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Corbett M, Tohani S, Ramli R, O'Duffy F. Clinical Response With Pembrolizumab for Cutaneous Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2024:2817535. [PMID: 38602669 DOI: 10.1001/jamaoto.2024.0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
This case report describes an 89-year-old patient with prior cutaneous squamous cell carcinoma who presented with a new isolated metastasis and was subsequently treated with pembrolizumab, which produced a complete clinical response.
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Affiliation(s)
- Mel Corbett
- University College Dublin Head and Neck Oncology Group, Dublin, Ireland
| | - Shivangy Tohani
- University College Dublin Head and Neck Oncology Group, Dublin, Ireland
| | - Ruzaimi Ramli
- University College Dublin Head and Neck Oncology Group, Dublin, Ireland
| | - Fergal O'Duffy
- University College Dublin Head and Neck Oncology Group, Dublin, Ireland
- Department of Head and Neck Surgery, Saint Vincent's University Hospital, Dublin, Ireland
- Department of Head and Neck Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
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2
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McHugh A, Wauchope J, Kieran S, Moran T, O'Duffy F. Ocular lymphoma: overcoming a diagnostic challenge with an endoscopic sinus approach. Ir J Med Sci 2024; 193:555-563. [PMID: 37526870 DOI: 10.1007/s11845-023-03460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Ocular lymphomas are rare, indolent tumours that pose a diagnostic challenge. Patients may be asymptomatic or present with symptoms of increased orbital mass. An index of suspicion is required alongside an understanding of the diagnostics and staging required to facilitate expedited multi-disciplinary work-up and management. METHODS A comprehensive literature review was performed. We present a series of three cases, each presenting their own diagnostic challenge. RESULTS Although ocular lymphomas are notoriously difficult to diagnose histologically, our case series show procurement of a diagnostic histological sample using an image-guided endoscopic sinus approach. CONCLUSIONS Although not typically involved in the diagnosis or management, the otolaryngologist may encounter ocular lymphoma masquerading as sinus disease or with disseminated disease at other sites in the head and neck. Endoscopic sinus surgery is considered a safe, effective approach for achieving a histological diagnosis in these cases.
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Affiliation(s)
- Alison McHugh
- Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | - Stephen Kieran
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tom Moran
- Mater Misericordiae University Hospital, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Fergal O'Duffy
- Mater Misericordiae University Hospital, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- University College Dublin School of Medicine, Dublin, Ireland
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3
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McInerney NJ, Moran T, O'Duffy F. Parathyroid carcinoma: Current management and outcomes – A systematic review. Am J Otolaryngol 2023; 44:103843. [PMID: 36989753 DOI: 10.1016/j.amjoto.2023.103843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Parathyroid carcinoma is rarely encountered in clinical practice. When faced with this clinical challenge, there is currently a paucity of evidence available for the optimal management of patients with parathyroid carcinoma. This systematic review synthesizes the available literature to evaluate the optimal management approach, thus providing guidance for future management. METHODS A systematic review was conducted according to PRISMA guidelines using Ovid MEDLINE, EMBASE, and PubMed databases for studies, published in English, reporting on parathyroid carcinoma. Full text of potentially eligible articles were reviewed by two authors independently and eligible studies selected. Treatment options and associated outcomes were evaluated. Descriptive statistics were used to describe pooled patient cohorts. RESULTS 3203 articles were initially identified using the search criteria with 59 full-text articles then screened for eligibility. Seven articles, all retrospective studies, concerning 2307 patients (median 224/study). Parathyroidectomy alone was the most frequently utilised surgical approach across all studies, followed by en-bloc resection (with adjacent thyroid and/or nodal tissue). There was no difference in post-operative morbidity, mortality or survival between surgical approaches (p < 0.005). Patients who underwent either form of surgery had longer overall survival than those managed non-operatively (p < 0.005). CONCLUSION Surgical resection is the optimal treatment of parathyroid carcinoma. However there remains no consensus on the optimal extent of surgery, and as such future randomised prospective studies are necessary to evaluate the effects of different surgical approaches on morbidity, mortality and oncologic outcomes. Following resection, long-term surveillance with PTH is advised.
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Affiliation(s)
- Niall James McInerney
- Department of Otorhinolaryngology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Tom Moran
- Department of Otorhinolaryngology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland; Department of Otorhinolaryngology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Fergal O'Duffy
- Department of Otorhinolaryngology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland; Department of Otorhinolaryngology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Ireland
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4
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Cino D, Drumm C, Sheahan K, D'Arcy C, Nolan N, Hoti E, Winter D, O'Duffy F, Dolan R, Moriarty B. Muir-Torre syndrome: a case of unusual coexisting genetic mutations. Clin Exp Dermatol 2021; 47:602-604. [PMID: 34762321 DOI: 10.1111/ced.15008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Abstract
Muir-Torre syndrome (MTS) is a rare autosomal dominant geno-dermatosis that was independently described by Muir in 1967 and Torre in 1968. MTS is a phenotypic subtype of Lynch syndrome and most commonly arises due to germline mutations in mismatch repair genes. MTS manifests with at least one cutaneous neoplasm and one visceral malignancy.
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Affiliation(s)
- D Cino
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - C Drumm
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - K Sheahan
- Department of Pathology, St Vincent's University Hospital, Dublin 4, Ireland
| | - C D'Arcy
- Department of Pathology, St Vincent's University Hospital, Dublin 4, Ireland
| | - N Nolan
- Department of Pathology, St Vincent's University Hospital, Dublin 4, Ireland
| | - E Hoti
- Department of Hepatobiliary and Liver Transplant Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - D Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4, Ireland
| | - F O'Duffy
- Department of Otolaryngology and Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - R Dolan
- Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - B Moriarty
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
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Asairinachan A, O'Duffy F, Fua T, Magarey MJR, Dixon BJ. Salvage transoral robotic surgery in early-stage oropharyngeal recurrence. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:18-25. [PMID: 33744203 DOI: 10.1016/j.oooo.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/23/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Limited data are currently available regarding outcomes following transoral robotic surgery (TORS) in the salvage setting. This study aims to investigate the functional and oncological outcomes following TORS in salvage oropharyngeal tumors. STUDY DESIGN All patients undergoing salvage TORS for a residual, recurrent, or new primary oropharyngeal squamous cell carcinoma within a previously radiated field between March 2014 and October 2018 were included. Patients undergoing salvage TORS for other subsites were excluded. Margin status, complication rates, long-term tracheostomy, and gastrostomy requirements and overall and disease-free survival outcomes were recorded. RESULTS A total of 26 patients were included. Three patients (11%) experienced a TORS-specific major complication. A gastrostomy tube was required in 42% of patients on discharge (n = 11), and in 28% of patients on long-term follow-up (n = 7) at a median of 34 (interquartile range, 11.8-47.8) months. A tracheostomy was placed in 5 patients and all were removed before discharge. The 3-year overall survival and disease-free survival were 74% and 70%, respectively. CONCLUSION Salvage TORS is a viable and effective option in the management of selected tumors within a previously radiated field.
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Affiliation(s)
- Ashwinna Asairinachan
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Fergal O'Duffy
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre
| | - Matthew J R Magarey
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Head & Neck Surgery, Epworth Healthcare, Richmond, Victoria, Australia
| | - Benjamin J Dixon
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Head & Neck Surgery, Epworth Healthcare, Richmond, Victoria, Australia
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Mansour KP, O'Duffy F, Webb A, Goh M, Morrison E. About face: can Vismodegib change the treatment paradigm of locally advanced basal cell carcinoma? ANZ J Surg 2020; 91:1304-1306. [PMID: 33091207 DOI: 10.1111/ans.16399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Kristy P Mansour
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Fergal O'Duffy
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Angela Webb
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michelle Goh
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Edwin Morrison
- Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Waters DK, Elliott JA, O'Duffy F, O'Dwyer T. High-grade chondrosarcoma of the larynx: a case report and literature review. J Surg Case Rep 2018; 2018:rjy222. [PMID: 30151112 PMCID: PMC6101518 DOI: 10.1093/jscr/rjy222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/19/2018] [Accepted: 07/26/2018] [Indexed: 11/25/2022] Open
Abstract
A 64-year-old male presented with a 2-month history of sudden onset dysphonia. Endoscopic evaluation of the larynx revealed a complete right vocal cord palsy. Computed tomography of the neck revealed a mass medial to the right thyroid associated with the cricoid cartilage. Histologic examination confirmed high-grade chondrosarcoma. The patient underwent right-sided hemicricoidectomy with tracheal flap reconstruction, right thyroid lobectomy and partial oesophagectomy with primary anastomosis followed by adjuvant radiation therapy. He is currently being followed as an outpatient with no evidence of disease. High-grade chondrosarcoma of the larynx is an exceedingly rare tumour, associated with a poor prognosis. Current best evidence suggests primary surgical resection with negative margins. There is a lack of evidence to guide post-operative management of high-grade chondrosarcoma. They have a poor prognosis following surgical resection and a 10-year survival rate of 29%.
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Affiliation(s)
- Darragh K Waters
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St. James's Hospital, Dublin, Ireland.,Department of Otorhinolarynogology, Mater Misercordiae University Hospital, Dublin, Ireland
| | - Jessie A Elliott
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St. James's Hospital, Dublin, Ireland
| | - Fergal O'Duffy
- Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin, and St. James's Hospital, Dublin, Ireland
| | - Tadgh O'Dwyer
- Department of Otorhinolarynogology, Mater Misercordiae University Hospital, Dublin, Ireland
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Sheahan P, O'Duffy F. Thyroid thyrothymic extension: An anatomic study in a surgical series. Head Neck 2014; 38:732-5. [PMID: 25524573 DOI: 10.1002/hed.23954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/16/2014] [Accepted: 12/06/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The thyrothymic extension (TTE) is a variable projection from the inferior thyroid pole along the course of the thyrothymic ligament. Awareness of the TTE is critical to ensure complete total thyroidectomy. However, there is little mention of the TTE in the literature. The purpose of the present study was to investigate the frequency of the TTE in our surgical series. METHODS We conducted a prospective cohort study of 284 thyroid and parathyroid surgeries performed by a single surgeon. RESULTS A TTE was present in 138 of 414 evaluable thyroid lobes (33.3%), with no predilection for left or right. The TTE was bilateral in 57% of cases. In 5 cases, there was significant nodular enlargement of the TTE. The inferior parathyroid gland was closely associated with 8% of TTEs. CONCLUSION The TTE is a commonly encountered projection from the inferior thyroid pole. Awareness of the TTE is important to ensure complete total thyroidectomy.
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Affiliation(s)
- Patrick Sheahan
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Fergal O'Duffy
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
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Dolan R, O'Duffy F, Seoighe D, Dias A, Earley M, O'Dwyer T. Novel use of a supraclavicular transverse cervical artery customised perforator flap: A paediatric emergency. J Plast Reconstr Aesthet Surg 2013; 66:1138-41. [DOI: 10.1016/j.bjps.2012.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 12/18/2012] [Indexed: 11/30/2022]
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Glynn RW, O'Duffy F, O'Dwyer TP, Colreavy MP, Rowley HM. Patterns of Internet and smartphone use by parents of children attending a pediatric otolaryngology service. Int J Pediatr Otorhinolaryngol 2013; 77:699-702. [PMID: 23434200 DOI: 10.1016/j.ijporl.2013.01.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/16/2013] [Accepted: 01/18/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess Internet use and the influence of smartphones on health-information seeking by parents and carers of children with ENT conditions. METHODS A paper-based questionnaire was circulated to parents attending otolaryngology services in both the out-patient and day-case settings at a tertiary referral centre. RESULTS 79.5% of questionnaires were returned. 29.9% had consulted the Internet for ENT-related information. Factors associated with increased rates of ENT-related online activity included younger age, university education, and access to a smartphone (all p ≤ 0.001). 65.7% and 57.7% had found the information which they had found online to be understandable and helpful, respectively; however, just 25.5% felt that it had influenced the medical decisions they had made for their child. 50.3% had previously or intended to discuss information found online with their surgeon. 9.2% had searched online for information regarding their child's surgeon; 19.6% of these said that this had been a factor in choosing that particular surgeon. On ranking 8 information sources in terms of importance (scale 0-5), the ENT Surgeon ranked as most important (mean=4.63), whilst the Internet ranked lowest (3.10). 48.6% of respondents or their partners had an Internet-enabled smartphone; 45.2% said they would definitely use an iPhone app regarding their child's condition if one was available. 36.1% reported they would definitely use the Internet in the future. CONCLUSIONS Whilst online sources must increasingly be considered in the dialogue with parents, it is clear that parents still rate the clinical team as most important for information gathering. Clinician-provided websites and smartphone applications may be the key to ensuring the provision of quality information into the future.
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Affiliation(s)
- Ronan W Glynn
- Department of Pediatric Otorhinolaryngology, Children's University Hospital, Temple Street, Dublin 1, Ireland.
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O'Duffy F, McAskill D, Keogh IJ. Children with Down's syndrome: are we hearing their needs? Ir Med J 2013; 106:38-39. [PMID: 23472381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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O'Duffy F, O'Dwyer TP. The growing epidemic of HPV associated oropharyngeal malignancy. Ir Med J 2012; 105:101-102. [PMID: 22708219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
AIM The authors present the novel and successful use of an air-filled breast prosthesis for extra pelvic exclusion of small bowel to facilitate adjuvant radiotherapy following resection of recurrent adenocarcinoma of the ascending bowel. The therapeutic use of radiotherapy in colon cancer can cause acute or chronic radiation enteropathy. Mobile small bowel can be sequestered in 'dead space' or by adhesions exposing it to adjuvant radiotherapy. A variety of pelvic partitioning methods have been described to exclude bowel from radiation fields using both native and prosthetic materials. METHOD In this case a 68 year old presented with ascending colon adenocarcinoma invading the peritoneum and underwent en bloc peritoneal resection. Thirty-seven months later surveillance CT identified a local recurrence. Subsequent resection resulted in a large iliacus muscle defect which would sequester small bowel loops thus exposing the patient to radiation enteropathy. The lateral position of the defect precluded the use of traditional pelvic partitioning methods which would be unlikely to remain in place long enough to allow radiotherapy. A lightweight air-filled breast prosthesis (Allergan 133 FV 750 cms) secured in place with an omentoplasty was used to fill the defect. RESULTS Following well tolerated radiotherapy the prosthesis was deflated under ultrasound guidance and removed via a 7-cm transverse incision above the right iliac crest. The patient is disease free 18 months later with no evidence of treatment related morbidity. CONCLUSION The use of a malleable air-filled prosthesis for pelvic partitioning allows specific tailoring of the prosthesis size and shape for individual patient defects. It is also lightweight enough to be secured in place using an omentoplasty to prevent movement related prosthesis migration. In the absence of adequate omentum a mesh sling may be considered to allow fixation. In this case the anatomy of the prosthesis position allowed for its removal without the need for repeat laparotomy. Pre-operative deflation of the air-filled prosthesis under ultrasound guidance also reduces the size of the incision required for removal. This technique may be valuable to prevent collateral small bowel irradiation following resection of renal or retroperitoneal malignancy.
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Affiliation(s)
- F O'Duffy
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.
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