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M S Brandwein

Publications and source records attributed to M S Brandwein.

11 recordsLinked to original sources

Nodal inclusion cysts of the parotid gland and parapharyngeal space: a discussion of lymphoepithelial, AIDS-related parotid, and branchial cysts, cystic Warthin's tumors, and cysts in Sjögren's syndrome.

The purpose of this report is to examine the computed tomography scans, magnetic resonance images, and pathologic findings in 44 patients, 42 of whom had inclusion-type cysts of the parotid and parapharyngeal space of varying etiologies. Two additional cases of cystic changes in the benign lymphoepithelial lesion (BLEL) of Sjögren's syndrome are highlighted here, since they had unusually large cystic components mimicking acquired immunodeficiency syndrome-related parotid cysts (ARPCs). A retrospective examination identified 18 ARPCs, 3 lymphoepithelial cysts (LECs), 13 cystic Warthin's tumors, 8 branchial cysts, and 2 cases of cysts in patients with Sjögren's syndrome (BLEL), all of whom had imaging studies and pathologic confirmation. There were 30 men and 14 women with an age range of 25 to 72 years (median, 46.82 years). Any similarities in the imaging appearances were noted, as were any differences in pathologic detail. On imaging, only the cystic Warthin's tumors had any focal wall nodularity; the other cysts had smooth walls. When multiple parotid cysts were present, the distinguishing feature between ARPCs and cysts in BLEL (and some cystic Warthin's tumors) was the presence of diffuse cervical adenopathy in patients with ARPCs. Imaging usually could not differentiate between a solitary parotid LEC, a branchial cyst, and some cystic Warthin's tumors. Extraparotid lesions were either branchial cysts or cystic Warthin's tumors. Physicians should be aware of the variety of different inclusion-type cysts that may occur in the parotid gland and parapharyngeal space, all of which may have similar imaging appearances. Although imaging clearly identifies these cysts and may suggest a specific diagnosis, it must always be remembered that the precise diagnosis remains in the province of the pathologist.

Acquired Immunodeficiency Syndrome

Inflammatory pseudotumor of the maxillary sinus: CT and MR findings in six cases.

OBJECTIVE: Inflammatory pseudotumor is a chronic inflammatory lesion of unknown origin. The purpose of this study was to analyze the CT and MR findings in six cases of inflammatory pseudotumor of the maxillary sinus in order to determine if there were any imaging findings that distinguish this lesion from the more common type of pseudotumor that occurs in the orbit. MATERIALS AND METHODS: Six patients with pseudotumor of the maxillary sinus were identified retrospectively. The diagnosis was based on biopsy specimens. Their CT scans and MR images were studied by two radiologists to identify specifically the presence of soft-tissue disease and the presence and type of any bone involvement. RESULTS: CT and MR images showed some degree of involvement of the bony wall in all cases. All patients had a soft-tissue mass with mild enhancement on CT scans and intermediate signal intensity on both T1- and T2-weighted MR images. CONCLUSION: Our experience shows that inflammatory pseudotumor of the maxillary sinus causes bone changes on CT and MR images, findings that mimic a malignant tumor. Bone involvement appears to be more common in pseudotumor of the maxillary antrum than in its orbital counterpart.

Adolescent

Analysis of prevalence of human papillomavirus in laryngeal carcinomas. Study of 40 cases using polymerase chain reaction and consensus primers.

In this study we determined the frequency of association of human papillomavirus (HPV) and laryngeal carcinomas and investigated the possibility that HPV may be associated with larger or more aggressive tumors. Laryngeal squamous cell carcinomas from 40 patients who did not have preexisting papillomas by clinical history were retrieved from formalin-fixed, paraffin-embedded blocks and analyzed for HPV. Twenty-two cases were tumors of the true vocal folds, and 18 were supraglottic. Clinical follow-up was available for 25 patients. We used the polymerase chain reaction (PCR) with the "hot start" modification and consensus primers that can detect over 30 distinct HPV types. Three of the 40 patients (8%) had detectable HPV DNA. These 3 patients did not have unusual age demographics and were smokers. All but 1 of the 22 HPV-negative patients who were questioned were also smokers. We compared the outcomes for large (4 cm or greater) HPV-positive and -negative tumors. Six of the 40 tumors were 4 cm or greater and involved contiguous structures. Two of these 6 were HPV-positive, and these patients died of disease after 3 and 16 months, respectively. Of the 4 HPV-negative patients with tumors greater than 4 cm, 3 are disease-free at 41, 42, and 3 months, respectively, and 1 was lost to follow-up. The third HPV-positive patient had a tumor less than 1 cm, and is disease-free after 38 months. While the number of HPV-positive cases is too small for definitive conclusions, it is possible that for large tumors the presence of HPV DNA may portend a worse prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Tumor-associated glycoprotein distribution detected by monoclonal antibody B72.3 in salivary neoplasia.

The expression of tumor-associated glycoprotein (TAG-72), an oncofetal mucin-like tumor-associated glycoprotein derived from membrane-enriched fractions of metastatic breast carcinoma, has been detected by monoclonal antibody (MoAb) B72.3 in adenocarcinomas of breast, colon, lung, endometrium, pancreas, and ovary. The authors reported the scope of TAG-72 expression detected by MoAb B72.3 in salivary neoplasia. They examined 96 salivary lesions (53 malignant and 37 benign primary tumors, 2 metastatic carcinomas, and 4 other benign lesions) and 17 normal tissues from parotid glands and found: diffuse TAG-72 expression in 29 of 55 (53%) malignant tumors and 6 of 36 (17%) benign tumors and in no normal tissue; focal TAG-72 expression in 10 of 55 (17%) malignant salivary tumors, 10 of 37 (25%) benign salivary tumors (all benign mixed tumors), and 1 of 17 (6%) histologically normal parotid gland ducts. Any expression of TAG-72, whether diffuse or focal, was found to have a 71% sensitivity for detecting salivary malignant tumors, but an unacceptably low specificity for malignant lesions (57%). Alternatively, if only diffuse TAG-72 expression was regarded as indicative of malignancy, the specificity of diffuse TAG-72 expression was 86%, but sensitivity of detection decreased to 53%. The authors studied a subset of benign and malignant mixed tumors (BMT and MMT) and found that 12 of 15 (80%) MMT diffusely and strongly expressed TAG-72, 2 of 15 MMT (13%) expressed TAG-72 focally, and 1 MMT (7%) was nonreactive. By contrast, most BMT did not express TAG-72; only sparse, focal TAG-72 expression was seen in 10 of 27 (37%) BMT. If diffuse TAG-72 expression is considered indicative of malignancy, its sensitivity and specificity for malignant mixed tumors is 80% and 100%, respectively. The authors suggest that diffuse TAG-72 expression may resolve conflicts in determining whether or not a mixed tumor is malignant.

Adenoma, Pleomorphic

Oncocytic tumors of major salivary glands. A study of 68 cases with follow-up of 44 patients.

Oncocytic tumors rarely occur in major salivary glands and generally account for less than 1% of all salivary tumors. Until now, a large series of these tumors with long-term follow-up has been lacking. We report on 68 cases of oncocytic major salivary gland tumors with clinical data on 44 patients. Eighty-four percent occurred in the parotid (male to female ratio of 1:1), and 11% arose in the submandibular gland (six males, one female). Additionally, 5% were incidentally found in salivary nests of the upper cervical lymph nodes. The mean age of all patients was 58 years. Unexpectedly, 20% of the patients had either radiotherapy to the face or upper torso or long-term occupational radiation exposure, 5-40 years prior to tumor discovery. Patients with previous radiation exposure had a mean age of 43 years at tumor discovery as compared with 63 years for all other patients (p less than 0.01). Among 44 patients, there were four definite, documented cases of recurrences: two were multiple and bilateral. A minimum 7% incidence of bilateral disease was noted. An association exists among bilateral disease, tumor recurrence, and extensive clear cell change ("clear cell oncocytosis"). Only one case metastasized: an oncocytic adenocarcinoma of the submandibular gland. None of the oncocytomas studied (including three with perineural spread) metastasized after 0.5-38 years' follow-up (mean 12 years). The literature is reviewed with regard to cases of metastasizing malignant oncocytomas.

Adenolymphoma

Salivary duct carcinoma (cribriform salivary carcinoma of excretory ducts). A clinicopathologic and immunohistochemical study of 12 cases.

Salivary duct carcinoma (cribriform salivary carcinoma of the excretory ducts [CSCED]) is an uncommon malignant tumor which occurs predominantly in men (83% in this series; mean age, 61 years) and most often in the parotid gland (92% in this series). The outcome is unfavorable for most patients; of 11 of 12 patients with follow-up, 45% had local recurrence, 54% had distant metastasis, and 45% were dead of disease within 10 years of diagnosis (mean, 3 years). Metastases to lymph nodes were common (72%). Immunohistochemical studies on paraffin-embedded tissue revealed that most tumors reacted with antibodies known to mark adenocarcinoma: B72.3 (11 of 11) and Lewis Y (ten of ten). High and low molecular weight cytokeratins were present in most tumors (nine of ten and seven of nine cases, respectively), supporting the concept that these adenocarcinomas were of ductal origin. Parotid ducts adjacent to CSCED expressed B72.3 in six of nine cases studied, but parotid ducts from normal tissue (adjacent to benign mixed tumors or enlarged periparotid lymph nodes) rarely expressed this marker (one of 17 cases). The detection of B72.3 diffusely in parotid ducts, especially those with atypia, may imply the presence of malignant tumor nearby, which could be useful in evaluating limited tissue from the parotid. However, further studies are necessary to confirm the significance of this finding.

Carcinoma, Intraductal, Noninfiltrating

Supraglottic hemangioma during pregnancy.

A 37-year-old woman, gravida 10, para 1-0-8-1, presented in her second trimester of pregnancy with complaints of frequent sore throats, change in voice quality, and recumbent dyspnea. These symptoms were noted initially during her previous pregnancy, and resolved after delivery. She was found to have a supraglottic hemangioma which occluded 40% of her upper airway. This lesion was noted to dramatically involute beginning at 36 weeks' gestation. The supraglottic hemangioma is a very rare cause of dyspnea in pregnancy. Its growth during pregnancy and regression postpartum is possibly related to the effects of estrogen and progesterone.

Adult

Inflammatory pseudotumor of the parapharyngeal space: case report and review of the literature.

Inflammatory pseudotumor of the upper airway is an uncommon lesion of unknown etiology, clinically mimicking a neoplastic process. We document a case of inflammatory pseudotumor of the parapharyngeal space, occurring in a patient with history of cocaine abuse. Corticosteroid treatment was successful in reducing the symptoms. The difficulties in establishing this clinicopathologic diagnosis are discussed and the pertinent literature is reviewed.

Adult