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Urken G.R.,Thyroid | Wenig B.M.,Mount Sinai School of Medicine
Head and Neck | Year: 2016

Background Intraoral sebaceous carcinoma is a rare form of sebaceous carcinoma with only 9 published cases in the world literature to date. We present a 10th case of intraoral sebaceous carcinoma located in the anterior maxillary gingiva with metastases to the lung and subcutis and discuss 3 possible etiologies for this unique presentation. Methods We analyze the clinical presentation, pathology, histology, and genetic testing for a single case study and review relevant literature. Results The histologic findings of the lung tumor and surgical excisions of the tumors in the gingiva and subcutis suggest the gingiva is the primary site. There is no evidence for the genetic abnormalities consistent with Muir-Torre syndrome. Conclusion The histologic findings suggest the oral cavity is the most likely site of tumor origin. This is the first case of intraoral sebaceous carcinoma reported to arise in the gingiva as well as to spread to cutaneous sites. © 2015 Wiley Periodicals, Inc. Source

Background: The revised American Thyroid Association (ATA) management guidelines for differentiated thyroid cancer emphasize a variety of clinicopathologic features of metastatic lymph nodes in determining the risk of recurrence. The mere presence of a positive node is not sufficient to confer reliable prognostic significance. The number and size of lymph nodes, as well as the presence of extranodal extension (ENE), impact risk stratification. Moreover, the presence of clinically evident lymph nodes is important for determining risk of recurrence. A patient's place on the risk spectrum has ramifications for the management of differentiated thyroid cancer. However, there are inherent inconsistencies in the identification and characterization of metastatic lymph nodes. Moreover, the significance of ENE must be clarified. Summary: There are many obstacles to the consistent reporting of metastatic lymph nodes. What constitutes a "clinically evident" lymph node has not been well defined, lacks precision, and varies depending on clinical context, as well as the experience of the surgeon and the ultrasonographer. The number of lymph nodes sampled by surgeons and reported by pathologists may vary from institution to institution. The literature on ENE has been limited by the fact that the definition of ENE has not been standardized. Nevertheless, 17/19 manuscripts reviewed herein suggest that ENE confers a worse prognosis. The ATA risk stratification for metastatic lymph nodes published in the 2015 guidelines combines clinicopathological features that are variably identified and reported across institutions. This review brings into question the significance of the number of nodes with ENE, a factor that is used as an important stratifying variable in the latest guidelines. Conclusions: Metastatic lymph nodes do not all carry the same prognostic significance, but a risk assignment based on the ATA guidelines is limited by a lack of standardization in clinical and pathologic definitions, lymph node sampling, and reporting. This study reviews the limitations of prior studies on ENE and concludes that the body of the evidence reported in those studies suggests that ENE increases the risk of recurrence. The impact of ENE in lymph nodes in thyroid cancer risk stratification should be reconsidered. © Copyright 2016, Mary Ann Liebert, Inc. 2016. Source

Al Shetawi H.,Mount Sinai Beth Israel | Alpert E.H.,Thyroid | Buchbinder D.,The New School
Journal of Oral and Maxillofacial Surgery | Year: 2015

Odontogenic sarcomas and their subtypes are very rare tumors. The authors' objectives were to report an additional case of ameloblastic fibrosarcoma, review the clinicopathologic features, discuss their treatment approach, and complete a thorough review of the literature. © 2015 American Association of Oral and Maxillofacial Surgeons. Source

Su H.K.,Thyroid | Ozbek U.,New York | Likhterov I.,New York | Brant J.,University of Pennsylvania | And 3 more authors.
Laryngoscope | Year: 2016

Objectives/Hypothesis: Minimally invasive transoral surgical approaches for the resection of oropharyngeal tumors offer unique opportunities to achieve oncologically sound results while reducing treatment-related morbidity. The objective of this study is to characterize the mortality and complication rates of transoral oncologic resections in a large, prospective, de-identified national dataset from multiple hospitals. Study Design: Retrospective, multi-institutional cohort study of 305 patients. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) datasets were accessed and examined for adult patients who underwent transoral surgical resection of oropharyngeal cancers during the years 2010 through 2013. Patient demographics, postoperative complications, and 30-day mortality were evaluated. Results: A total of 305 patients in the 2010 to 2013 ACS NSQIP datasets met study criteria. For the 18 postoperative complications that we assessed, 24 of 305 patients developed 37 complications, representing a complication rate of 7.9%. Among all patients, the 30-day mortality rate was 0.7%, representing two patient deaths. The presence of preoperative dyspnea, hypertension requiring medication, and an American Society of Anesthesiologists classification of 3 or 4 were significantly associated with extended hospital length of stay (LOS) (> 4 days). On multivariate analysis, hypertension was the only factor that was marginally significant with a longer LOS (odds ratio = 1.74, P = 0.057). Conclusion: Transoral resection of properly selected oropharyngeal tumors is safe, with low 30-day morbidity and mortality. A greater understanding of the risk factors for complications following transoral surgery may improve patient selection and safety. © 2016 The American Laryngological, Rhinological and Otological Society, Inc. Source

Su H.K.,Thyroid | Dos Reis L.L.,Thyroid | Milas M.,Oregon Health And Science University | Orloff L.A.,Stanford University | And 8 more authors.
Thyroid | Year: 2014

Background: The use of high-resolution ultrasound (US) imaging is a mainstay of the initial evaluation and long-term management of thyroid nodules and thyroid cancer. To fully capitalize on the diagnostic capabilities of a US examination in the context of thyroid disease, many clinicians consider it desirable to establish a universal format and standard of US reporting. The goals of this interdisciplinary consensus statement are twofold. First, to create a standardized set of US features to characterize thyroid nodules and cervical lymph nodes accurately, and second, to create a standardized system for tracking sequential changes in the US examination of thyroid nodules and cervical lymph nodes for the purpose of determining risk of malignancy. Summary: The Thyroid, Head and Neck Cancer (THANC) Foundation convened a panel of nine specialists from a variety of medical disciplines that are actively involved in the diagnosis and treatment of thyroid nodules and thyroid cancer. Consensus was achieved on the following topics: US evaluation of the thyroid gland, US evaluation of thyroid nodules, US evaluation of cervical lymph nodes, US-guided fine needle aspiration (FNA) of thyroid nodules, and US-guided FNA of cervical lymph nodes. Conclusion: We propose that this statement represents a consensus within a multidisciplinary team on the salient and essential elements of a comprehensive and clinically significant thyroid and neck US report with regards to content, terminology, and organization. This reporting protocol supplements previous US performance guidelines by not only capturing categories of findings that may have important clinical implications, but also delineating findings that are clinically relevant within those categories as specifically as possible. Additionally, we have included the specific features of diagnostic and therapeutic interventions that have not been previously addressed. © Mary Ann Liebert, Inc. Source

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