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Journal of International Translational Medicine
Journal of International Translational Medicine
JITM, ISSN 2227-6394
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Editor-in-chief:Feng Jifeng, China
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2019 Vol. 7, No. 1
Published: 30 March 2019

 
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Active Health Service Provision Scale up for HIV and Tuberculosis in 16 Prisons, Iran

Behnam FARHOUDI, Mehrzad TASHAKORIYAN, Mohammad NAZARI POUYA, Masoud JAFARINASAB, Maryam SARGOLZAEI MOGHADDAM, Saeed SHARFI, Sepideh ALIZADEH, SeyedAhmad SEYEDALINAGHI
Journal of International Translational Medicine, 2019, 7(1): 1-4 | doi:10.11910/2227-6394.2019.07.01.01
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Background: In most countries, the prevalence of HIV and tuberculosis (TB) among prisoners are higher than those in the general population. Nevertheless, the prison setting presents not only challenges, but also opportunities for the prevention and treatment of TB and HIV. Therefore, this program was designed to scale up a previously piloted guideline to screen and diagnose people living with HIV (PLWH) and those with TB diseases and then provide them actively needed health services.
Methods: Since the beginning of March 2015 the program for active health service provision (AHSP) for TB and HIV was started. This guideline was based on a model that provide diagnostic, treatment and follow-up services actively including all aspects of HIV/TB diagnosis, treatment and care services. Also major HIV/TB-related topics are described in it. In order to carry out the scaling up of the implementation of the guideline, following steps were taken: Formation of the Steering Committee, establishing required structures and holding workshops to train staff.
Results: Te mean number of HIV tests done before the intervention was 163.9 per season in 16 prisons, while this figure was 1106.5 per season after the intervention. Te mean number of patients receiving antiretroviral therapy (ART) increased afar the intervention. Te numbers are, respectively, 10.8, and 16.4 person per season, before and after the intervention.
Conclusion: Te changes of target variables before and after the program within 6 prisons in 3 provinces in Iran show the efficiency of AHSP. Since the prevalence of HIV and TB among prisoners are high and HIV infection, itself, is the greatest risk factor for developing TB, prisons as well as challenges are opportunities for the prevention and treatment of TB and HIV. Actively health services provided in prisons show positive results and suggest an efficient way of dealing with these infections.

       

Anti-nociceptive Effect of Hydro-alcoholic Extract of Cardamom Seed in Male Rat Hot!

Karamatollah RHMANIAN, Zhila RHMANIAN, Abdolreza Sotoodeh JAHROMI
Journal of International Translational Medicine, 2019, 7(1): 5-8 | doi:10.11910/2227-6394.2019.07.01.02
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Purpose: Cardamom seeds are widely used for flavoring purposes in food and also as carminative. We aimed to assess the analgesic effect of cardamom seed extract in mice.

Methods: In this experimental study, we used hydro-alcoholic extract of cardamom. The effect of extract on acute pain was evaluated by formalin (early phase) and tail flick tests. Te effect of extract on chronic pain was studied by formalin (second phase) test.

Significant findings: In the formalin test, intra peritoneal injection of cardamom at dose of 300 mg/kg showed significant analgesic effect on early phase (acute pain) in mice. Cardamom 200 and 300 mg/kg exhibited analgesic activity against second phase (chronic pain) of formalin test. Also, cardamom 200 and 300 mg/kg exhibited anti-nociceptive effect on tail flick test.Sodium salicylate (300 mg/kg) only affected on second phase of formalin test that its effect was beter than that of cardamom 300 mg/kg.

Conclusion: According to our results, cardamom seeds have analgesic effect on acute and chronic pain that may be atributed to tripnoids component in this plant.


       

Clinical Outcome of HIV Infected Patients Receiving Antiretroviral Therapy with Immunologic-Virologic Discordance (2012-2016)   Hot!

Ladan ABBASIAN, Masoumeh Farrokh ASHTIANI, Zeinab NAJAFI, SeyedAhmad SEYEDALINAGHI
Journal of International Translational Medicine, 2019, 7(1): 9-14 | doi:10.11910/2227-6394.2019.07.01.03
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Background: The aim of present study was to investigate the Consequence of Immunologic and Virologic Discordancy and its associated factors in people living with HIV (PLWH) receiving antiretroviral therapy (ART).

Methods: In this retrospective cohort study, case records of all HIV positive patients from 2012 were evaluated. Viral response less than 400 copies/mL defined positive for at least 6 months after treatment initiation and immunologic response considered acceptable when patient experienced a rise of more than 50 CD4 (cells/μL) one year after the treatment onset. The status of viral load and CD4 count was recorded, and the state of matching or discordance of the virologic and immunologic responses were determined.

Results: In the present survey, 339 patients were examined, the most ART regimen in the patients faced Immunologic -Virologic Discordance (IVD) was Atripla (Emtricitabine plus Tenofovir and Efavirenz) (59.4%), and then respectively Cobavir (Lamivudine plus Zidovudine) plus Efavirenz (25%), Cobavir plus Kaletra (Lopinavir plus Ritonavir) (12.5%) and Tenofovir plus Emtricitabine with Efavirenz (3.1%). The investigation of virologic response based on the patients gender, revealed that the rate of virologic response was approximately the same among male (97.1%) and female (97.6%) patients (P = 0.76). The investigation of HCV infection prevalence among patients revealed that 76 (22.8%) of patients was HCV positive and 257 (77.2%) was HCV negative. The prevalence of HCV among males (34%) was higher than female patients (4.7%). The prevalence of HBV infection was 3.4% in the males and 0.8% in the females (P = 0.13). Eight patients were HBV positive while 325 were negative. The CD4 measured in second year for male and female patients separately and the result revealed that it was more than 200 cells/μL in 168 cases containing 98 (73.3%) men and 70 (80.5%) women (P = 0.25). The investigation of opportunistic infections based on gender showed that 7 (3.4%) men and 3 (2.4%) women faced such infections (P = 0.59). Generally, 10(3.0%) patients faced opportunistic infections during the study. Of these, six (1.8%) patients had positive virologic response and four (44.4%) patients had negative virologic response (P < 0.001).

Conclusion: In the present study, regarding the fact that the IVD and CD4 below 100 cells/μL showed a significant relation, the faster identification of PLWH and suitable treatment would reduce the risk of IVD. The IVD rate was higher in HCV positive patients, which should be evaluated earlier and receive an efficient regimen as soon as possible if they need treatment. Regarding the association between the consumption of Cobavir and IVD incidence, it is recommended to revise the ART regimens containing Cobavir.

       

A Genetic Variant of KOZAK Region in Annexin-V Gene in Premature Myocardial Infarction: A Case Control Study Hot!

Saeideh ERFANIAN, Mohammad SHOJAEI, Nazanin REZAEI, Abdolreza Sotoodeh JAHROMI, Masihollah SHAKERI, Heshmatollah SHAKERI, Mohammad HOJJAT-FARSANGI
Journal of International Translational Medicine, 2019, 7(1): 15-18 | doi:10.11910/2227-6394.2019.07.01.04
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Purpose: Atherosclerosis is the major underlying cause of cardiovascular diseases. Recently has been revealed a genetic role in the occurrence of coronary artery disease (CAD). Annexin V is one of the genes which may play roles in early-onset CAD and has anti-coagulatory roles. The aim of this study was to determine the association between -1C>T polymorphism of KOZAK region in annexin-V gene and premature CAD.

Methods: This case-control study was done on 100 patients with premature acute myocardial infarction, patients matched with healthy people with sex and age-matched and some other cardiovascular risk factor. Genomic DNA was extracted from WBC and then the polymorphism was genotyped using PCR-RFLP method. The collected data were analyzed by SPSS.

Significant findings: There was no significant difference between genotypes of annexin-V gene and occurrence of premature CAD (P = 0.840) and there is a significant difference between alleles of the annexin-V gene (C and T) and occurrence of premature CAD in case and control groups (P = 0.013).

Conclusions: According to the results derived from this study, it seems like the existence of the genotype carrying the mutated allele (CT+TT) in -1C>T of KOZAK region in the annexin-V gene is not associated with an increased risk of premature myocardial infarction.

       

First Report of Drug Resistance against HIV-1 Integrase Inhibitors in Iran

Mohammad GHOLAMI, Negin Hosseini ROUZBAHANI, Leila TAJ, Katayoun TAYERI, SeyedAhmad SEYEDALINAGHI, Seyed Ali Dehghan MANSHADI
Journal of International Translational Medicine, 2019, 7(1): 19-24 | doi:10.11910/2227-6394.2019.07.01.05
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Background: Four Integrase Strand Transfer Inhibitors (INSTIs) have been approved for HIV-1 by the Food and Drug Administration (FDA). Recently, resistance against these INSTIs drugs and cross-resistance among them have been reported. The aim of the current study was to evaluate INSTIs drug resistant patterns in patients having virology failure to INSTIs and mutation analysis in the Nef gene.

Methods: Samples were collected from individuals who had treatment failure to INSTIs. DNA and RNA were extracted by QIAamp RNA and DNA extraction kit. The PCR reaction was performed by using Qiagen one step master mix and in-house developed primers. PCR products were sequenced by Sanger method and after performing the quality control in Recall web (http://pssm.cfenet.ubc.ca/home/process_data), drug resistant mutation was analyzed by Stanford database and phylogenetic analysis was performed by MEGA5 software.

Results: The phylogenetic analysis was done by 42 reference subtypes and result revealed that our sequences are in subtype CRF-35AD. The integrase major and minor mutations, T66AY143R, Y143R and T97A, showed high to intermediate resistance level to Raltegravir and Elvitegravir, respectively. The analysis of RT-RNA and proviruses revealed that pattern of drug resistance was similar in these two patients in RNA and proviruses, respectively. Moreover, analysis of the Nef sequence by codon software revealed that there were no deletion and mutation in Nef gene.

Conclusion: It is the first report regarding integrase inhibitor drug resistance in Iran. Considering the wide use of antiretroviral drugs, it is necessary to determine subtype-dependent resistance in Iranian society. It is also recommended that integrase inhibitor resistance should be evaluated in naive patients, and it needs more considerations in relation to the resistance to out locate integrase.

       

Association of rs1883832 SNP in Kozak Region of CD40 Gene with Diabetes Mellitus Type 2: A Case Control Study

Saeideh ERFANIAN, Masihollah SHAKERI, Heshmatollah SHAKERI, Zhila RAHMANIAN, Azin SOHRABI, Abdolreza Sotoodeh JAHROMI, Mohammad HOJJAT-FARSANGI
Journal of International Translational Medicine, 2019, 7(1): 25-28 | doi:10.11910/2227-6394.2019.07.01.06
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Purpose: Lifestyle and genetic factors are considered effective risk factors for Diabetes. Genetic factors are not as discussed as a lifestyle in the path of causing diabetes. CD40 is an inflammatory agent of TNF superfamily, which is believed to affect pancreatic beta cells during the interaction to its ligand, CD154. Polymorphism of rs1883832 of Kozak sequence of CD40 gene is suspicious to create different phenotypes, including uncontrolled Diabetes mellitus (DM). The present study was done to compare the association between rs1883832 SNP in CD40 Kozak sequence with Diabetes mellitus type 2 (DMT2) in diabetic patients and healthy people.

Method: This case-control study was done on 180 patients of DMT2 and 180 healthy subjects. The rs1883832 SNP of Kozak sequence of CD40 gene was studied using PCR-RFLP and DNA sequencing technique. Collected data analyzed by SPSS v.11.5.

Significant findings: The frequency of TT genotype and T allele were significantly higher in the patient's group, while CC genotype was higher in the control group.

Conclusions: According to the results of this study, it seems the existence of the genotype carrying the mutated allele (CT+TT) in -1C>T of KOZAK region in the CD40 gene is associated with an increased risk of DMT2.

       

Effectiveness of Life Skills Training on Coping Strategies of None-addict Women with Addict Husbands

Zahra SHAHABINEZHAD, Saeed GHODRATI, Ghazaleh HAZARATI EHSANI FARD, SeyedAhmad SEYEDALINAGHI, Afzal AKBARI BALOOTBANGAN, Parisa HOSSEINI KOUKAMARI
Journal of International Translational Medicine, 2019, 7(1): 29-32 | doi:10.11910/2227-6394.2019.07.01.07
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Aims: Discrepancy in substance use have negative implications for none-addict women. The present research, aimed to investigate the efficacy of life skills training on coping strategies of non-addict women who have addict husbands.

Methods: Among 120 women with addict husbands, we recruited 30 women who suffered from malfunctional coping strategies and assigned randomly into the two control and study groups in 2016. Analysis of covariance were used to investigate differences between the study and the control groups after conducting educational sessions.

Results: Findings indicated significant increase in problem-focused coping strategies (P < 0.001) and significant decrease in emotional-focused (P < 0.001) and insufficient coping strategies (P < 0.001) after the life skills training sessions.

Conclusion: Life skills training was effective to improve coping strategies of non-addict women with addict husbands. Life skills training has positive clinical and educational implications and can be used in health promotion programs.

       

Knowledge, Attitude and Practice Towards HIV/AIDS Conjoint with HIV, HBV, HCV and HSV2 Serosurveys among Girls from Dysfunctional Families in Tehran, Iran

Zahra Bayat JOZANI, Banafsheh Moradmand BADIE, Saeed BAYANOLHAGH, Mona MOHAMMADIFIROUZEH, Sara AHSANI-NASAB, Farzaneh VAKILI, SeyedAhmad SEYEDALINAGHI, Hanieh GOLCHEHREGAN, Maryam FOROUGHI, Minoo MOHR
Journal of International Translational Medicine, 2019, 7(1): 33-38 | doi:10.11910/2227-6394.2019.07.01.08
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To assess knowledge, attitude and practice (KAP) towards HIV/AIDS and to perform HIV, HBV, HCV and HSV2 serosurveys among girls from dysfunctional families in Tehran, Iran.

   A standard questionnaire was used to assess participants knowledge, attitude and practice towards HIV/AIDS by pre and post- tests within a three months interval. We also performed HIV, HBV, HCV and HSV2 serostatus assessment in our study group in post- test phase.

   Ninety eight (52.2%) of the participants had good knowledge about HIV/AIDS before our educational intervention, after which this was raised to 133 (70.7%) (Mc Nemar’s test, P = 0.031). Importantly, 177 (94.1%) of participants were willing to be tested for HIV before counseling. There was no positive result for HIV, HBV, HCV and HSV2 serosurvey.

   HIV/AIDS education and counseling significantly increased knowledge, attitudes and practice of girls from dysfunctional families regardless of their HIV, HBV, HCV, or HSV2 serostatus findings.

       

Menstrual Characteristics and Patterns of Menstrual Disorders among Women Living with HIV in Tehran, Iran Hot!

Zahra Bayat JOZANI, Farzaneh VAKILI, Zohreh ROSTAM-AFSHAR, Sara AHSANI-NASAB, Reza ADL-TABATABAI, SeyedAhmad SEYEDALINAGHI, Mehrnaz RASOOLINEJAD
Journal of International Translational Medicine, 2019, 7(1): 39-43 | doi:10.11910/2227-6394.2019.07.01.09
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Background: The relation between Human Immunodeficiency Virus (HIV) serostatus and menstrual irregularities is controversial. Toward a better understanding of menstrual abnormalities among HIV infected women and the role of HIV related variables, we conducted the present study.

Materials and methods: This cross-sectional study was conducted between September 2016 and December 2017 among 111 eligible HIV infected women and in Imam Khomeini Hospital, Tehran, Iran. Participant were recruited based on convenience sampling method. We addressed the menstrual data of 102 participants (returning at least three consecutive menstrual calendars) through a self-constructed questionnaire. We also assessed HIV viral load and CD4 cells count of each participant at the time of study enrollment. Descriptive statistics as well as Kruskal-Wallis test and Bonferroni post hoc tests were used to address our objectives, so we used Statistical Package for the Social Sciences (SPSS) version 16.0 for windows (SPSS, Inc, Chicago, IL). Significance level was considered as 0.05.

Results: Vaginal spotting (18%) and metrorrhagia (18%) were the most prevalent disorders among our participants. Despite of sociodemographic variables, we found significant relationship between HIV viral load and hypermenorrhea as well as CD4 cells count and polymenorrhea (Kruskal-Wallis test; P < 0.05).

Conclusion: HIV related immunosuppression seems to have significant impact on some aspects of menstrual cycles among Iranian women.

       

Epidemiology of Occupational Injuries in Hospital Personnel: Findings from a Hospital Registry in Tehran, Iran

Saeedreza Jamali Moghadam SIYAHKALI, SeyedAhmad SEYEDALINAGHI, Zoha ALI, Mohammad Reza SALEHI, Omid DADRAS
Journal of International Translational Medicine, 2019, 7(1): 44-47 | doi:10.11910/2227-6394.2019.07.01.10
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Background: Occupational injuries can expose healthcare workers (HCWs) to blood infectious diseases such as hepatitis B, C and HIV and other blood borne diseases. These could be prevented by implementing the precaution and safety procedures in workplace. This study explored the prevalence of occupational injuries among HCWs in Tehran, Iran, in 2016.

Methods: A cross-sectional study was conducted among 55 HCWs at Ziaeian Hospital in Tehran. Data for HCWs with a history of occupational injuries in 2016 were retrieved from the Hospital registry and analyzed by SPSS version 22.

Results: The occupational injuries were observed in 19 (34.6%) registered nurses (RNs), 8 (14.5%) licensed practical nurses (LPNs), and 7 (12.7%) doctors. The most common injuries were needle stick injuries (87.7%) and splashing blood and secretions into the eyes (12.7%). Needle stick injuries were mostly caused by drawing blood 18 (32.8%), suturing 14 (25.5%) and blood sugar testing 8 (14.5%).

Conclusion: Needle stick is the most common injury among healthcare workers which may cause serious and life-threatening infectious diseases such as Hepatitis B and C and HIV. This could be prevented by risk reduction through safety measures such as vaccination, precaution in handling of sharp and contaminated objects and safe disposal of infectious waste. Furthermore, post exposure prophylaxis, psychological support and counselling should be provided for the affected HCWs.

       

Usability Evaluation of a Mobile-based Self-management Application from the Perspective of People Living with HIV

Esmaeil MEHRAEEN, Reza SAFDARI, Seyed Mohammad GHAVAM, Jebraeil FARZI, Tayebeh NOORI, SeyedAhmad SEYEDALINAGHI
Journal of International Translational Medicine, 2019, 7(1): 48-53 | doi:10.11910/2227-6394.2019.07.01.11
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Background: People living with HIV (PLWH) are faced with a chronic condition that requires management and awareness of their situation. Mobile-based applications (apps) have the potential to support self-management and provide educational information for PLWH. In this study, we aimed to evaluate the usability of a mobile-based self-management app from the perspective of PLWH.

Methods: This study was a cross-sectional one that conducted to determine the usability of a mobile-based self-management app for PLWH. The statistical population was all PLWH in the Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital in 2018 (N = 65). We asked the end-users to use the mobile-based self-management app for 30 days. User feedback was collected using a researcher-made questionnaire. The collected data from the statistical population were analyzed using SPSS version 20.

Results: According to the findings, most features of the mobile-based self-management app from the perspective of PLWH were in "very high" level. Moreover, we finalized the design process, which included the functional features and user interface screens of a mobile-based self-management app for PLWH to manage their chronic condition. The functional features which were finalized at the end of usability evolution included: HIV/AIDS INFO, Antiretroviral therapy, Medication adherence, and Reminders.

Conclusion: Despite the widespread use of mobile-based apps, usability evaluation can help further develop these applications in the HIV-care. However, further study is needed to assess the impact of the mobile-based app on adherence to medication for PLWH and facilitate their communication with healthcare providers.

       

Preparation of Ciprofloxacin Ocular Ophthalmic Nano Emulsion and its Physicochemical Characterization In Vitro

Bahardokht SALEHI, Seyed Alireza MORTAZAVI, Zahra JAFARIAZAR
Journal of International Translational Medicine, 2019, 7(1): 54-60 | doi:10.11910/2227-6394.2019.07.01.12
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Background: The purpose of this study was to design and construct nano emulsion containing slow-release, lipophilic and biocompatible hydrochloride as an ideal ophthalmic drug delivery system for increasing bioavailability and reducing systemic effects.

Methods: Pre-formulation studies were conducted to investigate the UV and FT-IR spectra in artificial tear environments. In order to build a suitable base, various proportions of Span 60 and Tween 80 as surfactants were used, and propylene glycol was used as a co-surfactant. The effect of different oils on the formation of transparent base with an appropriate particle size was investigated. In the next steps, the drug was added to the base. Finally, all quality control tests were performed on the product,

Results: The best result is from the ratio of 1 to 3 surfactants to the co-surfactant (Smix) and the ratio 4 to 6 for the oil to Smix which has a transparency, nano particle size and release for about 10 hours.

Conclusion: The use of nano emulsions can result in controlled drug release in targeted tissues and the concentration of drug in the target tissue to reach therapeutic concentrations and the treatment process is carried out with higher speed and quality.

       

Update on New Therapies of Diabetic Foot Ulcers: A Systematic Review

Vahid ABOLGHASEMI, Mehdi MESRI
Journal of International Translational Medicine, 2019, 7(1): 61-64 | doi:10.11910/2227-6394.2019.07.01.13
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Diabetic foot ulcers (DFUs) are as a chronic wound with a serious and rampant complication of diabetes mellitus. Treatment of DFU remains often challenging and time-consuming due to consecutive uncomfortable outcomes. Therefore, this review helps to inform clinicians of the current status of new effective therapies for DFUs.

       

Cryptococcal Lymphadenitis in an HIV Positive Patient: A Rare Presentation

SeyedAli Dehghan MANSHADI, MohammadReza SALEHI, SeyedAhmad SEYEDALINAGHI, Hana SAFFAR, Seyedeh Rana KHATAMI
Journal of International Translational Medicine, 2019, 7(1): 65-69 | doi:10.11910/2227-6394.2019.07.01.14
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Human immunodeficiency virus (HIV) infection causes immune system suppression and many opportunistic infections. We reported a 24-year-old HIV infected man admitted to the infectious diseases ward of a referral hospital in Tehran with a complaint of cervical and chest wall masses. Regarding the history and clinical symptoms of the patient, opportunistic infections such as mycobacterial and fungal infections were worked up. The patient was treated with Amphotericin B. After three weeks of treatment, symptoms of the patient, especially cervical lymphadenopathies and sternal mass, resolved completely and the patient was discharged with oral fluconazole.

       

Rituximab as a Treatment for Limbic Encephalitis Associated with Leucine-Rich Glioma Inactivated 1: A Case Report and Literature Review

Behnam Safarpour LIMA, Mahtab RAMEZANI, Ehsan KARIMIALAVIJEH, Sepideh PAYBAST, Nahid BELADIMOGHADAM, Nikoo Hossein Khan NAZER
Journal of International Translational Medicine, 2019, 7(1): 70-73 | doi:10.11910/2227-6394.2019.07.01.15
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Leucine-rich glioma-inactivated-1 (LGI1) protein antibody-associated limbic encephalitis (LE) is a treatable autoimmune disease. This report is about the administration of rituximab in two patients with LGI1 antibody-associated LE. Both patients had progressive confusion, behavioral alteration, memory impairment and temporal lobe seizures. Treatment included steroids, intravenous immunoglobulin (IVIG) and rituximab. Patients showed a positive response to the therapy. Both patients satisfactorily tolerated rituximab and neither experienced side effects. We also reviewed the recommended treatments for the LGI1 LE. Based on the recent reports, rituximab has the potential to become one of the treatment options for LE. Nevertheless, more evidence is necessary in order to accurately evaluate its efficacy.

       

Diarrhea as Initial Manifestation of Systemic Lupus Erythematosus (SLE): A Case Report

Saeed Reza Jamali MOGHADAM, Omid DADRAS, Seyed Ali Dehghan MANSHAD, SeyedAhmad SEYEDALINAGHI
Journal of International Translational Medicine, 2019, 7(1): 74-76 | doi:10.11910/2227-6394.2019.07.01.16
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Systemic Lupus Erythematosus (SLE) is an autoimmune disease. The most common presentation is a female with fever,
arthralgia, and malar rash. Diarrhea usually occurs as a side effect of medications. Although digestive tract involvement in SLE
is common, its initial manifestation as diarrhea is rare. This paper describes one of the rare SLE manifestations as merely acute
diarrhea and abdominal discomfort.
       

Endolymphatic Sac Tumor: Misdiagnoses with Cerebellopontine Angle Tumor Transotic Approach

Mohammad MOHSENI, Zahra KARBASI
Journal of International Translational Medicine, 2019, 7(1): 77-80 | doi:10.11910/2227-6394.2019.07.01.17
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Endolymphatic sac tumor (ELST) is an uncommon neoplasm which can be encountered in Von Hippel-Lindau (VHL) disease or sporadically. Herein, we report a sporadic case of ELST in 30-year-old women who was at first recognized with cerebellopontine angle (cp angle) tumor. Computed tomography (CT) imaging showed an expansile lytic lesion of the mastoid process of the leftsided petrous bone. Magnetic resonance imaging (MRI) showed a 4 cm × 4 cm × 3 cm mass with hyperintensity on T1- and T2-weighted images. Histologic sections showed an aggressive papillary. Although the mass was large, it was incredulously removed completely with the transaortic approach. After surgery, the patient underwent radiotherapy for the microscopic residual of the tumor. The findings indicate that ELST can easily be misdiagnosed with other tumors, like paraganglioma, adenocarcinoma, middle ear adenoma, thyroid papillary carcinoma or papilloma of choroid plexus, because of the rarity of this tumor. When it is large, it is difficult to extirpate surgically, owing to its locally aggressive nature.

 
 
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