Biomedical subjects
Publications and source records attributed to M Brandwein.
An expansile temporal bone lesion above the temporomandibular joint (TMJ) in a 55-year-old woman was initially diagnosed as pigmented villonodular tenosynovitis. Preoperative embolization of the tumor had resulted in excessive tumoral hemorrhagic pigment. The surgical and CT findings suggested that the TMJ was not involved, and a final diagnosis of giant cell tumor was made.
We describe an unusual salivary neoplasm, an epithelial-myoepithelial carcinoma (EMEC) of the parotid gland, that occurred in a 64-year-old man. A CT scan showed a fairly well defined heterogeneous lesion with smooth margins and slight enhancement. MR images showed a lesion with intermediate T1-weighted signal intensity and a relatively high T2-weighted signal intensity. Although the imaging characteristics of EMEC on both CT and MR studies are nonspecific, clinicians and radiologists must be aware of its high local recurrence rate, which has been reported to approach 50% in some series, and thus the need for periodic postoperative imaging to detect early recurrence.
OBJECTIVE: To describe an uncommon clinical entity, laryngeal oncocytic salivary adenomas. BACKGROUND: While the nomenclature of these lesions may differ depending on their histologic appearance, these tumors are all generally part of a spectrum of clinically benign cystic and papillary lesions derived from oncocytic metaplasia and hyperplasia of minor salivary ducts. DESIGN: Eight cases of laryngeal oncocytic lesions collected from two institutions. Further clinical background and follow-up data were obtained on five of eight patients. RESULTS: Patients were mostly in their seventh and eighth decades of life, and all who were questioned had smoking histories. Hoarseness was a common presenting complaint, and all patients had polypoid laryngeal masses. One patient presented with progressive upper airway obstruction, which was ultimately fatal; the laryngeal oncocytic cystadenoma was diagnosed in this case during postmortem examination. The laryngeal lesions were predominantly supraglottic. Histologically, they consisted of oncocytic metaplasia of the minor salivary ducts, cystic dilation, and papillary and microcystic hyperplasia. No recurrences were seen in those patients with follow-up (four of eight). CONCLUSIONS: Laryngeal oncocytic lesions usually present as supraglottic masses in older patients. While they are oncologically benign and nonrecurring after endoscopic removal, they may occasionally be the cause of significant upper airway obstruction.
Congenital cervical teratoma can be clinically dramatic, although essentially benign. Prognosis is good provided that the airway is quickly stabilized and resection is not delayed. We present a case of massive cervical teratoma diagnosed using antenatal magnetic resonance imaging. The child was maintained on maternal circulation after cesarean section until successfully intubated, with a second team ready for emergent bronchoscopy or tracheotomy. After delivery, the lesion grew rapidly with persistent bleeding; biopsy revealed a benign, immature teratoma. On computed tomography all anatomy ventral to the vertebrae was obliterated. At surgery, however, the tumor was easily resected. The literature is reviewed, with attention to malignancy in neonatal cervical teratoma. Surgery was delayed because of the aggressive imaging appearance and rapid growth. This case suggests that when evaluating neonatal tumors, the standard criteria for infiltration and resectability may require modification.
We examined the incidence of human papillomavirus (HPV) in intraoral cancers from 64 patients as determined by the highly sensitive technique of "hot start" polymerase chain reaction (PCR) in formalin-fixed paraffin-embedded tissues. Polymerase-chain-reaction-amplified HPV DNA was detected in the carcinomas of 16 patients (25%). The percentage of men in the HPV-positive (HPV+) group was greater than that in the HPV-negative (HPV-) group (86% versus 68%), but the difference was not statistically significant. There was no intraoral site preference for the HPV+ tumors. The mean age of viral-positive and -negative groups was similar (55 versus 53.8 yr). Three of 16 HPV+ patients (19%) had never smoked cigarettes; however, 16% of the HPV- group had also never smoked. Of interest, 38% of patients interviewed had occupation-related exposures that may have contributed to their carcinogenesis, and a disproportionate percentage of these patients (57%) were from the HPV+ group. There were no statistically significant differences between HPV+ and HPV- cases regarding T stage, clinical stage, and tumor differentiation. The disease-free interval did not differ significantly for HPV+ and HPV- patients in total nor when patients were stratified for tumor stage and clinical stage. The only group that showed some difference in outcome was that of the stage III/IV patients with oral cancer. We observed a shorter survival time for the HPV+ patients as compared with the HPV- patients (P = 0.09). We conclude that, in general, HPV is associated with a minority of intraoral cancers and its presence is not predictive of patient outcome.
PURPOSE: To determine whether the MR finding of cysts along the intracranial margin of sinonasal esthesioneuroblastomas can be considered to suggest this tumor. METHODS: MR scans of 54 patients who had sinonasal lesions with intracranial extension were examined specifically for cysts along the intracranial margins of the lesions. RESULTS: Only 3 of the 54 patients had these cysts, and all 3 of these patients had esthesioneuroblastoma. Surgical pathologic findings of one specimen showed the cyst to be marginally located within the tumor. CONCLUSION: If cysts are seen on MR along the intracranial margin of a sinonasal mass, this finding highly suggests esthesioneuroblastoma.
PURPOSE: To review the varied presentations of metastatic cervical lymph node disease in patients with papillary thyroid carcinoma. METHODS: Thirteen cases were retrospectively collected and their clinical, imaging, surgical, and pathologic material was reviewed. In the cases reviewed there was no clinical or imaging evidence of a primary thyroid mass. RESULTS: On CT, metastatic nodes can have multiple discrete calcifications, appear as benign cysts or hyperplastic or hypervascular nodes, or have areas of high attenuation which reflect intranodal hemorrhage and/or high concentrations of thyroglobulin. On MR, the nodes can have low to intermediate T1- and high T2-weighted signal intensities or high T1- and T2-weighted signal intensities, the latter reflecting primarily a high thyroglobulin content. CONCLUSION: If any of these varied appearances of cervical lymph nodes are identified on CT or MR, especially in a woman between 20 and 40 years of age, the radiologist should suspect the diagnosis of papillary thyroid carcinoma, even in the absence of a thyroid mass.
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1. To increase diagnostic yield, the otolaryngologist should convey suspicions of mycotic sinus disease to the pathologist. 2. Fungal cultures are a necessary adjunct to histopathologic identification. 3. Any sinonasal chronic inflammatory or granulomatous sinus process, or allergic process, may have a fungal etiology, even with negative GMS stains. 4. The diagnosis of sinonasal "inflammatory pseudotumor" should be accepted with some reservation, as it may represent an unrecognized sinonasal mycotic process. 5. Aspergillus spp. may be definitively identified histologically in sinonasal mycetomas and in invasive disease. When only fragments of thin septate hyphae, are found, one cannot assume they always belong to Aspergillus. 6. One must not assume that all wide "pleomorphic" hyphal fragments belong to Rhizopus or, for that matter, Zygomycetes. 7. Candida, Pseudoallescheria, Rhinosporidium and Cryptococcus are rare sinonasal pathogens that may also be positively identified morphologically.
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Laryngeal paragangliomas are uncommon, usually benign neoplasms. The overwhelming majority of these tumors are supraglottic, arising from the superior laryngeal parasympathetic paraganglia. Few paragangliomas of the infraglottic region have been described. We describe the case of a 35-year-old man with a family history of carotid body tumors who presented with an infraglottic paraganglioma.
Laryngeal chondrosarcomas are uncommon, and those that contain a distinct, nonchondroid, high-grade spindle cell sarcoma (the so-called "dedifferentiated" chondrosarcoma or chondrosarcoma with additional malignant mesenchymal component [CAMMC]) are extremely rare. Laryngeal CAMMC merit special attention, as CAMMC in other sites portends a poor prognosis. Eleven patients with laryngeal chondrosarcomas are reported on; 2 of these patients had CAMMC. On follow-up, 3 of the 11 patients had recurrences. The first had recurrence 4 and 11 years after tumor enucleation; that patient died disease free 2 years after salvage total laryngectomy. The second had recurrence 2 years after partial laryngectomy and was lost to follow-up after salvage total laryngectomy. The last patient recurred 13 years after partial laryngectomy and underwent salvage total laryngectomy; that patient was one of the two who developed CAMMC, and he also developed stomal recurrence of the "dedifferentiated" component 3 years after total laryngectomy. The other 8 patients are disease free after partial laryngectomy (6) or total laryngectomy (2) 10 months to 12 years later (mean: 51 months). This includes the 1 other patient with CAMMC, who is disease free 60 months after total laryngectomy. Laryngeal CAMMC has been shown, in at least one of the two patients, to be associated with a poor outcome. Patients with recurrent laryngeal chondrosarcomas do not have a poorer outcome after salvage total laryngectomy. The authors advocate partial laryngectomy if technically feasible.
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We report 5 patients with AIDS who had an unusual spindle cell proliferation in the lymph nodes and skin caused by nontuberculous mycobacteriosis. The spindle cell proliferation in these tissues may mimic a spindle cell neoplasm and pose a diagnostic problem if an infectious aetiology is not suspected. The fibroblast-like spindle cells contained numerous acid fast bacilli. They were strongly positive for antibody markers of monocyte/macrophage and leukocyte derivation: Leu M3, Mo-9, T-200, and HLA-DR, and variably positive for alpha-1 anti-chymotrypsin and lysozyme. Ultrastructurally these spindle cells were predominantly fibroblast-like with poorly developed features of macrophages. These results reveal the dual macrophage and fibroblastic character of the spindle cells and probably imply a functional differentiation rather than a histogenetic one.
Schneiderian inverted papillomas may be troublesome lesions for clinicians with propensity for recurrences. Dysplasia is not uncommonly seen, and some of these lesions do progress to develop squamous carcinoma. The authors hybridized in situ seven inverted papillomas with RNA probes to human papillomavirus (HPV) 6, 11, 16, and 18. Four of these contained dysplasia, two were without dysplasia, and one contained invasive squamous cell carcinoma. Five inverted papillomas showed evidence of HPV infection based on hybridization. One with mild to moderate and one with severe dysplasia, and one without dysplasia hybridized with mixed probe HPV 6/11. One with mild dysplasia and one associated with invasive squamous cell carcinoma hybridized with mixed probe HPV 16/18. One inverted papilloma without dysplasia and one with severe dysplasia did not definitively hybridize with either mixed probe. These findings raise interesting questions as to role of HPV 6/11 and 16/18 in the development of inverted papillomas, and probably on the progression to and carcinoma.
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