Pathologic quiz case 2. Adenoid cystic carcinoma (ACC).
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Adult↗
Biomedical subjects
S Baredes
Publications and source records attributed to S Baredes.
Metastatic disease to the mandible.
Metastatic lesions to the mandible are rare, comprising less than 1% of all malignancies. Twenty-two cases of metastatic disease to the mandible were seen from 1938 to 1985. The records of 17 cases were available for detailed review. The age range was from 27 to 80 years with a female to male ratio of 12 to 5. A mandibular or paramandibular mass or swelling was the most common presenting sign. Three patients presented with mandibular metastasis prior to the discovery of the primary tumor. In the other 14 patients, the mandibular lesion appeared from 2 months to 20 years following discovery of the primary tumor. The mandibular lesion was the initial sign of distant metastatic disease in 11 of the 17 patients. Breast, lung, and colon cancer were the most common primary tumors. When presented with an isolated mandibular mass, a high index of suspicion is necessary to make the diagnosis of metastatic disease. Since plain x-rays may initially be normal, technetium or CT scan may be necessary to demonstrate osseous destruction. Inferior alveolar nerve anesthesia should be considered an indication of tumor until proven otherwise. Treatment is often of a palliative nature because of the presence of widespread metastatic disease; however, surgical resection may be considered in the rare patient with a well-documented, solitary mandibular metastasis.
Breast Neoplasms↗
Surgical management of swallowing disorders.
Many patients with severe swallowing disorders will require surgical intervention at some point in the course of their illness. Surgery should be designed to address specific dysfunctions identified by a thorough evaluation. Defining a patient's problem is usually a multidisciplinary effort, requiring the skills of several specialists.
Deglutition Disorders↗
The opacified maxillary sinus: CT findings in chronic sinusitis and malignant tumors.
To distinguish opacification owing to inflammatory conditions (sinusitis) from that caused by nasomaxillary malignancy, computed tomography scans in 24 proved cases of sinusitis or tumor were reviewed for features related to sinus size, wall thickness, and character of bone erosion. An anatomic system was defined for classifying lesions according to the surface and type of bony involvement. In 12 cases of chronic maxillary sinusitis, the involved sinus was usually small and thick walled. The nasal surface of the involved sinus usually was eroded; often the orbital surface was eroded. The erosion was, however, short, irregular, and in the region of a normal dehiscence (semilunar hiatus or infraorbital canal) in all cases. The infratemporal surface was never eroded. In 12 cases of nasomaxillary neoplasia, the sinus was enlarged, one or more walls of the involved sinus being thinned and expanded. Bone erosion was present in all cases; erosion of the infratemporal surface was specific for neoplasia and significant as the usual site of recurrence.
Chronic Disease↗
Evaluation of conservative neck dissection in partial laryngeal surgery.
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Female↗
The role of supraomohyoid neck dissection at the time of supraglottic laryngectomy.
Uncontrolled cervical metastasis is the most common source of failure in the surgical treatment of supraglottic carcinoma. This study was designed to determine the value of supraomohyoid neck dissection in patients undergoing supraglottic laryngectomy. The rationale for considering the role of supraomohyoid neck dissection is that such a dissection encompasses the subdigastric and midjugular nodes which are the first echelon of lymphatic drainage of the supraglottic larynx. Thirty-eight patients with a diagnosis of epidermoid carcinoma of the supraglottis were treated by subtotal supraglottic laryngectomy (SSL). Ten patients underwent SSL with no neck dissection, 16 patients underwent SSL with supraomohyoid neck dissection (SOHD)--9 unilateral and 7 bilateral, and 12 patients underwent SSL with radical neck dissection (RND). The 3 groups had comparable T classifications. All of the SSL and SSL with SOHD patients were classified as N0. Of the 12 patients treated with SSL and RND, 4 were classified as N0, 4 as N1, 3 as N2, and 1 as N3. The patients were studied to determine the incidence and pattern of subsequent neck disease, survival, complications, and length of hospitalization. The data indicates that supraomohyoid neck dissection offers little benefit as an adjunct to supraglottic laryngectomy.
Carcinoma↗
Computed tomography of the carotid space and related cervical spaces. Part II: Neurogenic tumors.
Fourteen neurogenic tumors of the neck were examined with computed tomography (CT) and, in ten cases, angiography. Schwannomas and paragangliomas occurred in the carotid space. These tumors could be distinguished on CT from those occurring more anteriorly, in relation to the parapharyngeal space, and more posteriorly, in relation to the paraspinal space. Schwannomas alone occurred in the paraspinal space. Schwannomas were heterogeneously hypodense before contrast enhancement and at least partially hyperdense after contrast enhancement, with displacement of adjacent vessels on CT, and, if they were of vagal origin, anteromedial displacement of the internal carotid artery on angiography. Paragangliomas usually were homogeneously hyperdense after contrast enhancement, with incorporation of adjacent vessels on CT, and, if they were of carotid body origin, lateral displacement of the internal carotid artery on angiography.
Adolescent↗
Nutritional considerations in the management of head and neck cancer patients.
Head and neck cancer patients are often malnourished. In addition, these patients also face nutritional problems related to the site of the tumor. Surgery and chemotherapy create additional difficulties in maintaining adequate nutritional status. Proper attention to the nutritional needs of these cancer patients is an important aspect of their overall management.
Anthropometry↗
The role of the psychiatrist in otolaryngology.
The patient, staff, and physician benefit when the otolaryngologist and psychiatrist are able to work closely together. Not only is clinical care improved, but time can be spent more efficiently in dealing directly with the patient's problem.
Adult↗
Otologic and audiologic evaluation of human immunodeficiency virus-infected patients.
PURPOSE: To quantify the incidence of ear disease in patients infected with human immunodeficiency virus (HIV). MATERIALS AND METHODS: This is a descriptive case series of HIV-positive patients, with data collected using an otologic questionnaire. otologic examination, audiologic evaluation, and chart review. The study was performed at an urban University Hospital's outpatient Infectious Disease and Otolaryngology clinics. A consecutive sample of 50 HIV-infected patients volunteered for this study. Ten subjects refused. Almost all patients received public assistance for medical care. Descriptive results were tabulated. Audiometric data were analyzed for ear, Centers for Disease Control (CDC) group, otologic complaint, and age effects. Data were compared with established norms. RESULTS: Twenty-three men and 27 women with a mean age of 40 years and mean duration of HIV disease of 3.5 years were studied. Eighteen percent of patients were in category CDC-A, 38% in CDC-B, and 44% in CDC-C. Otologic complaints were more prevalent than expected: 34% of patients reported aural fullness, 32% dizziness, 29% hearing loss, 26% tinnitus, 23% otalgia, and 5% otorrhea. Results of the neuro-otologic examination were abnormal in 33%. Tympanometric examination was abnormal in 21%. A significant degree of high-frequency sensorineural hearing loss was observed. CDC-B and CDC-C patients had worse hearing than CDC-A patients at 3 frequencies. Patients who complained of hearing loss had significantly worse otoacoustic emission results and hearing results than patients who did not, at all frequencies except 1,000 Hz. Patients in their 30s had better hearing in the speech frequencies than did all other patients. CONCLUSIONS: Ear disease affects up to 33% of HIV-infected patients. Otitis media is a frequent finding. Sensorineural hearing loss is more severe in patients with more severe HIV infection. Patients with ear complaints have demonstrable otopathology. Continuation of this preliminary descriptive work is necessary.
Adult↗
Distribution of blood flow in an experimental palatal carcinoma.
Tumor perfusion is an important factor in the success of many common and potential therapeutic and diagnostic modalities. We studied blood flow of an experimental squamous cell carcinoma of the rat palate using the radionuclide-labeled microsphere injection method. Tumors (N = 14) were studied for level and distribution of blood flow, and changes in blood flow with increasing size. The results show a wide variation in the absolute level of perfusion among the tumors, but a consistent pattern of blood flow distribution, with poor perfusion in the central parts and a sharp increase in perfusion at the periphery. The blood flow (in mL/min/100 g) in the five zones from center to periphery were 2.32 +/- 5.7, 5.62 +/- 16.3, 4.20 +/- 6.87, 15.04 +/- 23.6, and 32.31 +/- 41.8. The average level of perfusion decreased as tumor size increased, but the pattern of blood flow distribution remained constant. The data from this study provide an understanding of the basic pattern of blood flow in an experimental squamous cell carcinoma of the head and neck, and will serve as a foundation to further explore the hemodynamic characteristics of head and neck carcinomas.
Animals↗
The frequency of cricopharyngeal dysfunction on videofluoroscopic swallowing studies in patients with dysphagia.
PURPOSE: Dysphagia associated with cricopharyngeal dysfunction (CPD) is of particular interest to the otolaryngologist because it may respond to cricopharyngeal myotomy. There is a wide variation in the reported incidence of cricopharyngeal dysfunction in patients with dysphagia. This can be attributed to the different populations being studied, the lack of uniform criteria for diagnosis, and to different techniques used to evaluate patients. We have reviewed videofluoroscopic swallowing studies (VSS) conducted on 443 consecutive patients with complaints of dysphagia to identify the incidence of cricopharyngeal dysfunction. PATIENTS AND METHODS: The patient population consists of 443 veterans with complaints of dysphagia who were evaluated by videofluoroscopic swallowing studies at the Department of Veterans Affairs Medical Center, East Orange, NJ, between November 1988 and March 1993. RESULTS: Cricopharyngeal dysfunction was diagnosed radiologically as the appearance of a shelf in the posterior column of barium at the level of the cricoid cartilage. It was identified in 10 of 177 (5.7%) patients with neurological disorders, in 7 of 142 (4.9%) patients with head and neck or esophageal tumors, and in 11 of 124 (8.9%) patients with other medical problems. CONCLUSION: These results do not support the notion that cricopharyngeal dysfunction is an important factor in a significant proportion of patients with dysphagia. It is recognized that videofluoroscopy may not always detect cricopharyngeal dysfunction and that better criteria for identifying this entity are needed.
Adult↗