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Surveillance CT and the prompt use of CT-guided fine-needle aspiration in patients with head and neck cancer who have undergone surgery

Som, P M; Silvers, A R; Urken, M L
OBJECTIVE: The purpose of this study was to assess the usefulness of prompt CT-guided fine-needle aspiration in the evaluation of suspected tumor recurrence seen on surveillance images of patients who had undergone surgery for head and neck cancer. SUBJECTS AND METHODS: We reviewed 32 patients who had undergone CT-guided fine-needle aspiration after surgery for head and neck cancer. CT-guided fine-needle aspiration was performed with a 22-gauge spinal needle and a cytopathologist was present to assess the adequacy of the biopsy sample. As many as five needle passes were made. RESULTS: Of the 32 cases, pathologic findings revealed squamous cell carcinoma (n = 27), mucoepidermoid carcinoma (n = 2), neuroendocrine carcinoma (n = 1), papillary thyroid carcinoma (n = 1), and adenocarcinoma (n = 1). In 20 cases (62.5%) the results of CT-guided fine-needle aspiration were positive for tumor recurrence, whereas in 11 cases (34.4%) the results were negative. In one case (3.1%) the results were nondiagnostic. Of the 11 patients with negative findings on CT-guided fine-needle aspiration, two patients had a subsequent recurrence that was not at the biopsy site. There were no complications from the procedure. CONCLUSION: When a radiologist who is trained in head and neck imaging identifies with CT a possible early recurrence of tumor, the prompt use of CT-guided fine-needle aspiration is an effective way to diagnose these tumors so that appropriate treatment can be initiated
PMID: 10584792
ISSN: 0361-803x
CID: 133388

Isolated primary unilateral stenosis of the internal auditory canal [Case Report]

Rothschild, M A; Wackym, P A; Silvers, A R; Som, P M
Congenital primary stenosis of the internal auditory canal (IAC) may exist in isolation or along with a number of other osseous anomalies of the temporal bone. Most of the literature on IAC stenosis is concerned with its effect on the outcome of cochlear implantation (i.e. patients with profound bilateral hearing loss). In addition, some degree of canal asymmetry has been noted in patients with normal hearing, questioning the causal relationship of this finding to deafness. We describe two children with computed tomography (CT) documented severe primary unilateral narrowing of the IAC and an associated ipsilateral sensorineural hearing loss. Typical radiographic findings are described, and the relevant developmental pathology is discussed. The ipsilateral association of stenosis and hearing loss strengthens the link between narrowing of the IAC and deafness.
PMID: 10595667
ISSN: 0165-5876
CID: 478392

Clinical use of the optical digitizer for intracranial neuronavigation

Germano, I M; Villalobos, H; Silvers, A; Post, K D
OBJECTIVE:Computer-assisted frameless navigation techniques are used in many centers for intracranial neurosurgical procedures. In this study, we assessed the accuracy and the clinical usefulness of a frameless system based on the optical digitizer in a variety of intracranial procedures. METHODS:The optical digitizer (StealthStation, Sofamor Danek, Memphis, TN) was used to perform 170 neurosurgical operations. Its accuracy was judged before and after each operation by comparing the computer-estimated error with the real estimated error measured on the patient's anatomy. Several objective factors were evaluated to assess the clinical usefulness of the optical digitizer. For craniotomies, the intraoperative extent of resection based on computer-generated images was compared with that on postoperative images, and the length of hospital stay of patients undergoing frameless procedures was compared with that of patients undergoing conventional procedures. For needle biopsies, clinical usefulness was based on the rate of success in establishing a histological diagnosis. RESULTS:The optical digitizer was accurate to within 2 mm for all procedures. The computer-estimated error was not significantly different from the real estimated error. The intraoperative extent of resection was accurate in 58 of 60 tumor resection patients, as confirmed on postoperative images. Patients undergoing frameless procedures had a significantly shorter hospital stay than those undergoing conventional procedures (7.5 +/- 1 versus 10.8 +/- 1.3 d, P < 0.05). All biopsies were diagnostic. CONCLUSION/CONCLUSIONS:The optical digitizer is an accurate frameless device that offers clinical benefits. These include precise surgical resection, decreased hospitalization time, and accurate tissue diagnosis.
PMID: 10449070
ISSN: 0148-396x
CID: 4030292

Imaging central skull base neural tumor spread from paranasal sinus malignancies: a critical factor in treatment planning

Som, P M; Costantino, P D; Silvers, A R
Eight cases of paranasal sinus tumors with central skull base disease are presented. Each patient had coned down noncontrast and contrast-enhanced magnetic resonance imaging (MRI) studies to evaluate the tumor margins and any potential tumor spread into the cavernous sinuses, V2 and the Vidian nerve. Two patients had tumors that extended up to the face of the sphenoid bone and one had a tumor in the ventral cavernous sinus. These three patients had a complete tumor resection with postoperative irradiation. Two more patients had extensive tumor invasion of the central skull base, one was treated with only irradiation, one refused treatment. Three more patients had tumors that involved the ventral portion of the sphenoid bone with limited neural tumor extension. Two of these patients had surgery with cavernous sinus dissections followed by irradiation. One patient delayed treatment for 2 months and when he returned he had a more extensive tumor and was considered incurable by surgery. He refused further treatment. The technique of the focused MR examination and its impact on treatment planning is discussed.
PMID: 17171077
ISSN: 1052-1453
CID: 478192

Isolated vagal nerve palsy associated with a dissection of the extracranial internal carotid artery [Case Report]

Nusbaum AO; Som PM; Dubois P; Silvers AR
A 40-year-old man had paralysis of the right vocal cord. Imaging showed a dissection of the extracranial internal carotid artery, and physical examination disclosed paresis of the right side of the soft palate. To our knowledge, this is only the second report of carotid dissection presenting as an isolated vagal neuropathy. Most often, multiple lower cranial nerves are involved. The CT, MR imaging, and MR angiographic findings are presented and the topic is reviewed
PMID: 9874534
ISSN: 0195-6108
CID: 27840

Extranodal non-Hodgkin lymphoma involving the muscles of mastication [Case Report]

Chong, J; Som, P M; Silvers, A R; Dalton, J F
Involvement of the skeletal muscle by non-Hodgkin lymphoma (NHL) is unusual. The most commonly affected muscles are those of the extremities, pelvis, and gluteal regions; rarely are the muscles in the head and neck involved. We report the clinical, CT, and MR imaging findings in two patients with extranodal NHL in the head and neck region involving the muscles of mastication. One patient was immunocompetent and had lymphoma that arose within the muscles; the other was a patient with AIDS who had disseminated disease at diagnosis. In both patients, the involved muscles were isodense with normal muscles on CT scans. On MR images, the infiltrated muscles were isointense with normal muscles on the T1-weighted sequence and hyperintense on the fast spin-echo T2-weighted sequence, with variable enhancement after administration of intravenous contrast material.
PMID: 9874535
ISSN: 0195-6108
CID: 478432

Salivary glands

Silvers, A R; Som, P M
This article discusses the anatomy, physiology, and pathology of the parotid, submandibular, and sublingual glands, which often are referred to as the major salivary glands. Overall, diseases of the salivary glands are relatively uncommon; however, as an organ system, they have the greatest diversity of pathology. Acute viral and bacterial inflammatory diseases are the most common salivary gland abnormalities; tumors are uncommon. The imaging approach to these lesions is discussed.
PMID: 9747195
ISSN: 0033-8389
CID: 478442

CT of pilomatrixoma in the cheek [Case Report]

Som, P M; Shugar, J M; Silvers, A R
Pilomatrixoma is an uncommon benign tumor arising from hair follicles. They occur most commonly in the head and neck region, and are usually found in girls during the first two decades of life. These tumors may contain calcification, which, when present, is helpful in suggesting the diagnosis. We present a classic case of pilomatrixoma in the cheek of a young woman. The tumor was documented on CT studies, which showed a subcutaneous, noninvasive mass with calcifications.
PMID: 9726456
ISSN: 0195-6108
CID: 478452

A re-evaluation of imaging criteria to assess aggressive masticator space tumors

Som, P M; Curtin, H D; Silvers, A R
PURPOSE: To evaluate the correlation between the gross imaging evidence of an aggressive masticator space (MS) tumor and the presence of such a MS malignancy. MATERIALS AND METHODS: Thirty patients were identified retrospectively who had a malignancy that either arose in or metastasized to the MS, had pathologic verification of the diagnosis, and had magnetic resonance (MR) and/or computed tomographic (CT) images. Specifically evaluated was the presence or absence of gross imaging evidence of mandibular erosion and the integrity of the medial MS fascia as evaluated by a smooth margin between this fascia and the parapharyngeal space fat. RESULTS: Of the 30 tumors, 28 were high-grade malignancies and 2 were histiocytoses. Of these, 5 had mandibular erosion and violation of the MS fascia, 19 had bone erosion with an intact fascia, 4 had neither bone erosion nor fascial violation (3 of these patients were under the age of 20 years), and 2 had fascial violation with no bone erosion. CONCLUSIONS: In 76.7% of patients with a malignancy arising in the MS, on imaging the medial MS fascia was grossly intact. There were 4 patients with MS malignancy and neither violation of the medial MS fascia nor mandibular bone erosion. Thus, these imaging findings may not be good criteria to evaluate the presence of a high-grade MS malignancy, especially if the patient is under the age of 20 years, in which age group MS sarcomas are more likely to arise.
PMID: 9213112
ISSN: 1043-3074
CID: 478482

Sialoblastoma (embryoma): MR findings of a rare pediatric salivary gland tumor [Case Report]

Som, P M; Brandwein, M; Silvers, A R; Rothschild, M A
We report the findings in a 21-month-old girl who had a noninfiltrating mass in the left cheek, just anterior to the masseter muscle, which, at surgery, proved to be a sialoblastoma. Sialoblastoma has a histologic appearance reminiscent of a primitive state of salivary gland development; that is, it shows an arrested state of salivary maturation. MR imaging in this case showed that the lesion was isointense with muscle on T1-weighted images, had a high-intermediate signal intensity similar to that of fat on T2-weighted images, and enhanced sparsely and nonhomogeneously.
PMID: 9159361
ISSN: 0195-6108
CID: 478492