SMARCB1 (INI1)-deficient sinonasal carcinoma manifesting as oral lesions: A report of two cases.

BACKGROUND: Sinonasal carcinomas represent a rare group of malignancies, accounting for less than 5% of all head and neck cancers and a worldwide incidence of less than 1 case per 100 000 inhabitants annually. Despite the restricted anatomical location, sinonasal carcinomas harbor some of the most histologically and molecularly diverse groups of tumors. SMARCB1 (INI1)-deficient sinonasal carcinomas are locally aggressive tumors commonly detected late, leading to devastating morbidity and mortality. CASE REPORT: We present two cases of SMARCB1-deficient sinonasal carcinoma involving the oral cavity and presenting as progressive radiolucent lesions with local swelling associated with maxillary dentition and alveolar bone. Both cases were initially considered odontogenic in origin and involved the destruction of the left anterior maxilla. CONCLUSION: Given the rarity and the variable presentation of these tumors, they pose a challenge for head and neck surgeons, dentists, and pathologists due to the potential overlapping features with odontogenic and non-odontogenic inflammatory and neoplastic lesions. These cases highlight the importance of a multidisciplinary team and include SMARCB1-deficient sinonasal carcinomas in the differential diagnosis of destructive lesions of the maxilla.

Characterization of Immunophenotypic Aberrancies in Adult and Childhood Acute Lymphoblastic Leukemia: Lessons from Regional Variation.

BACKGROUND & OBJECTIVE: Although the antigen expression patterns of acute lymphoblastic leukemia (ALL) are well known, this study attempted to evaluate commonly used immune markers for immunophenotyping of acute leukemia to set the minimum of necessary diagnostic panels by flow cytometry. METHODS: This study evaluated 89 patients referred from all over the country to the Iranian Blood Transfusion Organization (IBTO) in Tehran from 2013 to 2015. We compared the immunophenotype patterns of childhood and adult ALLs including 69(77.5%) B-cell lymphoblastic lymphoma (B-LBL), 2(2.2%) Burkitt's lymphoma (BL), and 18(20.2%) T-cell lymphoblastic lymphoma (T-LBL) cases using flowcytometry with broad antibody panel. RESULTS: CD19 and CD79a were the most frequent markers for B-LBL while CD7 was the most sensitive marker in T-LBL; the frequency of CD7, CD3, and CD5 antigens were 100%, 38.9%, and 88.9%, respectively. TdT+/CD34+ was significantly higher in adult B-LBLs than children, which indicates blast cells are more immature in adults. In addition, CD10 and cCD79a were significantly higher in children with B-LBL like as CD5 and CD8 in children with T-LBL. Aberrant phenotypes including CD13, CD33, CD7, and CD117 were found in 7(10.1%) cases of B-LBL. These phenotypes were CD117, HLA-DR, and CD33 in 7(38/9%) cases of T-LBL. Expression of CD117 aberrant myeloid antigen was significantly more associated with T-LBL than with B-lineage ALL. CONCLUSION: Significant differences were observed in antigen-expression patterns between adult and childhood ALLs. Further studies are needed to correlate specific markers with recurrent cytogenetic abnormalities and prognosis with therapeutic response.

Toothpick Aspiration Induces Massive Hemoptysis: a Case Report.

BACKGROUND: Massive hemoptysis refers to bleeding from the sputum exceeding 100 ml/day. This condition is known to have a poor prognosis. Although foreign body aspiration is not as common as other risk factors, it may result in massive hemoptysis. In the current study, we presented a case of massive hemoptysis due to the aspiration of a toothpick. CASE PRESENTATION: The patient was a 49-year-old woman who was primarily suspected of having tuberculosis. After observing blood in the sputum, interventions, including chest computed tomography (CT) scan and conservative management, were performed. The CT scan showed no malignancy, and paraclinical investigations were negative. However, hemoptysis was progressing into an acute phase; therefore, a surgical intervention was performed for the patient. After the surgery, the cause of the lesion was found to be a toothpick. The patient was under intensive care after surgery and was discharged from the hospital in a good general condition. The morphological evaluation of the lesion showed a bronchial wall with ulceration, besides granulation tissue formation, hematoma, and fibrinoid necrosis due to foreign body aspiration into the lung, resulting in inflammatory reactions. CONCLUSION: In this case report, foreign body aspiration resulted in massive hemoptysis. Our primary attempts to diagnose the cause of lesion were unsuccessful, and surgery was performed due to the life-threatening condition of the patient. Overall, unexplained hemoptysis may occur following a serious accident due to foreign body aspiration.