our study. Investigation of other cytokines produced by Th1 and Th2 cells are warranted.

Introduction: Salivary gland tumors (SGTs) are important parts of human neoplasms. The most common SGT is pleomorphic adenoma and the most common malignant SGTs are mucoepidermoid carcinoma and adenoid cystic carcinoma (ACC). Metastasis-associated genes 1 (MTA1), a member of the nucleosome remodeling and histone deacetylation complex, is one newly discovered gene which recruits histone deacetylation, causing ATP-dependent chromosome remodeling, and regulating transcription. MTA1 had been shown to be overexpressed in malignant tumors with the enhancement of invasion and metastasis. Materials and Methods: Fifty-six samples of salivary tumors from the Khalili Hospital archive, including 20 cases of pleomorphic adenoma, 17 cases of mucoepidermoid carcinoma, 19 cases of ACC, and 23 cases of normal salivary gland tissues were chosen for immunohistochemical analysis of MTA1. Results: MTA1 expression in the malignant tumors was significantly higher than that in pleomorphic adenoma (P0.05). Conclusion: Our findings demonstrate that MTA1 was significantly overexpressed in malignant salivary gland neoplasm in comparison to a lower level in benign pleomorphic adenoma, suggesting that MTA1 protein might be involved in carcinogenesis.

Introduction: Vascular endothelial growth factor is thought to be an important angiogenic factor involved in tumor growth, progression, and metastasis. Objective: The present study evaluated the relation between tissue expression, serum and salivary levels of vascular endothelial growth factor in head and neck squamous cell carcinomas, and their correlation with clinicopathologic features. Methods: Samples were collected from 30 patients with head and neck squamous cell carcinomas and 24 healthy volunteers. Immunohistochemical analysis was used for tissue expression and enzyme-linked immunosorbent assay was employed to measure serum and salivary levels. Results: No vascular endothelial growth factor staining was observed in normal tissues, whereas vascular endothelial growth factor expression was seen in 6 patients (20%). Mean serum level of VEGF was 83.7 ± 104.47 in patients and 50.04 ± 32.94 in controls. Mean salivary level of vascular endothelial growth factor was 174.41 ± 115.07 in patients and 149.58 ± 101.88 in controls. No significant difference was found by Mann-Whitney test between controls and patients (p = 0.411, p = 0.944, respectively). No correlation was found between vascular endothelial growth factor tissue expression and its serum and salivary level. Conclusion: Overexpression of vascular endothelial growth factor was found in head and neck squamous cell carcinoma patients, suggesting its role in the pathogenesis of head and neck squamous cell carcinoma, but no relation was found between tissue expression, serum levels, and salivary levels of this marker.

Background: Treg cells are the most potent suppressants of antitumural activity of immune system and expression of CTLA-4 is essential for activation of FOXP3+ T-cells. IL-10 is an immunosuppressor which is one of the major obstacles of specific tumoral T-cells. Objective of this study was comparison of expression of FOXP3, CTLA-4 &IL10 genes among patients with and without laryngeal cancer local metastasis and patients with lymph node ivolvement. Material and Methods: 59 patients with laryngeal cancer which 8 of them had lacal metastasis were enrolled in this study. Also 31 samples of lymph node tissues were taken. The percentage and expression of FOXP3, CTLA-4 &IL10 genes were investigated by Real-Time PCR. Results: The results indicated that there were not any significant difference between laryngeal cancer patients with or without local metastasis and also between patients with or without lymph node involvement in percentage of FOXP3, CTLA-4 and IL-10 genes expression (P>0/05). As well as there were no statistical association with the genes expression and different stages and pathological differentiation of tumors (P>0/05). Conclusion: There is no significant association between percentage of expression of FOXP3, CTLA-4 and IL-10 genes in our patients with laryngeal tumor considering local invasion extension and lymph node involvements.

Introduction: Epistaxis is one of the most common medical emergencies, making the management of posterior epistaxis a challenging problem for the ear, nose, and throat (ENT) surgeon. In the cases of conservative management failure, ligation of the major arteries or percutaneous embolization of the maxillary artery is performed routinely in most units, but rates of failure and complications are high.The objective of this study was to assess the effectiveness of endoscopic sphenopalatine artery (SPA) cauterization in patients with refractory posterior epistaxis. Materials and Methods: Between April 2011 and January 2012, 27 patients (15 males and 12 females) with refractory posterior epistaxis underwent endoscopic SPA cauterization in two tertiary referral hospitals in Shiraz. Three patients underwent bilateral cauterization. Results: Four patients (from 30 arteries) had new epistaxis after surgery, three experienced subsequent epistaxis requiring medical treatment, and one patient had a minor epistaxis not needing treatment. Conclusion: The SPA electrocoagulation technique seems to be safe, simple, fast, and effective with low rates of morbidity and complications for the management of refractory posterior epistaxis. Endoscopic SPA cauterization should be considered as an immediate second-line management when conservative treatment as first-line management fails.

Introduction: The presence of HER-2 has been shown to be a prognostic factor in many kinds of cancers, but its role in head and neck squamous cell carcinoma (HNSCC) is not still defined. The purpose of the current study is to investigate the role of HER-2 in HNSCC and its correlation with various clinicopathologic parameters. Materials and Methods: Peripheral blood samples were obtained from 17 healthy volunteers and 69 patients with HNSCC before curative surgery. The HER-2 level was determined in each sample by sandwich ELISA. Statistical analysis was performed using an independent t-test, one-way ANOVA, and Mann-Whitney Test. Results: Mean HER-2 serum levels in patients with HNSCC compared with healthy controls was not statistically significant (3.85ng/ml vs. 3.75ng/ml; P>0.05). The mean serum level of HER-2 was higher in patients with lymph node involvement, metastasis, invasion, tumor size ≥2 cm, and stage>1, although the differences were not statistically significant (P>0.05). Discussion: Mean HER-2 serum levels in patients with tumor size T3 and higher were greater than those from patients in stage T1 and T2, a finding which may be translated into disease progression, growth and invasiveness. Conclusion: In this study the mean HER-2 serum level in patients with HNSCC was found statistically insignificant compared with the healthy control group. The role of soluble HER-2 as a tumor marker is still controversial and needs further studies to clarify its clinical relevance for early detection or screening for HNSCC.

Introduction: The presence of HER-2 has been shown to be a prognostic factor in many kinds of cancers, but its role in head and neck squamous cell carcinoma (HNSCC) is not still defined. The purpose of the current study is to investigate the role of HER-2 in HNSCC and its correlation with various clinicopathologic parameters. Materials and Methods: Peripheral blood samples were obtained from 17 healthy volunteers and 69 patients with HNSCC before curative surgery. The HER-2 level was determined in each sample sandwich by ELISA. Statistical analysis was performed using an independent t-test, one-way ANOVA, and the Duncan procedure. Results: Mean HER-2 serum levels were higher in patients with HNSCC compared with healthy controls, although the difference was not statistically significant (3.85ng/ml vs. 3.75ng/ml; P>0.05). The mean serum level of HER-2 in patients with was higher in patients with lymph node involvement, metastasis, invasion, tumor size ≥ 2 cm, and stage >1, although the differences were not statistically significant (P>0.05). Conclusion: In this study the mean HER-2 serum level in patients with HNSCC was found to be greater in comparison with the healthy control group, although the difference was statistically insignificant. From the analysis of the results of the current study we have come to the conclusion that by increasing sample size the rising of the serum HER-2 level in patients with HNSCC can be meaningful. Apart from this, the role of HER-2 as a tumor marker in patients with HNSCC is still controversial and needs further studies to clarify the significance of this biomarker for early detection or screening for HNSCC.

Introduction: The association between asthma and sinonasal disease has been established for years. As sinonasal disease is one of the factors that exacerbates asthma, effective treatment of this disorder may also improve and stabilize the asthmatic condition. This study examines the outcome of endoscopic sinus surgery (ESS) on asthmatic patients with massive nasal polyposis. Materials and Methods: Forty-five asthmatic patients were included in the study. All were operated on and analyzed in our department. A questionnaire (SNOT-20) investigating the subjective evaluation of asthma and sinonasal states was presented to the patients, while objective evaluations including nasal rhinoscopy, forced expiratory volume in 1 second (FEV1), and steroid use were conducted with 1–2 years of follow up. Results: Quality of life (QoL) improved in 97.8% of patients, while clinical symptoms, emotional signs, and social signs improved in 97.7%, 84.4%, and 93.3%, respectively. Medication use for asthma showed a similar improvement, with approximately 80% of patients reducing and 75.6% of patients discontinuing steroid use. A total of 91.1% of patients showed improvement in post-operative FEV1. Conclusion: ESS achieved a beneficial effect on sinonasal and asthma symptomatology in patients with nasal polyps and asthma. QoL was also improved in these patients.

O carcinoma espinocelular (CEC) é a neoplasia mais comum do trato aerodigestivo superior. A interleucina-13 (IL-13) é uma citocina imunorreguladora com polimorfismos relatados para seu gene associados com a mesma doença, especialmente asma e alergia. O presente estudo investigou se os polimorfismos do gene da IL-13 (posições 1055C/T no gene promotor da 1L-13 e +2044G/T exon 4) podem distinguir os pacientes com CEC de cabeça e pescoço de controles saudáveis. MÉTODO: O estudo analisou pacientes com CEC de cabeça e pescoço (n = 137) pareados por idade e sexo com um grupo de controles saudáveis (n = 127). A genotipagem do polimorfismo do gene da IL-13 foi executada pelo método de polimorfismo no comprimento de fragmentos de restrição baseado em reação em cadeia da polimerase. RESULTADOS: Não foram identificadas diferenças estatisticamente significativas nas frequências dos genótipos e alelos entre pacientes e controles em ambas as posições (p = 0,16). Além disso, não foi observada associação entre os genótipos investigados e outros fatores prognósticos, como idade, sexo, localização do tumor primário, tamanho do tumor e tabagismo. CONCLUSÃO: O presente estudo sugere que não há associação entre os polimorfismos do gene da IL-13 (nas posições -1055C/T e +2044GI A) e suscetibilidade dos pacientes a CEC de cabeça e pescoço.Squamous cell carcinoma (SCC) is the most common malignancy that involves the upper aerodigestive tract. Interleukin-13 (IL-13) is an immunoregulatory cytokine that has been reported to have some polymorphisms in it gene associated with same disease especially asthma and allergy. The present study aimed to investigate whether the polymorphisms of IL-13 gene (at positions of 1055C/T in the promoter of1L-13 gene and +2044G/T exon-4) differ in patients with head and neck SCC from healthy controls. METHODS: This study was investigated in patient with head and neck SCC (n = 137) and age- and sex-matched healthy controls (n = 127). Genotyping of IL-13 gene polymorphism was performed using polymerase chain reaction-based restriction fragment length polymorphism method. RESULTS: No statistically significant differences were found in the frequencies of genotypes and alleles between patients and control group at both sites (p = 0.16). In addition, no association was observed between investigated genotypes and other potential prognostic factors such as age, sex, primary tumor site, tumor size and smoking. CONCLUSION: This study suggests that there is no association between IL-13 gene polymorphisms (at position -1055C/T and +2044GI A) and susceptibility of the patients to SCC of head and neck.

Introduction: HER2/neu, a member of the epidermal growth factor receptor family, has been shown to be over-expressed in some tumors. The purpose of this study was to determine the salivary levels and tissue expression of HER2/neu in patients with head and neck squamous cell carcinoma (HNSCC) and their correlation with clinicopathologic parameters. Materials and Methods: Enzyme-linked immunosorbent assays (ELISA) were used to evaluate the salivary levels of HER2/neu and immunohistochemistry was used to measure tissue expression of HER2/neu in 28 patients with HNSCC and 25 healthy control subjects. Results: The salivary levels of HER2/neu in patients with HNSCC were not significantly higher compared to healthy control subjects. There was no apparent correlation between salivary HER2/neu levels and clinicopathological features such as age, sex, tumor grade, tumor size and nodal status. All HNSCC specimens were positive (membranous or/and cytoplasmic) for HER2/neu, except one sample. Only one HNSCC specimen showed staining purely in the tumor-cell cytoplasm. All control specimens were also positive for both membranous and cytoplasmic HER2/neu but there was a significant difference between the level of cytoplasmic staining in the HNSCC specimens and in the control specimens (P

Introduction: HER2/neu, a member of the epidermal growth factor receptor family, has been shown to be over-expressed in some tumors. The purpose of this study was to determine the salivary levels and tissue expression of HER2/neu in patients with head and neck squamous cell carcinoma (HNSCC) and their correlation with clinicopathologic parameters. Materials and Methods: Enzyme-linked immunosorbent assays (ELISA) were used to evaluate the salivary levels of HER2/neu and immunohistochemistry was used to measure tissue expression of HER2/neu in 28 patients with HNSCC and 25 healthy control subjects. Results: The salivary levels of HER2/neu in patients with HNSCC were not significantly higher compared to healthy control subjects. There was no apparent correlation between salivary HER2/neu levels and clinicopathological features such as age, sex, tumor grade, tumor size and nodal status. All HNSCC specimens were positive (membranous or/and cytoplasmic) for HER2/neu, except one sample. Only one HNSCC specimen showed staining purely in the tumor-cell cytoplasm. All control specimens were also positive for both membranous and cytoplasmic HER2/neu but there was a significant difference between the level of cytoplasmic staining in the HNSCC specimens and in the control specimens (P

Introduction: Hearing is essential for humans to communicate with one another. Early diagnosis of hearing loss and intervention in neonates and infants can reduce developmental problems. The aim of the present study was to assess the prevalence of hearing impairment in newborns admitted to a neonatal intensive care unit (NICU) and analyze the associated risk factors. Materials and Methods: This cross-sectional study was conducted to assess the prevalence of hearing loss in neonates who were admitted to the NICU at Nemazee Hospital, Shiraz University of Medical Sciences between January 2006 and January 2007. Auditory function was examined using otoacoustic emission (OAE) followed by auditory brainstem response (ABR) tests. Relevant potential risk factors were considered and neonates with a family history of hearing loss and craniofacial abnormality were excluded. For statistical analysis logistic regression, the chi-squared test, and Fisher’s exact test were used. Results: Among the 124 neonates included in the study, 17 (13.7%) showed hearing loss in the short term. There was a significant statistical relationship between gestational age of less than 36 weeks (P=0.013), antibiotic therapy (P= 0.033), oxygen therapy (P=0.04), and hearing loss. On the contrary, there was no significant relationship between hearing loss and use of a ventilator, or the presence of sepsis, hyperbilirubinemia, congenial heart disease, transient tachypnea of newborn, congenital pneumonia, or respiratory distress syndrome. Conclusion: Auditory function in neonates who are admitted to a NICU, especially those treated with oxygenor antibiotics and those born prematurely, should be assessed during their stay in hospital. The importance of early diagnosis of hearing loss and intervention in these neonates and avoidance of any unnecessary oxygenor antibiotic therapy needs to be further promoted.

Malignant lymphoma may occur in the oral cavity and oropharynx, but is most commonly located in Waldeyer's ring, particularly in the palatine and lingual tonsil. The occurrence of malignant lymphoma in the tongue is very rare. Clinical features are nonspecific ulcerative lesions that do not heal. In the literature, the majority of casesare non-Hodgkin’s lymphoma, diffuse large B cell type; however T-cell phenotype also may occur. We describe a 60-year-old man who presented with an ulcerative mass in the left lateral aspect of his tongue, unresponsive to medical therapy. After tissue biopsy, histopathological and immunohistochemical analyses confirmed a diagnosis of non-Hodgkin’s lymphoma, diffuse large B cell type.

Introduction: Maxillary osteomyelitis is a rare phenomenon. If it occurs, evaluation for underlying disease especially osteopetrosis must be considered. Osteomyelitis occurs as a complication in 10% of the cases of osteopetrosis. Case report: This is a case report of maxillary osteomyelitis presented in a 15-year old boy with osteopetrosis. In this case, the disease represented mainly with facial pain and swelling and also drainage from facial skin fistulas in bilateraral infraorbital area and lower eyelids. Diagnosis was confirmed by clinical and radiological findings. Treatment consisted of surgical debridment and intravenous antibiotic therapy which led to partial response. Conclusion: Maxillary osteomyelitis is a rare phenomenon. If it occurs, evaluation for underlying disease especially osteopetrosis must be considered.

Introduction: Actinomycosis is a systemic chronic bacterial infection caused by Actinomyces Israelii, an anaerobic organism normally resident in the human mouth. However, the actinomycosis of the larynx is very rare, and only about 15 cases have been reported in the literature so far. Most of the cases reported occurred in patients who had previously undergone radiotherapy for laryngeal cancer. Case Report: Here we report a case of actinomycosis of the larynx in a 14-year-old shepherd boy who was not immunocompromised but had a history of tooth extraction two months prior to admission to the hospital and severe laryngitis one year prior to admission. Conclusion: Laryngeal actinomycosis might be related to poor oral hygiene and mucosal barrier disruption, as well as to being immunocompromised.

Background: The present study aimed to report the characteristics and treatment outcomes of five patients with nasopharyngeal adenoid cystic carcinoma and a literature review. Methods: Between 2000 and 2009, five consecutive patients (4 men, 1 woman) were diagnosed with nasopharyngeal adenoid cystic carcinoma and treated at our institution. Three patients had stage IVa (T4N0M0) and two patients had stage III (T3N0M0) cancer. Primary treatment consisted of concurrent chemoradiation in three patients andradiotherapy alone in two patients. Surgery was limited to endoscopic biopsy for histological diagnosis. Results: Four patients achieved complete response during or after completion of treatment and remained free of disease for a median of 27 months. Four patients developed local recurrence 8-30 months after initial treatment. The fifth patient is alive and free of disease.Conclusion: The findings of the present study and literature review suggest that local failure is a major problem in adenoid cystic carcinoma of the nasopharynx.

O presente estudo tem por objetivo relatar as características, fatores prognósticos e desfecho de tratamento de 18 casos de melanoma da mucosa nasossinusal e conduzir uma revisão da literatura. MÉTODO: Entre 1995 e 2005, 18 pacientes consecutivos diagnosticados com melanoma da mucosa do trato nasossinusal e tratados em nossa instituição. Para encontrar as principais casuísticas de estudos relacionados, conduzimos uma revisão da literatura em PubMed e Scopus. No total, encontramos 35 casuísticas, incluindo 1.077 pacientes com melanoma da mucosa nasossinusal. RESULTADOS: Encontramos 16 homens e 2 mulheres. A idade de apresentação foi 51-80 anos (mediana de 58 anos). Todos os pacientes sofreram excisão cirúrgica seguida de radioterapia com ou sem quimioterapia. A mediana de sobrevida foi de 15 meses e a sobrevida geral de 5 anos foi de 23%. Sob análise univariada, estadiamento e remissão completa após tratamento inicial foram importantes fatores prognósticos. Entretanto, sob análise multivariada, somente estágio da doença teve significância estatística. CONCLUSÃO: Melanoma nasossinusal é um tumor raro e agressivo com alto fracasso locorregional e distante e pobre desfecho de tratamento. Entretanto, em uma revisão da literatura, encontramos significativa melhora em termos de sobrevida de 5 anos para casuísticas recentes comparadas com casuísticas previamente relatadas.The present study aimed at reporting on the characteristics, prognostic factors and treatment outcomes of 18 cases of nasosinusal mucosa melanoma, and do a literature review on the subject. METHODS: between 1995 and 2005, 18 patients consecutively diagnosed with nasosinusal mucosa melanoma were managed in our institution. We reviewed the literature in PubMed and Scopus in order to find the main series from studies associated with this topic. We found a total of 35 series, involving 1,077 patients with nasosinusal mucosa melanoma. RESULTS: we found 16 men and 2 women, with age at presentation between 51 and 80 years (median of 58 years). All these patients were submitted to surgical excision followed by radiotherapy with or without chemotherapy. The survival median was 15 months, and the 5-year general survival had a percentage value of 23%. Considering our univariate analysis: tumor staging and complete remission after initial treatment were deemed relevant prognostic factors. Nonetheless, considering the multivariate analysis, only disease stage was statistically significant. CONCLUSION: nasosinusal melanoma is a rare and aggressive tumor, with high loco-regional and distant failure rates, and poor treatment outcomes. Notwithstanding, in a literature review we found significant improvements considering the 5-year survival for recent series when compared to previously reported ones.

Introduction: IL-8 is one of the pro-inflammatory cytokines which can play an essential role in the pathogenesis of chronic rhinosinusitis (CRS) as well as nasal polyposis (NP). The ability of individuals in producing IL-8 is partially determined by IL-8-251 A/T polymorphism. Hence, the aim of the present study was to investigate the association between IL-8-251 A/T and CXCR2 +1208 C/T genes polymorphisms and susceptibility to CRS and NP. Materials and Methods: Two hundred and forty fiveCRS patients and 204 healthy controls were included in this study. CRS patients were categorized by the existence or absence of NP. IL-8 promoter-251 A/T and CXCR2 +1208 C/T gene polymorphisms were genotyped via the allele specific PCR (AS-PCR) method. Results: While no remarkable difference was demonstrated between patients and controls for both CXCR2 +1208 C/T and IL-8 -251 A/T polymorphisms, a significant increase in IL-8-251 AA genotype was detected in CRS patients with NP compared to those without it (29.3% and 16.2%, respectively; P=0.03). Interestingly, this association got far stronger when only non-asthmatic CRS patients were taken into consideration (P=0.001). Conclusion: The results of the present study indicate that the inheritance of IL-8-251 Aallele is associated significantly with NP development in CRS patients. Therefore, NP formation might be a result of the exposure to an intense inflammatory environment, which is more likely in genetically susceptible CRS patients.

Here, we describe young men with synovial sarcoma in the palatine tonsil, who presented with a 3-4 month history of progressive sore throat, tonsillar ulcerativemass and bleeding. Clinical and radiological examinations revealed that the tumors arose from the palatine tonsil and extended to the parapharyngeal space. Both tumors were too advanced to remove completely; therefore, they underwent surgical debulking during tonsillectomy and partial pharyngectomy. Histopathological and immunohistochem-ical studies confirmed the diagnosis of synovial sarcoma of the palatine tonsil. Despite postoperative radiotherapy and systemic chemotherapy, they relapsed 18 and 22 months later. The first patient died from unresectable local recurrent disease three years after primary diagnosis, and the second patient is alive after 36 months, but suffers from unresectable locoregional recurrent disease and is receiving palliative chemotherapy and supportive care.

O gene supressor tumoral p53 abriga um polimorfismo funcional que codifica ou arginina (Arg) ou prolina (Pro) no códon 72 da proteína p53. Este polimorfismo tem sido considerado associado com o desenvolvimento e prognóstico do carcinoma espinocelular de cabeça e pescoço (CECP). OBJETIVO: Foram avaliados genótipo e freqüências alélicas do códon 72 do p53 em pacientes iranianos com CECP. TIPO DE ESTUDO: Estudo de Caso. MATERIAIS E MÉTODOS: Um total de 132 pacientes com CECP e 123 controles saudáveis foram genotipados. A fonte de DNA foi composta de células mononucleares do sangue periférico. A amplificação do DNA foi realizada através da reação em cadeia da polimerase específica para alelos. RESULTADOS: A distribuição dos alelos e genótipos não foi significativamente diferente entre os pacientes e controles. Além disso, nenhuma associação estatisticamente significativa foi encontrada entre o polimorfismo do códon 72 do p53 e localização, sexo ou idade no momento do diagnóstico. No entanto, o genótipo Pro/Pro estava significativamente aumentado em pacientes no estágio IV (30,8%) quando comparado ao estágio I-III da doença (11,1%) (p=0,03), e um número significativamente maior de doentes com o alelo Pro teve um aumento no risco de desenvolver doença no estágio IV (OR=2,2, IC= 95% =1.2-4.2, p=0,01). CONCLUSÃO: Os dados revelaram que o polimorfismo do p53 não afeta o risco de CECP em iranianos; porém, pode afetar a progressão para um estágio superior tumor.p53 tumoral suppressor gene harbors a functional polymorphism which codes either arginine (Arg) or proline (Pro) in the protein p53 of codon 72. Such polymorphism has been associated with the development or prognosis of head and neck squamous cell carcinoma (HNSCC). AIM: we assessed codon 72 p53 allelic frequencies and genotypes in HNSCC Iranian patients. STUDY DESIGN: Case Study. MATERIALS AND METHODS: a total of 132 HNSCC patients and 123 healthy controls were genotyped. DNA source was from mononuclear cells of the peripheral blood. DNA amplification was done by means of the allele-specific polymerase chain reaction. RESULTS: genotypes and allele distribution were not significantly different between patients and controls. Moreover, no statistically significant association was found between the 72 and p53 codon tumor location, gender or age at the time of diagnosis. However, the Pro/Pro genotype was significantly increase in stage IV patients (30.8%) when compared to stages I-III of the disease (11.1%) (p=0.03), and a significantly higher percentage of patients with the Pro allele had and a risk increase in stage IV disease (OR=2.2, 95% CI=1.2-4.2, p=0.01). CONCLUSION: data revealed that the p53 polymorphism do not impact the risk of HNSCC in Iranians, nonetheless, it can affect tumor progression to a higher tumor stage.

Introduction: Galectin-3, a member of the family of ?-galactoside-bindinganimal lectins, has been implicated in tumor invasion and metastasis.Materials and Methods:Using an ELISAkit, we assessed the circulating levelsof galectin-3 in sera from 40 oral squamous cell carcinoma (OSCC) patients and from43 healthy controls.Results:Serum galectin-3 levels in OSCC patients were significantly higher(5.1±2.5 ng/ml) when compared with healthy controls (2.6±3.07 ng/ml, P

Introduction: Concurrent cisplatin-based chemoradiation is currently considered the treatment of choice for locoregional nasopharyngeal carcinoma. Celecoxib is a selective cyclooxygenase-2 (COX-2) inhibitor which can potentially enhance the effect of radiotherapy. The aim of this study was to determine the efficacy and safety of celecoxib in nasopharyngeal carcinoma. Materials and Methods: Patients with newly diagnosed locoregional nasopharyngeal carcinoma were included in this clinical trial study. The patients were assigned to receive 7 weeks concurrent chemoradiation with weekly cisplatin and either celecoxib 100 mg twice daily or placebo. After completion of chemoradiation, all patients received combined chemotherapy with cisplatin plus 5-Fu every 3 weeks for 3 cycles. Clinical response rates and treatment-related toxicity were the primary and secondary end-point of the study. Results: Total of 50 eligible patients with the median age of 43 years were enrolled in the trial. Overall (complete and partial) clinical response rate was 100% in both groups. Complete and partial clinical response rates were 64% and 36% in study group and 44% and 56% in control group respectively (P>0.25). There was no difference in terms of treatment-related toxicity rates between two groups. Conclusions: This clinical trial showed that addition of celecoxib 100 mg twice daily to concurrent chemoradiation does not increase the response rates and treatment-related toxicities in patients with locoregional nasopharyngeal carcinoma.

Introduction: Nasal polyposis is an inflammatory condition of unknown etiology. Recently concerns regarding gastroesophageal reflux or helicobacter pylori as a possible pathologic cause of nasal polyps have been increasing. The present study was planned to investigate the presence of helicobacter pylori in nasal polyps. Materials and Methods: This case-control study was undertaken enrolling 37 patients with nasal polyps who had undergone nasal endoscopic sinus surgery and 38 control subjects. Biopsy specimens of nasal polyps and inferior turbinates were assessed by rapid urease test. Blood samples of both study and control subjects were evaluated for anti H.pylori IgG by ELISA. H. pylori status was regarded positive, if both tests were positive. Results: Seropositivity was more common in the patients with nasal polyps (66.2%) than control subjects (36.8%) (P

We present a case of allergic fungal sinusitis (AFB) in a 20-year old man with few months' history of bilateral nasal obstruction and discharge with unilateral proptosis that underwent maxillary antrostomy due to the mass in paranasal sinuses. Histological examination of tissue showed branching fungal hyphae interspersed with allergic mucin without fungal invasion to soft tissue. The patient received local steroid for 4 months and had no problem during follow up. Fungal culture was performed and Bipolaris fungus grew. Although most dematiaceous fungal infections occur in immunocompetent patients, the incorrect diagnosis and insufficient treatment may be life threatening.

CONTEXT: Malignant neural sheath tumors of the trigeminal nerve affecting the nasal cavity and the paranasal sinuses are extremely rare. With conventional optical microscopy, their identification is difficult, and it is necessary to confirm them by means of electron microscopy and immunohistochemical techniques. CASE REPORT: The patient was a 41-year-old woman with a ten-month progressive history of pain followed by painful edema in the left facial region, and with symptoms of bleeding, secretion and nasal obstruction. Studies with imaging methods suggested the presence of an expansive process in the left nasal and paranasal cavities. In the biopsy, the histopathological findings from optical microscopy were suggestive of a tumor of neural origin in the trigeminal nerve. Immunohistochemical and electron microscopy studies confirmed that it was a malignant tumor of the neural sheath of the trigeminal nerve. We describe the clinical, radiological, and histological features of this tumor and review the literature.