Atypical presentation of invasive myoepithelioma in a pediatric patient.

A 15-year-old girl presented with a mobile lesion with yellowish hue on the posterior lamella of the right lower eyelid adjacent to the punctum. Four years prior, a lesion thought to be a chalazion was excised from the same location. There was subsequent progressive painless enlargement. The patient ultimately underwent an internal excision of the mass. Histopathology demonstrated infiltrative nests and cords of epithelioid and plasmacytoid cells with abundant eosinophilic myxoid-collagenous stroma along with focal infiltration of skeletal muscle with immunohistochemical staining consistent with an invasive myoepithelioma of mixed-cell type. Given concern for invasive disease, the patient underwent subsequent Mohs resection resulting in a 25% full thickness eyelid defect, which was repaired with direct closure of the wedge defect. There has been no recurrence of the disease for 7 months since the Mohs resection. This case illustrates the atypical presentation of an invasive myoepithelioma of the eyelid in a pediatric patient.

Basaloid follicular hamartoma of the eyelid in a pediatric patient.

PURPOSE: We report a case a pediatric patient with an eyelid lesion found to be a basaloid follicular hamartoma. OBSERVATIONS: A six-year-old female with juvenile diabetes who presented with a benign eyelid lesion harboring an aberrant eyelash. CONCLUSIONS AND IMPORTANCE: Basaloid follicular hamartoma is a rare benign neoplasm arising from hair follicles. These lesions can resemble basal cell carcinomas and require complete excision.

Incidence of late atrial fibrillation in bilateral lung versus heart transplants.

BACKGROUND: We compared the incidence of late-onset atrial fibrillation in orthotopic heart transplant recipients and bilateral orthotopic lung transplant recipients. METHODS: We reviewed the records of all heart and lung transplant operations carried out in our institution between 1995 and 2015. We performed 1:1 propensity-matching based on patient age, sex, body mass index, and hypertension. Our primary outcome, late-onset atrial fibrillation, was defined as atrial fibrillation occurring after discharge following hospitalization for transplantation. RESULTS: Over the study period, 397 orthotopic heart transplants and 240 bilateral orthotopic lung transplants were performed. Propensity matching resulted in 173 pairs who were matched with respect to age, sex, body mass index, and preoperative hypertension. The median follow-up was 5.3 years for heart transplant patients and 3.1 years for lung transplant patients. Late-onset atrial fibrillation occurred in 11 heart transplant patients (5 of whom had biopsy-proven evidence of rejection) and 19 lung transplant patients (2 of whom had biopsy-proven evidence of rejection). On Kaplan-Meier analysis, the probability of late-onset atrial fibrillation at 5 years was 4.3% for heart transplant patients vs. 13.9% for lung transplant patients (log-rank p = 0.01). CONCLUSIONS: We documented an increased probability of late-onset atrial fibrillation among bilateral orthotopic lung transplant patients compared to orthotopic heart transplant patients. This was a hypothesis-generating study that suggests a potential role for cardiac autonomic innervation in the genesis of atrial fibrillation.

Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation.

BACKGROUND: The aim of this study was to determine whether the duration of left ventricular device support (LVAD) influenced outcomes after orthotopic heart transplantation in a modern, bridge to transplant national cohort. METHODS: The United Network for Organ Sharing database, which has recently made pretransplant LVAD duration available, was queried for all adult bridge to transplant patients between January 2011 and December 2012. Three LVAD duration cohorts were generated, as follows: short (less than 90 days), intermediate (90 to 365 days), and prolonged (more than 365 days). Recipient, donor, and transplant-specific characteristics were compared among the duration cohorts. Unadjusted short-term and long-term survivals were estimated with the Kaplan-Meier method. Risk-adjusted models were also constructed to determine the independent impact of device duration on mortality. RESULTS: Of the 1,332 patients who met criteria for inclusion, 9.8% (n = 130), 54.7% (n = 729), and 35.5% (n = 473) were classified as short, intermediate, and prolonged, respectively. Although the performance status across each cohort was similar at listing (p = 0.38), more patients in the intermediate and prolonged cohorts were considered functionally independent before orthotopic heart transplantation (32% and 37%, respectively, versus 18%; p < 0.001). Additionally, despite worse baseline renal function in the intermediate and prolonged cohorts relative to the short cohort (glomerular filtration rate, 57 and 57 versus 69, p < 0.001), there was no difference in the incidence of new onset posttransplant renal failure (7% versus 10%, 9%, p = 0.41). There was also no difference in 30-day survival (98%, 96%, 95%, p = 0.51), 6-month survival (93%, 92%, 92%, p = 0.93), or 1-year survival (91%, 89%, 89%, p = 0.78) across the cohorts. After risk adjustment, duration did not independently predict mortality at any timepoint. CONCLUSIONS: In the largest, non-industry sponsored study of a modern bridge to transplant cohort, we demonstrated that duration of LVAD support before orthotopic heart transplantation does not influence posttransplant morbidity or mortality. In subanalysis, support for 90 days or more is associated with improvements in pretransplant functional performance.