S. M. Azeem Mohiyuddin

Evaluation of histomorphological and immunohistochemical parameters as biomarkers of cervical lymph node metastasis in squamous cell carcinoma of oral cavity: A retrospective study

Introduction: Oral squamous cell carcinoma (OSCC) is seen worldwide but is more common in India. Lymph node (LN) metastasis has been shown to be the strongest prognostic factor in OSCC. Many histopathological and immunohistochemical markers have been studied to predict the LN metastasis. Aims: To identify clinicopathological factors and immunohistochemical (IHC) biomarkers which predict cervical metastasis in OSCC patients. Study and Design: A total of 105 cases of OSCC were taken up for our study. Histopathological parameters such as tumor thickness, depth, degree of differentiation, pattern of invasion (POI), lymphovascular and neural invasion were assessed. IHC was done on all cases using antibodies against Ki-67, cyclin D, E-cadherin, p53, CD31 and each antibody was assessed according to the standard protocol. Statistical Analysis: To calculate the relation between clinical, histopathological parameter, IHC marker and the occurrence of LN metastasis, chi-square test was used. Variables were tested using multivariate logistic regression method to assess the predictive significance. Results: Out of 105 cases studied, 29 cases showed LN metastasis. Maximum numbers of cases affected were females with involvement of buccal mucosa. We found significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression. In our study; tumor depth, thickness, extent of peritumoral lympho-plasmacytic infiltration, presence of eosinophils, tumor nest type, p53 and microvessel density (MVD) showed no significant correlation. Conclusion: Significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression was seen.

Medially placed vagus nerve in relation to common carotid artery: a pointer to a non-recurrent laryngeal nerve

The aim of this study was to highlight a medialized vagus in relation to common carotid artery as an operative marker to a non-recurrent laryngeal nerve during thyroid surgeries. Three patients who underwent thyroidectomy, in who per operative diagnosis of right non-recurrent laryngeal nerve was made and the findings were confirmed radiologically by demonstration of aberrant subclavian artery were included in the study. A medially placed vagus nerve in relation to common carotid artery was the common observation in all the 3 patients. With no operative marker to identify a non-recurrent laryngeal nerve, it is more prone to injury during thyroidectomies. Vagus nerve which was constantly seen medial to the common carotid artery in all our three patients can be used as an operative marker to a non-recurrent laryngeal nerve.

Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa

Objective To evaluate the margins of resected specimen of oral squamous cell carcinoma (SCC) and to document the surgical margin (measured at the time of resection) and margins at the time of pathological examination (after immersion of the specimen in formalin). Methods Patients who were diagnosed and confirmed with squamous carcinoma of buccal mucosa were included in the study. Patients underwent resection of the tumor with a margin of 1 cm. Soon after resection, the distance between outermost visible margin of the tumor and the margin of the specimen was measured and documented. Specimens were fixed in 10% formalin and submitted for gross and histopathological examination. The closest histopathologic margin was compared with the in situ margin (10 mm) to determine and document any shrinkage of the margin and the percentage of discrepancy if any. Results A total of 52 specimens were collected from patients between January 2014 and December 2014. All specimens were obtained from the oral cavity (n = 52) of which 43 (82.7%) were squamous cell carcinoma and 9 (17.3%) were verrucous variant of squamous cell carcinoma. The average decrease in tumor margins measured after fixation in formalin was found to be statistically significant (P < 0.05) in 65% of cases. Conclusion Tumor margin shrinks significantly after formalin fixation by about 25%. The operating surgeon and pathologist should be well aware of such changes while planning for further management thereby ensuring adequate margin of resection and adjuvant treatment wherever required to prevent possible local recurrence of the disease.

Parotid abscess in children – A tertiary rural hospital experience

UNLABELLED Parotid abscess is a rare complication of acute parotitis in children. Acute parotitis occurs due to infection of intra-parotid or para-parotid lymph nodes or glandular parenchyma of the parotid gland which may progress to parotid abscess. OBJECTIVES To document the causative organism, clinical behaviour and response to treatment in paediatric parotid abscess. MATERIALS AND METHODS A retrospective study was done in our tertiary rural hospital from May 2007 to May 2015 to identify and analyse paediatric parotid abscess in 80 unilateral parotitis cases. RESULTS 7 cases of parotid abscess were identified. 4 cases were diagnosed clinically and in 3 cases ultrasound was done showing heterogenous, hyperechoic, solid and cystic areas. In 2 patients, abscess was extending to the submandibular space. Incision and drainage was done in all patients. The most common bacteria was Methicillin Sensitive Staphylococcus aureus. Escherichia coli was reported in one patient, and was rare in parotid region. 2 patients had House Brackmann grade 2 marginal mandibular nerve palsy, and they recovered within 4½ months. CONCLUSION Parotid abscess is an uncommon but life-threatening condition in paediatric age group. Poor orodental hygiene was most important predisposing factor. Abscess can be diagnosed clinically and ultrasound scan is also an important diagnostic tool. It is commonly caused by Gram positive cocci and responds well to incision and drainage followed by appropriate antibiotics. No fistula may result if treated early.

Recurrent laryngeal leiomyoma

Leiomyoma-a benign smooth muscle tumor which is most commonly reported in uterus and gastrointestinal tract is rare in the upper aero-digestive tract due to the paucity of smooth muscle in the area. To the best of our knowledge, only 40 cases of leiomyoma occurring in larynx have been reported since 1966 in English literature. We report a case in a 18-year-old lady who presented with recurrent laryngeal leiomyoma which was confirmed by immunohistochemistry. The post-operative course was uneventful.

Usefulness of supraclavicular flap in reconstruction following resection of oral cancer

Objective To evaluate the usefulness of supraclavicular artery flap in reconstruction of defects following resection of buccal mucosa cancer. Methods Twenty-five patients who presented to R.L Jalappa Hospital and Research centre and diagnosed as squamous cell carcinoma of buccal mucosa staged T2 and above were included in our study. All patients underwent wide excision of tumour and neck dissection. Six patients underwent hemi-mandibulectomy while 4 patients underwent marginal mandibulectomy depending on extent of the tumour along with neck dissection. The defect following surgery was reconstructed using the supraclavicular artery flap and were followed up for minimum 6 months during which they were assessed for the functional and aesthetic outcome using a scoring system. The details of the scoring system comprised of 7 attributes. Each attribute was given a score of 10 if the patients experienced that attribute, while a score of 0 was given if the patient did not experience that particular attribute. Results Seven (28%) patients had complete necrosis of the flap. One patient had a local recurrence 2 months following surgery and was lost to follow up. The remaining 17 patients were followed up for a minimum of 6 months and a scoring system was adopted to evaluate the functional and aesthetic outcome of the supraclavicular flap. We observed that 14 patients had an excellent outcome score (58%), 3 patients had a good outcome score (13%), while 7 patients (28%) had flap necrosis. Conclusions We find the supraclavicular flap to be safe, technically simple, sensate, thin, pliable and reliable regional fasciocutaneous flap in reconstructing intra oral defects. Preserving the external jugular vein and sacrificing supraclavicular nerves give good outcome.

Authors’ reply: changes in gustatory function in patients with chronic otitis media before and after tympanoplasty

We thank you for offering us the opportunity to reply to the comments raised on our manuscript. We also thank Zheng et al. for their constructive comments. The overall summary of the comments seems to be that electrogustometry (EGM) could be used instead of taste solutions to make the study objective. In addition, there are certain points raised against the prevalence of dysgeusia in inflammatory disorders of middle ear. The authors’ comment ‘‘we believe that subjective taste scores do not truly reflect changes in gustatory function; good taste function ipsilateral to a chronic inflammatory middle-ear disease is usually preoperatively evident in most patients. Any improvement in postoperative gustatory function does not seem to be associated with disease duration’’ [1]. Although patients with chronic otitis media (COM) rarely complain of taste disturbances, on testing the ipsilateral side, we found an elevated taste threshold [2]. Indeed, similar findings have been reported by various other studies [3–8]. The methodology in these studies includes the use EGM as well as taste solutions, taste strips, and filter paper strips. The results of our study show a significant association between gustatory function and duration of the disease [1]. Similar results were also obtained by Felix et al. [7]. While there are other studies which contradict our finding [4, 9], we are of the opinion that overall consensus remains divided and that more studies are required to confirm or refute the same. The authors also write ‘‘even if a patient with tympanoplasty does not complain of dysgeusia, this does not mean that the gustatory capacity is intact’’ [1]. They make this comment while describing the neurological basis of nerve damage by inflammatory factors. While we have not looked into this aspect, there are studies which have shown signs of regeneration in chorda tympani nerve (CTN) of patients suffering from COM, suggesting a potential for improvement [10]. We also believe that as patients do not usually complain/realize of gustatory disturbance in cases of COM, healthcare providers need to be proactive in assessing this particular aspect to gather better data. While describing the neurological damage occurring with injury, the authors make a case for using EGM. There is no question about EGM being reliable and valid. However, in the hierarchy of tests ranked by the objectivity in results, we think that EGM is not at the top. There are many ways of obtaining information for taste function. For instance, patients can self-report their taste abilities based on questionnaires. Within the spectrum of available methods, this is the most unreliable method as the information obtained is entirely subjective. Psychophysical tests designed to assess peripheral taste sensitivity involve either (a) application of a taste stimulus in the form of taste solutions, tablets, wafers, strips or filter paper discs, etc. or (b) application of electric stimulus on the tongue as in case of EGM. Both these methods allow for controlling the strength of stimulus and, therefore, add reliability to the test. Furthermore, in the next level of objectivity are the measurements of gustatory-evoked potentials and This reply refers to the article available at doi:10.1007/s00405-0174555-2.

Fine-needle aspiration findings in epithelioid myoepithelioma of the parotid gland: A diagnostic pitfall

The cytological features of myoepithelioma of the parotid gland are documented in only a few case reports. We describe the fine-needle aspiration cytological findings in a case of epithelioid myoepithelioma of the parotid gland in a 43-year-old male. The differential diagnosis with other salivary gland neoplasms is discussed.