A case of metachronous bilateral secretory carcinoma.

Secretory carcinoma (SC) was first recognized as a distinct salivary malignancy in 2010. In the nine years since its recognition, there have been multiple reports of SC of the major and minor salivary glands, as well one case of tongue base involvement. Here we present the first reported case of bilateral SC. The first tumor, diagnosed before the recognition of SC, was classified as mucoepidermoid carcinoma. After the contralateral parotid tumor was diagnosed as SC in 2016, the two histologies were compared, and the mucoepidermoid carcinoma was reclassified as SC. In this report, we describe our patient's clinical course and review the SC literature, with a focus on pathologic diagnosis and clinical prognosis.

Tonsillar carcinoma metastatic to the spleen presenting as trauma: a case report.

BACKGROUND: Cancers of the head and neck rarely metastasize to the spleen. To the best of our knowledge, there is no reported case of a tonsillar carcinoma metastasizing to the spleen. METHOD AND RESULTS: This patient had a splenic capsular rupture likely related to his metastases that presented as a traumatic splenic injury. The patient had received neoadjuvant chemotherapy followed by concurrent chemoradiotherapy. Two months after completion of radiotherapy, he fell out of bed. The next day he had acute abdominal pain and hypotension. CT findings were consistent with splenic rupture, and he underwent splenectomy. Pathologic assessment of the specimen showed metastatic SCC. CONCLUSION: New splemic lesions in patients with head and neck cancer should be investigated.

In vitro discrimination of tumor cell lines with an electronic nose.

OBJECTIVE: The electronic nose is a sensor of volatile molecules that is useful in the analysis of expired gases. Our hypothesis is that the electronic nose can distinguish between different types of upper aerodigestive tract tumor cells in vitro. STUDY DESIGN: Cells from both tumor and normal cell lines were suspended in saline, and a polymer composite electronic nose was used to evaluate the headspace gases. The data were subjected to principal components analysis, and Mahalanobis distances were calculated to demonstrate the ability of the electronic nose to distinguish among samples. RESULTS: The tumor cell lines, including adenocarcinoma, squamous cell carcinoma, and mesothelioma, were distinct from each other, and from the normal fibroblast and smooth muscle cells as seen on canonical discrimination plots. CONCLUSION: The electronic nose can distinguish between tumor cell lines in vitro and has the potential to be a useful screening test for cancer.

Vaccination with human papillomavirus type 16 E7 peptide with CpG oligonucleotides for prevention of tumor growth in mice.

OBJECTIVE: To test whether an E7 peptide/CpG vaccine is effective in preventing and treating human papillomavirus-positive tumors in a murine model. INTERVENTION: First, an E7 peptide/CpG vaccine was administered systemically on days -14 and -7, and tumor cells were injected subcutaneously on day 0. Second, tumor cells were injected on day 0, and vaccine was administered on days 7, 14, and 21. MAIN OUTCOME MEASURES: Tumor size was measured 3 times per week. A tetramer assay was used to assess the presence of activated, E7-specific lymphocytes in spleen and tumor cells harvested from mice treated with a similar vaccination regimen. RESULTS: In the prophylactic study, 75% of mice injected with E7 peptide/CpG resisted tumor formation. In the therapeutic setting, tumors initially regressed and experienced delayed progression when compared with controls. Survival rates improved in E7/CpG-vaccinated mice. Tetramer analysis detected increased numbers of activated, E7-specific lymphocytes in the spleens and tumors of animals treated with the experimental vaccine when compared with controls. CONCLUSION: The use of CpG motifs as an adjunct to peptide-based immunotherapy has potential impact on the treatment of human papillomavirus-associated cancers.

Pediatric submandibular triangle masses: a fifteen-year experience.

BACKGROUND: The purpose of this study was to evaluate the surgical results of pediatric submandibular triangle masses, with specific attention to neoplastic processes. METHODS: We retrospectively reviewed the medical records of 105 patients aged 6 months to 21 years who underwent surgery in the submandibular triangle at a major pediatric tertiary care hospital from 1987 to 2001. RESULTS: One hundred five patients who underwent surgery in the submandibular triangle were included in the study. Twenty patients had neoplastic processes, six of which were of primary salivary origin (two mucoepidermoid carcinomas and four pleomorphic adenomas). Twenty-four patients underwent excision of inflamed or infected lymph nodes, and 23 patients underwent excision of inflamed or infected submandibular glands. Thirty-eight patients were included who underwent surgery for sialorrhea or to gain access for another surgical procedure. Complications included tumor recurrence, transient and permanent marginal mandibular nerve weakness, ranula, postoperative fluid collection, and cellulitis. Duration of follow-up ranged from no follow-up to 11 years. CONCLUSION: Surgical excision of submandibular triangle masses is uncommon. We present our experience with these lesions, with a discussion of diagnosis, surgical indications, and surgical complications.

Sialorrhea: a management challenge.

Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired children (i.e., those with mental retardation or cerebral palsy) and in adults who have Parkinson's disease or have had a stroke. It is most commonly caused by poor oral and facial muscle control. Contributing factors may include hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill. Sialorrhea causes a range of physical and psychosocial complications, including perioral chapping, dehydration, odor, and social stigmatization, that can be devastating for patients and their families. Treatment of sialorrhea is best managed by a clinical team that includes primary health care providers, speech pathologists, occupational therapists, dentists, orthodontists, neurologists, and otolaryngologists. Treatment options range from conservative (i.e., observation, postural changes, biofeedback) to more aggressive measures such as medication, radiation, and surgical therapy. Anticholinergic medications, such as glycopyrrolate and scopolamine, are effective in reducing drooling, but their use may be limited by side effects. The injection of botulinum toxin type A into the parotid and submandibular glands is safe and effective in controlling drooling, but the effects fade in several months, and repeat injections are necessary. Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides the most effective and permanent treatment of significant sialorrhea and can greatly improve the quality of life of patients and their families or caregivers.

Clinical care pathway for head and neck cancer: a valuable tool for decreasing resource utilization.

OBJECTIVE: To evaluate the durability over time of the reduction of resource utilization after implementing a clinical care pathway (CCP) for head and neck cancer surgery. DESIGN: Cohort study. SETTING: A tertiary care academic medical center. PATIENTS: We studied control subjects from 1995 (pre-CCP) (n = 87), a cohort from July 1, 1996, through July 31, 1997 (the first year after CCP implementation) (n = 43), and a cohort from 1999 (n = 82) after major resection and tracheostomy for upper aerodigestive tract cancer. INTERVENTIONS: Starting July 1, 1996, all patients undergoing major resection for head and neck cancer were treated using a CCP, which delineates daily interventions and goals. MAIN OUTCOME MEASURES: Length of stay (LOS), readmission and complication rates, and hospital charges. RESULTS: Median total LOS and LOS exclusive of the intensive care unit decreased in the first year and remained stable at 3 years (from 13.0 to 8.0 days and from 10.5 to 6.4 days, respectively). The intensive care unit LOS decreased across 3 years from 2.2 to 1.1 days (P=.001). Median total charges declined from 105,410 US dollars pre-CCP to 65,919 US dollars at 3 years. Incidence of postoperative pneumonia decreased from 12% to 1% (P=.02), and readmission rate decreased from 18% to 11% (P=.37) across 3 years. CONCLUSIONS: The CCP for head and neck cancer maintained the improvement in LOS and charges seen in the first year of implementation and continues to decrease resource utilization while enhancing quality of care.