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Peripancreatic paraganglioma mimics pancreatic/gastrointestinal neuroendocrine tumor on fine needle aspiration: report of two cases and review of the literature

Zeng, Jennifer; Simsir, Aylin; Oweity, Thaira; Hajdu, Cristina; Cohen, Steven; Shi, Yan
Cytologic diagnosis of extra-adrenal paraganglioma presenting as a peripancreatic mass is challenging with a high error rate due to its rarity. We report two cases of peripancreatic masses identified by radiology. Endoscopic ultrasound-guided fine needle aspiration (FNA) of the masses showed a moderately cellular tumor composed of small to medium sized neoplastic cells with round to oval nuclei, arranged singly and in loose clusters. Focal rosette-like structures were present. The cells were positive for neuroendocrine markers (synaptophysin and chromogranin). A diagnosis of a neoplasm with neuroendocrine differentiation and neuroendocrine tumor was made respectively on FNA for each case. The subsequent surgical resection of the tumors revealed peripancreatic paraganglioma. Although paraganglioma has been reported in the literature, the detailed comparison of perpancreatic paraganglioma versus pancreatic/gastrointestinal neuroendocrine tumor is still lacking. Therefore using these two cases with literature review, we wish to illustrate the differential diagnosis between these two entities based on cytomorphology and immunohistochemical study.
PMID: 28560856
ISSN: 1097-0339
CID: 2591722

Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery

Masi, Antonio; Amodeo, Salvatore; Hatzaras, Ioannis; Pinna, Antonio; Rosman, Alan S; Cohen, Steven; Saunders, John K; Berman, Russell; Newman, Elliot; Ballantyne, Garth H; Pachter, Leon H; Melis, Marcovalerio
BACKGROUND: We investigated whether the surgical Apgar score (SAS) may enhance the Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk assessment for prediction of early postoperative outcomes. METHODS: We retrospectively evaluated demographics, medical history, procedure, SAS, VASQIP assessment, and postoperative data for patients undergoing major/extensive intra-abdominal surgery at the Manhattan Veterans Affairs between October 2006 and September 2011. End points were overall morbidity and 30-, 60- , and 90-day mortality. Pearson's chi-square, ANOVA, and multivariate regression modeling were employed. RESULTS: Six hundred twenty-nine patients were included. Apgar groups did not differ in age, sex, and race. Low SASs were associated with worse functional status, increased postoperative morbidity, and 30-, 60- , and 90-day mortality rates. SAS did not significantly enhance VASQIP prediction of postoperative outcomes, although a trend was detected. Multivariate analysis confirmed SAS as an independent predictor of morbidity and mortality. CONCLUSIONS: SAS effectively identifies veterans at high risk for poor postoperative outcome. Additional studies are necessary to evaluate the role of SAS in enhancing VASQIP risk prediction.
PMID: 27523923
ISSN: 1879-1883
CID: 2219252

Minimally Invasive Management of Ectopic Pancreas

Vitiello, Gerardo A; Cavnar, Michael J; Hajdu, Cristina; Khaykis, Inessa; Newman, Elliot; Melis, Marcovalerio; Pachter, H Leon; Cohen, Steven M
BACKGROUND: The management of ectopic pancreas is not well defined. This study aims to determine the prevalence of symptomatic ectopic pancreas and identify those who may benefit from treatment, with a particular focus on robotically assisted surgical management. METHODS: Our institutional pathology database was queried to identify a cohort of ectopic pancreas specimens. Additional clinical data regarding clinical symptomatology, diagnostic studies, and treatment were obtained through chart review. RESULTS: Nineteen cases of ectopic pancreas were found incidentally during surgery for another condition or found incidentally in a pathologic specimen (65.5%). Eleven patients (37.9%) reported prior symptoms, notably abdominal pain and/or gastrointestinal bleeding. The most common locations for ectopic pancreas were the duodenum and small bowel (31% and 27.6%, respectively). Three out of 29 cases (10.3%) had no symptoms, but had evidence of preneoplastic changes on pathology, while one harbored pancreatic cancer. Over the years, treatment of ectopic pancreas has shifted from open to laparoscopic and more recently to robotic surgery. CONCLUSIONS: Our experience is in line with existing evidence supporting surgical treatment of symptomatic or complicated ectopic pancreas. In the current era, minimally invasive and robotic surgery can be used safely and successfully for treatment of ectopic pancreas.
PMID: 28121494
ISSN: 1557-9034
CID: 2418502

Fatal Falls in New York City: An Autopsy Analysis of Injury Patterns

Obeid, Nabeel R; Bryk, Darren Jeremy; Lee, Timothy; Hemmert, Keith C; Frangos, Spiros G; Simon, Ronald J; Pachter, H Leon; Cohen, Steven M
INTRODUCTION: Falls from heights are an important cause of unintentional fatal injury. We investigated the relationship between the characteristics of fatal falls and resulting injury patterns. MATERIALS AND METHODS: We reviewed prospectively collected data from the Office of Chief Medical Examiner in New York City between 2000 and 2010. Data included fall height, work or non-work related, use of safety equipment, intentionality, specific organ injuries, and death on impact. The primary outcome was organ injury based on fall height. RESULTS: Higher falls were associated with hemorrhage as well as rib and various organ injuries. Organ injury pattern did not differ based on work status. The presence of equipment misuse or malfunction was associated with more deaths upon impact. Victims of falls from 200 ft or higher were 11.59 times more likely to die on impact than from lower than 25 ft. CONCLUSIONS: Fall height and work-related falls were significantly associated with death on impact. This is a public health issue, as 13% of falls were work related and 4% of falls were due to improper use of safety equipment. Some work-related falls are potentially preventable with proper safety equipment use. Understanding patterns of injury may play a role in prevention and management of survivors in the acute period.
PMID: 26825256
ISSN: 1533-404x
CID: 2044112

Five-Year Safety and Satisfaction Study of PMMA-Collagen in the Correction of Nasolabial Folds

Cohen, Steven; Dover, Jeffrey; Monheit, Gary; Narins, Rhoda; Sadick, Neil; Werschler, William P; Karnik, Jwala; Smith, Stacy R
BACKGROUND: A polymethylmethacrylate-collagen filler is generally believed to give long-term benefits, but the risk of granuloma formation over time remains unclear. OBJECTIVE: To determine the incidence of granuloma formation and response to treatment and assess the degree of patient satisfaction over 5 years. MATERIALS AND METHODS: Adults seeking correction of nasolabial folds underwent up to 3 injection sessions over 2 months. Subjects were then queried regularly for the development of signs and symptoms of a granuloma. Any positive responses were evaluated, and lesions suspicious for granulomas were confirmed by biopsy. Granulomas were treated at the discretion of the investigator. Subjects also completed regular satisfaction questionnaires. RESULTS: A total of 1,008 subjects were enrolled and 871 completed the full 5 years of the study. A biopsy-confirmed granuloma developed in 1.7% of subjects. Almost all granulomas responded to treatment. At study exit, 0.9% of subjects had an unresolved granuloma. Patient satisfaction remained high throughout the duration of the study. CONCLUSION: The incidence of granuloma formation with a polymethylmethacrylate-collagen dermal filler is low, and almost all lesions are manageable with simple therapeutic measures. Patient satisfaction remains durable over 5 years. Polymethylmethacrylate-collagen offers a well-characterized and very favorable risk/benefit profile.
PMID: 26618457
ISSN: 1524-4725
CID: 1863222

Increased intraoperative fluid volume administration is associated with worse outcomes after gastro-esophageal resection for cancer [Meeting Abstract]

Masi, Antonio; Desiato, Vincenzo; Melis, Marcovalerio; Pinna, Antonio; Hatzaras, Ioannis; Cohen, Steven M; Berman, Russell S; Ballantyne, Garth H; Pachter, Leon H; Newman, Elliot
ISI:000386899000317
ISSN: 1879-1190
CID: 2520242

Does lymph node ratio affect prognosis in gastroesophageal cancer?

Melis, Marcovalerio; Masi, Antonio; Pinna, Antonio; Cohen, Steven; Hatzaras, Ioannis; Berman, Russell; Pachter, Leon H; Newman, Elliot
BACKGROUND: Increasing evidence suggests that the ratio of number of nodes harboring metastatic cancer to the total number of lymph nodes examined (lymph node ratio, LNR) may affect survival after esophagogastric resection for cancer. We analyzed the impact of LNR in overall survival in patients undergoing esophagogastric resection for cancer. METHODS: Patients who underwent gastroesophageal resection for cancer (1998 to 2008) were categorized into 4 groups according to their LNR: 113 patients had negative nodes (N0), 86 LNR less than .3, 40 LNR .31 to .6, and 47 LNR greater than .6. Study endpoint was overall median survival. RESULTS: Higher LNR was associated (P < .001) with more advanced stage and adverse pathologic features (eg, grading, venous/perineural invasion). Multivariate analysis demonstrated that LNR is an independent predictor of survival. CONCLUSION: In our experience, LNR correlates with adverse pathologic features and is a negative prognostic factor in patients undergoing radical resection for gastroesophageal cancer.
PMID: 26003203
ISSN: 1879-1883
CID: 1603132

The Surgical Apgar Score Predicts Postoperative ICU Admission

Glass, Nina E; Pinna, Antonio; Masi, Antonio; Rosman, Alan S; Neihaus, Dena; Okochi, Shunpei; Saunders, John K; Hatzaras, Ioannis; Cohen, Steven; Berman, Russell; Newman, Elliot; Pachter, H Leon; Gouge, Thomas H; Melis, Marcovalerio
PMID: 25572972
ISSN: 1091-255x
CID: 1435842

A Case of a Peripancreatic Paraganglioma: A Diagnostic Challenge on Fine Needle Aspiration [Meeting Abstract]

Zeng, Jennifer; Zhou, Fang; Alexander, Melissa; Hajdu, Cristina; Cohen, Steven; Newman, Elliot; Simsir, Aylin; Oweity, Thaira; Melis, Marcovalerio
ISI:000364587200090
ISSN: 1943-7722
CID: 1859622

Pilot study of oral microbiome and risk of pancreatic cancer [Meeting Abstract]

Lin, I-Hsin; Wu, Jing; Cohen, Steven M.; Chen, Calvin; Bryk, Darren; Marr, Mollie; Melis, Marcovalerio; Newman, Elliot; Pachter, H. Leon; Alekseyenko, Alexander V.; Hayes, Richard B.; Ahn, Jiyoung
ISI:000331220600020
ISSN: 0008-5472
CID: 853292