Papillary Thyroid Carcinoma Arising from Thyroglossal Cyst-an Institutional Experience over a Decade.

Papillary carcinoma constitutes 80% of thyroglossal duct cyst carcinoma (TGCC). The mainstay of treatment for TGCC is Sistrunk procedure. Due to lack of clear-cut guidelines in managing TGCC, the role of total thyroidectomy, neck dissection and adjuvant radioiodine therapy is still debatable. This was a retrospective study which included cases of TGCC treated in our institution over a period of 11 years. The aim of study was to assess the need for total thyroidectomy in management of TGCC. Patients were divided into two groups based on the surgical treatment they underwent and the treatment outcomes were compared. The histology was papillary carcinoma in all cases of TGCC. Overall, 43.3% of TGCCs had a focus of papillary carcinoma in total thyroidectomy specimen. Lymph node metastasis was noted only in 10% of TGCC and not identified in isolated papillary carcinoma confined to thyroglossal cyst. 7-year overall survival (OS) for TGCC was 83.1%. Prognostic factors like extracapsular extension or lymph node metastasis did not affect OS. Addition of total thyroidectomy and neck dissection to Sistrunk procedure did not offer any survival advantage. In a case of TGCC, FNAC should be done from any clinically suspicious thyroid nodules or lymph nodes. TGCC has a good prognosis following treatment and none of the cases in our series has disease recurrence during follow-up. Sistrunk procedure was an adequate procedure for treatment of TGCC with clinically and radiologically normal thyroid gland.

Mucosal Melanomas of the Oral Cavity: A Tertiary Care Centre Experience of Surgically Treated Cases.

Mucosal melanoma of oral cavity (MMO) is a relatively rare tumour comprising of 40% of all head and neck mucosal melanomas. This study assessed the treatment outcomes and factors affecting prognosis in oral cavity mucosal melanomas. The clinical case records of 25 cases of oral cavity mucosal melanomas treated in our institution during 2003-2013 were retrospectively reviewed. Various clinicopathological parameters were taken into consideration and statistical analysis done by Kaplan-Meier method and Cox's proportional hazards model. The most common sites of MMO were upper alveolus and hard palate (64%) followed by lower alveolus (28%). 57.1% mucosal melanomas of hard palate and upper alveolus had associated metastatic lymph nodes whereas all cases of MMO of lower alveolus had lymph node metastasis. Disease failure at distant sites was higher than that at primary site or lymph nodes. The most common site of distant metastases was brain. The 5-year OS for treated cases was 23.8% and among subsites, MMO of hard palate and upper alveolus had the highest survival. Metastasis to lymph nodes and bone infiltration by tumour significantly decreased the survival. Recurrence at primary site had the worst prognosis. MMO with lymph nodal involvement and bone erosion had poor prognosis. Due to high chances of lymph node metastases and disease recurrence in lymph nodes following treatment, it is essential to do an elective neck dissection for all cases of MMO. Disease failure at primary site was an independent predictor of outcome in MMO.

Pattern of Post-Operative Infections Among Oral Cavity Cancer Patients in a Tertiary Care Cancer Centre: A Prospective Study.

Surgical site infections (SSIs) constitute a major problem among patients who undergo surgery for oral cancer and remain a substantial cause of morbidity, prolonged hospitalization and death. The aim of this study was to assess the microbial spectrum of post-operative wound infections and to assess the outcome of appropriate antibiotic usage in patients who underwent surgery for oral cancer. This was a prospective observational study done in a tertiary care cancer hospital. Patients who underwent surgery for cancers of the oral cavity during the period January 2014 to December 2016 were included in the study. The spectrum of infections, risk factors, microbial profile, antibiotic susceptibility pattern, treatment given and outcome were assessed. A total of 1431 patients who underwent surgery for cancers of the oral cavity during the study period were followed up. SSIs were noticed in 118 (8%) post-operative cases. This included 55 (76.4%) incisional SSIs and 17 (23.6%) organ/space SSIs. Culture of the surgical site in 72 infected patients yielded a total of 122 isolates. Thirty patients (41.6%) had polymicrobial infections. Gram-negative bacterial isolates (70.5%) outnumbered gram-positive bacterial isolates (27%). Majority of the patients (48 patients-66.6%) were in stage IV disease. Successful management of patients with bacterial infections depends on early identification of bacterial pathogens and selection of an effective antibiotic against the organism. Judicial use of antibiotics is also very essential to prevent the development of drug resistance.

A Rare Case of Extralaryngeal Schwannoma Arising from the Superior Laryngeal Nerve.

Schwannomas are the most common neurogenic tumours arising in the parapharyngeal space. Usually they arise from the vagus nerve but rarely have an extralaryngeal presentation arising from the superior laryngeal nerve. In the case reported here, cytology could not confirm the diagnosis and imaging could not identify the nerve of origin.

Correlation of TIRADS and Bethesda Scoring Systems with Final Histopathology of Thyroid Nodules - An Institutional Experience.

Fine needle aspiration cytology (FNAC) reduces the number of unnecessary thyroid surgeries for patients with benign nodules and appropriately triages patients with thyroid cancer to appropriate treatment. This was a observational study done on cases presenting with clinical suspicion of thyroid malignancy which underwent ultrasonography followed by FNAC of thyroid nodule. Ultrasonographic characterization of nodules was based on Thyroid Imaging Reporting and Data System (TIRADS) and cytology reporting was based on Bethesda system. All recruited patients underwent thyroidectomy. Pre-operative cytology and ultrasonography features were compared with final histopathology report. In our study, Bethesda system of cytology reporting for thyroid nodules had a better sensitivity, specificity and diagnostic accuracy than TIRADS system of ultrasound reporting. Bethesda system in FNAC had a larger area under the ROC curve (0.91) as compared to ultrasound TIRADS (0.70). Malignancy rate of TIRADS 5 nodules was 97.1% with significant p value (0.022). 100% of Bethesda VI lesions were malignant according to final histopathology report. Ultrasound TIRADS could pre-operatively predict malignancy in 63.6% of indeterminate thyroid nodules which were malignant according to post-operative histopathology. The overall concordance of ultrasound TIRADS, Bethesda system and histopathology was 69.8%. Higher TIRADS and Bethesda scoring among thyroid nodules was associated with increased risk of malignancy. US TIRADS is a good predictor of malignancy in indeterminate thyroid nodules.

Voice Rehabilitation After Laryngectomy: A Regional Cancer Centre Experience and Review of Literature.

Alaryngeal speech in laryngectomees has revolutionized the patient outlook toward the morbid procedure and the concept of permanent stoma unlike olden era when stigma of stoma with loss of voice was rampant. To analyse acceptance of voice rehabilitation options and their success and management of complications in a tertiary care centre. All patients who underwent laryngectomy from August 2014 to 2018 June at our institution were included in the study. The voice rehabilitation options like oesophageal speech, tracheao-oesophageal puncture and voice prosthesis insertion (TEP), and electrolarynx were explained to the patients. The options put forward to the patients, the importance of Taub test, Interval between treatment and secondary TEP insertion, life span of the prosthesis, Patients acceptance and success rates and the troubleshooting were noted. A total of 96 patients underwent total laryngectomy, 72 patients were willing for rehabilitation. 15% (11) patients had primary TEP, 22% (16) had secondary TEP insertion, esophageal speech in 36% (26) patients and 27% (19) patients opted for the electrolarynx. The rest 24 patients were not keen on any further interventions after laryngectomy. Speech rehabilitation is an integral part in surgical management of carcinoma of the larynx. Alaryngeal speech in laryngectomees have revolutionized the patient outlook towards the morbid procedure. Esophageal speech is the least successful method of rehabilitation but still the cheapest method and requires a lot of motivation. Primary and Secondary TEP insertions have similar success rates. Successful treatment for cancer of larynx ends with successful voice rehabilitation.

Clinicopathological Profile and Treatment Outcomes of Sinonasal Small Cell Neuroendocrine Carcinoma: A Rare Case Series.

Sinonasal small cell neuroendocrine carcinoma is a rare tumour in the head and neck region. Patients become symptomatic as the disease progresses to advanced stages. They are at risk for recurrence and distant metastasis following treatment. Early diagnosis and treatment have shown to improve the disease prognosis. This is a retrospective analysis of sinonasal small cell neuroendocrine carcinomas that underwent treatment based on institutional protocol. Data was collected from medical records of the patients and analyzed using descriptive statistics. Cell morphology on electron microscopy and immunohistochemistry played a significant role in differentiating small cell neuroendocrine carcinoma from other neuroendocrine tumours. 75% of cases presented in an advanced stage of malignancy. None of the patients had distant metastasis at initial presentation. Equal proportion of cases underwent surgery followed by adjuvant radiation (33.3%) and concurrent chemoradiation (33.3%). 25% of patients had recurrence of disease. The 2-year overall survival rate was 78.8%. Disease-free survival for cases that underwent surgery followed by radiation was higher than that of chemoradiation or radiation alone arms. There has been an improvement in treatment outcomes of sinonasal small cell neuroendocrine carcinoma which is best explained by paradigm shift in multimodality management towards surgery followed by adjuvant treatment.

'Doing as little as possible and as much as necessary' - Oncological efficacy of marginal mandibulectomy in resection of oral cavity cancers.

BACKGROUND: In carefully selected oral cavity cancers, marginal mandibulectomy is an adequate procedure which achieves good disease control adhering to the principle of "doing as little as possible and as much as necessary". METHODOLOGY: This was a retrospective study done by reviewing the medical records of all patients who underwent marginal mandibulectomy for resection of oral cavity cancers in our institution during a period of 5 years. Data was collected from medical case records and analyzed. RESULTS: 125 cases underwent marginal mandibulectomy for resection of oral cavity cancers. 88.5% of advanced oral cavity cancers that underwent neoadjuvant chemotherapy followed by marginal mandibulectomy are still disease free. The local recurrence rate was 10.4%. Among cases which recurred, 61.5% were in T2 stage of the disease and 30.8% recurred in buccal mucosa. For lesions on the mandible (26/125), the final histopathology showed bone infiltration in only 12% cases and among them only one recurred. Among 88/125 cases where the lesion was abutting mandible even after stretching mucosa, recurrence was noted only in 11.4% with 3-year overall survival of 79.3%. CONCLUSIONS: The low recurrence rate following marginal mandibulectomy in our study shows good locoregional control when performed for a lesion close to or abutting alveolar periosteum. In management of advanced oral cavity cancers, neoadjuvant chemotherapy followed by marginal mandibulectomy was effective in achieving significant locoregional control. For superficial lesions on the mandible, marginal mandibulectomy gives adequate margin clearance resulting in long term survival.

Vocal Cord Dysfunction: Analysis of 27 Cases and Updated Review of Pathophysiology & Management.

Introduction Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord movement resulting in abnormal inappropriate adduction, especially during inspiration; this predominantly manifests as unresponsive asthma or unexplained stridor. It is prudent to be well informed about the condition, since the primary presentation may mask other airway disorders. Objective This descriptive study was intended to analyze presentations of vocal cord dysfunction in a tertiary care referral hospital. The current understanding regarding the pathophysiology and management of the condition were also explored. Methods A total of 27 patients diagnosed with vocal cord dysfunction were analyzed based on demographic characteristics, presentations, associations and examination findings. The mechanism of causation, etiological factors implicated, diagnostic considerations and treatment options were evaluated by analysis of the current literature. Results There was a strong female predilection noted among the study population ( n = 27), which had a mean age of 31. The most common presentations were stridor (44%) and refractory asthma (41%). Laryngopharyngeal reflux disease was the most common association in the majority (66%) of the patients, with a strong overlay of anxiety, demonstrable in 48% of the patients. Conclusion Being aware of the condition is key to avoid misdiagnosis in vocal cord dysfunction. Fiberoptic laryngoscopy is the diagnostic gold standard to demonstrate paradoxical vocal cord adduction during an attack. A multidisciplinary approach should be adapted for the management, which should be specific and tailored for individual patients.

Vocal cord dysfunction: analysis of 27 cases and updated review of pathophysiology & management

Introduction: Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord movement resulting in abnormal inappropriate adduction, especially during inspiration; this predominantly manifests as unresponsive asthma or unexplained stridor. It is prudent to be well informed about the condition, since the primary presentation may mask other airway disorders. Objective: This descriptive study was intended to analyze presentations of vocal cord dysfunction in a tertiary care referral hospital. The current understanding regarding the pathophysiology and management of the condition were also explored. Methods: A total of 27 patients diagnosed with vocal cord dysfunction were analyzed based on demographic characteristics, presentations, associations and examination findings. The mechanism of causation, etiological factors implicated, diagnostic considerations and treatment options were evaluated by analysis of the current literature. Results: There was a strong female predilection noted among the study population ( n = 27), which had a mean age of 31. The most common presentations were stridor (44%) and refractory asthma (41%). Laryngopharyngeal reflux disease was the most common association in the majority (66%) of the patients, with a strong overlay of anxiety, demonstrable in 48% of the patients. Conclusion: Being aware of the condition is key to avoid misdiagnosis in vocal cord dysfunction. Fiberoptic laryngoscopy is the diagnostic gold standard to demonstrate paradoxical vocal cord adduction during an attack. A multidisciplinary approach should be adapted for the management, which should be specific and tailored for individual patients (AU)

Prevalence and clinical profile of fungal rhinosinusitis.

BACKGROUND: There are only a few landmark studies from the Indian subcontinent on fungal rhinosinusitis. The lack of awareness among clinicians regarding the varying clinical presentations of fungal rhinosinusitis prompted us to undertake this study. OBJECTIVE: To determine the prevalence, etiologic basis, clinical features, radiologic features, and microscopic features of fungal rhinosinusitis, and to evaluate the various treatment modalities available. METHODS: This was a prospective study in which evaluation of 100 patients with chronic rhinosinusitis was done. Specimens collected were subjected to both microbiology and pathologic examination; data collected, including clinical and radiologic features, were analyzed by the Pearson χ(2) test and Fisher's exact test. RESULTS: The prevalence of fungal rhinosinusitis in our study was 30% (n = 30). Mucor was the most commonly isolated species (n = 15 [50%]) of fungus. Pathologic examination had a higher sensitivity (76.67%) compared with microbiology tests (50%) in the diagnosis of fungal rhinosinusitis. Fungus ball (n = 14 [46.6%]) was the most prevalent entity in the spectrum of fungal rhinosinusitis. Forty percent of cases (n = 12) were of invasive fungal rhinosinusitis. The prevalence of fungal rhinosinusitis was higher among individuals who were immunocompetent (n = 17 [56.6%]). Of patients who were immunocompromised, 84.6% (n = 11) had mucormycosis. CONCLUSIONS: Unilateral involvement of paranasal sinuses was more in favor of fungal etiology. Complications were more common in fungal rhinosinusitis caused by Mucor species. Mucormycosis, a rare clinical entity, in subjects who were immunocompetent, had a high prevalence in our study.