Adenocarcinoma of the Ethmoid Sinus Presenting with Epiphora

Abstract: Low-grade non-intestinal type adenocarcinomas are rare tumors that arise from the surface epithelium of the sinonasal tract. They frequently involve the ethmoid sinus, the nasal cavity, and the maxillary sinus. These tumors present at a mean age range of 37-53 years with various non-specific symptoms including nasal obstruction and epistaxis. We report the first case of a low-grade non-intestinal type sinonasal-adenocarcinoma of the ethmoid sinus presenting with persistent unilateral epiphora. Case Presentation: A 67-year-old man presented with complaints of bloody tearing and right medial canthus swelling for several months. Examination of the area revealed a small bump beneath the skin which burst with a green mucopurulent discharge on gentle palpation. Computed tomography (CT) scans revealed a large growth in the ethmoid sinus invading into the right medial orbit and extending into the maxilla. Histopathology (H&E) demonstrated a cribriform pattern, moderately graded nuclei, and eosinophilia consistent with non-intestinal type sinonasal adenocarcinoma. The patient underwent orbital exenteration and large sinus resection. Discussion: Cancers of the paranasal sinuses are extremely uncommon and account for just 1% of all human cancers. Low-grade non-intestinal type adenocarcinoma is an extremely rare subtype that has only been reported a handful of times. Synonyms in the literature include terminal tubulus adenocarcinoma, sinonasal tubulopapillary low-grade adenocarcinoma, and sinonasal seromucinous adenocarcinoma. Microscopic analysis is key for differentiation of this tumor type from other similar sinonasal malignancies as well as for prognostication purposes. Histologically, non-ITAC is recognized by its trabecular, cribaform, or papillary growth pattern and the single layer of uniform columnar or cuboidal cells that line its glands. Pleomorphic nuclei and mitotic figures are rarely seen in this subtype. Immunohistochemically, non-ITAC is characterized by positive CK7 staining and/or negative CDX-2 and CK-20 staining. Differential diagnoses to consider include intestinal type adenocarcinoma (ITAC), acinic cell carcinoma, and oncocytic Schneiderian papilloma. ITAC is an aggressive malignancy that is differentiated from non-ITAC on the basis of its resemblance to the mucosa found in the small and large intestine, its high-grade histologic appearance, and cellular expression of CDX-2. Distinguishing the two tumors types is of crucial clinical importance given that low-grade non-ITAC has not, to date, displayed metastatic behavior while several instances of low-grade ITAC metastases have been reported. Rarely, non-intestinal type adenocarcinoma may be confused with oncocytic Schneiderian papillomas. However, the epithelium of oncocytic Schneiderian papillomas are multilayered and lack glandular lumina. The presenting clinical symptoms of non-ITAC vary, however the most common reported symptoms are nasal obstruction and epistaxis. In our case, the patient presented with persistent unilateral epiphora which has not, to date, been reported in association with this tumor subtype. The mainstay in treatment of low-grade non-ITAC includes surgery followed by radiation therapy. Overall, the prognosis of patients with non-ITAC is good and rarely does death occur due to the disease.https://scholarlycommons.henryford.com/merf2020caserpt/1125/thumbnail.jp

Paediatric obsessive-compulsive disorder and depressive symptoms: clinical correlates and CBT treatment outcomes.

Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 - 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 - 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms

Correlates of Obsessive–Compulsive Disorder in a Sample of HIV-Positive, Methamphetamine-using Men Who have Sex with Men

Substance use has been identified as a risk factor for elevated levels of obsessive–compulsive disorder (OCD). This study examined methamphetamine use and sexual risk behaviors as correlates of OCD in a sample of 245 HIV-positive men having sex with men (MSM) in San Diego, CA. In a logistic regression analysis, OCD was associated with greater frequency of methamphetamine use, more depressive symptoms, seeking out risky venues and risky sexual partners when “high” on methamphetamine, and reporting fewer sex acts in the past 2 months. These data suggest the need for increased awareness and understanding of the role that OCD may play in the drug use behaviors and risky sexual practices of methamphetamine users

Redundant or separate entities?—roles of Twist1 and Twist2 as molecular switches during gene transcription

Twist1 and Twist2 are highly conserved members of the Twist subfamily of bHLH proteins responsible for the transcriptional regulation of the developmental programs in mesenchymal cell lineages. The regulation of such processes requires that Twist1 and Twist2 function as molecular switches to activate and repress target genes by employing several direct and indirect mechanisms. Modes of action by these proteins include direct DNA binding to conserved E-box sequences and recruitment of coactivators or repressors, sequestration of E-protein modulators, and interruption of proper activator/repressor function through protein–protein interactions. Regulatory outcomes of Twist1 and Twist2 are themselves controlled by spatial-temporal expression, phosphoregulation, dimer choice and cellular localization. Although these two proteins are highly conserved and exhibit similar functions in vitro, emerging literature have demonstrated different roles in vivo. The involvement of Twist1 and Twist2 in a broad spectrum of regulatory pathways highlights the importance of understanding their roles in normal development, homeostasis and disease. Here we focus on the mechanistic models of transcriptional regulation and summarize the similarities and differences between Twist1 and Twist2 in the context of myogenesis, osteogenesis, immune system development and cancer

Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder

The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5–17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed

The Mycotoxin Deoxynivalenol Potentiates Intestinal Inflammation by Salmonella Typhimurium in Porcine Ileal Loops

Background and Aims: Both deoxynivalenol (DON) and nontyphoidal salmonellosis are emerging threats with possible hazardous effects on both human and animal health. The objective of this study was to examine whether DON at low but relevant concentrations interacts with the intestinal inflammation induced by Salmonella Typhimurium. Methodology: By using a porcine intestinal ileal loop model, we investigated whether intake of low concentrations of DON interacts with the early intestinal inflammatory response induced by Salmonella Typhimurium. Results: A significant higher expression of IL-12 and TNF alpha and a clear potentiation of the expression of IL-1 beta, IL-8, MCP-1 and IL-6 was seen in loops co-exposed to 1 mu g/mL of DON and Salmonella Typhimurium compared to loops exposed to Salmonella Typhimurium alone. This potentiation coincided with a significantly enhanced Salmonella invasion in and translocation over the intestinal epithelial IPEC-J2 cells, exposed to non-cytotoxic concentrations of DON for 24 h. Exposure of Salmonella Typhimurium to 0.250 mu g/mL of DON affected the bacterial gene expression level of a limited number of genes, however none of these expression changes seemed to give an explanation for the increased invasion and translocation of Salmonella Typhimurium and the potentiated inflammatory response in combination with DON. Conclusion: These data imply that the intake of low and relevant concentrations of DON renders the intestinal epithelium more susceptible to Salmonella Typhimurium with a subsequent potentiation of the inflammatory response in the gut