Urticarial vasculitis in a COVID-19 recovered patient Dear Editor, Coronavirus disease 2019 (COVID-19) typically presents with fever and respiratory symptoms, but the clinical spectrum appears to be wide. 1 Skin is rarely involved in the course of COVID-19, but its involvement may be underreported. 2 Herein, we report a case of COVID-19 who developed urticarial vasculitis after recovery. On March 24, 2020, a 64-year-old woman presented to the emergency room with fever, dry cough, dyspnea, nausea, and anorexia. The past medical history was significant for diabetes mellitus and hypertension. She was screened for COVID-19 with a low-dose chest CT scan that showed patchy parenchymal ground-glass opacities with peripheral distribution typical for COVID-19 infection. Her lab tests showed a normal WBC count without lymphopenia and elevated levels of both lactate dehydrogenase (LDH: 554 U/L) and C-reactive protein (CRP: 61 mg/l; Positive > 10). Nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) was positive for SARS-CoV-2. She was treated with hydroxychloroquine (200 mg BD) and azithromycin 250 mg/day for 5 days with advice to keep home quarantine, which led to a gradual improvement of the symptoms. On April 22, 2020, she presented again with weakness, malaise, anorexia recurring for the previous 1 week, and newonset generalized skin lesions. Skin lesions had appeared abruptly 48 hours before the presentation. Cutaneous examination revealed prominent periorbital

Background:Germ cell tumors are neoplasms that originate from multi potential germ cells and can be intra or extra gonadal. According to pathologic classification, they have different subtypes. They account for 3% of pediatric malignancies and most commonly happen in children before the age of 15 years old. Epidemiologic evidence about pediatric germ cell tumors is scant in our region.Objectives:The aim of current study was to determine demographic characteristics, recurrence and survival rate of germ cell tumor patients under the age of 21 years.Patients and Methods:During a 10-year period (1996 - 2006), 106 patients under the age of 21 years suffering from germ cell tumor were admitted to our centers. We extracted the data needed for our study from patients’ medical records in the hospitals.Results:Thirty seven boys and 69 girls with a mean age of 8.4 ± 7.8 years were included. Most tumors were diagnosed before the age of one year (37%). The most common pathologic subtype was mature teratoma (44%). Ovary (35%) was the most common primary site. Surgery plus chemotherapy were used to treat 54 patients and BEP was the most common chemotherapy regimen. Metastasis and recurrent tumor were seen in 22% and 8% of cases, respectively. Four-year overall survival was 89%.Conclusions:Our study showed that demographic characteristics of GCT patients in our population are similar to patients of other geographic regions in the world. Primary tumor site, histologic subtype and metastasis were significant prognostic factors for survival.

Background:The literature is inconsistent for the role of neutrophil-to-lymphocyte ratio (NLR) obtained before neoadjuvant therapy (pre-NLR) in predicting pathological response to neoadjuvant chemoradiation (neoCRT) in patients with locally advanced rectal cancer (LARC). In the present cohort study, we explored the predictive role of pre-NLR in this setting. Methods: We prospectively included patients with LARC who were candidates for neoCRT at the Shohada-e-Hafte Tir Hospital (Tehran, Iran) between Mar 2018 and Feb 2020. The pre-NLR was obtained through a peripheral blood smear before CRT. We used the AJCC system for evaluating tumor regression grade (TRG). The TRGs were categorized into: response-group 1 (TRG 0-1 vs. 2-3), response-group 2 (TRG 0 vs. 1-3), and responsegroup 3 (TRG 0-2 vs. 3). We applied receiver operating characteristic (ROC) analysis to assess the predictive value of pre-NLR. Results: Of the 86 screened patients with rectal cancer, 30 patients who fulfilled the inclusion criteria were included in the study. In total, 63.3% were responsive, and 23.3% had complete pathologic response. Pre-NLR could not predict the pathologic response in response-group 1 (area under the ROC curve [AUC]: 0.45, 95%CI 0.23-0.66) and response-group 2 (AUC: 0.36, 95%CI 0.13-0.59). Nevertheless, it had a poor predictive value in response-group 3 (AUC: 0.55, CI%95 0.33-0.75) with an optimal NLR cutoff value of 2.94. Conclusions: Pre-NLR could not predict the pathological response to neoCRT in our cohort of patients with LARC.

Background:Evidences about survival of the patients with head and neck squamous cell carsinoma (HNSCC) have been scant in our region.Objectives:The aim of current study was to determine clinico-pathological and treatment-related factors, influencing outcome of these patients.Patients and Methods:We have reviewed all patients with a new diagnosis of HNSCC admitted between 2008 and 2014 in “Jorjani Cancer Center”, Tehran, Iran. Overall survival (OS) and event free survival (EFS) of the patients, and their relation with demographic and clinico-pathological factors have been analyzed.Results:Among 119 included patients, 90 were male and 29 were female with mean age of 58 years. Larynx was the most common primary tumor site (55% of all patients). With a median follow-up period of 28 months, OS and EFS of the study patients was 61.2% and 52.4%, respectively. Tumor stage was the only parameter has significantly influenced the patients’ OS. Patients with normal BMIs had significantly higher mean EFS compared with patients with bellow or above normal BMIs. Surgical treatment modalities have resulted in the same prognosis as non-surgical approaches.Conclusions:Our study seems to be the first that investigated outcome of Iranian patients with head and neck cancer and its influencing factors.

To investigate whether excision repair cross complementing-group1 (ERCC1) expression status could serve as a bio-predictor of response to platinum-based induction chemotherapy for head and neck cancers (HNCs) patients with a diagnosis of epithelial HNC were studied retrospectively. Paraffin embedded tumor samples of the patients were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) to determine ERCC1 expression status and its correlation with response to platinum-based induction chemotherapy was investigated. Of 44 included patients, 33 were male (75%) and 11 were female (25%) with a mean age of 53 years. Some 36% of patients whose tumor samples had high ERCC1 expression showed no response to induction chemotherapy. The value for patients with low ERCC1 expression was 9% and the difference was statistically significant (p=0.03). The ERCC1 expression state did not significantly vary between patient groups according to sex, age, primary tumor site, and tumor and node stage. Our study indicates that ERCC1 expression status detected by RT-PCR might serve as a bio-predictor of response to platinum-based induction chemotherapy for epithelial HNCs.