Salivary Gland Secretory Carcinoma With High-Grade Transformation, CDKN2A/B Loss, Distant Metastasis, and Lack of Sustained Response to Crizotinib.

BACKGROUND: Salivary gland secretory carcinoma is usually a low-grade neoplasm. However, high-grade transformation can occur and has important implications for clinical outcome. METHODS: A patient presented with an enlarging buccal mass. Magnetic resonance imaging (MRI) showed a tumor with a biphasic appearance along the right parotid duct. Local excision and histopathologic examination confirmed the diagnosis of secretory carcinoma with high-grade transformation. ETV6-NTRK3 translocation and loss of CDKN2A/B were identified. RESULTS: The patient subsequently presented with cough and dyspnea and was found to have pleural metastases. Carboplatin and paclitaxel exacerbated the symptoms. Crizotinib resulted in initial symptomatic and radiographic improvement; however, the patient soon succumbed to progressive intrathoracic disease. CONCLUSIONS: High-grade salivary gland secretory carcinoma can have a biphasic appearance on MRI. Diagnosis is confirmed by the histologic appearance and associated ETV6-NTRK3 fusion. Additional molecular genetic events leading to transformation are unknown; however, loss of CDKN2A/B may have contributed. Treatment with multimodal chemotherapy was of limited benefit.

Prevalence of Human Papillomavirus in Oropharyngeal Cancer: A Systematic Review.

PURPOSE: The global incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been increasing, and it has been proposed that a rising rate of human papillomavirus (HPV)-associated cancers is driving the observed changes in OPSCC incidence. We carried out this systematic review to further examine the prevalence of HPV in OPSCC over time worldwide. METHODS: A systematic literature search was performed to identify all articles through January 31, 2014, which reported on the prevalence of HPV in OPSCC. Articles that met the inclusion criteria were divided into 4 time frames (pre-1995, 1995-1999, 2000-2004, and 2005 to present) based on the median year of the study's sample collection period. Using a weighted analysis of variance model, we examined the trends of HPV-positivity over time worldwide, in North America, and in Europe. RESULTS: Our literature search identified 699 unique articles. One hundred seventy-five underwent review of the entire study, and 105 met the inclusion criteria. These 105 articles reported on the HPV prevalence in 9541 OPSCC specimens across 23 nations. We demonstrated significant increases in the percentage change of HPV-positive OPSCCs from pre-1995 to present: 20.6% worldwide (P for trend: P < 0.001), 21.6% in North America (P = 0.013), and 21.5% in Europe (P = 0.033). CONCLUSIONS: Interestingly, whereas in Europe there was a steady increase in HPV prevalence across all time frames, reaching nearly 50% most recently, in North America HPV prevalence appears to have plateaued over the past decade at about 65%. These findings may have important implications regarding predictions for the future incidence of OPSCC.

Peer mentorship in student-run free clinics: the impact on preclinical education.

BACKGROUND AND OBJECTIVES: Our study examines the perceptions of first-year medical students (MS1s) toward fourth-year colleagues (MS4s) in student-run free clinics to investigate the impact of peer mentorship on augmenting the clinical education received by MS1s in a primary care setting. To our knowledge, this is the first study examining the impact of MS4 mentorship in free clinics. METHODS: A 55-item online questionnaire was administered to MS1s 9 months after matriculation in April 2012. Questions focused on MS1 perceptions of MS4 impact on comfort with patients, self-reported improvement in clinical skills, and overall satisfaction with mentorship in free clinics. The MS4s referenced in the questionnaire were enrolled in a longitudinal service-learning elective. Results were analyzed using one-sample Wilcoxon sign-ranked median test and ordered logistic regression with STATA software. RESULTS: Fifty-five of 77 (71.4%) eligible students began the online survey, with 48 (62.3%) completing it. Responses reflected experiences at four student-run free clinics. Overall, MS4 presence improved MS1 comfort with patients and enhanced interactions with attendings. MS1s were satisfied with the level of MS4 mentorship and agreed that MS4s had a distinct mentoring role from attendings. Ordered logistic regression showed that presence of MS4s was significantly associated with self-reported improvements to physical exam skills at one clinic. CONCLUSIONS: At each clinic, MS1s reported improved comfort with patients and satisfaction with mentorship received from MS4s. MS4s did not merely duplicate the role of attending physicians but enhanced interactions between MS1s and physicians. This suggests that the consistent presence of MS4s is a valuable adjunct to the educational experience of free clinics volunteering for MS1s.

The impact of obesity on surgeon ratings and patient-reported outcome measures after degenerative cervical spine disease surgery.

OBJECTIVE: Obesity is a growing public health problem. A considerable number of patients undergoing cervical spine surgery are obese, but the correlation between obesity and surgical outcome is still unclear. In this study, we investigated the impact of body mass index (BMI) on patients' and surgeons' perception of spine surgery outcomes. METHODS: We analyzed a prospectively collected spine surgery registry with patient-reported outcome measures and surgeon ratings. Mixed-effects linear models and linear regression models were applied to investigate the relationship between different World Health Organization obesity classifications and surgical outcome. RESULTS: A total of 88 patients had surgery for degenerative cervical spine disease, with 97.72% follow-up at 3 months and 94.31% at 6 months postoperatively. Mean BMI was 27.92 ± 7.9 kg/m(2); 28.57% were overweight (BMI 25-29.9), and 31.57% were obese (Class I obesity, BMI 30-34.9). We found a positive correlation between BMI and VAS at 6 months (R = 0.298, P < 0.05) and between BMI and change in Neck Disability Index (R = 0.385, P < 0.01), suggesting that obese patients had less improvement and more pain 6 months postoperatively than nonobese patients. Overweight patients had worse MCS values (R = -0.275, P < 0.05) and obese patients had worse visual analog scale values 6 months after surgery (R = 0.284, P < 0.03). Interestingly, surgeon ratings matched the aforementioned results. Patients with greater BMI had worse surgeon ratings 3 and 6 months postoperatively (R = 0.555, P < 0.05), whereas normal-weight patients had better outcomes when rated from the surgeon's perspective (R = -0.536, P < 0.05). CONCLUSION: Obese patients had worse postoperative patient-reported outcome scores and less overall patient-rated improvement compared with nonobese patients. Patients with BMI >25 reported less improvement after surgery both in the patients' and in the surgeons' perspectives.