Clear-cell Variant of Mucoepidermoid Carcinoma Presenting as a Palatal Mass in a 10-Year-old Boy.

BACKGROUND: The clear-cell variant of mucoepidermoid carcinoma (MEC) involving minor salivary glands is extremely rare in children. CASE REPORT: We report a case of clear-cell variant MEC in the minor salivary gland in a 10-year-old boy who presented with a mass of the right hard palate. Fine-needle aspiration showed features suggestive of clear-cell variant of MEC. Microscopically, the tumor cells showed predominant clear cells and scattered mucous cells. There was increased mitotic activity (6/mm2). No tumor necrosis or nuclear pleomorphism was identified. The tumor cells were positive for cytokeratin 7 (CK7), tumor protein p63, P40 (ΔNp63), CK5/6 and mucicarmine. Rearrangement of mastermind-like transcriptional coactivator 2 (MAML2) (11q21) gene was present in the tumor cells by fluorescence in situ hybridization, supporting the diagnosis of an intermediate-grade clear-cell variant of MEC. A right infrastructure maxillectomy for palate carcinoma with negative margins was performed. Grossly, the tumor was a 2.1 cm well-circumscribed, friable, pale tan mass with focal areas of cystic change. The final pathological diagnosis was clear-cell variant of MEC, intermediate grade, pT2. Post surgery, the patient recovered and was doing well, with no tumor recurrence or metastasis at the 6-month follow-up. CONCLUSION: To the best of our knowledge, this is the first documented case of clear-cell variant MEC in a child. Due to low to intermediate tumor grade, an overtly aggressive treatment should be avoided in a child.

Subgemmal Neurogenous Plaque: A Clinical and Pathologic Review With Comparison to Common Head and Neck Neural Tumors.

OBJECTIVE: In humans, subgemmal neurogenous plaques (SNPs) are normally found associated with taste buds. On histology, SNP may be mistaken for a neural neoplasm. The objective of this study was to correctly differentiate SNP among head and neck neural lesions and provide clinical and pathologic information that may assist in avoiding misdiagnosis. To our knowledge, this is the first study to provide an estimate of the degree of overdiagnoses of mucosal lesions in the head and neck mucosal area. STUDY DESIGN: Retrospective pathology and chart review. METHODS: All cases of head and neck mucosal neural lesions only in the mucosa of the oral cavity, oropharynx, or larynx from the pathology archives of a single urban tertiary care center between 3/2000 and 6/2017 were obtained. The pathologic and clinical data were reviewed. RESULTS: Twenty-six cases were identified: 9 neuromas, 9 neurofibromas, 2 ganglioneuromas and 6 cases of hyperplastic subepithelial nerve bundles. The mean greatest dimension of SNPs was 2.0 mm (range 1-3 mm) and most were subjacent to taste buds (13 cases). The 20 cases of SNP involved 15 women and 5 men. Their median age was 60 years (range 30-85 years). Clinical data were available in 19 cases. The most common presenting complaint was of a painless lesion (8 patients). CONCLUSIONS: This review confirmed the rarity of true neural neoplasms in the head and neck mucosa and estimates the risk of their over diagnosis given the possible diagnostic confusion with SNP.

Amino acid and acetylcholine chemistry in the central auditory system of young, middle-aged and old rats.

Older adults generally experience difficulties with hearing. Age-related changes in the chemistry of central auditory regions, especially the chemistry underlying synaptic transmission between neurons, may be of particular relevance for hearing changes. In this study, we used quantitative microchemical methods to map concentrations of amino acids, including the major neurotransmitters of the brain, in all the major central auditory structures of young (6 months), middle-aged (22 months), and old (33 months old) Fischer 344 x Brown Norway rats. In addition, some amino acid measurements were made for vestibular nuclei, and activities of choline acetyltransferase, the enzyme for acetylcholine synthesis, were mapped in the superior olive and auditory cortex. In old, as compared to young, rats, glutamate concentrations were lower throughout central auditory regions. Aspartate and glycine concentrations were significantly lower in many and GABA and taurine concentrations in some cochlear nucleus and superior olive regions. Glutamine concentrations and choline acetyltransferase activities were higher in most auditory cortex layers of old rats as compared to young. Where there were differences between young and old rats, amino acid concentrations in middle-aged rats often lay between those in young and old rats, suggesting gradual changes during adult life. The results suggest that hearing deficits in older adults may relate to decreases in excitatory (glutamate) as well as inhibitory (glycine and GABA) neurotransmitter amino acid functions. Chemical changes measured in aged rats often differed from changes measured after manipulations that directly damage the cochlea, suggesting that chemical changes during aging may not all be secondary to cochlear damage.

Prevention of Tracheostomy-Related Hospital-Acquired Pressure Ulcers.

Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head. One year after the bundle was initiated, a retrospective analysis was performed to compare the percentage of tracheostomy patients who developed pressure ulcers versus the preintervention period. Results The incidence of tracheostomy-related pressure ulcers decreased from 20 of 183 tracheostomies (10.93%) prior to use of the standardized protocol to 2 of 155 tracheostomies (1.29%). Chi-square analysis showed a significant difference between the groups, with a P value of .0003. Discussion Adoption of this care bundle at our institution resulted in a significant reduction in the incidence of hospital-acquired tracheostomy-related pressure ulcers. The impact of any single intervention within our protocol was not assessed and could be an area of further investigation. Implications for Practice Adoption of a standardized posttracheostomy care bundle at the institution level may result in the improved care of patients with tracheostomies and specifically may reduce the incidence of pressure ulcers.

Use of ß-tricalcium phosphate grafts for Airway reconstruction in rabbits: A pilot study.

OBJECTIVES/HYPOTHESIS: To assess the safety and feasibility of using ß-tricalcium phosphate grafts in airway reconstruction in rabbits. STUDY DESIGN: Interventional animal study. METHODS: Ten New Zealand White rabbits underwent division of the anterior cricoid cartilage with interposition of a graft sculpted from ß-tricalcium phosphate blocks. Grafts were secured with sutures or were self-retaining. Rabbit larynges were harvested according to the following schedule: one at 1 week, one at 3 months, and two each at 2 weeks, 4 weeks, 6 months, and 1 year after graft implantation. Specimens were evaluated grossly for overall graft incorporation. Sections through the graft substance were prepared for histology. All sections were reviewed by a pathologist for evidence of vascular ingrowth, granulation tissue, inflammation, epithelialization, and graft resorption. RESULTS: There were no major postoperative complications. Gross examination revealed persistent widening of the airway at the level of graft placement. Histologic evaluation of the larynges showed growth of new blood vessels within all specimens and absence of significant granulation tissue near the airway lumen. The graft was at least partially covered by an epithelium in seven of the 10 specimens. Evidence of graft resorption was present as early as 4 weeks after implantation, with replacement of the graft substance by fibrous tissue, fatty tissue, bone, or cartilage. CONCLUSIONS: ß-tricalcium phosphate grafts can be used safely in airway reconstruction procedures in rabbits. Further research is necessary to demonstrate its safety in human airway reconstruction in addition to further clarifying the processes of graft resorption and integration. LEVEL OF EVIDENCE: NA Laryngoscope, 126:E255-E260, 2016.