LncRNA SNHG12: A budding star in human diseases.

Small nucleolar RNA host gene 12 (SNHG12) is a long non-coding RNA (lncRNA) that contributes in a variety of human pathologies. This lncRNAs acts as molecular sponge for various miRNAs, namely miR-200c-5p, miR-129-5p, miR-30a-3p, miR-195, miR-133b, miR-199a/b-5p, miR-320b, miR-16, miR-15a, miR-218-5p, miR-320 and a number of other miRNAs. Through this mechanism, SNHG12 can affect activity of HIF-1α, Wnt/ß-catenin, VEGF, PI3K/AKT/mTOR, PTEN, NF-κB and ERK-1/2 signaling. SNHG12 can affect pathogenesis of several disorders, including those arising from genitourinary, gastrointestinal, pulmonary, central nervous and cardiovascular systems. These effects have been best characterized in the context of cancer where it can be used as a possible diagnostic and prognostic marker. In order to summarize the role of this lncRNA in human disorders, particularly cancer and highlight its potential application in biomedical studies, we designed the current review. We also emphasized on its diagnostic and prognostic roles.

New insights of miRNA molecular mechanisms in breast cancer brain metastasis and therapeutic targets.

Brain metastases in breast cancer (BC) patients are often associated with a poor prognosis. Recent studies have uncovered the critical roles of miRNAs in the initiation and progression of BC brain metastasis, highlighting the disease's underlying molecular pathways. miRNA-181c, miRNA-10b, and miRNA-21, for example, are all overexpressed in BC patients. It has been shown that these three miRNAs help tumors grow and metastasize by targeting genes that control how cells work. On the other hand, miRNA-26b5p, miRNA-7, and miRNA-1013p are all downregulated in BC brain metastasis patients. They act as tumor suppressors by controlling the expression of genes related to cell adhesion, angiogenesis, and invasion. Therapeutic miRNA targeting has considerable promise in treating BC brain metastases. Several strategies have been proposed to modulate miRNA expression, including miRNA-Mimics, antagomirs, and small molecule inhibitors of miRNA biogenesis. This review discusses the aberrant expression of miRNAs and metastatic pathways that lead to the spread of BC cells to the brain. It also explores miRNA therapeutic target molecular mechanisms and BC brain metastasis challenges with advanced strategies. The targeting of certain miRNAs opens a new door for the development of novel therapeutic approaches for this devastating disease.

Expression analysis of PPAR-related lncRNAs in breast cancer.

Breast cancer is a genetically heterogeneous disorder associated with dysregulation of several genes. Peroxisome proliferator-activated receptor gamma (PPARγ) is a ligand-dependent transcription factor that is expressed by many tumoral cells such as transformed breast cancer cells. We investigated expressions of nine PPARγ-related lncRNAs, namely KCNIP2-AS1, TRHDE-AS1, FAM13A-AS1, ALDH1A1-AS2, SH3BP5-AS1, HID1-AS1, LINC01140, LIPE-AS1 and ABCA9-AS1 in paired breast cancer samples and non-tumoral tissues. Expression assays showed lower expression levels of TRHDE-AS1, ALDH1L1-AS2, KCNIP2-AS1, ABCA9-AS1, LIPE-AS1 and LINC01140 in tumoral compared with non-tumoral samples. The mentioned genes could differentiate between breast tumors and non-tumoral samples with AUC values ranging from 0.77 to 0.62 for LINC01140 and LIPE-AS1, respectively. The highest specificity and sensitivity values were reported for KCNIP2-AS1 and LINC01140, respectively. Significant correlations were reported between all pairs of genes in both tumoral and non-tumoral tissues. The most robust ones were between ABCA9-AS1 and KCNIP2-AS1 (correlation coefficient=0.85) in non-tumoral tissues and between LIPE-AS1 and TRHDE-AS1 (correlation coefficient=0.83) in tumoral tissues. There was a significant negative association between expression levels of KCNIP2-AS1 gene in tumor tissues and different histological grades. Besides, there was a significant negative association between expression levels of FAM13A-AS1, KCNIP2-AS1and LIPE-AS1 genes in tumor tissues and different mitotic rates. Taken together, PPARγ-related lncRNAs might be regarded as potential contributors to the pathogenesis of breast cancer.

Role of long non-coding RNAs and TGF-ß signaling in the regulation of breast cancer pathogenesis and therapeutic targets.

The cytokine known as transforming growth factor (TGF) is essential for cell development, differentiation, and apoptosis in BC. TGF-ß dysregulation can either promote or inhibit tumor development, and it is a key signaling pathway in BC spread. A recently identified family of ncRNAs known as lncRNAs has received a great deal of effort and is an important regulator of many cellular processes, including transcription of genes, chromatin remodeling, progression of the cell cycle, and posttranscriptional processing. Furthermore, both TGF-ß signaling and lncRNAs serve as important early-stage biomarkers for BC diagnosis and prognosis and also play a significant role in BC drug resistance. According to recent studies, lncRNAs can regulate TGF-ß by modulating its cofactors in BC. However, the particular functions of lncRNAs and the TGF-ß pathway in controlling BC progression are not well understood yet. This review explores the lncRNAs' functional properties in BC as tumor suppressors or oncogenes in the regulation of genes, with a focus on dysregulated TGF-ß signaling. Further, we emphasize the functional roles of lncRNAs and TGF-ß pathway in the progression of BC to discover new treatment strategies and better comprehend the fundamental cellular pathways.

A ventral hernia containing appendix; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Abdominal wall hernia is a protrusion of abdominal contents through an acquired or congenital weakness or wall defect. A ventral hernia, including an appendix, is a rare condition. The appendix in the hernial sac is already known as inguinal and femoral hernia and has been named Amyand hernia and De Garengeot hernia, respectively. CASE PRESENTATION: We have presented a 74-year-old woman with complaints of point tenderness in the right lower abdomen and para-umbilical and a palpable non-reducible mass over the para-umbilicus with some erythema on the skin, which started two days ago. With the help of imaging, diagnosis of abdominal wall hernia was made, with the appendix as the possible content, as there was evidence of an inflamed appendix lumen incarcerated through the abdominal wall. CLINICAL DISCUSSION: We have provided a detailed review of recent articles. Our comprehensive discussion includes an exploration of the typical manifestations, the significance of imaging in accurate diagnosis, and the appropriate measures to facilitate optimal surgical preparation. The treatment for ventral hernia typically involves appendectomy and abdominal wall hernia repair, with the specific approach depending on the severity of inflammation. CONCLUSION: Although abdominal wall hernia containing appendicitis is extremely rare, its clinical manifestations are hernia and acute appendicitis, the most common diseases in general surgery. Imaging may be helpful in diagnosis. According to our study, diagnostic laparoscopy could be used in case of clinical suspicion of abdominal wall hernia containing an appendix, although more studies are needed.

Spontaneous ventral gallbladder hernia complicated with perforation; a case report and literature review.

INTRODUCTION AND IMPORTANCE: Ventral gallbladder hernia is a rare condition mostly related to past acquired abdominal wall defects, but spontaneous ones are scarce. It happens more in elderly patients. Etiology and causes are still unspecified, but the most related known causes of spontaneous gallbladder herniation are carcinoma, biliary tracked occlusion or abdominal wall weakness in elderly patients, respectively. CASE PRESENTATION: We have presented a complicated 90-year-old woman with a bulged and warm area at the right upper abdomen with tenderness and positive rebound tenderness. In help with imaging, we found a ventral gallbladder hernia perforated in the subcutaneous layer. Then cholecystectomy and herniation site repair was performed. CLINICAL DISCUSSION: We have explained this infrequent scenario and reviewed recent similar papers to find further relevant information. The common presentations, probable causes, the role of imaging in diagnosis and the management are discussed for the best surgical planning. CONCLUSION: The spontaneous ventral herniation of the gallbladder is an exceedingly uncommon occurrence. The diagnosis of this condition heavily relies on imaging, with computed tomography (CT) scan utilizing both intravenous and oral contrast being the optimal modality. Management of this condition can be accomplished via both laparoscopic and laparotomy approaches. It is our recommendation to perform cholecystectomy and hernia repair simultaneously and expeditiously in all cases. We advise against conservative management strategies.

Breast Cancer Survivors' Experiences of Acceptance Following Recurrence: A Qualitative Content Analysis.

BACKGROUND: Breast cancer recurrence is a traumatic event for patients, and its treatment depends on the patient's ability to accept the circumstances. OBJECTIVE: The aim of this study was to explore how patients experience breast cancer recurrence and go through a process of negotiating acceptance. METHODS: This study explored the experiences of 16 patients with breast cancer recurrence regarding the acceptance of recurrence in a hospital in Tehran, Iran. Purposive sampling with maximum diversity was used. Data were collected through semistructured telephone interviews from November 2020 to November 2021 and analyzed using the qualitative content analysis. RESULTS: Four themes emerged that described the process of accepting cancer recurrence: (1) response to recurrence (emotional reactions and loss of trust); (2) psychological preparedness (confirmation of medical diagnosis and acceptance of fate); (3) mobilizing supports (using spiritual capacities, utilizing supportive resources, and seeking relationships to promote knowledge); and (4) return to the path of treatment (rebuilding trust and continuation of treatment). CONCLUSIONS: The acceptance of breast cancer recurrence is a process that begins with emotional reactions and ends with returning to the treatment path. The patient's psychological preparation, support systems, behavior of healthcare providers, and rebuilding trust are the determining factors in acceptance of recurrence. IMPLICATIONS FOR PRACTICE: Nurses can compensate for the failures created in the primary treatment of breast cancer by spending time with patients and paying attention to their concerns, providing effective education, strengthening communication between patients with similar conditions and using the spiritual capacities of patients, and mobilizing the support of family and relatives.

A review on the role of ncRNAs in the pathogenesis of cholangiocarcinoma.

Cholangiocarcinoma is a rare tumor but a challenging cancer in terms of pathological changes, clinical manifestations and therapeutic options. Recent studies have provided evidence for participation of non-coding RNAs in the carcinogenic process of cholangiocarcinoma. We demonstrate the role of long non-coding RNAs, microRNAs and circular RNAs in the pathogenesis of cholangiocarcinoma and highlight their significant position as therapeutic targets and biomarkers for this type of cancer. We also list a number of molecular axes comprising these non-coding RNAs that represent potential targets for therapeutic options in cholangiocarcinoma, based on their significant roles in the regulation of cell proliferation, differentiation and apoptosis of these cells.

A review on the role of NR2F1-AS1 in the development of cancer.

NR2F1-AS1 is a natural antisense transcript with prominent roles in the carcinogenesis. It acts as an oncogene in almost all types of cancers except for cervical and colorectal cancers. It can act as a molecular sponge for miR-17, miR-371a-3p, miR-363, miR-29a-3p, miR-493-5p, miR-190a, miR-140, miR-642a, miR-363, miR-493-5p, miR-483-3p, miR-485-5p, miR-146a-5p, miR-877-5p, miR-338-3 P and miR-423-5p to influence expression of several cancer-related genes. Thus, the sponging role of NR2F1-AS1 is the most appreciated route of its contribution in the carcinogenesis. In addition, NR2F1-AS1 affects activity of IGF-1/IGF-1R/ERK, PI3K/AKT/GSK-3ß and Hedgehog pathways. The current narrative review aims at summarization of the results of studies that highlighted the role of NR2F1-AS1 in the carcinogenesis.

Molecular mechanisms of inhibitor of growth (ING) family members in health and malignancy.

ING genes belong to family of tumor suppressor genes with regulatory functions on cell proliferation, apoptosis, and cellular senescence. These include a family of proteins with 5 members (ING1-5), which are downregulated in human malignancies and/or affected by pathogenic mutations. ING proteins are highly evolutionarily conserved proteins containing several domains through which bind to chromatin structures by exerting their effects as readers of histone modification marks, and also binding to proteins like p53 involved in biological processes such as cell cycle regulation. Further, they are known as subunits of histone acetylation as well as deacetylation complexes and so exert their regulatory roles through epigenetic mechanisms. Playing role in restriction of proliferative but also invasive potentials of normal cells, INGs are particularly involved in cancer development and progression. However, additional studies and experimental confirmation are required for these models. This paper highlights the potential impact that INGs may have on the development of human cancer and explores what new information has recently arise on the functions of ING genes.

miR-1908: a microRNA with diverse functions in cancers and non-malignant conditions.

MicroRNAs (miRNAs) are small-sized transcripts with about 22 nucleotide length. They have been shown to influence almost every aspect of cellular functions through regulation of expression of target genes. miR-1908 is a miRNA with diverse roles in human disorders. This miRNA is encoded by MIR1908 gene on chr11:61,815,161-61,815,240, minus strand. Expression assays have confirmed dysregulation of miR-1908 in cancer-derived cell lines in addition to biological samples obtained from patients affected with cancer. In most assessed cell lines, miR-1908 has an oncogenic role. However, this miRNA has been shown to act as a tumor suppressor in chordoma, lung cancer and ovarian cancer. In addition, several lines of evidence have shown involvement of this miRNA in the pathoetiology of bipolar disorder, myocardial infarction, obesity, renal fibrosis, rheumatoid arthritis and scar formation. In the current review, we elucidate the results of diverse studies which evaluated participation of miR-1908 in these conditions.

Emerging role of non-coding RNAs in the regulation of Sonic Hedgehog signaling pathway.

Sonic Hedgehog (Shh) signaling cascade is one of the complex signaling pathways that control the accurately organized developmental processes in multicellular organisms. This pathway has fundamental roles in the tumor formation and induction of resistance to conventional therapies. Numerous non-coding RNAs (ncRNAs) have been found to interact with Shh pathway to induce several pathogenic processes, including malignant and non-malignant disorders. Many of the Shh-interacting ncRNAs are oncogenes whose expressions have been increased in diverse malignancies. A number of Shh-targeting miRNAs such as miR-26a, miR-1471, miR-129-5p, miR-361-3p, miR-26b-5p and miR-361-3p have been found to be down-regulated in tumor tissues. In addition to malignant conditions, Shh-interacting ncRNAs can affect tissue regeneration and development of neurodegenerative disorders. XIST, LOC101930370, lncRNA-Hh, circBCBM1, SNHG6, LINC-PINT, TUG1 and LINC01426 are among long non-coding RNAs/circular RNAs that interact with Shh pathway. Moreover, miR-424, miR-26a, miR-1471, miR-125a, miR-210, miR-130a-5p, miR-199b, miR-155, let-7, miR-30c, miR-326, miR-26b-5p, miR-9, miR-132, miR-146a and miR-425-5p are among Shh-interacting miRNAs. The current review summarizes the interactions between ncRNAs and Shh in these contexts.

Emerging role of circular RNAs in the pathogenesis of ovarian cancer.

Ovarian cancer is a female malignancy with high fatality-to-case ratio, which is due to late detection of cancer. Understanding the molecular mechanisms participating in these processes would facilitate design of therapeutic modalities and identification of novel tumor markers. Recent investigations have shown contribution of circular RNAs (circRNAs) in the evolution of ovarian cancer. These transcripts are produced through a back-splicing mechanism. The enclosed configuration of circRNAs protects them from degradation and potentiates them as biomarkers. Several circRNAs such as circMUC16, circRNA_MYLK, circRNA-UBAP2, circWHSC1, hsa_circ_0013958, circFGFR3, hsa_circRNA_102958 and circ_0072995 have been found to be up-regulated in this cancer, acting as oncogenes. On the other hand, circ-ITCH, circPLEKHM3, circ_100395, circ_0078607, circATRNL1, circHIPK3, circRHOBTB3, circEXOC6B, circ9119 and CDR1as are among down-regulated circRNAs in ovarian cancer. Expression levels of circCELSR1, circ_CELSR1, circATL2, circNRIP1, circTNPO3 and hsa_circ_0000714 have been shown to affect resistance of ovarian cancer cells to chemotherapy. Moreover, circ_100395, circFGFR3, circ_0000554, circCELSR1, circ-PTK2, circLNPEP, circ-CSPP1, circ_0000745, circ_100395 and circPLEKHM3 have been shown to regulate epithelial-mesenchymal transition and metastatic ability of ovarian cancer cells. In the current review, we explain the roles of circRNAs in the evolution and progression of ovarian cancer.

Down-regulation of MEG3, PANDA and CASC2 as p53-related lncRNAs in breast cancer.

TP53 encodes a major tumor suppressor protein which blocks carcinogenesis process in a variety of tissues including breast tissue. Expression and function of this gene is regulated by a number of long non-coding RNAs (lncRNAs) among them are PANDA, MEG3 and CASC2. We measured expression of TP53 and these transcripts in a cohort of Iranian breast cancer patients. Expression levels of TP53, MEG3, CASC2 and PANDA were significantly lower in tumoral samples compared with non-tumoral samples (Posterior mean differences = -4.26, -1.66, -5.98 and -3.13, respectively; P values < 0.0001). Expression of CASC2 was higher in Her2 1+ cases compared with Her2 negative cases (Beta = 1.85, P value = 0.037). Expression levels of MEG3 and TP53 were lower in grade 2 samples compared with grade 1 (Beta = -1.86, P value = 0.006 and Beta = -2.24, P value = 0.003, respectively). There was no other significant association between expression of genes and clinical variables. CASC2 had the best performance among these genes with area under curve value of 0.78 and sensitivity and specificity values of 56.33% and 88.73%, respectively (P value < 0.0001). The current investigation supports the role of TP53-related lncRNAs in the pathogenesis of breast cancer.

A case-report on diverticulitis misdiagnosed as tubo-ovarian abscess.

INTRODUCTION AND IMPORTANCE: Tubo-ovarian abscesses (TOA) is presented with multiple clinical manifestations including gastrointestinal findings. CASE PRESENTATION: Herein, we present a case of complicated diverticulitis that was misdiagnosed as TOA, owing to overlapping genital involvement. CLINICAL DISCUSSION: Imaging could be misleading in these patients as a result of severe inflammation of intestines and surrounding organs. CONCLUSION: Patients who do not respond to antibiotic treatment should be suspected of other gastrointestinal pathologies such as diverticulitis and should be evaluated accordingly.

Preoperative Smoking Cessation and its Association with Postoperative Complications and Length of Hospital Stay in Patients Undergoing Herniorrhaphy.

BACKGROUND: To assess the effect of preoperative smoking cessation on postoperative complications in patients undergoing herniorrhaphy. MATERIALS AND METHODS: This prospective study was conducted on 163 consecutive patients, undergoing herniorrhaphy. Demographic characteristics and postoperative complications were compared between smokers (group A), patients who reduced smoking by 50% (group B), and patients who completely quit smoking (group C). RESULTS: The mean age of the patients was 42.9 (SD=10.3) years. Group A (n=77), group B (n=27), and group C (n=59) were not significantly different in terms of age, body mass index (BMI), medical history, laboratory data, smoking habit, type of hernia, type of anesthesia, the American Society of Anesthesiologists (ASA) class, repair method, surgery approach, and duration surgery (P>0.05 for all). However, significant differences were observed between group B and group A, group C and group A, and group C and group B regarding postoperative complications, such as wound healing complications and length of hospital stay (LOS) (P<0.05 for all). CONCLUSION: Decreased preoperative smoking is associated with the reduced risk of respiratory, cardiovascular, and wound healing complications and decreased LOS in patients undergoing herniorrhaphy.

Effect of Isolated Serum from Breast Cancer Patients with Pectoral Nerves Block on Breast Cancer Cell Line (MDA-MB-231) Apoptosis Index.

BACKGROUND: Breast cancer (BC) is the most frequent cause of cancer death in women. The thoracic pectoral nerve (PECS) block has been described as the gold standard analgesic modality for BC surgery. It has been previously reported that PECS is associated with decreased BC recurrence post-mastectomy. Although several anesthetic drugs and techniques are used in surgical oncology, their effects on the behavior of cancer cells are yet to be known and the key question of whether the anesthetic technique affects cancer outcome remains unresolved. OBJECTIVES: Since anesthetic drugs and techniques and post-operative pain may affect BC recurrence, this study aimed to determine whether the anesthetic choice and technique, PECS II block, affects in vitro apoptosis of the MDA-MB-231 BC cell line. METHODS: Twenty-two female BC patients, 20 to 75-years-old, with the same pathologic grades were included in this study. The patients were randomly divided into two groups. The first group received propofol general anesthesia (PGA) associated with PECS and the second group received standard PGA. Blood was sampled pre and post-operation from all patients. The sera were isolated and then exposed to the MDA-MB-231 human BC cell line. The mean percentage of apoptosis indices was analyzed by flow cytometry using Annexin V-fluorescein isothiocyanate 24 hours after treatment with patients' sera. RESULTS: A significant decrease was seen in the mean viability percentage of BC cell line in the PECS group, besides a significant increase in the mean percentage of necrosis and late apoptosis indices compared to the control group after exposure to sera collected from patients post-operation. Intra-group analysis of the control group showed that the exposure of the tumoral cell to post-operation sera resulted in a significant increase in the mean percentage of necrosis and late apoptosis index compared to pre-operation sera exposure. In the PECS group, the exposure of the tumoral cell to post-operation sera resulted in a significant increase in the mean percentage of cell viability and late apoptosis index compared to pre-operation sera exposure. CONCLUSIONS: In conclusion, anesthesia and BC surgery may induce apoptosis indices in the MDA-MB-231 human BC cell line. We also found that sera collected from PECS II block patients with BC could induce more apoptosis in the MDA-MB-231 cell line compared to collected sera from systemic analgesia alone after BC surgery.

Down-regulation of a panel of immune-related lncRNAs in breast cancer.

Breast cancer is a common neoplasm among women. This type of cancer is among malignancies in which role of long non-coding RNAs (lncRNAs) has been extensively explored. Some recently recognized lncRNAs have been less investigated in this neoplastic condition. LncRNAs that regulate tumor immunity are among those contributing in the pathogenesis of cancer. In the present expression assay, we compared expressions of nine immune-related lncRNAs namely lnc-MICAL3-2 (AC016027.1), lnc-DDX31 (AL445645.1), LINC01063, LINC02381, ENST0000615051 (AC083809.1), AC009237.14 (lnc-TRIM43B-1), ENST0000603791, LINC1234 and AC008760.1 between breast cancer samples and their paired non-cancerous samples. Expression levels of lnc-MICAL3-2, lnc-DDX31, LINC01063, LINC02381, ENST0000615051 and lnc-TRIM43B-1 were significantly decreased in breast cancer samples compared with paired control tissues (Posterior mean difference= -2.774, -2.012, -2.012, -2.015, -0.884 and -2.872; P values= 0.019, 0.0001, 0.0001, 0.0001, 0.032 and 0.0001, respectively). Expression levels of these lncRNAs have been associated with a number of clinical characteristics of breast cancer patients. Lnc-TRIM43B-1 had the highest performance in distinguishing between tumoral and non-tumoral tissues (AUC=0.82, Sensitivity=76%, Specificity=73.24%). As these lncRNAs could differentiate tumor samples from control samples, they might be regarded as putative tissue markers for breast cancer.

A case report of primary isolated extrahepatic hydatid cyst of the soft tissues of the breast and thigh.

INTRODUCTION: Hydatid Disease (HD), or hydatidosis or echinococcosis, is an endemic infection and a major public health concern in the Mediterranean region. At times it involves the primary soft tissues, such as in the breast and muscle, though this is quite uncommon even in endemic areas. PRESENTATION OF CASES: A. A 31 year-old woman complained of a gradual progressive, painless lump in the left axillary tail of spence for two years. Examination revealed a firm lump measuring 5cm × 5cm, non-mobile, in the left axillary tail of Spence. B. A 32 year-old woman presented with mild and continuous pain in lateral aspect of left thigh. On examination, there was a round, non-tender, non-mobile mass in the lateral aspect of her left thigh. Preoperative imaging studies in both patients revealed evidence of HD. Both of the patients underwent surgery and received Albendazole twice per day for 10 days, before and three months after surgery. DISCUSSION: The disease can be diagnosed by serological and radiological modalities, both of which are not definitive. Ultrasonography should be the first diagnostic modality of soft tissue HD, however, MRI can be used to understand clearly the surgical involvements of structures. The standard treatment of soft tissue HD is surgery using pericystectomy techniques, as well as anthelmintic therapy. CONCLUSION: HD should be suggestive in soft tissues if mass is slowly developing and presenting with local extension, particularly in endemic countries. Excision of HD using pericystectomy technique is the first choice of intervention for HD of soft tissues.

Spontaneous perforation as a fatal presentation of esophageal tuberculosis: A case report.

INTRODUCTION: Tuberculosis is a multisystematic disease and is the most common cause of infectious disease-related mortality worldwide. Gastrointestinal tract is an uncommon site for extrapulmonary tuberculosis (TB). Esophageal TB is exceedingly rare. PRESENTATION OF CASE: We report a 22-years-old male with esophageal TB that presented in septic shock from esophageal perforation. Despite all measures including surgical intervention and aggressive support in the intensive care unit, patient passed away. DISCUSSION: The most common mechanism for esophageal involvement is secondary to direct spread from mediastinal structures and/or spreading the inoculation of swallowed sputum, or hematogenous or lymphatic spread. Once the diagnosis of TB is established, antibiosis is the cornerstone of treatment. Surgery is reserved only for complications of TB such as fistula, abscess, strictures or perforation. Less than 50% of cases are diagnosed within 24 h, and delay in diagnosis lead to significant increases in the mortality. CONCLUSION: In countries with high prevalence of TB, this diagnosis should be considered in those with esophageal perforation with no underlying etiology and medical treatment for TB should be initiated in addition to conventional treatment in appropriate group of patients.