Extramammary Paget Disease of Oral Mucosa: Case Report with Literature Review

Extramammary Paget disease (EPMD) of the oral mucosa is an unusual and extremely rare condition, with fewer than ten cases documented. Here, we report a case of EMPD extensively involving oral mucosa and underlying salivary ducts in a 72-year-old male and review published clinical, histologic, immunophenotypic, and prognostic features of this rare entity.

CDK4/6 Inhibition Induces Senescence and Enhances Radiation Response by Disabling DNA Damage Repair in Oral Cavity Squamous Cell Carcinoma

Purpose: HPV(−) OCSCC resists radiation treatment. The CDKN2A gene, encoding p16INK4A, is commonly disrupted in OCSCC. p16 inhibits CDK4/CDK6, leading to cell cycle arrest, but the biological sequelae of CDK4/6 inhibition in OCSCC remains understudied. This study examines whether inhibition of CDK4/6 enhances radiation response in OCSCC. Methods: MTT assays were performed in OCSCC cell lines HN5 and CAL27following treatment with palbociclib. Clonogenic survival and synergy were analyzed after radiation (RT-2 or 4Gy), palbociclib (P) (0.5 µM or 1 µM), or concurrent combination treatment (P+RT). DNA damage/repair and senescence were examined. CDK4/6 were targeted via siRNA to corroborate P+RT effects. Three-dimensional immortalized spheroids and organoids derived from patient tumors (conditionally reprogrammed OCSCC CR-06 and CR-18) were established to further examine and validate responses to P+RT. Results: P+RT demonstrated reduced viability and synergy, increased β-gal expression (~95%), and ~two-fold higher γH2AX. Rad51 and Ku80 were reduced after P+RT, indicating impairment of both HR and NHEJ. siCDK4/6 increased senescence with radiation. Spheroids showed reduced proliferation and size with P+RT. CR-06 and CR-18 further demonstrated three-fold reduced proliferation and organoids size with P+RT. Conclusion: Targeting CDK4/6 can lead to improved efficacy when combined with radiation in OCSCC by inducing senescence and inhibiting DNA damage repair.

COVID-19-Induced Anosmia and Ageusia Are Associated With Younger Age and Lower Blood Eosinophil Counts

BACKGROUND

Anosmia and ageusia are symptoms commonly associated with COVID-19, but the relationship with disease severity, onset and recovery are unclear.

OBJECTIVE

To examine factors associated with anosmia and ageusia and the recovery from these symptoms in an ethnically diverse cohort.

METHODS

Individuals tested for SARS-CoV-2 between March and April 2020 were eligible for the study. Randomly selected participants answered a telephone questionnaire on COVID-19 symptoms with a focus on anosmia and ageusia. Additionally, relevant past medical history and data on the COVID-19 clinical course were obtained from electronic medical records. 486 patients were in the COVID-19 group and 103 were COVID-19-negative.

RESULTS

Patients who were younger were more likely to report anosmia and/or ageusia (odds ratio (OR) for anosmia per 1-year increase in age: 0·98, 95%CI:0-97-0·99, p = 0·003; for ageusia: 0·98, 95%CI:0·97-0·99, p = 0·005) as were patients with lower eosinophil counts (OR for anosmia per 0.1-K/μL increase in eosinophils: 0·02, 95%CI:0·001-0·46, p = 0·01, for ageusia 0·10, 95%CI:0·01-0·97, p = 0·047). Male gender was independently associated with a lower probability of ageusia (OR:0·56, 95%CI:0·38-0·82, p = 0·003) and earlier sense of taste recovery (HR:1·44, 95%CI:1·05-1·98, p = 0·02). Latinos showed earlier sense of taste recovery than white patients (HR:1·82, 95%CI:1·05-3·18, p = 0·03).

CONCLUSION

Anosmia and ageusia were more common among younger patients and those with lower blood eosinophil counts. Ageusia was less commonly reported among men, and time to taste recovery was earlier among both men and Latinos.

Implementation of an Online Multimedia Pediatric Tracheostomy Care Module for Healthcare Providers

OBJECTIVES/HYPOTHESIS

To investigate the effect of a multimedia educational module on provider attitudes toward pediatric tracheostomy care. We also describe the process of module development and dissemination at an academic children's hospital.

STUDY DESIGN

Prospective observational study.

METHODS

The pediatric airway committee at an urban tertiary care center developed a multimedia pediatric tracheostomy care module. Nurses, respiratory therapists, as well as resident, fellow, and attending physicians caring for pediatric patients with tracheostomies were eligible. Managers and clinical supervisors from various units recruited participants to complete the pediatric tracheostomy care electronic module and pre- and postassessment knowledge quizzes and surveys. Provider confidence was analyzed using Kruskal-Wallis H-test and Mann-Whitney U-test, and paired t-test was used to compare pre- and postmodule quiz scores.

RESULTS

A total of 422 participants completed the module. A total of 275 participants completed the premodule survey, 385 completed the premodule quiz, 253 completed the postmodule survey, and 233 completed the postmodule quiz. Participants included providers in the neonatal intensive care unit, pediatric intensive care unit, pediatric emergency department, and pediatric wards. Postmodule surveys demonstrated a significant reduction in the average percentage of participants indicating lack of confidence with regards to changing an established tracheostomy, responding to accidental decannulation of established tracheostomy, and responding to accidental decannulation of fresh tracheostomy (P < .001). Average quiz scores increased by 5.6 points from 83.0% to 88.6% (P < .00001).

CONCLUSIONS

A multimedia educational module can improve provider perception of their knowledge and confidence surrounding pediatric tracheostomy management.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:1893-1901, 2021.

Maternal anemia associated with walkable distance to healthy food sources in Bronx, New York

The relationship between walkable access to healthy food sources and risk of anemia in pregnancy was evaluated for a cohort of 4678 women who initiated prenatal care in the year 2010 at an academic medical center in Bronx, New York. After geocoding patient residences, street network distances were obtained for the closest healthy food sources, which were identified from multiple databases. For lower-income patients, as indicated by Medicaid or lack of health insurance, those who lived less than 0.25miles from a healthy food source were less likely to be anemic when compared to those who lived farther (adjusted OR=0.65, 95% CI 0.48, 0.88). Patients with commercial insurance showed no effect. These results help to understand how a nutritionally-mediated condition such as anemia during pregnancy can be affected by one's built environment, while also highlighting the importance of conditioning on socioeconomic status for these types of studies.

HPV types and variants among cervical cancer tumors in three regions of Tunisia

Cervical cancer is the second most common cancer among Tunisian women, and the incidence rates vary by region. Three Tunisian registries report age-standardized rates of 6.3/10(5) in the central region, 5.4/10(5) in the north, and 2.7/10(5) in the south. High-risk human papillomavirus (HPV) types and their variants differ in carcinogenic potential and geographic distribution. The HPV type and variant distribution could be a factor in the differing rates between regions of Tunisia. Tumor tissue was collected from 142 Tunisian cervical cancer patients. Demographic and reproductive characteristics of the patients were abstracted from cancer registry and hospital records. HPV type and variant analyses were performed using PCR-based Luminex and dot-blot hybridization assays. Eighty-three percent of tumors were infected with at least one HPV type. European variants of HPV16/18 were the most prevalent in tumors from all three regions, with all HPV18 infections and 64% of HPV16 infections being of European lineage. A higher frequency of HPV16 was present in Northern Tunisia (80%) than in Central (68%) or Southern Tunisia (50%) (P=0.02). HPV18/45 was significantly more common in adenocarcinomas (50%) than in squamous cell carcinomas (11%) (P=0.004). Frequent infection with European HPV variants most likely reflects the history of European migration to Tunisia. In addition to the importance of understanding the variants of HPV in Tunisia, behavioral and cultural attitudes towards screening and age-specific infection rates should be investigated to aid the development of future vaccination and HPV screening programs and policies.

Abstract 5733: HPV type and variant distribution in cervical cancer cases in three cancer registry regions of Tunisia

Cervical cancer disproportionately affects women in developing countries. Cervical cancer is the second most common cancer among Tunisian women, and the cervical cancer incidence rates vary by region. Three Tunisian registries report ASRs of 7.1/105 in the central region, 6.1/105 in the north, and 2.7/105 in the south. High-risk HPV types have genetic variants that differ in both carcinogenic potential and geographic distribution, with aggressive cervical cancers more often reported amongst women infected with HPV16 non-European variants. The HPV type and variant distribution could be a factor in the differing rates between regions.

To establish the distribution of HPV types and variants in a cross-sectional study, cervical cancer cases diagnosed in 2007-2008 were identified from the Institut Salah Azaiez in Tunis and from the Central Tunisian Cancer Registry (2002-2007) of the Hôpital Farhat Hached in Sousse. Formalin-fixed paraffin-embedded sections were obtained from case tissue samples for analysis of HPV type and variant using PCR assays. Clinical information was abstracted from the pathology reports and medical records.

A geographic location for each case was ascertained using residential information included in medical records. Of the 142 samples collected, 73 cases were from governorates included in the northern registry, 56 from the central registry, and 13 from the southern registry. Preliminary results show 110 cases (77.5%) were infected with at least one HPV type. HPV16 and HPV18 were present in 88.7% and 7.5% of cases infected with a single HPV type, and in 91.8% and 5.9% of squamous cell carcinomas (SCC), respectively. Whereas, HPV18/45 were detected in 33% of adenocarcinomas but in only 7.1% of SCC (p=0.02). Three cases were infected with both HPV16 and HPV18. HPV types 35, 45, 58, 66 and 73 were also identified.

All of the HPV18 and 54.7% of HPV16 positive cases were European variants. The distribution of European variants was: 67.9% in the northern, 62.1% in the central, and 66.7% in the southern. Cases infected with a non-European variant of HPV16 had an average age at diagnosis of 53 years, while European infections were later at 55.9 years; although this difference was not significant. There was no difference in distribution of variants by stage of disease. There was no difference in HPV16 variant distribution by histologic type.

This is the first study to evaluate HPV variants in Tunisia. Currently approved HPV vaccines will protect against the HPV types most commonly associated with cervical cancer in Tunisia. Although Tunisia is in Africa, frequent infection with European HPV variants most likely reflects the history of European migration both to and from Tunisia. Behavioral and cultural attitudes about screening and age-specific infection rates should be investigated to aid the development of any future vaccination and HPV screening policies.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5733.