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Trabzonlu L, Martinez-Lage M, Deschler D, Paly JJ, Faquin WC. FNA of Meningioma with Rhabdoid Features Presenting as a Lateral Neck Mass. Head Neck Pathol 2024; 18:32. [PMID: 38658429 PMCID: PMC11043294 DOI: 10.1007/s12105-024-01644-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
Primary meningioma at extracranial head and neck sites is uncommon. Since fine needle aspiration (FNA) is often the first line diagnostic modality for the evaluation of masses in the head and neck, extracranial meningiomas can create a significant diagnostic pitfall for FNA. We report a case of meningioma with rhabdoid features and BAP1 loss in a 26-year-old woman, presenting as a large neck mass along the carotid sheath. FNA biopsy of the mass demonstrated a highly cellular specimen with clusters of uniform, epithelioid cells with round to ovoid nuclei and moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel performed on cell block sections showed that the tumor cells were weakly EMA positive, progesterone receptor was focally positive, and SSTR2A was diffuse and strongly positive. BAP1 immunohistochemistry showed a diffuse loss of expression in the tumor cells. After the cytologic diagnosis of meningioma, a tissue biopsy was performed, and the diagnosis of meningioma with rhabdoid features and BAP1 loss was confirmed. We also perform a literature review of meningioma cases presenting as a neck mass and evaluated by FNA. Our case highlights the significant diagnostic challenges that can be caused by extracranial meningiomas on FNA and the importance of ancillary studies to avoid diagnostic pitfalls.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA
| | - Maria Martinez-Lage
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
| | - Jonathan J Paly
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA.
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Pusztaszeri M, Deschler D, Faquin Md PhD WC. The 2021 ASCO guideline on the management of salivary gland malignancy endorses FNA biopsy and the risk stratification scheme proposed by the Milan System for Reporting Salivary Gland Cytopathology. Cancer Cytopathol 2023; 131:83-89. [PMID: 36574228 DOI: 10.1002/cncy.22678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Daniel Deschler
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - William C Faquin Md PhD
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Park BJ, Mattox AK, Clayburgh D, Patel M, Bell RB, Yueh B, Leidner R, Xiao H, Couey M, Li S, Qin T, Sartor MA, Cairns B, MacDonough T, Halliwill K, Deschler D, Lin DT, Faquin WC, Sadow PM, Pai SI. Chemoradiation therapy alters the PD-L1 score in locoregional recurrent squamous cell carcinomas of the head and neck. Oral Oncol 2022; 135:106183. [PMID: 36215771 PMCID: PMC10283355 DOI: 10.1016/j.oraloncology.2022.106183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022]
Abstract
PD-L1 testing guides therapeutic decision-making for head and neck squamous cell carcinoma (HNSCC). We sought to understand whether chemoradiation therapy (CRT) influences the PD-L1 combined positive score (CPS) and other biomarkers of response to immunotherapy. PD-L1 expression was assessed using immunohistochemistry, and bulk RNA sequencing was performed on 146 HNSCC patients (65 primary sites, 50 paired local recurrences, and 31 paired regional recurrences). PD-L1 was scored using the CPS of ≥1, ≥20, and ≥50. Overall, 98 %, 54 %, and 17 % of HNSCCs had a CPS ≥1, ≥20, and ≥50, respectively. When using a cut-off of ≥1, CRT did not significantly change CPS at the locoregional recurrent site. However, there were significant changes when using CPS ≥20 or ≥50. The CPS changed for 32 % of patients when using a CPS ≥20 (p < 0.001). When using a CPS ≥50, there was a 20-23 % (p = 0.0058-0.00067) discordance rate at the site of locoregional recurrence. Oral cavity cancers had a significantly higher discordant rate than other primary sites for CPS ≥50, 44 % (8/18, p = 0.0058) and 58 % (7/12, p = 0.00067) discordance at the site of local and regional recurrence, respectively. When evaluating the 18 gene IFN-ɣ signature predictive of response to anti-PD-1 blockade, there was a statistically significant increase in the IFN-ɣ signature in recurrent larynx cancer (p = 0.02). Our study demonstrates that when using a higher cut-off of CPS ≥20 and ≥50, a repeat biopsy may be warranted after CRT for local and regional recurrent HNSCCs.
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Affiliation(s)
- Brian J Park
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Austin K Mattox
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daniel Clayburgh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Mihir Patel
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - R Bryan Bell
- Earle A. Chiles Research Institute in the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, United States
| | - Bevan Yueh
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN, United States
| | - Rom Leidner
- Earle A. Chiles Research Institute in the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, United States
| | - Hong Xiao
- Department of Pathology, Providence Health and Services-Oregon, Portland, OR, United States
| | - Marcus Couey
- Department of Pathology, Providence Health and Services-Oregon, Portland, OR, United States
| | - Shiting Li
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Tingting Qin
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A Sartor
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | | | | | | | - Daniel Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sara I Pai
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Center for Systems Biology, Massachusetts General Hospital, Boston, MA, United States.
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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5
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Tapias LF, Wright CD, Lanuti M, Muniappan A, Deschler D, Mathisen DJ. Hyperbaric oxygen therapy in the prevention and management of tracheal and oesophageal anastomotic complications. Eur J Cardiothorac Surg 2021; 57:1203-1209. [PMID: 31930317 DOI: 10.1093/ejcts/ezz364] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Failure of anastomotic healing is a morbid complication after airway or oesophageal surgery. Hyperbaric oxygen therapy (HBOT) has been used extensively in the management of complex wound-healing problems. We demonstrate the use of HBOT to rescue at-risk anastomoses or manage anastomotic failures in thoracic surgery. METHODS Retrospective review of 25 patients who received HBOT as part of the management of tracheal or oesophageal anastomotic problems during 2007-2018. HBOT was delivered at 2 atm with 100% oxygen in 90-min sessions. RESULTS Twenty-three patients underwent airway resection and reconstruction while 2 patients underwent oesophagectomy. There were 16 (70%) laryngotracheal and 7 (30%) tracheal resections. Necrosis at the airway anastomosis was found in 13 (57%) patients, partial dehiscence in 2 (9%) patients and both in 6 (26%) patients. HBOT was prophylactic in 2 (9%) patients. Patients received a median of 9.5 HBOT sessions (interquartile range 5-19 sessions) over a median course of 8 days. The airway anastomosis healed in 20 of 23 (87%) patients. Overall, a satisfactory long-term airway outcome was achieved in 19 (83%) patients; 4 patients failed and required reoperation (2 tracheostomies and 1 T-tube). HBOT was used in 2 patients after oesophagectomy to manage focal necrosis or ischaemia at the anastomosis, with success in 1 patient. Complications from HBOT were infrequent and mild (e.g. ear discomfort). CONCLUSIONS HBOT should be considered as an adjunct in the management of anastomotic problems after airway surgery. It may also play a role after oesophagectomy. Possible mechanisms of action are rapid granulation, early re-epithelialization and angiogenesis.
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Affiliation(s)
- Luis F Tapias
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ashok Muniappan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Deschler
- Department of Otolaryngology, Norman Knight Hyperbaric Medicine Center, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, Glastonbury C, Kaufman M, Lamarre E, Lau HY, Licitra L, Moore MG, Rodriguez C, Roshal A, Seethala R, Swiecicki P, Ha P. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39:1909-1941. [PMID: 33900808 DOI: 10.1200/jco.21.00449] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lisa Licitra
- Istituto Nazionale Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | | | | | | | - Patrick Ha
- University of California San Francisco, San Francisco, CA
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Bulbul MG, Wu M, Lin D, Emerick K, Deschler D, Richmon J, Goldsmith T, Zenga J, Puram SV, Varvares MA. Prediction of Speech, Swallowing, and Quality of Life in Oral Cavity Cancer Patients: A Pilot Study. Laryngoscope 2021; 131:2497-2504. [PMID: 33881173 DOI: 10.1002/lary.29573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/21/2021] [Revised: 03/09/2021] [Accepted: 04/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the impact of specific treatment-related variables on functional and quality of life outcomes in oral cavity cancer (OCC) patients. STUDY DESIGN Retrospective Cohort. METHODS Patients with primary OCC at least 6 months after resection and adjuvant therapy were included. Patients completed surveys including the Speech Handicap Index (SHI), M.D. Anderson Dysphagia Inventory (MDADI), and Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN). Performance Status Scale (PSS) and tongue mobility scale were completed to allow provider-rated assessment of speech and tongue mobility, respectively. Additional details regarding treatment were also collected. These data were used to generate a predictive model using linear regression. RESULTS Fifty-three patients with oral tongue and/or floor of mouth (FOM) resection were included in our study. In multivariable analysis, greater postoperative tongue range of motion (ROM) and time since treatment improved SHI. Flap reconstruction and greater postoperative tongue ROM increased MDADI and PSS (eating and speech). A larger volume of resected tissue was inversely correlated with PSS (diet and speech). Tumor site was an important predictor of PSS (all sections). There were no statistically significant predictors of FACT-HN. CONCLUSIONS In this pilot study, we propose a battery of tools to assess function in OCC patients treated with surgery. Using the battery of tools we propose, our results show that a surgical endpoint that preserves tongue mobility and employs flap reconstruction resulted in better outcomes, whereas those with greater volume of tissue resected and FOM involvement resulted in poorer outcomes. Larger prospective studies are needed to validate our findings. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Michael Wu
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Derrick Lin
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kevin Emerick
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel Deschler
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeremy Richmon
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Tessa Goldsmith
- Department of Speech, language and swallowing disorders, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Joseph Zenga
- Department of Otolaryngology, Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology, Head and Neck Surgery Washington University in St Louis, St Louis, Missouri, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
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Reddy PD, Nguyen SA, Deschler D. Bronchoscopy, laryngoscopy, and esophagoscopy during the COVID-19 pandemic. Head Neck 2020; 42:1634-1637. [PMID: 32348600 PMCID: PMC7267422 DOI: 10.1002/hed.26221] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background The United States now has the highest death toll due to COVID‐19. Many otolaryngology procedures, including laryngoscopy, bronchoscopy, and esophagoscopy, place otolaryngologists at increased risk of coronavirus transmission due to close contact with respiratory droplets and aerosolization from the procedure. The aim of this study is to provide an overview of guidelines on how to perform these procedures during the coronavirus pandemic. Methods Literature review was performed. Articles citing laryngoscopy, bronchoscopy, esophagoscopy use with regard to COVID‐19 were included. Results Laryngoscopy, bronchoscopy, and esophagoscopy are all used in both emergent and elective situations. Understanding the risk stratification of cases and the varied necessity of personal protective equipment is important in protecting patients and health care workers. Conclusions Summary guidelines based on the literature available at this time are presented in order to decrease transmission of the virus and protect those involved.
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Affiliation(s)
- Priyanka D Reddy
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Chen JX, Kozin E, Bohnen J, George B, Deschler D, Emerick K, Gray ST. Tracking operative autonomy and performance in otolaryngology training using smartphone technology: A single institution pilot study. Laryngoscope Investig Otolaryngol 2019; 4:578-586. [PMID: 31890874 PMCID: PMC6929585 DOI: 10.1002/lio2.323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/04/2019] [Accepted: 10/18/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In the era of duty hour restrictions, otolaryngology residents may not gain the operative experience necessary to function autonomously by the end of training. This study quantifies residents' autonomy during key indicator cases, defined by the Accreditation Council for Graduate Medical Education. STUDY DESIGN Prospective cohort study. METHODS Faculty and residents at a large academic institution were surveyed on the surgical autonomy trainees should achieve for otolaryngology key indicator surgeries at each training level. Residents and faculty used the mobile application "System for Improving and Measuring Procedural Learning" (SIMPL) between December 2017 and July 2018 to log trainees' operative autonomy during cases on a validated four-level Zwisch scale, from "show and tell" to "supervision only." RESULTS The study included 40 participants (23 residents and 17 attendings). The survey response rate was 83%. In surveys, residents overestimated the autonomy PGY5 residents should achieve for parotidectomy, rhinoplasty, thyroid/parathyroidectomy, and airway procedures compared with faculty (P < .05). Using SIMPL, 833 evaluations were logged of which 253 were paired evaluations for key indicator cases. Comparing survey predictions with actual cases logged in SIMPL, residents and faculty overestimated the autonomy achieved by senior trainees performing mastoidectomy (PGY5, P < .05) and ethmoidectomy (PGY4/5, P < .05); both felt that senior residents should operate with between "passive help" and "supervision only" whereas residents actually had "passive help." Residents overestimated their autonomy during rhinoplasty (PGY5, P = .017) and parotidectomy (PGY5, P = .007) while attendings accurately expected chief residents to have "passive help." CONCLUSIONS Resident surgical autonomy varies across otolaryngology procedures. Multicenter studies are needed to elucidate national trends. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Jenny X. Chen
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
| | - Elliott Kozin
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
| | - Jordan Bohnen
- Department of General SurgeryMassachusetts General HospitalBostonMassachusetts
| | - Brian George
- Department of General SurgeryUniversity of MichiganAnn ArborMichigan
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
| | - Kevin Emerick
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
| | - Stacey T. Gray
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and Ear/Harvard Medical SchoolBostonMassachusetts
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10
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Chen JX, Zenga J, Emerick K, Deschler D. Sublingual gland excision for the surgical management of plunging ranula. Am J Otolaryngol 2018; 39:497-500. [PMID: 30017374 DOI: 10.1016/j.amjoto.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/26/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A plunging ranula is a pseudocystic collection of mucin extravasated from the sublingual gland into the floor of mouth and through the mylohyoid muscle into the neck. While the lining of a ranula is non-secreting and resection of the sublingual gland is adequate for simple sublingual mucoceles, many surgeons attempt to address plunging ranulas with extensive transoral and transcervical dissections. We review our experience managing plunging ranulas with intraoral sublingual gland excision and ranula drainage alone. METHODS This is a case series of patients with plunging ranulas who underwent transoral sublingual gland excision and ranula drainage in the past 10 years at the Massachusetts Eye and Ear. All ranulas were confirmed by radiographic imaging. Data were gathered from the medical record and telephone surveys. RESULTS Twenty-one patients with 22 distinct ranulas underwent this surgical approach. Average ranula size on imaging was 4.3 cm (SD = 1.3). Thirteen patients with 14 ranulas were followed up for greater than 6 months while the remaining 7 patients were lost to follow-up. Median follow-up for the 13 patients was 30 months (range 6 to 80). One ranula recurred requiring excision of residual sublingual gland (7%). One patient developed a local infection that was treated with antibiotics (7%). No long term complications were reported. CONCLUSION Simple transoral excision of the sublingual gland with ranula drainage is sufficient for treatment of plunging ranulas. It is essential to obtain a full resection of the gland to prevent relapse. This limited approach has low rates of complications and ranula recurrence.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States
| | - Joseph Zenga
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Kevin Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, United States; Division of Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, United States.
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Creighton FX, Feng AL, Goyal N, Emerick K, Deschler D. Chicken thigh microvascular training model improves resident surgical skills. Laryngoscope Investig Otolaryngol 2017; 2:471-474. [PMID: 29299526 PMCID: PMC5743170 DOI: 10.1002/lio2.94] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives Microsurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high‐fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills. Study Design Validation study Methods Thirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model. Anastomoses were video‐recorded and the time required for trainees to complete the first stitch of their first anastomosis was compared to the time required for the first stitch of their last anastomosis. Comparison of first and last stitch times was completed using a paired student t‐test. All participants completed a survey regarding their experience with the simulator. Results There was a statistically significant decrease between the time required for the first stitch (235 s, 95%CI 198–272 s) compared to last stitch (120 s, 95%CI 92–149 s), and an average 48.7% (115 s) decrease in time (p < 0.001). Junior (PGY 2/3) and senior (PGY 4/5) residents had similar decreases in time, 49.1% and 48.21%, respectively. One hundred percent of residents felt they improved during the session and 92% of residents agreed or strongly agreed that their final stitch was better than their last stitch. All residents agreed or strongly agreed that the simulation is realistic, effective in teaching the procedure, and would translate to improved intraoperative performance. Conclusions The chicken thigh model demonstrates objective improvements in resident microvascular surgical skills. Level of Evidence NA
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Affiliation(s)
- Francis X Creighton
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Allen L Feng
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Neerav Goyal
- Department of Otolaryngology Penn State Medical School Hershey Pennsylvania U.S.A
| | - Kevin Emerick
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Daniel Deschler
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
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12
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Affiliation(s)
- Sidharth V Puram
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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13
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Dwojak S, Deschler D, Sargent M, Emerick K, Guadagnolo BA, Petereit D. Knowledge and screening of head and neck cancer among American Indians in South Dakota. Am J Public Health 2015; 105:1155-60. [PMID: 25320895 PMCID: PMC4431103 DOI: 10.2105/ajph.2014.302177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We established the level of awareness of risk factors and early symptoms of head and neck cancer among American Indians in South Dakota and determined whether head and neck cancer screening detected clinical findings in this population. METHODS We used the European About Face survey. We added questions about human papillomavirus, a risk factor for head and neck cancer, and demographics. Surveys were administered at 2 public events in 2011. Participants could partake in a head and neck cancer screening at the time of survey administration. RESULTS Of the 205 American Indians who completed the survey, 114 participated in the screening. Mean head and neck cancer knowledge scores were 26 out of 44. Level of education was the only factor that predicted higher head and neck cancer knowledge (b = 0.90; P = .01). Nine (8%) people had positive head and neck cancer screening examination results. All abnormal clinical findings were in current or past smokers (P = .06). CONCLUSIONS There are gaps in American Indian knowledge of head and neck cancer risk factors and symptoms. Community-based head and neck cancer screening in this population is feasible and may be a way to identify early abnormal clinical findings in smokers.
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Affiliation(s)
- Sunshine Dwojak
- Sunshine Dwojak, Daniel Deschler, and Kevin Emerick are with the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA. Michele Sargent and Daniel Petereit are with the John T. Vucurevich Cancer Care Institute at Rapid City Regional Hospital, Rapid City, SD. B. Ashleigh Guadagnolo is with the University of Texas M.D. Anderson Cancer Center, Houston
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Yarlagadda BB, Hatton E, Huettig J, Deschler D. Patient and staff perceptions of social worker counseling before surgical therapy for head and neck cancer. Health Soc Work 2015; 40:120-124. [PMID: 26027420 DOI: 10.1093/hsw/hlv015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patients who undergo surgical therapy for head and neck cancer often face a tremendous challenge involving considerable psychological distress and impaired social functioning. These difficulties are often compounded by logistical difficulties such as transportation, financial assistance, and continuity of care after the acute hospitalization. Social workers have a unique opportunity to address the psychosocial and logistical issues facing these patients through preadmission counseling and coordination. The study reported in this article aimed to assess the effect of preadmission counseling for patients planning to undergo major surgical therapy for head and neck cancer. Ten patients who received preadmission counseling were surveyed to ascertain the utility of it in regard to multiple social and logistical factors. Comparisons were made with patients who did not receive such counseling. Staff perceptions were likewise obtained. The surveys indicated that preadmission counseling helped in regard to improving peri-admission support and access to financial and logistical resources, and lowered levels of anxiety during admission. Areas of potential improvement were identified, including addressing substance abuse issues in a timely manner.
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Yip D, Liebsch N, Deschler D, Lin D, Vavares M, Chan A. Definitive Proton Beam Therapy for Adenoid Cystic Carcinoma of the Nasopharynx. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1370471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Icuspit P, Yarlagadda B, Garg S, Johnson T, Deschler D. Heat and moisture exchange devices for patients undergoing total laryngectomy. ORL Head Neck Nurs 2014; 32:20-23. [PMID: 24724345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients undergoing total laryngectomy face the challenge of an altered anatomy with the resultant changes in quality of life and significant requirements for post-operative care. Increased production of secretions and sputum, the need for ongoing suctioning, and the formation of stomal crusting require meticulous post-operative care. The use of Heat and Moisture Exchange (HME) devices has been shown to decrease the effect of these factors. This article describes the nature of these devices and their use. The literature is reviewed regarding the long term benefits and new data are presented suggesting an immediate post-operative benefit as well. Finally, costs and other considerations for successful use of HME devices are presented.
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Chapman AJ, Deschler D, Judge BS. A man with severe leg burns. Clin Toxicol (Phila) 2013; 51:904-5. [PMID: 23992444 DOI: 10.3109/15563650.2013.831437] [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: 11/13/2022]
Abstract
A 52-year-old Hispanic male was transported to the emergency department after sustaining severe bilateral lower extremity burns in an electroplating factory. His examination revealed circumferential burns to the lower extremities with spotting in the perineum. The epidermis was stained green and sloughed off with gentle pressure. The underlying dermis was white and non-blanching, consistent with a full thickness burn. His feet were partially protected by his work boots where he had small areas of pink, blanchable, partial thickness burns (Fig. 1). Pertinent initial studies included a lactic acid level of 3.1 mmol/L and a creatinine of 1.02 mg/dL.
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Affiliation(s)
- A J Chapman
- From Grand Rapids Medical Education Partners/Michigan State University General Surgery Residency Program , Grand Rapids, MI , USA
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Sethi R, Kozin E, Remenschneider A, Meier J, VanderLaan P, Faquin W, Deschler D, Frankenthaler R. Mammary analogue secretory carcinoma: update on a new diagnosis of salivary gland malignancy. Laryngoscope 2013; 124:188-195. [PMID: 23775296 DOI: 10.1002/lary.24254] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/24/2013] [Accepted: 05/24/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review the known histopathologic findings and clinical behavior of mammary analogue secretory carcinoma (MASC). DATA SOURCES PubMed. REVIEW METHODS Literature search using the terms "Mammary analogue secretory carcinoma," "Mammary analog secretory carcinoma," and "MASC" to identify all relevant publications. RESULTS MASC is an unusual and rare malignant salivary gland tumor first described in 2010. It shares histologic, immunohistochemical, and genetic features with secretory carcinoma of the breast. The clinical behavior of MASC ranges from slowly growing tumors that infrequently recur after surgical resection to aggressive tumors that cause widespread metastasis and death. Many cases of MASC were discovered in archived cases previously classified as acinic cell carcinoma, mucoepidermoid carcinoma, and adenocarcinoma not otherwise specified. CONCLUSION MASC is a newly recognized variant of salivary gland malignancy. Further research is needed to better delineate its overall prevalence and to define an appropriate treatment algorithm for this new clinical entity.
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Affiliation(s)
| | - Elliott Kozin
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary / Harvard Medical School, Boston, MA
| | - Aaron Remenschneider
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary / Harvard Medical School, Boston, MA
| | - Josh Meier
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary / Harvard Medical School, Boston, MA
| | | | - William Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Daniel Deschler
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary / Harvard Medical School, Boston, MA
| | - Robert Frankenthaler
- Division of Otolaryngology, Beth Israel Medical Center, Boston, MA; Department of Pathology, Beth Israel Medical Center, Boston, MA
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Herr M, Lin A, Curry W, Baker F, Chan A, Deschler D, Lin D. Esthesioneuroblastoma: An Update on the Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital Experience with Craniofacial Resection, Proton Beam Radiation, and Chemotherapy. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Remenschneider A, Chambers K, Meier J, Herr M, Lin A, Lin D, Deschler D, Gray S. The Use of Hyperbaric Oxygen Therapy in the Management of Osteoradionecrosis of the Skull Base. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nardi V, Sadow PM, Juric D, Zhao D, Cosper AK, Bergethon K, Scialabba VL, Batten JM, Borger DR, Iafrate AJ, Heist RS, Lawrence DP, Flaherty KT, Bendell JC, Deschler D, Li Y, Wirth LJ, Dias-Santagata D. Detection of novel actionable genetic changes in salivary duct carcinoma helps direct patient treatment. Clin Cancer Res 2012. [PMID: 23186780 DOI: 10.1158/1078-0432.ccr-12-1842] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Salivary duct carcinomas (SDC) are a rare and aggressive subtype of salivary gland cancers for which cytotoxic chemotherapy has limited efficacy. We investigated whether genotyping analysis could detect novel tumor-specific mutations that would help direct SDC patient treatment using targeted agents. EXPERIMENTAL DESIGN We genotyped 27 SDC archival specimens from patients followed at Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary (Boston, MA) between 2000 and 2011. These included the tumors of 8 patients who were tested prospectively. Targeted mutational analysis of 13 clinically relevant cancer genes was conducted using SNaPshot multiplexed genotyping. FISH was conducted to detect HER2 gene amplification. Patient medical records and tumor histopathologic features were retrospectively reviewed. RESULTS Mutually exclusive genetic aberrations were detected in 15 of 27 (56%) tumors, including 2 (7%) mutations in BRAF, 5 (19%) mutations in PIK3CA, and 8 (30%) cases of HER2 gene amplification. To our knowledge, this is the first time that BRAF and PIK3CA mutations have been reported in this tumor type. Prospective clinical testing of 8 patients with SDC identified actionable genetic alterations in 6 tumors and influenced therapeutic decisions for all 6 patients. CONCLUSION SNaPshot molecular profiling identified novel genetic changes in SDCs, expanded the therapeutic options for patients with this rare tumor, and is changing SDC management at our institution. These findings highlight the importance of using broad-based genetic profiling to expedite the identification of effective-targeted therapies for patients with rare malignancies.
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Affiliation(s)
- Valentina Nardi
- Departments of Pathology and Medicine, Massachusetts General Hospital; Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Lee L, Gray S, Curry W, Chan A, Clark J, Holbrook E, Deschler D, Lin D. Multimodality Treatment Outcomes of Sinonasal Undifferentiated Carcinoma of the Skull Base. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tward A, Quesnel A, Moore M, Deschler D, McKenna M, Lin D. Outcomes Following Lateral Temporal Bone Resection for Squamous Cell Carcinoma. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Henderson E, Deschler D. Occurrence of Flap Related Complications & Outcomes in Reconstruction of Circumferential Defects After Total Layrngopharengectomy. Laryngoscope 2011. [DOI: 10.1002/lary.21999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Wirth LJ, Nardi V, Juric D, Cosper AK, Bergethon K, Scialabba V, Borger DR, Iafrate AJ, Ellisen LW, Deschler D, Zhao D, Sadow PM, Dias-Santagata D. Detection of novel genetic aberrations in salivary duct carcinoma (SDC) by SNaPshot analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Deschler D, Holsinger FC, Rocco J, Clark JR, Smith R. HPV & Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gray S, Curry W, Barker F, Chan A, Deschler D, Lin D. Orbital Preservation in Patients with Esthesioneuroblastoma. Skull Base 2009. [DOI: 10.1055/s-2009-1242385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Gray S, Curry W, Chan A, Barker F, Deschler D, Lin D. Delayed Complications of Craniofacial Resection and Proton Beam Radiation Therapy for Malignant Tumors of the Skull Base. Skull Base 2009. [DOI: 10.1055/s-2009-1242384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Purdon PL, Pierce ET, Bonmassar G, Walsh J, Harrell PG, Kwo J, Deschler D, Barlow M, Merhar RC, Lamus C, Mullaly CM, Sullivan M, Maginnis S, Skoniecki D, Higgins HA, Brown EN. Simultaneous electroencephalography and functional magnetic resonance imaging of general anesthesia. Ann N Y Acad Sci 2009; 1157:61-70. [PMID: 19351356 DOI: 10.1111/j.1749-6632.2008.04119.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It has been long appreciated that anesthetic drugs induce stereotyped changes in electroencephalogram (EEG), but the relationships between the EEG and underlying brain function remain poorly understood. Functional imaging methods including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), have become important tools for studying how anesthetic drugs act in the human brain to induce the state of general anesthesia. To date, no investigation has combined functional MRI with EEG to study general anesthesia. We report here a paradigm for conducting combined fMRI and EEG studies of human subjects under general anesthesia. We discuss the several technical and safety problems that must be solved to undertake this type of multimodal functional imaging and show combined recordings from a human subject. Combined fMRI and EEG exploits simultaneously the high spatial resolution of fMRI and the high temporal resolution of EEG. In addition, combined fMRI and EEG offers a direct way to relate established EEG patterns induced by general anesthesia to changes in neural activity in specific brain regions as measured by changes in fMRI blood oxygen level dependent (BOLD) signals.
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Affiliation(s)
- Patrick L Purdon
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Vakharia KT, Richmon JD, Deschler D. S157 – A Novel Approach to Managing Nasopharyngeal Stenosis. Otolaryngol Head Neck Surg 2008. [DOI: 10.1016/j.otohns.2008.05.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Nasopharyngeal stenosis is a rare and challenging problem that is difficult to treat successfully. We present a novel solution in a patient with idiopathic inflammatory nasopharyngeal stenosis by using a tracheoesophageal puncture prosthesis. Methods Case report and review of the literature. Results We present the case of a 51-year-old man with an aggressive idiopathic inflammatory process of the nasal cavity resulting in complete nasopharyngeal stenosis. Despite numerous surgical interventions and obturator placement, stenosis recurred. Eventually, a tracheoesophageal voice prosthesis was placed through a controlled puncture in the nasopharyngeal stenosis which has successfully relieved his symptoms. Various treatments within the literature are discussed. Conclusions The use of a tracheoesophageal puncture voice prosthesis in treating nasopharyngeal stenosis is a novel solution to a difficult problem and may be considered in recalcitrant cases.
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Moore M, Lin D, Deschler D, Resto V, Chan A. Incisional Recurrence after Midface and Anterior Skull Base Surgery in Sinonasal Malignancies. Skull Base 2007. [DOI: 10.1055/s-2006-958358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Resto V, Chan A, Deschler D, Varvares M, Lin D. Extent of Surgery in the Management of Locally Advanced Sinonasal Malignancies. Skull Base 2007. [DOI: 10.1055/s-2006-958269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chan A, Pommier P, Liebsch N, Deschler D, Lin D, McIntyre J, Thornton A, Varvares M. Dose Escalation with Proton Radiotherapy for Skull Base Adenoid Cystic Carcinoma. Skull Base 2007. [DOI: 10.1055/s-2006-958275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Truong M, Liebsch N, Lin D, Deschler D, McIntyre J, Thornton A, Varvares M, Chan A. The Role of Elective Neck Irradiation in the Management of Sinonasal Malignancies. Skull Base 2007. [DOI: 10.1055/s-2006-958390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
OBJECTIVE To evaluate the efficacy of using hyperbaric oxygen to enhance auricular composite graft survival via a prospective, randomized, placebo-controlled, double-blind study. DESIGN Eighteen New Zealand White rabbits were randomly assigned to treatment (n = 9) and control (n = 9) groups after amputation and reattachment of 20 x 10-mm auricular composite grafts. The treatment group received twice-daily hyperbaric oxygen treatments for 5 days. The control group received twice-daily hyperbaric room-air treatments for 5 days. After 21 days, digital photographs of the composite grafts were taken and compared with photographs taken on the day of surgery. From these photographs, digital imaging software was used to calculate the percentage of graft survival. RESULTS The treated group (18 ears) had a mean +/- SD graft survival area of 80.67% +/- 19%, whereas the control group (18 ears) had a mean +/- SD graft survival area of 26.33% +/- 29%. Variance analysis with the Snedecor test allowed the comparison of the groups. The paired, 2-tailed t test proved a significant difference (P<.001) between groups. CONCLUSION Hyperbaric oxygen therapy is an effective way to enhance the survival of 2-cm auricular composite grafts.
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Affiliation(s)
- David Lewis
- Division of Head and Neck Surgical Oncology, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Nichols A, Chan A, Curry W, Deschler D, Lin D. Esthesioneuroblastoma: The Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary Experience with Craniofacial Resection, Proton Beam Radiation, and Chemotherapy. Skull Base 2007. [DOI: 10.1055/s-2007-981833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Moore M, Deschler D, McKenna M, Varvares M, Lin D. The Use of Lateral Temporal Bone Resection in the Management of Malignancies of the Ear and Temporal Bone: A Review of Survival. Skull Base 2007. [DOI: 10.1055/s-2007-981811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Lewis C, Lin D, Deschler D. Use of Nasal Trumpets for Airway Diversion in Anterior Craniofacial Resections. Skull Base 2007. [DOI: 10.1055/s-2007-981812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Deschler D. Miniseminar: diagnosis and treatment of the unknown primary. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-5998(03)00855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Lipoblastomas are rare tumors of embryonal fat that occur in infants and children. They are usually located in the extremities and trunk. Two cases in the parotid region have been described. A diagnosis on fine needle aspiration (FNA) specimens has been reported in six cases. CASE Lipoblastoma of the parotid region occurred in a 6-year-old boy and was diagnosed by FNA. Cytology showed rare lipoblasts and hibernomalike cells in a myxoid background with spindle and stellate mesenchymal cells, mature adipose cells and plexiform capillaries. A 7.0-cm, well-circumscribed mass with lobulated adipose tissue and delicate fibrous bands was resected. Microscopically, it showed a lobulated myxoid stroma, many capillaries, mesenchymal cells, lipoblasts and mature adipose cells. CONCLUSION Lipoblastoma has to be differentiated from myxoid and lipomatous soft tissue tumors, especially from myxoid liposarcoma, a malignancy that classically affects older individuals and shows pleomorphism, atypical lipoblasts and chromosome-12 translocation. A lipoblastoma diagnosis must be established only after careful consideration of all available clinical, radiologic, cytogenetic and morphologic data.
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Affiliation(s)
- Marino E Leon
- Departments of Pathology and Laboratory Medicine and of Ear, Nose and Throat Surgery, Medical College of Pennsylvania-Hahnemann University, Broad and Vine St., Mail Stop 435, Philadelphia, Pennsylvania 19102, USA
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Abstract
Benign lymphoepithelial cysts (BLCs) are a widely recognized cause of parotid gland swelling in HIV-infected patients. Although they are neither invasive nor associated with malignant degeneration, BLCs can become large and disfiguring. Multiple modalities have been used to control these cysts, but no ideal treatment has been identified. The current study examines the efficacy of doxycycline as a BLC sclerosant in eight patients, and nine BLCs (bilateral BLC in one patient). Follow-up ranged from 12 to 17 months in all cases. Doxycycline sclerosis controlled further cyst growth in 100% of cases with no serious complications. The BLCs became negligible or unnoticeable in two patients, and in six patients (seven BLCs) the cyst became fibrosed and showed no evidence of further growth over the follow-up period. Although further studies are needed to determine the long-term efficacy of this treatment modality, doxycycline sclerosis appears to offer a simple, safe, cost-effective, office-based therapeutic option for the treatment of BLCs in patients infected with HIV.
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Affiliation(s)
- L R Lustig
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco 94143-0342, USA
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Affiliation(s)
- David Greene
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco
| | - Daniel Deschler
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco
| | - Michael J. Kaplan
- Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco
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Greene D, Deschler D, Kaplan MJ. Dermal metastases of pectoralis major flap donor site from a laryngeal squamous cell carcinoma. Ear Nose Throat J 1998; 77:102-4. [PMID: 9509723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- D Greene
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco 94143, USA
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