Richard O. Wein

Cytopathology by Optical Methods: Spectral Cytopathology of the Oral Mucosa

Spectral cytopathology (SCP) is a novel approach for diagnostic differentiation of disease in individual exfoliated cells. SCP is carried out by collecting information on each cells biochemical composition through an infrared micro-spectral measurement, followed by multivariate data analysis. Deviations from a cells natural composition produce specific spectral patterns that are exclusive to the cause of the deviation or disease. These unique spectral patterns are reproducible and can be identified and used through multivariate statistical methods to detect cells compromised at the molecular level by dysplasia, neoplasia, or viral infection. In this proof of concept study, a benchmark for the sensitivity of SCP is established by classifying healthy oral squamous cells according to their anatomical origin in the oral cavity. Classification is achieved by spectrally detecting cells with unique protein expressions: for example, the squamous cells of the tongue are the only cell type in the oral cavity that have significant amounts of intracytoplasmic keratin, which allows them to be spectrally differentiated from other oral mucosa cells. Furthermore, thousands of cells from a number of clinical specimens were examined, among them were squamous cell carcinoma, malignancy-associated changes including reactive atypia, and infection by the herpes simplex virus. Owing to its sensitivity to molecular changes, SCP often can detect the onset of disease earlier than is currently possible by cytopathology visualization. As SCP is based on automated instrumentation and unsupervised software, it constitutes a diagnostic workup of medical samples devoid of bias and inconsistency. Therefore, SCP shows potential as a complementary tool in medical cytopathology.

Anaplastic thyroid carcinoma: Palliation or treatment?

Purpose of reviewTo review the recent published literature on the topic of anaplastic thyroid carcinoma and discern if significant advances have occurred that alter the historically poor prognosis associated with this diagnosis. Recent findingsSurgical resection for patients with stage IVA disease (intra-thyroidal without extracapsular extension) with postoperative chemoradiation remains the standard recommendation. Care for patients with stage IVB disease, extrathyroidal spread without distant metastases, remains varied and controversial. Research into different molecular therapies (deacetylase inhibitors, tubulin binding compounds, etc.) and the pathogenesis of anaplastic carcinoma continues to evolve. Care for patients with metastatic disease, stage IVC, is focused on quality of life. SummaryAlthough occasional reports exist of long-term survivors with anaplastic thyroid carcinoma, the prognosis remains poor. Accurate staging is critical to offering the most appropriate treatment. Multimodality treatment is required if prolonged locoregional control or survival is desired.

Esthesioneuroblastoma: A Contemporary Review of Diagnosis and Management

Esthesioneuroblastoma (ENB) is a rare malignancy, representing only 3% to 6% of all sinonasal malignancies. A wide array of treatment options for ENB have been described in the literature, but prospective clinical trials are absent given the tumors rarity and natural history. Delay in diagnosis leading to an initial advanced stage of presentation is common secondary to the clinically hidden primary site at the anterior skull base. This article presents data from the current body of literature and reviews the advocated roles for surgery, radiation therapy and chemotherapy.

Comparison of Treatment Outcomes Associated With Early Versus Late Treatment of Mandible Fractures: A Retrospective Chart Review and Analysis

PURPOSE We conducted outcomes assessment for all patients who had undergone treatment of mandible fractures at Tufts Medical Center across the 2 specialties of oral and maxillofacial surgery and otolaryngology. The aim of the present study was to determine whether a correlation existed between the development of postoperative complications and late treatment of mandible fractures (defined as treatment provided >48 hours after the time of injury). PATIENTS AND METHODS All patients with mandible fractures treated at Tufts Medical Center between January 1, 2003 and January 1, 2008, underwent chart review to document the relevant data, including the time of fracture, time of treatment, and complications recorded during postoperative follow-up. The only patients included in the review were those who had follow-up data with good documentation. RESULTS Our dataset included 92 patients, with a mean age of 28.74 years. The injury scores, compared between the early and late treatment and complication and noncomplication groups, were equivocal. Of our 92 treated patients, 19 (20.7%) had ≥1 postoperative complication. Of the 19 patients with any complication, 10 had undergone early treatment and 9 had been treated after 48 hours. Of our late treatment group, 25% developed ≥1 complication. The overall complication rate for the early group was 18%. CONCLUSIONS Our study did not reveal a statistically significant difference in the development of postoperative complications after mandible fracture repair between the early and late treatment groups. Our study seemed to have a result similar to that of some of the earlier studies investigating the same variable.

Plasma cell mucositis of the oral cavity: report of a case and review of the literature

Plasma cell mucositis (PCM) is a rare plasma cell proliferative disorder of the upper aerodigestive tract with an unknown etiology. Including the present case, only 22 cases have been reported in the English-language literature. PCM affects adult patients at an average age of 56.6 years. Clinical features are an intensely erythematous mucosa with papillomatous, cobblestone, nodular, or velvety surface changes. Symptoms include oral pain of long duration, dysphagia, persistent hoarseness, and pharyngitis. The majority of cases have a history of autoimmune or immunologically mediated disease. The histopathologic features of a dense, submucosal plasma cell infiltrate are not specific and must be differentiated from other reactive and neoplastic conditions. Diagnosis of PCM depends on clinical pathologic correlations. The present case was complicated by evidence of a monoclonal plasma cell population. The significance of this case is the differentiation of a benign disease from one that is potentially life threatening.

Papillary thyroid carcinoma and familial adenomatous polyposis of the colon.

OBJECTIVE Case report and limited review of the literature on the topic of papillary thyroid carcinoma and familial adenomatous polyposis and its genetic associations. METHODS A patient with multiple prior surgeries for colonic polyps, abdominal perineal resection for colorectal cancer, and wedge resection for metastatic adenocarcinoma (consistent with rectal primary) presented with a thyroid mass. Fine-needle aspiration demonstrated papillary thyroid carcinoma. RESULTS The patient underwent total thyroidectomy. Pathologic examination revealed the cribriform-morular variant of papillary carcinoma that has been reported in patients with familial adenomatous polyposis. CONCLUSIONS Cribriform-morular variant of papillary thyroid carcinoma is an uncommon diagnosis known to be associated with familial adenomatous polyposis. Although the incidence is rare, this diagnosis should raise the clinicians suspicions to recommend both colorectal screening and genetic counseling for family members.

Management of an acquired tracheoesophageal fistula with a fascial free flap.

Failure in the primary repair of a benign acquired tracheoesophageal fistula limits the operative options available at revision. Use of a fascial free flap to treat this condition has not been previously reported.

Thyroid hemiagenesis: a case series and review of the literature

PURPOSE The purpose of this study is to present a case series and review recommendations within the literature concerning thyroid hemiagenesis. MATERIALS AND METHODS This is a (1) retrospective case series review of 5 patients and (2) literature review (using Medline) on thyroid hemiagenesis. RESULTS Most reported cases are female with the left thyroid lobe absent. Compensatory hypertrophy occurs in most thyroid remnants. Associated diagnoses in the remaining lobe include hyperthyroidism, hypothyroidism, simple and multinodular goiter, and carcinoma. There is no increased risk for the subsequent development of cancer in the remaining lobe, and empiric thyroidectomy is not justified. CONCLUSIONS Thyroid hemiagenesis is an uncommon presentation that is frequently asymptomatic and detected incidentally when imaging for another condition. Awareness of its existence can help prevent unnecessary interventions associated with incorrect assumptions in patient care.

Preoperative Smoking Cessation: Impact on Perioperative and Long-term Complications

Habitual tobacco use is the leading preventable cause of death in the United States and is responsible for 1 of every 5 deaths. Although there has been a steady decline in the percentage of smokers since 1960, a plateau in this progress has been noted in the past decade. In 2000, 25.7% of males and 21.0% of females were smokers. The physiologic impact of smoking is well described and includes impaired mucus transport and pulmonary macrophage function, increased bronchial reactivity and arterial carbon monoxide levels, reduced oxygen transport, and inhibited mitochondrial oxidative metabolism. In addition, active smoking, including heavy ( 20 cigarettes/d) and lighter users, has also been associated with an increased relative risk (1.44 overall) of the future development of type 2 diabetes mellitus. Attempts at smoking cessation are most successful in highly motivated individuals; however, even within established tobacco cessation programs, long-term abstinence rates are often low. In a study by Anthonisen et al, patients were involved in a 10week smoking cessation program that included physician input, 12 group meetings with behavioral modification, and nicotine gum. At 5 years, 21.7% of the intervention participants had stopped smoking. Only 5.4%of thecontrol grouphadstopped smoking during that same period. Not surprisingly, the death rates for both lung cancer and cardiovascular disease were noted to be significantly lower in the intervention group when compared with controls. The number of studies within the field of otolaryngology–head and neck surgery examining the impact of smoking cessation on surgery are limited. The question this article will explore is whether a short-term period of preoperative smoking cessation has an effect on the perioperative and postoperative results in head and neck surgery. The treatment of head and neck cancer requires that surgery be performed within a reasonable period of time after the establishment of diagnosis. As a result, it is not always possible to allow for extended periods of time to be dedicated to programs specifically addressing alcohol and tobacco dependence. Although not focused exclusively on head and neck cancer, a review of the literature concerning the surgical experience with preoperative smoking cessation can provide insight relative to this topic.

PRISM: Phase 2 trial with panitumumab monotherapy as second‐line treatment in patients with recurrent or metastatic squamous cell carcinoma of the head and neck

Panitumumab Regimen In Second‐line Monotherapy of Head and Neck Cancer (PRISM) trial evaluated the safety and efficacy of panitumumab as second‐line monotherapy in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN).