Utility of the Milan System for Reporting Salivary Gland Cytopathology in Parotid Gland Masses: The Experience of Two Tertiary Centers.

Background The application of fine needle aspiration (FNA) in parotid masses via the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) enhances the diagnosis of these lesions alongside radiological investigations.  Objectives Our objective was to assess the risk of malignancy, sensitivity, specificity, and false positive and negative results for each category of the MSRSGC. Additionally, we assessed the level of agreement between the FNA results using MSRSGC and post-resection histopathological diagnosis. Methods We conducted a retrospective chart review of parotid gland masses that received FNA and postoperative pathological diagnosis at King Saud University Medical City and King Fahad Medical City between 2018 and 2022. We summarized the categorical variables using frequencies and percentages. Results A total of 172 cases met the inclusion criteria. Males encompassed 102 patients (59.3%) of the study sample, and 89 (51.7%) of parotid masses were on the left side. The risk of malignancy for the MSRSGC categories was 37.5% (Category I), 9.0% (II), 50.0% (III), 4.7% (IVa), 50.0% (IVb), 100.0% (V), and 71.0% (VI). FNA had an overall success rate of 81%. The sensitivity was 64% and specificity was 94% for non-neoplastic masses. For benign masses, the sensitivity was 91% and specificity was 66%; however, the sensitivity was 40% and specificity was 97% for malignant lesions. We found that the percentage of agreement between the FNA and final pathology was 80%. Conclusion FNA using MSRSGC is a valuable preoperative clinical tool. However, the low sensitivity rates based on the diagnosis of malignant lesions should alert clinicians not to be overly reliant on biopsy results and instead defer to definitive surgical management.

Translation and validation of the Arabic version of the sleep-related breathing disorder scale of the pediatric sleep questionnaire (PSQ-SRBD).

BACKGROUND/OBJECTIVES: The incidence of sleep-related breathing disorders is underestimated because polysomnography is required to confirm its diagnosis. The pediatric sleep questionnaire-sleep-related breathing disorder (PSQ-SRBD) scale is a self-reported questionnaire completed by a patient's guardian. There is no validated Arabic version of the PSQ-SRBD that can be used in the Arabic-speaking population. Therefore, we aimed to translate, validate, and culturally adapt the PSQ-SRBD scale. We also aimed to evaluate its psychometric properties for the diagnosis of obstructive sleep apnea (OSA). METHODS: The cross-cultural adaptation method consisted of the following steps: forward-backward translation, appraisal of a sample of 72 children (aged between 2 and 16 years) by an expert group, and performing Cronbach's alpha coefficient testing, Spearman's rank correlation coefficient testing, Wilcoxon signed-rank testing, and sign testing. The reliability of the Arabic version of the PSQ-SRBD scale was assessed using a test-retest comparison, and a factor analysis of the items was used to verify construct validity. For statistical purposes, p-values <0.05 were considered to indicate significance. RESULTS: All subscales had adequate internal consistency: 0.799 for snoring and breathing, 0.69 for sleepiness, 0.711 for behavioral problems, and 0.805 for the entire questionnaire. Comparing questionnaire responses administered 2 weeks apart revealed no statistically significant difference in total scores between the two groups (p-values >0.05 by Spearman's rank correlation coefficient test for all domains) and also no statistical difference among 20 out of 22 questions independently (p-value >0.05 by sign test). A factor analysis conducted to assess the structure of the Arabic-SRBD scale revealed good correlational patterns. The mean score before surgery was 0.464 ± 0.166, and this changed to 0.185 ± 0.142 after surgery with a reduction of 0.278 ± 0.184 which was statistically significant (p < 0.001). CONCLUSION: The Arabic version of the PSQ-SRBD scale is a valid tool for the assessment of pediatric OSA patients and can be used to follow-up patients after surgery. Future research will determine this translated questionnaire's applicability.

Pediatric Patient with Rhabdomyosarcoma Involving Temporal Bone: Case Report and Overview of Recent Cases.

BACKGROUND In the pediatric age group, middle ear tumors are rare. Rhabdomyosarcoma is considered the most common soft-tissue sarcoma in children. It comprises 5% of all pediatric malignant tumors. It is hypothesized to originate from embryonic mesenchymal cells of striated skeletal muscles. These malignant lesions display an aggressive behavior with local and distant metastasis and can be staged as per the Intergroup Rhabdomyosarcoma Study Group, depending on the organs involved, such as the orbit, head, neck, or genitourinary tract. CASE REPORT In this study, a 2-year-old boy with no medical ailments was presented with a history of ear pain and on/off bleeding from the right ear for 1 year. The patient's case was initially managed medically, for the clinical picture of an ear infection. However, clinical improvement was not seen. Therefore, radiological imaging was done. After further investigations, the diagnosis was confirmed, and a rare case of embryonal rhabdomyosarcoma of the temporal bone was reported. CONCLUSIONS Rhabdomyosarcoma is an uncommon tumor in which delayed diagnosis could cause a significant fatality rate in children. Physicians need a strong index of suspicion to make an early diagnosis. The presented case is of a 2-year-old boy with a clinical picture of a complicated ear infection who was found to have rhabdomyosarcoma of the temporal bone. Early detection and multimodal treatment are critical for a positive outcome.

An Atypical Lipomatous Tumor of the Hypopharynx: Case Report.

Nearly 20% of all mesenchymal tumors are liposarcoma in origin, mostly occurring in extremities and trunk. However, few cases of liposarcoma in the hypopharynx have been documented. This atypical localization of liposarcoma warrants a great interest in reporting such a case. Here, we report an 81-year-old Saudi male who presented to our clinic complaining of progressive dysphagia and globus sensation for two months. On examination, using a flexible nasopharyngoscopy, a hypopharyngeal mass occupying the left piriform sinus originating from the mucosa of the posterior pharyngeal wall and anteriorly from the anterior and medial piriform sinus mucosa was observed. Contrasted head and neck CT-scan revealed a benign-looking well-defined left-sided submucosal cyst aligned along the left aryepiglottic fold encroaching and narrowing the laryngeal inlet with dimensions of 1.8×2.1×2.7 cm. The mass was resected successfully using a trans-oral approach. A histopathological review showed spindle stromal cells that reacted positively for CD34 (Qbend10) on immunohistochemical staining and positive result for MDM2 (12q15) Amp. The pathology result indicates an abnormal amplification of the MDM2 gene region. The patient was followed for almost two years without evidence of recurrence. In conclusion, atypical lipomatous tumors (ALTs) of the hypopharynx are rarely diagnosed, and the gold standard for diagnosis is biopsy. Transoral endoscopic approach has a better outcome than cervical approach. Follow-up of patients with ALT is crucial, due to the highly recurring nature of the disease. Here we present a rare case of ALT, the patient had complete remission without complication.

Validation and Cultural Adaptation of the Arabic Version of the Aging Voice Index.

BACKGROUND: The aging voice index (AVI) is a 23-item self-administered, patient-reported outcome measure. It was developed in the English language to assess the impact of voice disorders on the elderly population. OBJECTIVES: This study aimed to develop an Arabic version of the AVI (A-AVI), test its reliability and validity, and assess its psychometric aspects in Arabic-speaking elderly persons with voice disorders. STUDY DESIGN/METHODS: This was an observational, cross-sectional study involving elderly patients aged ≥60 years. Eighty-two patients with voice disorders were included in the dysphonia group and 77 patients without voice disorders were included in the vocally healthy group. The translated A-AVI and Arabic voice handicap index 10 (A-VHI10) were distributed to the study groups. The A-AVI was tested for its reliability (test-retest reliability and internal consistency) and validity (content, construct, and concurrent with A-VHI10). RESULTS: The A-AVI showed excellent test-retest reliability and internal consistency (intraclass correlation coefficient = 0.987 and Cronbach's alpha = 0.954, respectively). There was a significant difference in A-AVI scores between the elderly in the dysphonia and vocally healthy groups (P < 0.001). In addition, a significant correlation was demonstrated between A-AVI and A-VHI10 (r = 0.89). Unilateral vocal fold immobility and inflammatory laryngeal disorders were most frequently reported by the dysphonia group (28%). CONCLUSIONS: A-AVI has excellent validity and reliability in Arab-speaking elderly patients with voice disorders. It can be considered in the assessment of the effect of voice disorders on the quality of life of the elderly.