Robert E. Morales

Induction of MAGE-A3 and HPV-16 immunity by Trojan vaccines in patients with head and neck carcinoma.

We performed a pilot study using Trojan vaccines in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). These vaccines are composed of HLA‐I and HLA‐II restricted melanoma antigen E (MAGE)‐A3 or human papillomavirus (HPV)‐16 derived peptides, joined by furin‐cleavable linkers, and linked to a “penetrin” peptide sequence derived from HIV‐TAT. Thirty‐one patients with SCCHN were screened for the trial and 5 were enrolled.

Oropharyngeal cancer as a driver of racial outcome disparities in squamous cell carcinoma of the head and neck: 10‐year experience at the University of Maryland Greenebaum Cancer Center

Racial outcome disparities have been observed in head and neck squamous cell carcinoma (HNSCC) with diminished survival for black patients compared with white patients.

Demyelination as a harbinger of lymphoma: a case report and review of primary central nervous system lymphoma preceded by multifocal sentinel demyelination.

BackgroundPrimary central nervous system lymphoma (PCNSL) may rarely be preceded by “sentinel demyelination,” a pathologic entity characterized by histologically confirmed demyelinating inflammatory brain lesions that mimic multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM). Interpreting the overlapping radiologic and clinical characteristics associated with each of these conditions—contrast-enhancing demyelination of white matter and relapsing and remitting steroid-responsive symptoms respectively—can be a significant diagnostic challenge.Case presentationWe describe a 57-year-old woman with an unusual clinical course who presented with multi-focal enhancing white matter lesions demonstrated to be inflammatory demyelination by brain biopsy. Despite a good initial response to steroids and rituximab for treatment of presumed tumefactive multiple sclerosis, the patient’s condition rapidly deteriorated, and a repeat brain biopsy six months later was consistent with a diagnosis of diffuse large B-cell lymphoma.ConclusionsEarly clinical suspicion for PCNSL and awareness that biopsied lesions may initially show sentinel demyelination suggestive of alternate diagnoses may be essential for early initiation of appropriate therapies and mitigation of disease progression. Clinical, pathophysiological, and diagnostic aspects of sentinel demyelination and PCNSL are discussed.

Evaluation of superficial musculoaponeurotic system flap and fat graft outcomes for benign and malignant parotid disease.

Objective (1) To evaluate the effectiveness of the superficial musculoaponeurotic system (SMAS) flap and free fat graft in reconstructing the parotidectomy defect. (2) To evaluate the long-term viability of the free fat graft following parotidectomy for benign and malignant disease, including in the postradiation setting. Study Design Prospective study of consecutive patients. Setting Academic tertiary care medical center. Subjects and Methods Thirty-one consecutive patients underwent parotidectomy with SMAS flap and free fat graft reconstruction from 2006 to 2012. Data were compiled through a manual chart review. Results Twenty-three of the 31 total patients had benign disease, including pleomorphic adenoma, oncocytoma, and Warthin tumor. The 8 remaining patients (9 parotidectomies) underwent surgery for malignant disease, followed by postoperative radiation. The average age was 56 years (range, 16-84 years). The mean follow-up was 22.5 months. Satisfactory volumetric symmetry was achieved in all procedures for benign and malignant disease. Magnetic resonance imaging confirmed long-term fat graft viability in the postradiation setting. There was 1 case of Frey syndrome and no cases of unexpected, permanent facial nerve weakness among the patients. Conclusion The combined technique of SMAS flap and free fat graft is effective for immediate reconstruction of the parotidectomy defect with minimal morbidity and low complication rates. This study demonstrates long-term viability of the free fat graft even in the setting of postoperative radiation.

Sebaceous adenoma of the parotid gland in a 2-year-old male

Sebaceous adenomas of the major salivary glands are uncommon tumors. Although sebaceous differentiation within the major salivary glands is a frequent histopathologic finding (approximately 20% to 42% of parotid glands 1-3 ), sebaceous neoplasms of salivary gland origin are not. A number of publications review the clinical and histologic features of sebaceous neoplasms, however, these reports focus on adult patients. The finding of these tumors in a pediatric patient is exceedingly rare. 4 We present a case

Oropharyngeal cancer (OPC) drives racial outcome disparities in squamous cell carcinoma of the head and neck (HNSCC): Ten year experience at the university of maryland greenebaum cancer center (UMGCC)

Racial outcome disparities have been observed in head and neck squamous cell carcinoma (HNSCC) with diminished survival for black patients compared with white patients.

Pearls and Oy-sters: The utility of cytology and flow cytometry in the diagnosis of leptomeningeal leukemia

Diagnosis of leptomeningeal leukemia (and more broadly, leptomeningeal metastasis [LM]) is based on:

Chapter 9 – Imaging of the Facial Nerve

Facial nerve dysfunction can occur from a variety of causes, including congenital, inflammatory, traumatic, vascular, and neoplastic processes. Imaging plays an important role in the evaluation of facial nerve disorders. Knowledge of the complex anatomy of the facial nerve is essential to localize the site of pathology. This article reviews the anatomy of the facial nerve and the current clinical evaluation and imaging strategies.

Evaluation and treatment of pulsatile tinnitus associated with sigmoid sinus wall anomalies: Sigmoid Sinus Wall Anomalies

Describe clinical and radiographic features of sigmoid sinus wall anomalies (SSWA) associated with pulsatile tinnitus (PT) and determine factors predictive of response to surgery.

Oropharyngeal cancer as a driver of racial outcome disparities in squamous cell carcinoma of the head and neck: 10-year experience at the University of Maryland Greenebaum Cancer Center: Racial disparities in HNSCC

Racial outcome disparities have been observed in head and neck squamous cell carcinoma (HNSCC) with diminished survival for black patients compared with white patients.