Assessing the Agreement Between Preoperative Fine-Needle Aspiration Cytology (FNAC) Done for Major Salivary Gland Neoplasm When Reported by Head and Neck Pathologists and Non-head and Neck Pathologists with Its Final Histopathology.

The preoperative FNA is an important investigation in the workup of a salivary gland pathology. A preoperative diagnosis is important to plan management and counsel patients accordingly. In this study, we aimed to assess the agreement between the preoperative FNA and the final histopathology report when reported by a head and neck and a non-head and neck pathologist. All patients with major salivary gland neoplasm having undergone a preoperative FNA before surgery from January 2012 to December 2019 at our hospital were included in the study. Analysis was done to check for concordance between head and neck and non-head and neck pathologists of the preoperative FNA and final histopathology. Three hundred and twenty-five patients were included in the study. The preoperative FNA could identify the tumour as benign or malignant in the majority (n = 228, 70.1%). The agreement between the preoperative FNA, frozen section diagnosis and the reporting of grade in the frozen section and the final HPR was slightly better with the head and neck pathologist (kappa = 0.429, kappa = 0.698 and kappa = 0.257), respectively, than with the non-head and neck pathologist (kappa = 0.387, kappa = 0.519 and kappa = 0.158), all of which was statistically significant (p < 0.001). The diagnosis made with the preoperative FNA and reporting in the frozen section had a fair agreement with the final histopathology when reported by a head and neck pathologist in comparison to a non-head and neck pathologist.

Parathyroid Carcinoma: a Review.

Parathyroid cancer is a rare endocrine malignancy with only a few thousand cases reported worldwide. As a result, there exists considerable controversy regarding the various aspects of this disease, viz., etiology, diagnosis, and management. We hereby attempt to review the literature on parathyroid carcinoma (PC) and summarize the practices based on the current evidence available. The majority of the PC are sporadic although an association with hyperparathyroidism-jaw tumor syndrome, multiple endocrine neoplasia (MEN) 1 and 2, and isolated familial hyperparathyroidism has been shown. As preoperative diagnosis is challenging, PC should be suspected in patients presenting with a neck mass with signs and symptoms of invasion to surrounding structures. Skeletal and renal symptoms are often associated with PC as presenting complaints. The biochemical parameters are more pronounced in the case of PC compared with benign countpart. Due to its rarity, the American Joint Committee of cancer control (AJCC) acknowledges that as yet a clear distinct staging system to prognosticate the disease would be premature. Complete excision with negative margins at first surgery offers the best chance of cure. The role of radiotherapy (RT) is still unclear; however few series have suggested a better locoregional control with adjuvant RT. Recurrences are common and are most significantly associated with an incomplete clearance at initial surgery. Surgical salvage of recurrent/metastatic disease with medical management of hypercalcemia is the treatment of choice. Large prospective studies and trials need to be conducted to understand the pathology better and improve management protocols; however this is a challenge due to rarity of cases.

The clinical challenges and dilemma in the management of uncommon maxillary sinus tumors - A report of two cases.

Maxillary sinus is the common site for the nose and paranasal sinus tumors with diverse histopathological types and the treatment for each may differ. Making a histopathological diagnosis on occasion can be challenging. We had two patients presenting with upper alveolus growth in whom establishing the histopathological diagnosis was challenging. Through clinical evaluation, imaging (computed tomography and/or magnetic resonance imaging) and identification of key histopathological features helped in the management of these patients.

Results of sequential swallowing assessments in patients undergoing upfront surgery for oral tongue squamous cell carcinoma.

BACKGROUND: The swallowing outcomes in patients undergoing glossectomy have been inconsistently reported in the literature owing to variable follow up times, different tools for assessment and lack of single institution large scale studies. The aim of our study was to assess the patterns of swallowing outcomes over time and identify factors affecting nasogastric tube dependency at 1-year post-surgery. MATERIALS AND METHODS: This was a retrospective study of treatment naïve patients with oral tongue carcinoma who underwent surgery and attended the speech and swallow clinic between January 2016 and December 2019 at our institute were included in the study. The findings of swallowing assessment by a speech language pathologist at three time points were recorded. RESULTS: A total of 606 patients were found eligible for the study. The median age of the patients was 50 years with the 211 (34.8%) patients having T3/T4 disease. The swallowing outcomes in terms of tube dependence and the spectrum of diet tolerance seem to improve over time with an increasing number of patients switching over to a solid diet by 1 year. A higher defect class (HR = 24.43 [3.48-171.27]) and presence of co-morbidities (HR = 4.17 [1.59-10.92]) were associated with sustained feeding tube dependency status at 1 year. A nomogram was developed based on these findings. CONCLUSION: The swallowing outcomes in terms of tube dependence and the spectrum of diet tolerance seem to improve over time. A higher defect class and presence of co-morbidities were associated with NGT dependency at 1 year.

Factors Predisposing to the Unplanned Hospital Readmission (UHR) in Patients Undergoing Surgery for Oral Cavity Squamous Cell Carcinoma (OSCC): Experience from a Tertiary Cancer Centre.

Unplanned hospital readmissions (UHR) are known to add to patient morbidity, increase the cost of the treatment, and negatively impact the postoperative quality of life. The objective of the study was to identify the UHR rates of oral cavity squamous cell carcinoma (OSCC) patients following surgery and identify the predisposing factors for UHR. We conducted this retrospective analysis of all patients who underwent surgery for OSCC in our (single) surgical unit from January 2016 to December 2018. A total of 804 patients satisfied the eligibility criteria. Majority of the patients were males (n = 650, 80.8%). The median age of the patients was 50 years (Range: 16-89 years). The most common oral cavity subsite was buccal mucosa gingivobuccal (BM-GBS) OSCC. Forty patients (5%) required an UHR after discharge. The most common reason for readmissions was flap-related issues (11/40) and orocutaneous fistula (10/40). Other causes included wound infection (7/40), chest infection (2/40), hematoma/bleeding (3/40), and other lesser prevalent causes (7/40). Factors that significantly predisposed patients for UHR were re-exploration following the initial surgery [p < 0.001, OR 7.9 (4.09-15.59)] and BM-GBS subsite [< 0.001, OR: 2.89(1.24-6.73)]. The UHR rate in our study was 5%. Patients requiring re-exploration following the initial surgery and those with BM-GBS cancer were most likely to have the UHR.