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R A Khafif

Publications and source records attributed to R A Khafif.

17 recordsLinked to original sources
PubMed1999

Hürthle cell carcinoma: A malignancy of low-grade potential.

BACKGROUND: Hürthle cell carcinoma of the thyroid is a variant of follicular carcinoma, which has been considered by many as a more aggressive disease than the usual well-differentiated carcinoma of the thyroid. Others, however, have found Hürthle cell carcinoma to be a low-grade malignancy with little morbidity or mortality. METHODS: This is a retrospective report on all patients with Hürthle cell carcinoma diagnosed during the years 1951-1997 by the authors. The behavior of the disease and results of treatment were analyzed biostatistically and the outcome was compared with that of patients with pure follicular carcinoma treated during the same period. RESULTS: Forty-two patients were diagnosed with Hürthle cell carcinoma and 153 with follicular carcinoma during this period (2.8% and 10.3% of all differentiated carcinomas of the thyroid, respectively). The rate of local recurrence and disease-related mortality were both 9.5%, compared with 3.2% & 15.7%, respectively, for the follicular cancers. There was a trend for better outcome in patients younger than 55 years of age, in patients with tumors under 4 cm in size, and in patients treated by total thyroidectomy. Distant metastases occurred in four patients (9.5%) and were the cause of disease-related mortality in three. CONCLUSIONS: When treated assertively, Hürthle cell carcinoma of the thyroid, an oncocytic variant of follicular carcinoma, has a favorable outcome, similar to that of pure follicular carcinoma. Uniting those two entities in a future classification and reporting should be considered.

Adenocarcinoma↗
PubMed1991

Elective radical neck dissection in epidermoid cancer of the head and neck. A retrospective analysis of 853 cases of mouth, pharynx, and larynx cancer.

A retrospective analysis of 853 patients with cancer of the mouth, pharynx, and larynx operated on over a 30-year period was performed. Four hundred fifty-seven of them had a radical neck dissection (RND) at some point. Five hundred ninety patients had no clinically positive nodes (N-o) necks at the time of primary treatment; 99 of these had elective neck dissection, whereas 95 others had a delayed RND when nodes became clinically involved. Twenty-three percent of all N-o patients had microscopically involved nodes and less than half of these were among those patients selected for elective RND. Furthermore, 58% of those patients who had elective RND did not have positive nodes. Comparative analysis of elective RND, delayed therapeutic RND after clinical appearance of nodes, and composite operations for patients with N1-N3 disease indicates little difference in disease-free survival when the nodes in the elective RND were positive microscopically for tumors (56%, 49% and 47% respectively). It thus seems that elective RND offers no real advantage over a careful watchful waiting approach in most patients.

Carcinoma, Squamous Cell↗
PubMed1991

Effectiveness of radiotherapy with radical neck dissection in cancers of the head and neck.

A retrospective analysis of 457 radical neck dissections performed over a 30-year period for cancers of the oral cavity, pharynx, and larynx was carried out. Two hundred thirteen patients underwent radiotherapy to the primary cancer site and/or to the neck. Of these, 164 underwent perioperative adjuvant radiotherapy and 24 underwent definitive radiation for cure and were followed up by salvage surgery. Thus, 188 patients received radiotherapy for nonrecurrent disease. Twenty-five additional patients underwent radiation for surgical failure following radical neck dissection. The goal of the study was to determine whether radiotherapy altered the course or end result of the disease. The T and N stage at onset of disease was similar for the radiotherapy and nonradiotherapy groups. Preoperative radiotherapy was effective in down staging the disease at the primary site and, to a lesser extent, in the lymph nodes, but had limited impact on survival. Failure to control the disease in the neck occurred in 60 (32%) of the 188 patients who received radiotherapy for primary disease; recurrence rates were lower in the combined therapy group than in the surgical group of patients with N2 and N3 stages of disease. The 3-year disease-free survival was 45%; this was no better than the 63% survival rate in patients who did not receive radiotherapy, although survival was better in the combined therapy group for patients with N3 stage of disease. The worst results were in those patients who were irradiated for surgical failure (14% survival); the 24 patients who required salvage radical neck dissection following failure of definitive radiotherapy for cure had a 42% survival.

Adult↗
PubMed1990

Calciphylaxis and systemic calcinosis. Collective review.

The phenomenon of calciphylaxis as defined by Selye is a condition of hypersensitivity that results in acute local calcification of various organs, with a whole host of morbid processes. Nephrocalcinosis and cutaneous calcifications have long been recognized in patients with chronic renal failure, but they have not often been reported in acute hyperparathyroidism or other causes of calcium-phosphate metabolism aberrations. The pathogenesis is not clear, and both the sensitizer and challenging agent in the hypersensitivity theory are often elusive, though hypercalcemia is the most consistent factor. The clinical features vary according to the organs affected and often mimic a gamut of more common conditions. Treatment is primarily supportive, with specific measures only possible when a sensitizer or challenger is identified. Correction of the hypercalcemia is, however, imperative. It is important to recognize this rare condition to avoid the more serious end results often reported.

Calcinosis↗
PubMed1989

Thirty-year experience with 457 radical neck dissections in cancer of the mouth, pharynx, and larynx.

A retrospective analysis of 457 radical neck dissections (RNDs) performed for epidermoid cancers of the head and neck was performed. There was a 27 percent overall neck recurrence rate, 17 percent being confined to the neck. Only 5 percent occurred in the ipsilateral dissected neck. Failure in the neck correlated well with the node stage at the time of surgery, but was not affected by the size of the primary tumor, the timing of the RND, or the type of RND performed. Treatment of neck recurrences was predominantly surgical, with a 56 percent local control and a 24 percent disease-free survival rate. Overall disease-free survival was 53 percent, ranging from 68 to 29 percent according to the node stage. Survival was further affected by the size of the primary tumor and failure to control disease in the neck; it was not affected by the type of RND or its timing, or the addition of radiotherapy. Overall recurrence after modified RND was 28 percent. Increased neck recurrences were noted only in N2 and N3 cases, although survival was not affected even in these late stages.

Adult↗
PubMed1989

Acute hyperparathyroidism with systemic calcinosis. Report of a case.

A patient with a huge mediastinal parathyroid adenoma had an acute hypercalcemic crisis. The patient exemplifies the many pitfalls in diagnosis and management of this unusual complication. Postoperatively the patient further developed severe calciphylaxis with calcinosis cutis and systemic and pulmonary calcinosis, a most rare condition.

Acute Disease↗
PubMed1986

TRU-CUT needle biopsy of the breast. An analysis of its specificity and sensitivity.

One hundred fifty needle core biopsies of the breast, performed with the use of the Travenol TRU-CUT disposable needle, were done from January 1980 to November 1984. There were 112 diagnoses of breast cancer and 33 diagnoses of normal breast tissue or nonneoplastic breast disease, including 2 diagnoses of marked atypia. In five biopsy specimens, no breast tissue or tumor could be identified. Fourteen cases of malignancy were not diagnosed by TRU-CUT biopsy specimens. There were no false-positive diagnoses. Sensitivity for the diagnoses of breast cancer was 89% overall and 94% for lesions greater than 2.5 cm in diameter. The histopathologic correlation between the core biopsy specimen and the excised specimen is excellent. The core biopsy specimen permits the pathologist to accurately classify the mammary carcinoma. The overall specificity for the TRU-CUT needle biopsy is 100%, and the overall predictive value of a positive needle biopsy is 100%. A factor not apparent in all reports, whether they be fine needle aspiration or core biopsy, is the ability of the individual obtaining the tissue and the cytopathologist or pathologist interpreting the material.

Adult↗
PubMed1982

Preoperative chemotherapy for giant cell carcinoma of the thyroid.

Reported is the case of a 24-year-old white man with inoperable giant cell carcinoma of the thyroid who achieved tumor regression following therapy with bleomycin, Adriamycin and cisplatinum. After 2 courses of chemotherapy, the tumor was deemed operable, and the patient underwent total thyroidectomy followed by radiation to the neck and upper mediastinum without maintenance chemotherapy. Two-and-one-half years after the initial diagnosis, he developed pulmonary metastases which again responded to Adriamycin and cisplatinum therapy. The above approach suggests that inoperable thyroid carcinoma can be made operable by preoperative combination chemotherapy. This treatment program deserves further exploration for a greater number of patients.

Adult↗
PubMed1976

Surgical exploration in asymptomatic hypercalcemia.

The use of the serum auto-analyzer (SMA-12) has resulted in a marked increase in the diagnosis of hyperparathyroidism. Seventy-five patients with asymptomatic hypercalcemia were explored: sixty-eight with solitary adenomas, six with multiple adenomas, and one with diffuse hyperplasia. Postoperatively, all patients reverted to normocalcemia. Surgical exploration of asymptomatic hypercalcemia is advocated to reduce surgical morbidity and mortality and to prevent the development of renal and osseous complications of hyperparathyroidism.

Adenoma↗
PubMedDate not supplied

Primary branchiogenic carcinoma.

An extensive historical review of branchial cleft cyst carcinoma is undertaken and a critical analysis of all 67 cases reported in the English literature since Martin's landmark report is carried out and tabulated. Forty-one of the 67 cases were definitely ruled out as carcinomas of branchial cysts. Though only eight of the remaining 26 cases satisfied Martin's criterion of 5-year follow-up without evidence of primary carcinoma elsewhere, 14 patients had incontrovertible evidence of branchiogenic carcinoma, evidenced by a branchial cyst with histologic evidence of epithelial dysplasia progressing to squamous cell carcinoma within the cyst wall. Two previously unreported cases are presented. A therapeutic approach including wide local excision, radical neck dissection, and radiotherapy is recommended. A more thorough search for an occult head and neck primary, and a clearer understanding of the histopathology of branchiogenic carcinoma, are suggested as alternate requirements for this diagnosis.

Adult↗
PubMedDate not supplied

Modified radical neck dissection in cancer of the mouth, pharynx, and larynx.

A retrospective analysis of 390 determinate radical neck dissections (RND) performed for cancers of the mouth, pharynx, and larynx was carried out. There were 75 patients (19%) who had a modified RND. These were separately analyzed and the outcome was compared to those who had a standard total RND. Our goal was to assess the effectiveness of modified RND in controlling disease in the neck, and to identify its impact on survival and quality of life. Overall neck recurrence rate in the entire modified RND group was 28%, 35% in the partial RND, and 25% in the comprehensive modified RND. Neck recurrence rate was no worse in the comprehensive modified RND for N0 and N1 cases, but increased significantly (as compared to the group of patients with standard RND) in the N2 and N3 cases (52% vs. 33%). Treatment of neck recurrences following modified RND was primarily by surgery, with a 48% 3-year disease-free survival. Overall survival was the same for modified RND (68%) and for standard total RND (63%). This was true for all N stages individually. The morbidity of standard total RND is discussed and the goals of modified RND are analyzed. Definitions and a standardized nomenclature for the various types of modified RND are suggested for uniformity of reporting.

Carcinoma, Squamous Cell↗