Myxoid type of malignant fibrous histiocytoma of the maxillary sinus: a case report

Myxofibrosarcoma was originally described as the myxoid variant of Malignant Fibrous Histiocytoma [MFH], a high-grade and aggressive sarcoma, which is very uncommon in the head and neck region, with about 100 cases reported up to now. MFH occurring in the maxillary sinus is so rare that only 23 cases have been reported. We hereby report a case of myxofibrosarcoma in the maxillary sinus. The case was a 54-year-old male with symptoms of toothache in the right posterior maxillary teeth, a swelling adjacent to maxillary molar region and symptoms of chronic maxillary sinusitis. In clinical examination, the teeth were sensitive to percussion and palpation, but no caries and restoration was detected on his molar teeth. He was suffering from local pain and tenderness over his midface and mild fever, fatigue and some nonspecific vague pain. CT scan showed a mass lesion involving right nasal cavity, maxillary and ethmoidal sinuses. A lowgrade malignancy arising from the right maxillary sinus was highly suspected. A surgery was done to remove the mass. The histological and immunohistochemical studies proved the diagnosis of myxoid variant of Malignant Fibrous Histiocytoma. Therefore radiotherapy and chemotherapy was started for the patient but six months later the symptoms returned and CT scan showed a right maxillary and ethmoidal mass that extended to base of the skull. Maxillectomy and ethmoidectomy were performed for the patient, but 2 months later he died because of the extension of the tumor, which confirmed the necessity of early diagnosis. Amplified radical surgery is the first choice of treatment. The second surgery has special value to the recurrent patients. Radiotherapy alone or chemotherapy alone is not effective to MFH of head and neck region

Pilomatrix carcinoma with subsequent pulmonary metastases: a case report

Pilomatrix carcinoma is the malignant counterpart of the pilomatrixoma which is a hamartoma of the hair matrix. It is a rare locally aggressive skin tumor with a great tendency for recurrence but its metastatic potential is limited. We report a pilomatrix carcinoma with proven metastases to the lung in a 51-year old man who was admitted to the hospital for respiratory symptoms such as productive cough with green colored sputum and halitosis since one year ago

unusual presentation of ulcerative colitis in a young girl: a case report

Pulmonary manifestations of ulcerative colitis have been well recognized, but incidence of bronchiectasis is rare, particularly in children. In this study, a 16-year old girl is presented with rectorrhagy and abdominal cramp, who developed pulmonary symptoms as productive cough and dyspnea after a short period of time. Arterial blood gas [ABG] analysis showed hypoxia and hypercapnea. Chest x- ray and high resolution computerized tomography [HRCT] demonstrated honey comb pattern and changes indicating bronchiectasis in lower segments of both lungs. Ulcerative colitis pattern was present in rectosigmoid biopsy. Open lung biopsy was performed to achieve definite diagnosis. Pathologic findings along with clinical and radiological presentations revealed a bronchiectatic pattern. The patient underwent treatment with bronchodilators, sulfasalazine and prednisolone; consequently, the symptoms were relieved

Pulmonary complications of chemical warfare 15 years after exposure

Chemical weapons, [mainly mustard gas-MG] were heavily used by Iraq against Iranian soldiers between 1984-1986. It has acute effects on respiratory tract in the form of tracheobronchitis and ARDS, whereas chronic respiratory complications include chronic bronchitis, bronchiectasis, asthma and pulmonary fibrosis. There are few reports about human victims. Some of them describe acute effects while our purpose is to define chronic sequelae and their microbiologic, radiologic and physiologic behavior. Fourty four chemical weapon injured patients with moderate to severe disability were selected by AMA criteria [1]. All of them underwent history taking and physical examination, ABG, spirometry, CXR, HRCT, bronchoscopy and BAL for cytology and quantitative culture. Of fourty four patients; 29[66%] had diagnosis of chronic bronchitis by ATS criteria [2], 8 [18%] and 7 [16%] had diagnosis of bronchiectasis and asthma respectively. The most common HRCT finding was ground glass appearance. In one-fourth of patients BAL culture was positive and revealed unusual organisms [S.aureus, S.coagulase negative, E.coli]., BAL neutrophils were increased in bronchiectatic group [258 136 hpf] vs. [96 49 hpf], [148 133 hpf] [p<0.01 p]. Bronchiectatic patients were younger than the other groups [35.5 6.1 yr] vs. [43.5 5.2 yr], and [42.3 5.2 yr] [p<0.01]. The most common respiratory complication of MG is chronic bronchitis. Unusual microorganisms should be considered in the treatment of pulmonary infections. Persons who are exposed to mustard gas at younger age maybe more prone to development of bronchiectasis