Teresa Coleman

The Effect of treatment on survival in patients with advanced laryngeal carcinoma

Over the last 2 decades, survival from laryngeal cancer has decreased. We sought to identify factors associated with decreased survival in laryngeal cancer.

The effect of occult nodal metastases on survival and regional control in patients with head and neck squamous cell carcinoma

Objectives: To determine factors associated with disease‐free survival (DFS) and regional control in clinically node‐negative head and neck squamous cell cancer (HNSCC) patients with occult metastasis.

Identification of distant metastases with positron-emission tomography-computed tomography in patients with previously untreated head and neck cancer.

Objectives: To investigate the utility of positron–emission tomography‐computed tomography (PET‐CT) in identifying distant metastatic disease in patients with previously untreated head and neck squamous cell cancer (HNSCC) prior to definitive treatment.

Revisiting the role of positron-emission tomography/computed tomography in determining the need for planned neck dissection following chemoradiation for advanced head and neck cancer†

Planned neck dissection following chemoradiation (CR) has been advocated in patients with head and neck squamous cell cancer (HNSCC) with advanced nodal disease and a clinical complete response to CR because of the potential for residual occult nodal disease. The utility of positron‐emission tomography/computed tomography (PET‐CT) in identifying occult nodal disease in this scenario is controversial.

Identification of distant metastases with PET-CT in patients with suspected recurrent head and neck cancer

To investigate the utility of positron‐emission tomography/computed tomography (PET‐CT) in identifying distant metastatic disease in patients with suspected recurrent head and neck squamous cell cancer (HNSCC).

Cefepime neurotoxicity despite renal adjusted dosing

Abstract Neurotoxicity is a rare side-effect of cefepime. There are previous reports of cefepime neurotoxicity in patients whose dosages were not adjusted for their kidney disease. We report a toxic case of non-convulsive status epilepticus in a patient receiving renally-dosed cefepime. A 70-y-old woman was admitted with febrile neutropenia for which renally-dosed cefepime was started. On day 4 she developed altered mental status with orofacial myokymia. Blood and urine cultures were negative. Cerebrospinal fluid analysis was normal. Head computed tomography and magnetic resonance imaging showed no acute intracranial process. An electroencephalogram showed non-convulsive status epilepticus. Anticonvulsants were started, but she continued to have seizures. At this time, careful review of her medication list with temporal association of symptoms suggested cefepime as a probable cause and the drug was stopped. Within 24 h of discontinuation, her mental status began to improve and returned to baseline in 3 days. Our case illustrates that cefepime toxicity may still occur in patients who are dose-adjusted for renal insufficiency. It also underscores the importance of assessing for additional risk factors like history of stroke and seizures. Because cefepime-induced status epilepticus is completely reversible, prompt recognition and medication discontinuance can prevent further morbidity and mortality.

Temsirolimus in the treatment of renal cell carcinoma associated with Xp11.2 translocation/TFE gene fusion proteins: a case report and review of literature

Xp11.2 translocation renal cell carcinomas (TRCCs) are a rare family of tumors newly recognized by the World Health Organization (WHO) in 2004. These tumors result in the fusion of partner genes to the TFE3 gene located on Xp11.2. They are most common in the pediatric population, but have been recently implicated in adult renal cell carcinoma (RCC) presenting at an early age. TFE3-mediated direct transcriptional upregulation of the Met tyrosine kinase receptor triggers dramatic activation of downstream signaling pathways including the protein kinase B (Akt)/phosphatidylinositol-3 kinase (PI3K) and mammalian target of rapamycin (mTOR) pathways. Temsirolimus is an inhibitor of mammalian target of rapamycin (mTOR) kinase, a component of intracellular signaling pathways involved in the growth and proliferation of malignant cells. Here we present a case of a 22-year old female who has been treated with temsirolimus for her Xp11.2/TFE3 gene fusion RCC.

Utility of 18F-FDG PET/CT in identifying penile squamous cell carcinoma metastatic lymph nodes

OBJECTIVES Due to the significant potential morbidity of inguinal and pelvic lymphadenectomy, the search for an imaging modality that can accurately identify penile squamous cell carcinoma (SCCA) lymphatic metastases continues. Initial (18)F-FDG PET/CT studies have reported 80% sensitivity and 100% specificity in the detection of inguinal and obturator lymph node metastasis. We review a single institutional experience of (18)F-FDG PET/CT imaging of SCCA of the penis to assess for accuracy and potential impact on clinical management. METHODS Three patients diagnosed with penile SCCA at a single institution underwent staging (18)F-FDG PET/CT and went on to subsequent inguinal lymph node dissection. The (18)F-FDG PET machine was a Philips Gemini Time-of-Flight PET with LYSO crystals with 4.7 mm spatial resolution. The CT was a 16-slice helical CT with 5 mm slice widths. (18)F-FDG PET/CT findings were compared with the histologic findings of these procedures. Decision to proceed with lymphadenectomy was based on clinical judgment of a single urologist and all fused (18)F-FDG PET/CT imaging was assessed by a single experienced radiologist. RESULTS No patient received chemotherapy or radiation before the (18)F-FDG PET/CT or surgery. The first patient was obese (BMI > 30), clinically node negative, and the (18)F-FDG PET/CT showed inflammation. Histologic examination showed a positive 2 cm right inguinal metastatic node. The second patients (18)F-FDG PET/CT showed a suspicious 1 cm left inguinal node. Histologically, the suspicious lymph node was positive for SCCA as was a second positive 2 cm lymph node not identified on preoperative (18)F-FDG PET/CT. Clinical exam of this patient was negative. The third patient was (18)F-FDG PET/CT and clinically negative but subsequently developed a palpable lymph node approximately 1 month later, which was suspicious on repeat (18)F-FDG PET/CT and positive for SCCA on histological examination. CONCLUSIONS (18)F-FDG PET/CT has shown initial promise in the staging of penile SCCA. However, our review shows that false negative studies occur at alarmingly high rates, and (18)F-FDG PET/CT is poor in detection of micro-metastasis. Thus, close follow-up in these patients is imperative.

Response of Metastatic Renal Medullary Carcinoma to Carboplatinum and Paclitaxel Chemotherapy

Introduction Renal medullary carcinoma (RMC) is a rare and extremely aggressive tumor that is almost exclusively found in African American patients in the setting of sickle cell hemoglobinopathies, most commonly the sickle cell trait. Most patients have evidence of metastatic disease at the time of presentation, with an average reported length of survival in various case reports is 15 weeks from the time of diagnosis (range, 3-52 weeks). There is a case report in the literature of the use

Congenital Melanocytic Nevus

A 29-year-old man presented with headache and numbness in his right face and right upper extremity. He had a large congenital melanocytic nevus involving the chest, upper extremities, neck, and lower part of his face.