Investigation of electrocardiography and echocardiography changes after adjuvant radiation therapy of left-sided breast cancer.

INTRODUCTION: The primary objective of radiation therapy (RT) is to deliver lethal radiation doses to abnormal cancer cells so that healthy cells are exposed to minimal radiation. In the present study, changes in electrocardiography (ECG) and echocardiography(ECHO) following adjuvant RT were investigated in patients with left-sided breast cancer. MATERIALS AND METHODS: 30 patients with left-sided breast cancer who had previously undergone breast-conserving surgery or mastectomy underwent RT after completing chemotherapy from February 2019 to January 2020. ECG and ECHO tests were performed before RT, immediately following RT, and three months after RT. Dose-volume parameters of the heart and its substructures as an organ at risk were analyzed. RESULTS: The mean heart dose (±SD) for all patients was 7.51 ± 2.42 Gy. T-wave inversion was observed 3 months after RT in 47% of patients. T-wave decline was associated with mean heart radiation dose (ß = 0.605, p-value = 0.005). The present study showed that the left ventricular volume receiving the 5 Gy (LV-V5) parameter was associated with a reduction in ST segment duration (p-value = 0.027) as well as with an increase in left ventricular systolic diameter (LVESD, mm) (P-value = 0.027). CONCLUSION: RT-induced ECG and ECHO changes are frequent in patients with left breast cancer. LVEF and Twave abnormalities were observed after RT in our patients. ECG and ECHO modalities can be used to monitor the cardiac function after RT in patients with left-sided breast cancer.

A Survey of Human Papillomavirus and Epstein-Barr virus Immunohistochemical Status in Patients with Head and Neck Squamous Cell Carcinoma (HNSCC).

BACKGROUND: Head and neck cancers are among the most prevalent cancers in the body. The aim of this study was to evaluate the expression of P16 and Epstein-Barr virus/latent membrane protein (EBV/LMP1) markers by immunohistochemistry in patients with squamous cell carcinoma of the head and neck. METHODS: In this study, all tissue samples of head and neck biopsies from 75 patients with confirmed diagnosis of squamous cell carcinoma (HNSCC) during 2016 to 2018 who admitted to the pathology laboratory of Imam Khomeini Hospital, Iran were selected. Paraffin blocks which prepared from these tissue samples were obtained. The slides were prepared from all samples for routine Hematoxylin-Eosin and immunohistochemical staining to evaluate the expression of EBV/LMP1 and P16 markers in cancer cells. RESULTS: The mean age of patients was 63 years and most patients (85.3%) were male in 75 patients with HNSCC. There was a significant relationship between EBV/LMP1 biomarker expression and vascular invasion in patients (p < 0.05). There was no relationship between EBV/LMP1 biomarker expression and age, sex ,anatomical site of tumor and tumor differentiation of patients (p > 0.05). There was no relationship between P16 biomarker expression and age, sex, tumor differentiation, anatomical site of tumor and vascular invasion of patients (p > 0.05). There is a significant relationship between P16 biomarker and EBV/LMP1 biomarker staining (p < 0.05). CONCLUSION: The level of P16 positive biomarker was high in patients with HNSCC. However, the EBV/LMP1 positive biomarker was moderate in patients. There was a relationship between EBV/LMP1 biomarker expression and vascular invasion in HNSCC patients, as well as between P16 biomarker and EBV/LMP1 biomarker staining.

A Systematic Review of Nasal Chondromesenchymal Hamartoma (NCMH) with a New Case Report.

Nasal chondromesenchymal hamartoma (NCMH) is a very rare, benign sinonasal tract tumor commonly affecting infants. In this paper, in addition to presenting a systematic review of the literature on NCMH, we also report an unusual case of NCMH in an adolescent patient. A systematic review conducted following the PRISMA guidelines. PubMed, EMBASE and manual search through references of relevant publication were utilised to gather all published case-reports of NCMH. Data collected from each case-report for patient demographics, site and size of NCMH, clinical presentation, co-morbidities, diagnostic methods, treatment options and follow-up methods. The systemic review collected sixty-two case-reports of NCMH (including our case) affecting 42 men and 21 women (2:1 male to female ratio). Mean average age was 5.1 years (age range: 1 day to 70 years). The anatomical sites of the tumor were: nasal cavity (n = 17), paranasal sinuses (n = 30), orbital region (n = 17), and the base of the skull (n = 16). The reported clinical manifestations were nasal obstruction or congestion (n = 29), nasal mass (n = 27), epistaxis (n = 6), orbital symptoms (n = 14). NCMH is a very rare cause of nasal masses in infants and toddlers. Our case and previous case reports confirm that NCMH can mimic other benign and malignant tumors, therefore we should be vigilant for rare pathologies that lead to nasal masses. Recently the link between DIECR1 mutation with NCMH has been established, so NCMH should be considered in any patient with nasal or orbital symptoms with a history of DICER1-related tumor spectrum.

Mucinous eccrine carcinoma of the eyelid: A case report study.

BACKGROUND: Primary mucinous eccrine carcinoma (PMEC) is a quite rare malignant tumor that typically involves the head and neck region in approximately 75% of patients and the periorbital area is the most common area. CASE PRESENTATION: A 57-year-old man was seen with a painless red mass involving the left lower eyelid for the past 7 months. Examination revealed a small mass measuring 0.6 cm with shiny red smooth appearance of the skin. H&E stained examination revealed a tumor mass that composed of polygonal cells in nests, lobules and islands separated by large amount of mucin. The neoplastic cells showed eosinophilic cytoplasm and round nuclei with mild pleomorphism. There was no necrosis, no atypical mitosis, no lymphovascular and perineural invasion. Rare mitotic figures were found. Tumoral nests present on all surgical margins. Primary MEC is a slow-growing neoplasm that may recur after incomplete surgical excision. This tumor is often clinically mistaken for other cutaneous tumors due to its variable appearance. Recurrent tumor tends to be locally invasive with a rare metastatic rate of 9.6%. CONCLUSION: As a result of the recurrence risk, patients should be followed up regularly. Thus, our patient was recommended to have a regular follow-up every six months.

Circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction in western Iran.

BACKGROUND: Circadian variation is known as an important factor in acute myocardial infarction (AMI). Moreover, the circadian pattern may help in disease prevention and better medication prescription. Therefore, the aim of our study was to investigate the circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: This cross-sectional study was conducted on 777 patients admitted to the Imam Ali Cardiovascular Center, Kermanshah, Iran, with a diagnosis of STEMI from March 2018 to February 2019. Data were collected using a checklist developed based on the study's objectives. Differences between subgroups were assessed using one-way analysis of variance (ANOVA) with post-hoc testing and chi-square test (or Fisher's exact test). RESULTS: Out of the 777 patients, 616 (79.3%) were men. The mean and standard deviation (SD) of age of the patients was 60.93 ± 12.86 years. 380 patients (48.9%) were current smoker, 40.3% were hypertensive, 21.1% had hypercholesterolemia, 18.3% had diabetes mellitus (DM), 25.2% had history of angina, and about 15.0% had history of myocardial infarction (MI). The occurrence of STEMI was most common during hours between 06:01-12:00 (27.7%), followed by 12:01-18:00 (27.3%), 00:00-06:00 (24.3%), and 18:01-24:00 (20.7%), respectively. Gender was significantly associated with circadian pattern of STEMI. Women showed a double peak of symptom onset in 06:01-12:00 and 12:01-18:00. CONCLUSION: The present study of Iranian patients displayed circadian pattern of STEMI with 2 peaks in the morning and afternoon, and the both peaks were dominated by women.

Laryngeal Lipoma: A Clinicopathologic Case Report.

Lipoma is not usual in the head and neck and the intrinsic form of isolated laryngeal lipoma is quite rare. Because isolated laryngeal lipoma symptoms are uncharacteristic and often has no systemic manifestation, clinical diagnosis is difficult. We describe an extremely rare case of intrinsic laryngeal lipoma.