No abstract

Acinic cell carcinoma with high-grade transformation of the salivary gland is an unusual variant with less than fifty cases being reported in the literature. It is characterized by a low- and high-grade component juxtaposed with one another and tends to take on a more aggressive clinical course than its low-grade counterpart, suggesting a poor clinical outcome. We, hereby, report a case of acinic cell carcinoma in a 48-year-old woman with a 6-month history of a right parotid facial swelling rapidly increasing in size. The tumor was initially resected; however, residual focal tissue subsequently revealed areas typical of low-grade acinic cell carcinoma as well as high-grade transformation/dedifferentiation via histopathology.

Background Family medicine physicians may encounter a wide variety of conditions, including acute and urgent cases. Considering the limited access to diagnostic investigations in primary care practice, chest X-ray remains the imaging modality of choice. The current study assessed the competency of family medicine residents in the interpretation of chest X-rays for emergency conditions and to compare it with that of diagnostic radiology residents, general practitioners, and medical interns. Methods An online survey was distributed to 600 physicians, including family medicine residents, medical interns, general practitioners, and diagnostic radiology residents. The study included some background information such as gender, years in practice, training type, interest in pulmonary medicine and diagnostic radiology, and having adequate training on the interpretation of chest X-rays. The survey had 10 chest X-ray cases with brief clinical information. Participants were asked to choose the most likely diagnosis and to rate their degree of confidence in the interpretation of the chest X-ray for each case. Results The survey was completed by 205 physicians (response rate = 34.2%). The overall diagnostic accuracy was 63.1% with a significant difference between family medicine and radiology residents (58.0% vs. 90.5%; P < 0.001). The COVID-19 pneumonia (85.4%) and pneumoperitoneum (80.5%) cases had the highest diagnostic accuracy scores. There was a significant correlation between the diagnostic confidence and accuracy (rs = 0.39; P < 0.001). Multivariable regression analysis revealed that being diagnostic radiology residents (odds ratio [OR]: 13.0; 95% confidence interval [CI]: 2.5–67.7) and having higher diagnostic confidence (OR: 2.2; 95% CI: 1.3–3.8) were the only independent predictors of achieving high diagnostic accuracy. Conclusion The competency of family medicine residents in the interpretation of chest X-ray for emergency conditions was far from optimal. The introduction of radiology training courses on emergency conditions seems imperative. Alternatively, the use of tele-radiology in primary healthcare centers should be considered.

Primary mediastinal synovial sarcomas are exceedingly uncommon tumors. Herein, we present the case of primary mediastinal synovial sarcoma (monophasic spindle cell-shaped variant) fully occupying the right hemithorax in a 37-year-old woman who presented to clinic with a 2-month history of right-sided chest pain and shortness of breath. Although extremely rare, however, synovial sarcoma should be considered in the differential diagnosis of all monophasic and biphasic spindle cell neoplasms of the mediastinum. Despite molecular testing for (t[x; 18] [p11.2; q11.2]) is characteristically positive in 90% of synovial sarcoma cases, it is not routinely done. Histopathological and immunohistochemical analyses can greatly confirm the diagnosis. Optimal surgical resection is the standard of care. Adjuvant therapy (radiotherapy and/or chemotherapy) is indicated in inoperable advanced disease or unachieved surgical tumor-free surgical margins. Prognosis is poor with a 5-year overall survival (OS) rate of 35.7%. Early diagnosis and prompt appropriate management yield better disease-free and OS rates.

Inverted papilloma is an uncommon benign epithelial tumor that typically affects the nasal cavity and originates from the lateral sinonasal wall. Inverted papilloma occurring in the middle ear is an even more rare and aggressive condition. We describe a case of a 76-year-old man who was treated for isolated sinonasal inverted papilloma and after 20 months he was found to have a recurrence in the nasal cavity with middle ear involvement and malignant changes consistent with nonkeratinizing squamous cell carcinoma arising from inverted papilloma. Several surgical procedures were required to remove the tumor along with radiation therapy postoperatively.