Iranian Journal of Medical Sciences

Document Type : Original Article(s)


1 Faculty of Medicine, Zagazig University, Zagazig, Egypt

2 Department of Pathology, Faculty of Medicine, University of Benghazi, Benghazi, Libya

3 3Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia

4 Department of Histology and Cell Biology, Faculty of Medicine, Tanta University, Tanta, Egypt

5 Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Zagazig, Zagazig, Egypt

6 Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

7 Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

8 Department of Basic Medical Sciences, Faculty of Medicine, University of Bisha, Bisha, Saudi Arabia

9 Department of Pathology, Faculty of Medicine and Health Sciences, University of Kordofan, Elobeid, Sudan

10 Department of Pathology, Faculty of Medicine, Beni-Suef University, Beni-Suef Egypt



Background: Human papillomavirus (HPV)-related multi phenotypic sinonasal carcinoma (HMSC) is a recently described tumor subtype with an unknown prognosis, often misdiagnosed with other sinonasal carcinomas, and associated with high-risk HPV (HR-HPV). The present study aimed to evaluate the expression of vascular endothelial growth factor (VEGF), Bcl-2-associated X protein (BAX), epidermal growth factor receptors (EGFR), ProEx™C, and human telomerase reverse transcriptase (hTERT) and assess their association with survival and clinicopathological characteristics.
Methods: Between 2017 and 2022, 40 HMSC patients underwent surgical resection at the School of Medicine, Zagazig University Hospitals (Zagazig, Egypt). Tissue samples were examined for the presence of HR-HPV; absence of myeloblastosis (MYB), MYB proto-oncogene like 1 (MYBL1), and nuclear factor I/B (NFIB) fusions; the presence of myoepithelial proteins (calponin, S100, SMA), squamous differentiation markers (p63, p40, calponin), VEGF, BAX, ProEx™C, and hTERT by immunohistochemistry. All patients were followed up for about 54 months until death or the last known survival data. Data were analyzed using the Chi square test and Kaplan-Meier method.
Results: The expression of VEGF, hTERT, and ProEx™C was significantly associated with age, advanced tumor stages, lymph node metastasis, tumor size, mortality, relapse, poor disease-free survival (DFS), and overall survival (OS) (P<0.001). BAX expression was significantly associated with tumor size, age, poor DFS, and relapse (P=0.01, P<0.001, P=0.035, and P=0.002, respectively). 
Conclusion: HMSC is strongly associated with HR-HPV. The expression of VEGF, EGFR, BAX, hTERT, and ProEx™C is associated with aggressive malignant behavior, poor survival, and poor prognosis; making them novel prognostic biomarkers for targeted therapeutics in HMSC.


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