bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mammary Analog Secretory Carcinoma of the Parotid Gland
Authors: Kozin Elliot D. , Remenschneider Aaron K. , Naunheim Matthew , Carter Margaret , Meier Josh , Vanderlaan Paul , Frankenthaler Robert A. 
Published: August 2013

Objectives:1) Describe newly classified salivary gland tumor, mammary analog secretory carcinoma (MASC) of the salivary gland. 2) Present a patient with a right parotid mass with pathology consistent with MASC and discuss our institution's diagnostic and therapeutic approach.Methods:We identified a rare case of MASC of the parotid gland. We conducted a PubMed literature review on MASC with reports in the pathology and otolaryngology literature.Results:A 58‐year‐old female presented to our clinic after noticing swelling in her right cheek. An MRI of the neck found a well‐encapsulated benign appearing parotid mass measuring 3.2 × 2.2 × 3.1 cm. A fine‐needle aspiration was performed and was concerning for high‐grade carcinoma, with a differential diagnosis including acinic cell carcinoma and mucoepidermoid carcinoma. She underwent a parotidectomy and modified radical neck dissection. Histologic evaluation was consistent with MASC. Subsequent FISH testing demonstrated the characteristic t(12;15) ETV6‐NTRK3 translocation, confirming the diagnosis of MASC.Conclusions:First described in 2010, MASC of the salivary gland is a newly described pathologic diagnosis. It has few reports in the literature. Our case raises the question as to when to consider MASC in the differential diagnosis based on imaging, FNA, and final pathology, including de‐differentiation from acinic cell carcinoma. Further study is needed to best delineate appropriate diagnostic and therapeutic approach for the otolaryngologist for this emerging pathologic entity.
Metatypical Basal Cell Carcinoma: Histopathological Features in Aggressive Tumors
Authors: Andrade Natalia M. M. , Calvas Oscar I. J. , Cernea Claudio R. , Brandao Lenine G. , Santos Andre B. 
Published: August 2013

Objectives:The incidence and histological characteristics of metatypical basal cell carcinoma (MBCC) are divergent in the literature, especially in large dimension lesions. Retrospective studies suggest that this neoplasm represents from 1.2% to 2.7% of all BCCs, with a particular behavior that is prone to metastasis. The purpose of this study is to compare the demographics and histopathological features of cervicofacial MBCC with other BCCs treated by head and neck surgery.Methods:Data from 354 basal cell carcinomas were reviewed (1994‐2012). Sex, age, histological subtype, localization, size, perineural and angiolymphatic invasions were analyzed, comparing MBCC with other basal cell carcinoma subtypes.Results:MBCC was found in 35 cases (10.77%), either as principal or associated subtype. Average age of MBCC was 64.8 ± 12.8, and 65.1 ± 14.2 years in the other group (P = 0.89). There was no statistical difference in the items sex and angiolymphathic invasion. Zone H tumors were in 75.6% of MBCC and 89.7% of the negative group (P = 0.02). Median size was 4.18 cm in MBCC and 2.67 cm in the negative group (P < 0.01). Perineural invasion was observed in 47.2% in MBCC, while the frequency in the general BCC group was 20.8% (P < 0.01).Conclusions:MBCC lesions with large dimensions, described as more aggressive behavior, present with bigger size, higher frequency of perineural invasion, and lower location in Zone H.
Orbital Exenteration for Advanced Peri‐orbital Skin Cancer: Prognostic Factors and Survival
Authors: Gerring Robert C. , Ott Cody T. , Wester Sara D. , Sargi Zoukaa B. 
Published: August 2013

Objectives:Orbital exenteration for advanced periorbital malignancies is a relatively rare but highly morbid procedure, often done for cancers arising from periorbital skin. The purpose of this research is to investigate and describe cases of cutaneous malignancy of the periorbital skin for which orbital exenteration was done.Methods:This is a retrospective single institution case series at a tertiary care university hospital, including all cases of orbital exenteration for advanced periorbital malignancies performed between January 2002 and January 2012 at the University of Miami/Bascom Palmer Eye Institute/Jackson Memorial Hospital. Patient demographics, tumor characteristics, operative reports, histologic, radiologic and clinical follow‐up data were recorded. Outcome measures were overall survival and disease free survival, univariate analysis for multiple clinical factors including prior surgery, bony erosion on pre‐operative CT scan, intracranial involvement, and surgical margins.Results:There were 64 patients with a mean age of 70 years (41 male, 23 female) who underwent orbital exenteration for periorbital skin cancers. Of these, 24 patients had squamous cell carcinoma, 24 basal cell carcinoma, 11 sebaceous carcinoma, and 5 cases of malignant melanoma. The most common sites of origin were facial skin (17), medial canthus (14), inferior lid (14), and upper lid (11).Conclusions:Surgical outcome and survival were reviewed with relation to significant prognostic variables.
Perineural Invasion in Head and Neck Basal Cell Carcinomas: A Major Factor in Mutilating Tumors
Authors: Andrade Natália M. M. , de Oliveira Santos Andre Bandiera , Cernea Claudio R. , Brandao Lenine Garcia 
Published: August 2013

Objectives:Basal cell carcinoma is the most frequent neoplasia in Caucasians. Morbidity is mainly related to local invasion. Perineural invasion (PI) was recently included in TNM staging and is rare in this skin malignancy. Our goal was to characterize the cases of basal cell carcinoma with PI submitted to surgery by head and neck surgeons, in its clinical, epidemiological and histopathological features.Methods:From 1994 to 2012, 354 basal cell carcinomas were submitted to surgery under general anesthesia. Sex, age, hystological subtype, localization, size and PI were retrospectively analyzed. The cases with and without PI were compared.Results:PI was positive in 23.1% of the tumors. 58.5% were men, whereas 49.6% were men in the PI negative patients (P = 0.16). Mean age in the positive group was 65.4‚±13.2 years, while in the negative group mean age was 65.0‚±14.4 years (P = 0.8). Mean size of primary tumors in the positive group was 3.8‚±2.2cm and 2.5‚±1.8cm in the negative group (P < 0.01). Morpheaform subtype was predominant in 48.2% in the positive group and 26.4% in the negative group (P < 0,001). Nodular subtype was predominant in 33.7% in the positive and 53.2% in the negative group (P = 0.002).Conclusions:In this series of aggressive and mutilating tumors, with a 8‐fold increase of PI, basal cell carcinomas with PI had higher mean tumor size and more frequency of morpheaform as predominant subtype.
Pharyngolaryngoesophagectomy with Gastric Transposition Reconstruction: Comparison of Single Institution Outcomes from 1965 to Today
Authors: Lambert Aileen L. , Giddings Charles E. , Vaz Francis M. , O'Flynn Paul E. 
Published: August 2013

Objectives:1) Comparison of our current operative and functional outcomes with those published previously from our institution for pharyngolaryngoesophagectomy (PLO) with gastric transposition reconstruction. 2) Analysis of the role of this reconstructive option in contemporary head and neck surgery.Methods:Retrospective review of patients who underwent PLO with gastric transposition and feeding jejunostomy from 2010 to 2013. Comparison was made with previously published data from our institution dating back to 1965 for the same procedure, and with more recent literature reports.Results:Nine patients were identified: 3 had primary T4 squamous cell carcinoma, 3 had local recurrence from radical radiotherapy, and 3 had previously treated metastatic tumor. There was no in‐hospital mortality. Early complications occurred in 44% including salivary fistula (n = 1). Average length of stay was 36.4 days. 1 patient had local recurrence at 6 months. Disease free survival was 89% at last follow up (range 1‐28 months). Method of communication at 12 months included esophageal speech, electrolarynx and voice prosthesis. Time to jejunostomy removal was 2‐16 months.Conclusions:The in‐hospital mortality rate of zero in this series compares with rates of 7‐12% previously in our institution. However our contemporary morbidity rates are higher than the 8% and 29% previously reported, which may reflect our 67% rate of salvage surgery and exclusively T4 or metastatic caseload. Our complication rates are comparable with those published in the last decade for both gastric transposition and free tissue transfer reconstruction and highlights that gastric transposition is an effective reconstruction option in these advanced tumors.
Predictive Factors for Gastrostomy Tube Placement in Patients Undergoing Surgery for Upper Aerodigestive Tract Cancers
Authors: Biddy Ashley C. , Moustafa Farah , Waltonen Joshua D. 
Published: August 2013

Objectives:1) Determine which factors of the pre‐operative assessment, cancer location, and planned surgical resection are predictive of postoperative need for gastrostomy placement in patients undergoing resection of upper aerodigestive tract cancers. 2) Determine if a pre‐operative assessment algorithm can accurately predict need for gastrostomy placement.Methods:Retrospective chart review of all adult patients diagnosed with head and neck cancers that subsequently underwent cancer resection at Wake Forest Baptist Medical Center from 2007‐2012. Patient charts were screened for placement of postoperative gastrostomy tube, patient demographics (ie, gender, age), tumor characteristics including size, location, bilaterality, and surgical treatment type. Univariate analysis was run on all patient variables and compared against gastrostomy placement.Results:Gastrostomy tube placement was found to be strongly associated with the patient characteristics of pre‐operative weight loss (<.001), history of radiation (.001) and prior dysphagia (.001). Characteristics of the disease including clinical nodal disease (.04) and tongue base tumor location (.05) were also associated. Tracheostomy placement (<.001), supracricoid laryngectomy (.01), floor of mouth resection (.02), total glossectomy (.025) and free flap reconstruction (<.001) were the procedures most significantly associated with gastrostomy tube placement. Post‐operative failed swallowing evaluation was most strongly associated with G tube placement (2.8 × 10‐22).Conclusions:Preliminary data suggest that certain patient characteristics, tumor features, and types of surgical procedures can predict post‐operative gastrostomy tube placement. A risk stratification algorithm can likely be developed given the strength of multiple positive and negative associations between patient and tumor variables.
Predictors of Single Adenoma versus Four Gland Disease in Normohormonal Patients with Parathyroid‐Induced Hypercalcemia
Authors: Hunt Jason , Patel Rusha J. 
Published: August 2013

Objectives:1) Examine differences in spatial measurements of parathyroid glands in normohormonal patients with parathyroid‐related hypercalcemia. 2) Determine a predictive value to stratify which patients will require single‐ or four‐gland surgery.Methods:A retrospective chart review was conducted of parathyroidectomy patients from 2008‐2011 at our tertiary care institution. Patients with parathyroid hormone levels < 65 pg/ml were included and divided into single adenoma (SA) or four gland surgery (FGS). Exclusion criteria included diagnoses of secondary or tertiary hyperparathyroidism. Preoperative ultrasound measurement (cm), intraoperative gland weight (g), and intraoperative parathyroid hormone (iPTH) were recorded and used to calculate gland volume (cm3) and density (g/cm3). Significant differences between groups were examined with the student t‐test (P < 0.05).Results:24 patients were included, 18 (75%) with SA and 6 (25%) with FGS. There was no significant difference in age or gender between included patients and those with elevated PTH levels. SA patients were significantly more likely to have larger maximum ultrasound measurements, larger gland volume, weight and density, and greater iPTH values than patients with FGS. Of the spatial measurements collected, a cut‐off density of < 0.3 g/cm3 was 100% specific and sensitive for predicting patients who required FGE surgery. Positive predictive value was 100%.Conclusions:Normohormonal patients with hypercalcemia have a higher incidence of four gland disease than those with elevated PTH levels. Regardless, single adenomas can be found in these patients. Pre‐operative ultrasound and intraoperative calculation of gland density are easily done and may be an alternative to iPTH for surgical decision making.
Risk Factors in Development of Incidental Papillary Thyroid Microcarcinoma: A Review of 2100 Patients
Authors: Subramaniam Somasundaram , Tan Hiang K. , Lim K. W. K. , Siow J. B. 
Published: August 2013

Objectives:Risk factor analysis of incidental papillary thyroid microcarcinoma in a cohort of 2100 patients undergoing thyroid surgery.Methods:Retrospective review of 2103 patients over a 10 year period (2000‐2010) treated at Singapore General Hospital and Singapore National Cancer Centre. Outcome measurement Risk factors for developing incidental papillary thyroid microcarcinoma including sex (male vs female), age, size of thyroid nodule, fine needle aspiration cytology (FNAC) and ultrasound features at diagnosis.Results:Of the cohort of 2103 patients who underwent thyroid surgery for benign causes, 168 patients had incidental papillary microcarcinoma identified post‐operatively. There was a preponderance of females (2:1), older age (>45), larger nodule size (>4cm). Ultrasound features that were commonly associated with this diagnosis included hypoechogenicity and increased vascularity of nodules, although these were noted to be benign on FNAC.Conclusions:Presence of the abovementioned risk factors in patients undergoing thyroid surgery for benign diseases may be included in the decision making process for advocating surgery in these patients.
Perineural Invasion in Oral Cavity Squamous Cell Carcinoma Does Not Affect Survival
Authors: Schleiffarth Jack R. , Kowalski Christopher , Karnell Lucy , Pagedar Nitin A. 
Published: August 2013

Objectives:1) Determine if the presence of perineural invasion (PNI) affects survival in oral cavity cancer patients. 2) Determine what factors affect survival in oral cavity cancer patients.Methods:We performed a retrospective review of patients who underwent surgical resection with or without a neck dissection for treatment of primary oral squamous cell carcinoma from January 1, 2000, to December 31, 2009. Data were extracted from the institute's cancer registry and the electronic medical record. Univariate and multivariate analysis were used to test the significance of pathologic characteristics including: PNI, extra‐capsular extension, site, and positive surgical margin on survival.Results:443 patients were identified, and 374 patients fit selection criteria. Mean age at diagnosis was 60.9 years. 59.1% were male. PNI was present in 38.5% and positive surgical margin in 28.3%. Patients with PNI had poorer disease specific survival rate than those without (p=0.001) (5‐year survival, 64.4% vs 79.8%). Univariate analysis found that patients with PNI (P < 0.001), palate site (P = 0.013) (sub‐sites were compared to all other cases of oral cavity cancer), retromolar trigone site (P = 0.015), positive margins (P = 0.013), and extra‐capsular extension (P < 0.001) had significantly worse survival. Those patients who had tumors of the gums (P = 0.013) had significantly better survival. Multivariate analysis found that patients with tumors of the palate (P =0.12), extra‐capsular extension (P = 0.004), and positive surgical margins (p=0.004) had significantly worse survival. Those with tumor of the gums (P = 0.006) had significantly better survival.Conclusion:The presence of perineural invasion in oral cavity squamous cell carcinoma does not independently affect survival.
The Role of Intraoperative Facial Nerve Monitoring during Parotidectomy for Benign Parotid Gland Tumors
Authors: Lin Jiahui , Kuhel William I. , Voigt Erich P. , Cohen Marc A. , Kutler David I. 
Published: August 2013

Objectives:1) Compare outcomes of parotidectomy with and without electrophysiologist‐assisted intraoperative nerve monitoring (IOM) for the treatment of benign parotid gland tumors. 2) Recognize potential benefits of IOM in parotidectomy.Methods:Retrospective case control of 151 consecutive patients undergoing parotidectomy for treatment of benign tumors between March 2006 and December 2011 at Weill Cornell Medical College. Interventions included parotidectomy and IOM. Outcome measures included complications from intervention(s).Results:Sixty‐four percent of patients were female, and the median age at surgery was 57 years (range 17 ‐ 86 years). The majority of patients (70%) had pleomorphic adenomas. One surgeon performed all 81 parotidectomies with IOM (54%), while another surgeon performed the remainder without IOM (46%). IOM use depended on the attending surgeon and was not due to any other factor. Superficial parotidectomies comprised 81% and 70% of surgeries performed with and without IOM, respectively. Temporary facial nerve dysfunction occurred in 10.6% of patients. No statistically significant difference was seen in temporary facial nerve paralysis rates post‐operatively between groups with IOM (9.9%) and those without (11.4%) (P = 0.76). In cases with IOM, electrical mapping and presence of transient nerve irritation did not influence the rate of complications (P = 0.19).Conclusions:Use of IOM does not appear to impact the rate of facial paralysis post‐parotidectomy for benign parotid gland tumors. However, IOM may be beneficial in aiding the surgeon in difficult cases, to preserve smaller branches, or when the tumor lies particularly close to the facial nerve.
Sentinel Lymph Node Biopsy in Cutaneous Squamous Cell Carcinoma of the Head and Neck
Authors: Lipin Rosa , Moore Brian A. 
Published: August 2013

Objectives:1) Recognize the potential indications for sentinel lymph node biopsy (SLNB) in the treatment of aggressive cutaneous squamous cell carcinoma of the head and neck (CSCCHN). 2) Understand how to incorporate SLNB into the multidisciplinary management of high‐risk CSCCHN.Methods:A retrospective review was performed on patients with CSCCHN at a tertiary care head and neck surgical oncology center who underwent SLNB between August 2011 and January 2013. This is a pilot, feasibility study with the main outcome measures of regional failure and surgical complications.Results:Five patients (4 males, 1 female) with a median age of 69 (range 55‐80) were identified with an average follow up of 34 weeks (range 2‐63). No patients were immunocompromised. 4 had poorly differentiated lesions, 2 of which were recurrent. Traditional wide local excision was performed in 4 patients, while Mohs surgery was performed on 1 patient. An average of 1.6 sentinel lymph nodes were identified on preoperative imaging (range 1‐3), with an average of 4.6 SLN excised (range 2‐8). One patient demonstrated a positive sentinel node (20%), facilitating additional treatment with radiation to the primary and regional lymphatics, as he refused completion lymphadenectomy. There were no postoperative complications, including facial nerve weakness. All patients are alive without evidence of disease at the last reported encounter.Conclusions:SLNB is feasible in patients with high‐risk CSCCHN, allowing prompt treatment of the regional lymphatics. Further multi‐center, multidisciplinary, prospective studies are required to clarify the indications and impact of SLNB in CSCCHN.
Swallowing Outcomes in Mandibular Osteoradionecrosis Treated with Free Tissue Transfer
Authors: Ranasinghe Viran , Oyer Samuel L. , Nguyen Shaun A. , Hornig Joshua D. 
Published: August 2013

Objectives:Evaluate swallowing outcomes after free tissue transfer (FTT) reconstruction for mandibular osteoradionecrosis (ORN), using aspiration and postoperative tube feed (TF) dependence as surrogates for swallowing ability.Methods:Study Design: Case series with chart review. All patients undergoing osteocutaneous FTT reconstruction in an academic tertiary‐care hospital for mandibular ORN from 2004‐2012 were reviewed. Preoperative patient characteristics, postoperative aspiration, and postoperative TF dependence were noted for each patient. Analysis of patient factors associated with aspiration or TF dependence was performed using Pearson correlation and Fisher's exact test (when appropriate).Results:Sixteen patients met inclusion criteria with an average age of 63.4 years (range 36‐81 years) and median follow up of 20 months (range 3‐72 months). TF dependence pre‐ and post‐operatively was total dependence in 25% vs. 31%, partial in 25% vs. 31%, and none in 50% vs. 38%, with strong correlation between pre and post‐operative TF dependence (r = 0.524, P = 0.04). Aspiration at postoperative follow‐up correlated with long‐term TF dependence (r=0.701, P < 0.01). Less aspiration was seen after scapular FTT compared to fibular, but this did not reach statistical significance (22% vs. 57% respectively, P = 0.62). Females had lower aspiration rates than males (r = 0.595, P = 0.02), and all females in this study were treated with scapular FTT. Tracheostomy decannulation was achieved in 94% (15/16) of patients.Conclusions:TF dependence following osteocutaneous FTT for ORN correlates with pre‐operative TF dependence and post‐operative aspiration. Aspiration is less likely in females and patients receiving scapular FTT.
Vitamin D Levels and Their Relationship to Thyroid Malignancy
Authors: Marino Matthew , Siegel Eric R. , Bodenner Don , Stack Brendan C. 
Published: August 2013

Objectives:Vitamin D deficiency is endemic in the USA. Vitamin D deficiency has been observed in many cohorts of cancer patients and thought to be a possible risk factor. We sought to compare the 25‐hydroxyvitamin D levels between a cohort of patients undergoing completion and total thyroidectomy for benign and malignant thyroid diseases.Methods:A retrospective institutional review board (IRB) approved study with chart review was done at a tertiary referral academic medical center. Data were retrospectively collected on consecutive patients who underwent completion and total thyroidectomy at the University of Arkansas for Medical Sciences between October 2005 and December 2012. Postoperative 25‐hydroxyvitamin D levels were collected universally and reported when available. Statistical analysis was performed to determine if vitamin D levels varied based on pathology, categorized as either benign or malignant.Results:A total of 220 total and completion thyroidectomies were performed during the study period. Total thyroidectomy (n = 172) was more common than completion (n = 48). Of these, 166 had vitamin D levels available for analysis: 38 with malignant disease and 128 with benign disease. Average vitamin D levels were 29.8 µg/dl for those with malignant disease versus 28.3 µg/dl for those with benign disease. There was no statistically significant difference in vitamin D levels between those with benign versus malignant pathology in this cohort of patients (P = 0.81).Conclusions:There is no correlation between perioperative Vitamin D status and pathological findings in patients undergoing completion and total thyroidectomy.