Four distinct ipsilateral vestibular schwannomas: A case of mosaic NF2-related schwannomatosis

OBJECTIVES

Distinguishing between sporadic and germline/mosaic NF2-related schwannomatosis is important to ensure that patients have appropriate long-term care. With this report, we describe a unique case of a patient with 4 ipsilateral schwannomas and identify a combination of sequencing modalities that can accurately diagnose mosaic NF2-related schwannomatosis.

METHODS

We present a 32-year-old woman with a familial history of vestibular schwannoma in her father and right-sided schwannomas involving the apical and basal turns of cochlea, lateral semicircular canal, and internal auditory canal (IAC). Genetic analysis of blood and frozen tissue from 2 tumors (intralabyrinthine and IAC tumors) was performed using next-generation sequencing (NGS), multiplex ligation-dependent probe amplification (MLPA), and optical genome mapping (OGM).

RESULTS

Germline testing for NF2, LZTR1, and SMARCB1 was negative. Tumor genetic testing revealed a shared NF2 pathogenic variant between the 2 tumors ("first hit") but distinct "second hit" NF2 variants, including mosaic loss of chromosome 22 in the IAC tumor seen only with OGM, consistent with mosaic NF2-related schwannomatosis.

CONCLUSIONS

Multimodality sequencing, including NGS, MLPA, and OGM, was required to ensure appropriate diagnosis of mosaic NF2-related schwannomatosis in this patient. A similar approach can be used for other patients with multiple ipsilateral tumors and suspected tumor predisposition.

Content Validity of a High-Fidelity Surgical Middle Ear Simulator: A Randomized Prospective International Multicenter Trial

OBJECTIVE

After demonstration of face validity of a surgical middle ear simulator (SMS) previously, we assessed the content validity of the simulator with otolaryngology residents.

STUDY DESIGN

Multicenter randomized prospective international study.

SETTING

Four academic institutions.

METHODS

Novice participants were randomized into control, low-fidelity (LF), and high-fidelity (HF) groups. Control and LF produced 2 recordings from 2 attempts, and HF produced 4 recordings from 10 attempts, with trials 1, 4, 7, and 10 used for scoring. Three blinded experts graded videos of the simulated stapedectomy operation using an objective skills assessment test format consisting of global and stapedotomy-specific scales.

RESULTS

A total of 152 recordings from 61 participants were included. Baseline characteristics did not differ significantly between groups. Depending on the step of the operation, inter-rater reliability ranged from 24 to 90%. For LF and HF, years of training was significantly associated with improved scores in certain objective skills assessment test subparts. HF outperformed the control group on stapes and global scores ( p < 0.05). The HF group demonstrated improvement in global score over trials, but plateaued after four trials. Scores varied greatly for participants from different institutions in certain operative steps, such as transecting incudostapedial joints, likely due to differences in instrumentation and time elapsed since manufacture.

CONCLUSION

Practice with SMS led to better performance in both global and stapes-specific scores. Further studies are needed to examine construct validity and to create otology-appropriate grading systems. Variables like instrumentation and decline in flexibility of the simulator after 12 months greatly affect performance on the simulator.

Laserthermia enhances the clastogenic effects of antineoplastic agents in aerobic and chronically hypoxic HeLa cells in vitro

The interactive clastogenic effects of Nd-YAG laser induced hyperthermia (laserthermia) in combination with antineoplastic agents on normally oxygenated and chronically hypoxic HeLa cells were investigated. Exponentially growing HeLa cells were treated with bleomycin sulfate (BLM) (2-4 microg/ml), adriamycin (ADM) (2-4 microg/ml) and actinomycin D (ACT) (0.2-0.4 microg/ml) alone or in combination with laser at various powers (7-13 W) or different laser induced elevated temperatures (39.5-43.5 degrees C). HeLa cells were incubated with 3 microg/ml cytochlasin B for 36 h after treatments and the frequency of micronuclei (MN) were determined in binucleated cells. Results showed a relatively high frequency of MN formation after drug treatments in normally oxic and chronically hypoxic cells, although there was a decrease in the frequency of MN in hypoxic cells compared to oxygenated cells. Laserthermia at various powers and different induced temperatures produced a slight increase in MN formation both in oxic and hypoxic cells. When drug treatment and laserthermia was combined, a profound synergistic effect in MN formation was observed for all three drugs used in these experiments. ACT at a concentration of ten times lower than ADM and BLM produced similar effect. Also, ADM showed a marked synergistic effect with laserthermia compared to BLM at similar concentrations. This study suggests that laserthermia in combination with ADM, BLM or ACT would have a greater genotoxic effect on hypoxic cell populations. Therefore, Nd-YAG laser induced hyperthermia may be a useful modality for elimination of the radioresistant hypoxic cells.