Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Τρίτη 3 Αυγούστου 2021

Combined loss of expression of involucrin and cytokeratin 13 is associated with poor prognosis in squamous cell carcinoma of mobile tongue

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Abstract

Background

This study aimed to evaluate the prognostic significance of expression levels of involucrin (IVL), cytokeratin (CK)-10 and -13 at different intratumor sites (tumor center and invading area) of oral tongue squamous cell carcinoma (OTSCC).

Methods

IVL, CK13 and CK10 expression levels were examined in a multicenter cohort of 146 OTSCCs using immunohistochemistry. External mRNA datasets were used for expression analysis and/or to validate survival associations.

Results

External transcriptomic datasets showed downregulation of IVL and KRT13 in oral malignancies including OTSCC as compared to normal controls. The combined loss of IVL and CK13 expression at the invading core but not at the center core was significantly associated with poor differentiation and reduced 5-year overall survival. Multivariate Cox analysis confirmed the loss of CK13 and IVL expression to be an independent prognostic factor. Transcriptomic dataset corroborated immunohistochemistry results.

Conclusions

Combined expression levlels of IVL and CK13 might be useful as prognostic biomarkers in OTSCC.

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Dermatofibrosarcoma Protuberans of Face: A Rare Entity and Review of Literature

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Abstract

Dermatofibrosarcoma protuberans is a very rare tumour that accounts for less than 0.1% of all malignant neoplasms. It is a locally aggressive tumour with high recurrence rate. Head and neck involvement is very uncommon and hence diverse treatment protocols have been recommended for its management in the currently available literature. We present a case of dermatofibrosarcoma protuberans over the lower part of right cheek in a middle aged male, which was successfully treated with wide local excision and reconstruction along with post-op radiotherapy. The patient was followed-up for 18 months with no recurrence. Prompt and accurate diagnosis along with multidisciplinary treatment is crucial for optimal management of this rare tumor. The optimal treatment option is surgical resection with wide margins along with adjuvant radiotherapy, which leads to better outcomes even in patients with positive surgical margins. Larger clinical trials with Imatinib will firmly establish its chemotherapeutic role in its management. Lifelong regular follow-up is essential for early detection of tumor.

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Cancer in children with intellectual disabilities: Questioning and ethical issues

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Bull Cancer. 2021 Jul 30:S0007-4551(21)00273-3. doi: 10.1016/j.bulcan.2021.07.001. Online ahead of print.

ABSTRACT

The Parents and Caregivers group in the face of ethics in pediatrics of the Île-de-France Ethics Area wondered about the association of the words Disability and Cancer by focusing on the study of the course of children with intellectual disability, treated for cancer. These situations are exceptional, the number of cases in France must not be more than fifty per year. We gathered the testimony of five families of children using a semi-directive survey taking up the journey from birth, announcement of the handicap, the diagnosis of cancer and its treatment. The verbatim show that each story is unique and rich in lessons, despite the feeling of "double penalty": "He did not deserve this, a handicap plus cancer is a lot for one person", "the shot moreover." A healthcare team was also interviewed and raised an additional ques tion: "First, the double penalty… then, what's the point?" Through these testimonies, we sought to question the ethical principles of care, which can be shaken up in these extraordinary supported.

PMID:34340841 | DOI:10.1016/j.bulcan.2021.07.001

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Identification of death risk factors of primary melanoma based on the competing risk model

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Bull Cancer. 2021 Jul 30:S0007-4551(21)00247-2. doi: 10.1016/j.bulcan.2021.04.020. Online ahead of print.

ABSTRACT

OBJECTIVE: To preliminarily explore death risk factors in primary melanoma patients.

METHOD: Competing risk model analysis was used using a large sample public cohort and Cox proportional hazard model was compared.

RESULT: In the competing risk model analysis, age, gender, ethnicity, stage, site, TMN stage and metastases were the independent risk factors of single primary melanoma (SPM) death. T stage had a particularly important impact on SPM death. T2 stage had a 3.212 times greater risk of interest event than T1 stage [hazard ratio (HR)=3.212, 95%CI: 2.994-3.446], T3 stage was 5.747 times greater than that T1 stage (HR=5.747, 95%CI: 5.337-6.187) and T4 stage had a 7.086 times than T1 stage (HR=7.086, 95%CI: 6.514-7.708). Gender, ethnicity, stage, site, T stage and brain and liver metastases were the independ ent risk factors of multiple primary melanoma (MPM) death. When some groups had a very high death rate or the reference group had a very low death rate in competing events, the results of Cox proportional hazard model may not be as accurate as the results obtained by fine-Gray regression model.

CONCLUSION: Early diagnosis and therapy, and prevention of tumor progression and metastases of primary melanoma patients are important measures to improve its prognosis and survival.

PMID:34340842 | DOI:10.1016/j.bulcan.2021.04.020

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Treatment of Childhood High-Grade Subglottic Stenosis (SGS) Through Laryngotracheoplasty (LTP) in a Tertiary Pediatric Center from 2013 to 2020

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Abstract

Laryngotracheal reconstruction is the most common and effective treatment in childhood subglottic stenosis (SGS). Our aim is to review the success rate of laryngotracheoplasty (LTP) in pediatric high grade SGS cases in our tertiary center. The retrospective review was conducted on children with high grade subglottic stenosis who had undergone laryngotracheoplasty over a 7-year period (2013–2020) in tertiary pediatric care. A total of 20 patients who had history of high grade SGS during the stipulated period were included. All of them had undergone LTP. Decannulation was considered the primary outcome measure of success. Surveillance bronchoscopy was performed one year post airway reconstruction to detect residual stenosis. From January 2013 to December 2020, 20 patients aged between 1 and 16 years old underwent LTP. Among them, 10 patients (50%) had Grade III SGS while 5 had Grade III SGS with glottis stenosis (25%). The remaining 5 (25%) had severe Grade IV stenosis. Decannulation was achieved in 14 patients overall (70%) including 1 with revision. These 14 patients who achieved decannulation included 7 out of the 10 patients (70%) with Grade III, 2 out of the 5 (40%) patients with Grade III with glottic involvement, and 4 out of the 5 patients (80%) with Grade IV SGS. Fifteen (80%) patients had double stage LTP while 5 patients had single stage LTP. The study suggests that LTP is a promising approach in the treatment of Complex SGS. Furthermore, pediatric SGS, which is inherently complicated, can be treated with LTP effectively.

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Anatomical Variations of Sphenoid Sinus

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Abstract

Pituitary adenomas are one among the most common neurosurgical tumors with an incidence of 10–25% among intracranial neoplasms (Ezzat et al., Cancer 101:613–619, 2004). Surgical management for the same has been practiced since long, and has evolved from trans cranial approach to endoscopic trans sphenoidal method (Hammer and Radberg, Acta Radiol 56:401–422, 1961). Preoperative radiological analysis with CT &MRI is inevitable in planning endonasal trans-sphenoid surgery to avoid complications because of the high variability concerned with sphenoid anatomy. The present study intends to analyze the incidence of various anatomical variations of sphenoid sinus in a cohort of south Indian population as detected by CT& MRI and assess its impact on surgical approach. Retrospective analysis of CT&MRI images of patients who underwent Endonasal Trans-sphenoidal resection of pituitary tumors at JSS Hospital Mysuru from a period of 2009 to 2020 is done. Anat omical variations of sphenoid sinus esp. degree of pneumatization, sellar configuration, septation pattern, inter carotid distance were evaluated. Results were significant and in concordance with other similar studies. Most frequently encountered pnuematization was sellar type and least was conchal type Sphenoid sinus pneumatization is directly linked to safe access to sella. Presence of septae within sinus need to be identified preoperatively to avoid damage and confusion intraoperatively. A meticulous preoperative analysis of sphenoid sinus anatomy will help surgeon in smooth conduct of a complication free surgery.

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Impact of Thyroid surgery on Voice: A prospective study

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Abstract

Background

Thyroidectomy is one of the most common neck surgery done worldwide. It is associated with debilitating post-operative voice changes even without recurrent laryngeal nerve (RLN) injury. Aims and Objectives: To study the impact of thyroidectomy on voice parameters in the absence of Recurrent Laryngeal Nerve and External Branch of Superior Laryngeal Nerve injury and comparison between the pre and post-operative changes in the subjective and objective voice parameters. Methodology: Patients fulfilling the inclusion criteria underwent thyroidectomy. The Subjective voice assessment was done using Voice Impairment Score (VIS) and objective parameters were analyzed using Multi-Dimensional Voice Program (MDVP) pre-operatively and post-operatively at 1 week, 1 month and 3 months interval. Results: On MDVP analysis of patients, a fall in Mean F0 (Hz), Minimum F0 (Hz) and Maximum F0 (Hz) values was noted at 1 week after surgery. But a trend toward the pre-operative values was observed at 3 months post-operatively.

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The efficiency of polyglycolic acid felt in the prevention of pharyngocutaneous fistula after total laryngectomy

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Publication date: November–December 2021

Source: American Journal of Otolaryngology, Volume 42, Issue 6

Author(s): Taskin Tokat, Togay Muderris, Abdulhalim Aysel, Elif Sari, Ferda Erol

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Risk stratification of parotid neoplasms based on intraoperative frozen section and preoperative fine needle aspiration cytology

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Eur Arch Otorhinolaryngol. 2021 Aug 3. doi: 10.1007/s00405-021-07015-w. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to determine the relationship of frozen section (FS) to final histology and determine how incorporating FS may change preoperative malignancy risk estimates based on preoperative fine needle aspiration cytology (FNAC). The secondary aim is to determine if FS is useful in influencing intraoperative decision-making.

METHODS: Retrospective review of 426 intraoperative FS for parotidectomies performed for primary parotid lesions.

RESULTS: Risk of malignancy with a benign FS was 2.5%, with indeterminate 36.1%, and with malignant 100%. Incorporating FS to fine needle aspiration for cytology helped to stratify malignancy risk especially in the Milan categories of atypia of undetermined significance, neoplasm of uncertain malignant potential and non-diagnostic categories, where a malignant FS increased ma lignancy risk significantly. FS was only able to identify 11% of high-risk histological subtypes for which a neck dissection would be recommended.

CONCLUSIONS: FS may be used to stratify malignancy risk intraoperatively but has limited utility in clinical decision-making to perform a neck dissection and more extensive parotid resection in high-risk histological subtypes.

PMID:34342679 | DOI:10.1007/s00405-021-07015-w

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Expression of Cyclin-D1 and p53 as Prognostic Markers in Treatment of Oral Squamous Cell Carcinoma

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Abstract

Cyclin D1 and p53 play an important role in tumorigenesis of human cancers. The present study aims to evaluate cyclin D1 and p53 expression in resectable OSCC, and to determine their prognostic significance at the end of 5 year follow-up: A total of 100 patients aged 31–74 years, stage 3/4 were recruited. Cyclin D1 and p53 expression in the tumour tissue was estimated by IHC and was statistically correlated with demographic and clinicopathological data and prognosis was evaluated at the end of 5 year outcome. The positive expression rate of cyclin D1 was 50% and p53 it was 40% and they neither showed any statistical significant correlation with each other nor with demographic or clinicopathological data. The OS was 32%.Negative and weak expression predicted better outcomes with regard to DFS and OS. DFS and OS were significantly worse in patients of overexpressed cyclin D1 (p < 0.001) and p53 (p = 0.008). Cyclin D1 is a better prognostic marker as compared to p53 for both DFS and OS. p53 expression (high versus low) for disease free non-survival and overall nonsurvival showed an OR of 3.576 (p = 0.003) and 8.803(p < 0.001) respectively for strong expression while in case of cyclin D1 it showed an OR of 13.067(p < 0.001) and 37.465(p < 0.001) for strong expression.So higher the level of expression of tumour markers higher is the odds ratio so poorer is the prognosis. Overexpression of cyclin D1 and p53 was significantly associated with poor prognosis in terms of DFS and OS

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A supervised machine learning algorithm predicts intraoperative CSF leak in endoscopic transsphenoidal surgery for pituitary adenomas: model development and prospective validation

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J Neurosurg Sci. 2021 Aug 3. doi: 10.23736/S0390-5616.21.05295-4. Online ahead of print.

ABSTRACT

BACKGROUND: Despite advances in endoscopic transnasal transsphenoidal surgery (ETNS) for pituitary adenomas (PAs), cerebrospinal fluid (CSF) leakage remains a life-threatening complication predisposing to major morbidity and mortality. In the current study we developed a supervised ML model able to predict the risk of intraoperative CSF leakage by comparing different machine learning (ML) methods and explaining the functioning and the rationale of the best performing algorithm.

METHODS: A retrospective cohort of 238 patients treated via E-TNS for PAs was selected. A customized pipeline of several ML models was programmed and trained; the best five models were tested on a hold-out test and the best classifier was then prospectively validated on a cohort of 35 recently treated patients.

RESULTS: Intraoperative CSF leak occurred in 54 (2 2,6%) of 238 patients. The most important risk's predictors were: non secreting status, older age, x-, y- and z-axes diameters, ostedural invasiveness, volume, ICD and R-ratio. The random forest (RF) classifier outperformed other models, with an AUC of 0.84, high sensitivity (86%) and specificity (88%). Positive predictive value and negative predictive value were 88% and 80% respectively. F1 score was 0.84. Prospective validation confirmed outstanding performance metrics: AUC (0,81), sensitivity (83%), specificity (79%), negative predictive value (95%) and F1 score (0,75).

CONCLUSIONS: The RF classifier showed the best performance across all models selected. RF models might predict surgical outcomes in heterogeneous multimorbid and fragile populations outperforming classical statistical analyses and other ML models (SVM, ANN etc.), improving patient management and reducing preventable morbidity and additional costs.

PMID:34342190 | DOI:10.23736/S0390-5616.21.05295-4

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