Prevalence of human papilloma virus in sinonasal papilloma in southern Iranian population

Statement of the Problem: Sinonasal papilloma [SNP] is a rare benign lesion characterized by high recurrence rate and malignant transformation

Purpose: This study aimed to investigate the prevalence of human papilloma virus [HPV] infection in these lesions in South of Iran

Materials and Method: In this cross sectional retrospective study, a total of 41 patients, 38 SNP and 3 SNP/Squamous cell carcinoma cases, from 2007 to 2014 were studied. Human papilloma virus [HPV] DNA detection was performed by nested PCR method and positive cases were analyzed for high risk HPV-16 and HPV-18

Results: HPV was detected in 31.7%; HPV- 16 in 4.9% and HPV 18 was not detected at all. Dysplastic epithelium was detected in 53% that was not associated with HPV. Three cases were accompanied with malignant transformation that HPV genome was detected in only one case and none of them were positive for HPV16 /18 genomic DNA

Conclusion: Current research suggests that HPV may be involved in the development of SNP. But the high risk HPV is not important in malignant transformation. More studies are needed to elucidate the possible etiologic mechanism between HPV, inverted papilloma, and squamous cell carcinoma

Evaluation of the Ki-67 and MCM3 expression in cytologic smear of oral squamous cell carcinoma

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 bi-omarker than Ki-67 in SCC patients

T-helper type 1 and 2 cytokine levels in patients with benign and malignant salivary gland tumors

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- [gamma]], 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-[gamma] and IL-4 were measured using ELISA method. Nonparametric tests were used for data analysis

Results: serum levels of IFN-[gamma] 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-[gamma], 4.57 +/- 1.57 vs. 4.41 +/- 1.31 pg/ml, p=0.28 for IL-4]. IFN-[gamma] 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-[gamma] seem not to be associated with salivary gland tumor in our study. Investigation of other cytokines produced by Th1 and Th2 cells are warranted

Serum level of matrix metalloproteinase-9 in patients with salivary gland tumor

Statement of the Problem: Matrix metalloproteinases [MMPs] have been implicated in the pathogenesis of certain diseases and cancers via tissue destruction and can be secreted into the blood stream. MMP9 expression in the salivary gland tissue was evaluated but their serum level in the salivary gland tumors was not studied

Purpose: The aim of our study was to determine the concentration of serum MMP-9 in healthy participants and in patients with salivary gland tumor

Materials and Method: Using an ELISA kit, the circulating levels of MMP-9 in sera from 58 patients with salivary gland tumor [31 pleomorphic adenoma, 17 adenoid cystic carcinoma and 10 mucoepidermoid carcinoma] and 30 healthy controls was assessed

Results: The serum MMP9 level in patients with salivary gland tumors [380.0 +/- 301.3 pg/ml] also patients with benign tumors [354.3 +/- 218.7 pg/ml] [354.3 +/- 218.7 pg/ml] were significantly lower than that in the healthy group [727.4 +/- 624.6 pg/ml] [Respectively p= 0.02 and p= 0.01]. Mean serum MMP9 concentration in malignant tumors was [402.3 +/- 441.8pg/ml] higher than benign tumors [354.3 +/- 218.7 pg/ml] but the difference was not significant [p= 0.9]

Conclusion: Our results showed that serum level of MMP9 decreased in patients with salivary gland tumors which suggest that MMP9 may not have a potential role in development and pathogenesis of salivary gland tumor

Anaplastic solitary plasmacytoma of mandible, masquerading as sarcoma

Plasma cell neoplasm is characterized by a monoclonal neoplastic proliferation of plasma cells and solitary plasmocytoma of bone [SPB] is a localized form. It usually occurs in vertebrae and secondarily in long bones. Its presence in mandible is extremely rare event. A 48-year-old man consulted to our clinic with a chief complaint of pain in his mandible. Radiography revealed a destructive lesion in body and ramus. The initial pathologic evaluation revealed a high grade pleomorphic neoplasm. The diagnosis was confirmed by immunohistochemical markers. Overall, plasmacytoma with anaplastic features can be confused with high grade sarcoma clinically and histologically

Strong association of ctla-4 variation [ct60a/g] and ctla-4 haplotypes with predisposition of Iranians to head and neck cancer

Variations in Cytotoxic T Lymphocyte Antigen-4 [CTLA-4] affect the expression and function of this protein. We aimed to investigate the association of +49 A/G [rs231775], +1822 C/T [rs231779] and +6230 A/G [CT60, rs3087243] genetic variations, as well as the merged haplotypes in CTLA-4 gene with susceptibility to, or progression of head and neck cancer. Eighty patients with confirmed head and neck [HN] cancer [age 54.9 +/- 16.1 years] and 85 healthy age/sexmatched controls [age 56.3 +/- 12.4 years] were enrolled in the study. Genotypes were investigated by the PCR-RFLP method. Arlequin software package was used to check for Hardy-Weinberg equilibration, and to estimate the haplotypes. At position +6230 A/G [CT60], AA genotype, as well as A allele was significantly decreased in patients with HN cancers than controls [18.8% vs. 40.7%, p=0.004; odds ratio=0.34, and 46.3% vs. 61.7, p=0.007; odds ratio=0.53%, respectively]. Nearly the same results were obtained when we compared the subgroup of patients with squamous cell carcinoma of the HN [SCC-HN] with control subjects. The frequencies of genotypes and alleles at other positions were not significantly different between patients and controls, however ACG, GTA and GCA haplotypes emerged from three investigated loci occurred with significantly more frequencies in patients [p<0.0001], while ACA and GTG haplotypes were more frequent among controls [p<0.0001]. Significant differences of haplotypes, genotypes and alleles frequencies resisted the Bonferroni correction. Our results suggest that CT60 A allele, as well as ACA and GTG haplotypes in CTLA-4 gene may have protective roles against HN cancer in Iranian population, while ACG, GTA and specially GCA haplotypes may render susceptibility.

Helicobacter pylori in nasal polyposis

Nasal polyposis is an inflammatory condition of unknown etiology. Recently concern regarding GER or Helicobacter pylori as a possible pathologic cause of nasal polyps has been increasing. The present study was planned to investigate the presence of Helicobacter Pylori in nasal polyps by PCR, rapid Urease test and serology. Case control study. ENT ward of Shiraz, Khalilli Hospital, Iran, April 2006 to March 2008. 37 patients with nasal polyps who had undergone nasal endoscopic sinus surgery and 38 control subjects who had undergone septoplasty and turbinectomy. Biopsy specimens of nasal polyps and inferior turbinates were assessed by PCR and Rapid Urease test. Blood sample of both study and control subjects were evaluated for anti H.pylori Ig G by ELISA. HP status was regarded as positive, if 2 tests were positive. Seropositivity was more common in the patients with nasal polyps [72.97%] than in the control patients [31.57%] [P-value= 0.000] RUT was positive in 9 [24.3%] of 37 patients with nasal polyps, but was not positive in control group [P-value= 0.001]. Only 3 of [8.1%] of 37 patients with nasal polyps were positive for both RUT and ELISA [P-value=0.115]. PCR was negative in all patients and controls. Polypoid tissue can be colonized by some other agents containing a urease enzyme other than Helicobacter Pylori. So, result of RUT can be false positive, and addition test may be performed. In the our study by using PCR, we were not able to confirm presence of Helicobacter pylori in the nasal polyps. However, further epidemiologic studies using different and specific diagnostic tests with control of documented GER is recommended

Interleukin-8-251 A/T and CXCR2 +1208 C/T genes polymorphisms in chronic rhinosinusitis

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. Two hundred and forty five CRS 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. 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]. 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

Vocal cord actinomycosis: a case report

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. 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. Laryngeal actinomycosis might be related to poor oral hygiene and mucosal barrier disruption, as well as to being immunocompromised

Serum level of galectin-3 in patients with oral squamous cell carcinoma

Galectin-3, a member of the family of beta-galactoside-binding animal lectins, has been implicated in tumor invasion and metastasis. Using an ELISA kit, we assessed the circulating levels of galectin-3 in sera from 40 oral squamous cell carcinoma [OSCC] patients and from 43 healthy controls. 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<0.0005]. There was no apparent correlation between serum galectin-3 concentration and clinico-pathological features such as stage, tumor size, nodal status, distant metastasis and histological grade. This result suggests that, in addition to other tests, measurement of serum galectin-3 concentrations can be utilized as an adjuvant test for establishing a diagnosis of OSCC

Polymerase chain reaction; detection of human papilloma virus [HPV] type - 16 and 18 infection in laryngeal and oral squamous cell carcinoma in southern Iran

One fifth of cancers world wide are associated with viral infection. Epidemiologic and biomolecular evidence suggested that Human Papilloma Virus [HPV] infection may be associated with the development of head and neck cancer. [1] To clarify the role of HPV infection in head and neck cancers. [2] To evaluate the presence of HPV DNA in laryngeal and oral squamous cell carcinoma in southern Iran and comparison of results with studies in other regions Department of Otolaryngology-Head and Neck Surgery, Khallili Hospital, Shiraz Medical University Iran From 2003 to 2006. Eighty three [83] patients with Squamous Cell Carcinoma [SCC] of the larynx, 40 patients with benign mucosal lesion of the larynx [control], 47 patients with SCC of oral cavity and 10 patients with benign oral lesion were studied for the presence, of HPV DNA by Polymerase Chain Reaction [PCR]. None of the laryngeal SCCs or control group was positive for HPV DNA. Only 3/47 specimens from oral SCC were positive for HPV DNA. Oral control group was negative for HPV DNA. The present work suggests that HPV infection has not important role in carcinogenesis of laryngeal or oral SCC in southern Iran. However a multi center case-control study is needed to clarify this association

Airway foreign bodies; a retrospective review

To study the pattern of laryngotracheal foreign bodies in South of Iran and to compare it with other studies. A retrospective chart review of patients who had airway foreign body. From 1991 to 2000. Department of Otolaryngology Khalili Hospital, Shiraz, Iran. Patient characteristics including age, sex, laryngobronchoscopic findings, clinical presentations and history of foreign body aspiration were recorded .Type and site of foreign body aspirated was also recorded to determine the common type and site of foreign body enlodgement in this country. From 1012 patients with airway foreign bodies,683 patients were male and 329 patients were female. Aspiration most commonly occurred in the 1-6 year age group. The most common presenting symptom was cough, dyspnea and chocking. The most common site of foreign body enlodgement was right bronchus and the most common foreign bodies in our area were various types of seeds. Education of physicia ns and public awareness are important steps needed to reduce the morbidity and mortality of foreign body aspiration. Parents should be instructed to abstain from feeding nuts and seeds to young children and to keep small, potentially ingestible objects out of their reach

Allergic fungal sinusitis presenting as a paranasal sinus tumor

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

effect of prophylactic antibiotic therapy on the incidence of post tonsillectomy bleeding

Adenotonsillectomy is one of the most common operations worldwide. Post operative hemorrhage is the most common serious complication. Many studies has been done on possible factors that may influence the rate of bleeding. In this study the role of prophylactic antibiotic therapy [amoxicillin] on decreasing the rate of post tonsillectomy bleeding has been investigated. In this retrospective study, performed on 200 patients, the rate of bleeding in the study group [100 patients who received amoxicillin [25mg/kg] immediately after operation and continued for 5-7 days] was compared with the rate of bleeding in the control group [100 patients who did not receive antibiotics]. One patient in the study and 3 patients in the control groups had bleeding that was not significant statistically. Although more study is needed, our study showed no influence of prophylactic antibiotic therapy on the rate of post tonsillectomy bleeding