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Kenneth O Devaney

Publications and source records attributed to Kenneth O Devaney.

At least 37 records · Page 2Linked to original sources
PubMed2004

Crohn's disease manifesting in the head and neck.

Crohn's disease may present to the head and neck surgeon with symptoms and signs attributed to the disease. Many clinical presentations, both specific and non-specific, have been recorded in the oral cavity, nose and larynx. Some of these clinical manifestations have been found to be consistent with Crohn's disease, but most have been attributed to Crohn's disease without histologic confirmation of the presence of non-caseating granulomas, which is pathognomonic of Crohn's disease. Lesions, when present without an associated diagnosis of Crohn's disease, should be ascribed the diagnosis of orofacial granulomatosis, until a diagnosis of intestinal Crohn's disease has been confirmed.

Crohn Disease↗
PubMed2004

Immunohistochemical studies in the identification of lymph node micrometastases in patients with squamous cell carcinoma of the head and neck.

In the prediction of likely disease-free and overall survival intervals in patients with squamous carcinomas of the head and neck, cervical lymph node status assumes a prime role, and patients with cervical node metastases have diminished survivals, as a group, compared with patients whose cervical nodes are reported as negative for metastatic carcinoma. Conventional means of pathologic examination of cervical node biopsy specimens include examination of a single section through each individual node identified on gross examination, a process which, of necessity, leaves a significant portion of the node unexamined by microscopy. Recently, it has become apparent that more exhaustive pathologic sampling techniques, such as examining multiple sections of each lymph node, or staining each lymph node with antibodies to keratin via immunohistochemistry, will reliably yield a greater incidence of positive cervical lymph nodes ("micrometastases") than do conventional pathologic techniques. This suggests that the next line of inquiry should answer this question: just because micrometastases can be detected, should they be? Does the identification of (otherwise likely to be overlooked) tiny microscopic foci of spread of tumor in regional nodes by more sophisticated techniques yield additional data of real import to the patients, or is such information of lesser value? Should a role be defined in the care of head and neck cancer patients for the use of such advanced inquiries in the structuring of therapies, then the best approach to finding such elusive micrometastases (intraoperative immunohistochemistry? immunohistochemistry using routinely fixed tissues? polymerase chain reaction?) may subsequently be established.

Carcinoma, Squamous Cell↗
PubMed2004

Salivary gland choristoma of the middle ear. A review.

While head and neck surgeons are accustomed to recognizing malignancies in their practices, developmental lesions are much less often encountered, and as such are not as likely to be included amongst other (more aggressive) differential diagnostic considerations. One such developmental lesion is the choristoma, defined as an architecturally normal arrangement of mature tissues found in a location not normally host to such tissues. Choristomas composed of recognizable salivary gland tissue may be found in a variety of locations including the middle ear. Middle ear salivary choristomas are distinctly unusual lesions and typically manifest as unilateral conductive hearing loss; while both adult and pediatric patients have been diagnosed with middle ear choristomas, most patients have been in the first two decades of life. As these are benign, nonprogressive lesions, treatment has been directed toward complete surgical excision whenever feasible, and biopsy for diagnosis with subsequent observation in the case of those lesions which are difficult to remove without endangering the facial nerve. There have been rare instances in which choristomas have been linked to the subsequent development of neoplasms, but in the main choristomas are regarded as self-limited developmental heterotopias.

Choristoma↗
PubMed2003

Current management of mucosal melanoma of the head and neck.

While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies.

Head and Neck Neoplasms↗
PubMed2003

Sentinel lymph node biopsy in head and neck cancer.

In the past decade, the technique of sentinel lymph node biopsy (SLNB) has been applied to a vast array of primary neoplasms, ranging from head and neck melanoma to vulvar carcinoma. At present, experience with SLNB is greatest in patients with melanoma and breast cancer. In view of the well known complications associated with cervical node dissection, it has been suspected for some time that cervical SLNB, if successful, might reduce the morbidity associated with the definitive care of patients with head and neck cancers. This report assesses the current status of SLNB in the treatment of head and neck cancers; while formal investigations of the efficacy of this technique are recommended, SLNB has not yet been demonstrated to possess the same level of utility seen in SLNB in melanoma and breast cancer patients. As a consequence, the application of SLNB to head and neck cancers remains an experimental technique--one which has not yet acquired the status of the standard of patient care.

Carcinoma, Squamous Cell↗
PubMed2003

Endolymphatic sac tumor (low-grade papillary adenocarcinoma) of the temporal bone.

The entity which has come to be known as an endolymphatic sac tumor (ELST) has, in the past, been known as adenocarcinoma of endolymphatic sac origin, aggressive papillary tumor of the temporal bone and Heffner's tumor. ELSTs arise in the vicinity of the inner ear and may extend to involve both the posterior fossa as well as the middle ear and the external ear canal, which may complicate the differential diagnosis ELSTs are typically seen in adults, with only rare descriptions in pediatric patients. They may be sporadic tumors or they may arise as part of the symptom complex of von Hippel-Lindau disease. Clinical signs at presentation range from a mass in the external ear canal to sensorineural deafness to cranial nerve palsies. Imaging studies reveal a destructive lesion of the petrous bone which is heterogeneous on MR scanning. Light microscopy reveals two chief patterns: a follicular pattern, reminiscent of thyroid parenchyma; and a papillary/solid pattern. Both patterns are often admixed in the same tumor, and the individual tumor cells are cytologically bland. Immunohistochemically, ELSTs are typically keratin-, vimentin- and epithelial membrane antigen-positive; they are often S-100 protein-positive and neuron-specific enolase-positive as well. ELSTs are difficult to extirpate surgically (owing to their locally aggressive nature); nevertheless, surgical excision remains the mainstay of current therapy. These are slow-growing (albeit locally aggressive) tumors which have only rarely been reported to metastasize; as such, they remain principally a problem of local control.

Adenocarcinoma, Papillary↗
PubMed2003

Epithelial tumors of the middle ear--are middle ear carcinoids really distinct from middle ear adenomas?

Primary tumors of the middle ear are much less commonly encountered in clinical practice than non-neoplastic lesions such as inflammatory polyps (aural polyps) or cholesteatomas. The rarity of such tumors can complicate attempts, by both clinicians and pathologists, to correctly classify them. It has been customary for many authors to segregate middle ear adenomas (MEAs) from middle ear carcinoids as two discrete benign neoplastic entities. It has become apparent, however, that MEAs and carcinoids of the middle ear share a sufficient number of overlapping pathologic features and similarities of clinical behavior to warrant their collapse into a single diagnostic category. It is proposed that these tumors should be designated as MEAs, which are defined as benign, indolent epithelial tumors of the middle ear that do not invade or erode bone and do not metastasize. The individual tumor cells are cytologically bland and polygonal, columnar or plasmacytoid-shaped; they may be arranged in islands, glandular formations or trabeculae, but not in papillary structures. They are typically keratin- and vimentin-positive immunohistochemically, and are often positive as well with antibodies for chromogranin A, synaptophysin, neuron-specific enolase, Leu-7, serotonin, pancreatic polypeptide and S-100 protein. Dense core neurosecretory granules may be identifiable by electron microscopy. Conservative surgical excision is the treatment of choice, and local recurrence following complete excision is quite uncommon.

Adenoma↗