Faculty Bibliography

Atypical fibroxanthoma is a cutaneous soft tissue tumor that may mimic squamous cell carcinoma and melanoma on clinical and histologic examination. Immunohistochemical stains for cytokeratin, S100 protein, and vimentin may be helpful in differentiating atypical fibroxanthoma from the latter two diagnoses. We report a patient with atypical fibroxanthoma of the cheek who underwent successful local excision. The clinical and laboratory features of this neoplasm are reviewed

A review of the international literature has revealed 68 paragangliomas, 42 large cell, and 74 small cell tumors of the larynx. Paragangliomas are usually benign, although malignant cases have been reported. Large cell tumors are malignancies associated with a high incidence of early cervical metastasis. Small cell tumors are aggressive cancers characterized by early, diffuse metastatic disease. All three neoplasms demonstrate a propensity for the supraglottic larynx. While surgery remains the treatment of choice for paragangliomas and large cell cancers, small cell cancers are best treated by radiotherapy and chemotherapy. The determinate 5-year survival for patients with paragangliomas, large cell, and small cell cancers is 60%, 34%, and 14%, respectively. While representing distinct clinical entities, these neoplasms demonstrate similar ultrastructural and histochemical features and should be classified as neuroendocrine tumors of the larynx (NETL). A comprehensive analysis of these laryngeal tumors is presented herein. Their clinical behavior and management options are reviewed and a scheme for their nomenclature and classification is proposed

Six consecutive patients with ectopic parathyroid lesions were studied by preoperative thallium-technetium scintigraphy. Ectopic lesions were accurately localized in 5 of 6 patients. Four of five lesions deep in the superior mediastinum, and 1 in the superior carotid sheath, were correctly identified. Ectopic lesions in 4 of 5 patients, who had previously undergone unsuccessful exploration, were correctly localized. In 1 previously unoperated patient, a mediastinal lesion was identified by preoperative scintigraphy. In 2 patients, deep mediastinal exploration via manubriotomy was successfully conducted without confirmation by 'invasive' intravascular procedures. There were no false-positive studies. Lesions identified weighed from 185 mg to 9 g and were from 1.1 to 3.0 cm in size. Scintigraphy is particularly effective for demonstration of ectopic parathyroid tissue, because the absence of thyroid tissue in the mediastinum or superior cervical region permits appreciation of areas of abnormal thallium uptake unobscured by uptake in adjacent thyroid tissue. We conclude that ectopic parathyroid tissue may be accurately identified by thallium-technetium scintigraphy without confirmation by invasive intravascular studies

Management of the clinically negative neck in patients with carcinoma of the oral tongue remains a complex and controversial subject. While statistical proof of the value of elective neck dissection in tongue cancer remains elusive, the high incidence of occult cervical metastases, even with small primary tumors, and the poor salvage rates and increased incidence of extracapsular spread in cases that have developed palpable adenopathy, provide a logical basis for treatment of the neck in a preclinical stage

The best treatment for carcinoid tumor is surgical excision. The mainstay of treatment for atypical carcinoid tumor is wide surgical resection, often with elective neck dissection. Although it is not effective in the management of paragangliomas and carcinoid tumors, primary radiation therapy with adjuvant chemotherapy is the treatment of choice for small cell neuroendocrine carcinoma of the larynx. Management of laryngeal paraganglioma is surgical and may often be accomplished by partial laryngectomy. Most tumors are supraglottic and may be resected via modified lateral pharyngotomy. Preoperative angiography and embolization are occasionally useful

We evaluated the accuracy and usefulness of fine-needle aspiration cytologic evaluation of intraparotid masses in 64 patients who underwent subsequent surgery. Adequate specimens for cytologic evaluation were obtained in 46 of the 64 patients (72 percent). Thirty-three lesions in this group (72 percent) were benign and 13 (28 percent) were malignant. There was agreement of cytologic with final histologic diagnosis with regard to distinction of malignant from benign lesions in 43 of the 46 cases (93 percent). Eleven of 13 malignant tumors (sensitivity 85 percent) and 32 of 33 benign lesions (specificity 97 percent) were predicted. Exact tissue diagnosis was correctly determined in 34 of the 46 tumors (74 percent). There were no instances of hematoma, infection, facial nerve injury, implantation of tumor, or other complications as a result of 71 aspirations performed in 64 patients. Information gained by fine-needle aspiration was often valuable in assessing the suitability and extent of surgical treatment

We performed a retrospective analysis of 50 patients with acute frontal sinusitis who came to the Albert Einstein College of Medicine affiliated hospitals between 1981 and 1984. Cases were analyzed for age and sex in an attempt to determine the sex predilection for this disease in various age groups. Of the 50 patients studied, 38 (76%) were male and 12 (24%) were female. When subdivided into adult (older than 21 years of age) and adolescent (11 to 21 years of age) subgroups, a similar male predominance was noted. Among adults (28 patients), 21 (75%) were male and 7 (25%) were female. Among adolescents (22 patients), 17 (77%) were male and 5 (23%) were female. Of the 50 patients studied, 3 developed intracranial complications. All of these latter patients (all males) were in the adolescent group. Our findings indicate that male adolescents may be a high risk subgroup for developing intracranial complications secondary to their sinus infections

A case of subperiosteal and Bezold's abscesses that occurred in a 60-year-old man with cholesteatoma has been described and the literature reviewed. Bezold's abscess is rarely seen in the current era of antibiotics. The simultaneous occurrence of a subperiosteal abscess in association with cholesteatoma, particularly in an adult, makes this case even more unusual. Although antibiotics have reduced the complications associated with acute otitis media, rare complications still occur and should be recognized by the otolaryngologist