Publications by authors named "Azita S Khorsandi"

41 Publications

Rare case of anaplastic plasmacytoma in the sinonasal tract.

Head Neck 2021 Jul 17. Epub 2021 Jul 17.

The Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.

Background: Extramedullary plasmacytomas are tumors that develop from plasma cells and rarely express anaplastic features. To our knowledge, there have only been three reported cases of anaplastic plasmacytomas of the sinonasal tract in the English literature. We detail the fourth case.

Methods: A 70-year-old male was seen with a 4-month history of nasal congestion, bloody mucous, and left sided nasal obstruction. On positron emission tomography/computed tomography, the lesion was FDG-avid with an SUV of 25.1. A biopsy of the lesion and subsequent immunohistochemical staining confirmed the diagnosis of an anaplastic plasmacytoma.

Results: The patient is undergoing a 5-week course of curative-intent radiation therapy.

Conclusion: Extramedullary plasmacytomas with anaplastic features are very rare. We highlight the value of thorough histopathological review and detailed immunostains to arrive at a diagnosis of anaplastic extramedullary plasmacytoma.
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http://dx.doi.org/10.1002/hed.26818DOI Listing
July 2021

Reconstruction of the external auditory canal: The tragal flap revisited and review of contemporary reconstructive techniques.

Am J Otolaryngol 2021 May 31;42(6):103094. Epub 2021 May 31.

Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA.

Background: Primary malignancies arising in the external auditory canal (EAC) are rare and usually are treated surgically. We review techniques to reconstruct the EAC following ablative surgery, and introduce a rarely utilized tragal skin flap which has particular advantages for reconstruction of limited anterior EAC defects.

Methods: The terms "tragal flap", "external auditory canal", "preauricular tragal flap", "reconstructive techniques" were searched on PubMed and Google Scholar.

Results: Our review identified one description of a tragal flap to reconstruct the EAC following resection of a malignancy. We add an additional case of a preauricular tragal flap to reconstruct the anterior EAC following resection of a recurrent basal cell carcinoma located in the EAC that led to a circumferential defect.

Conclusion: There are several surgical techniques that can be utilized to reconstruct the EAC. We describe a novel tragal flap used to reconstruct the anterior EAC following resection of a recurrent tumor.
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http://dx.doi.org/10.1016/j.amjoto.2021.103094DOI Listing
May 2021

Diagnosis and management of pharyngoesophageal stenosis: A comprehensive approach to prophylactic, endoscopic, and reconstructive treatment options.

Am J Otolaryngol 2021 Mar 22;42(5):103003. Epub 2021 Mar 22.

Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America.

Background: Pharyngoesophageal stenosis (PES) is a serious complication that substantially impacts functional outcomes and quality of life (QOL) for up to a third of head and neck cancer patients who undergo radiotherapy. Dysphagia is often multifactorial in nature and is a devastating complication of treatment that impacts patients' QOL, general health and overall wellbeing. The authors detail the clinical presentation, risk factors, imaging characteristics, preventive measures, and multimodality treatment options for PES.

Methods: The authors present a comprehensive management algorithm for PES, including treatment by dilation, stenting, spray cryotherapy and dilation, and reconstructive treatment options utilizing different pedicled and free flaps.

Results: The authors advocate for a thorough assessment of the extent and degree of pharyngoesophageal involvement of PES to determine the optimal management strategy.

Conclusions: The development of post treatment dysphagia requires appropriate imaging and biopsy, when indicated, to rule out the presence of persistent/recurrent cancer. Multidisciplinary management by a team of physicians well-versed in the range of diagnostic and therapeutic interventions available for PES is critical to its successful management.
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http://dx.doi.org/10.1016/j.amjoto.2021.103003DOI Listing
March 2021

Extraskeletal Ewing sarcoma of the buccal space.

Clin Imaging 2021 May 25;73:108-110. Epub 2020 Dec 25.

Thyroid, Head, and Neck Cancer (THANC) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY 10003, USA.

Extraskeletal Ewing sarcoma (EES) is a rare soft tissue tumor, and EES of the head and neck is particularly rare. Radiographic imaging of these lesions is crucial given their anatomical complexity and infrequent incidence. Conventional EES imaging features include a large, hyperintense, heterogeneously enhancing lesion, with frequent invasion of local structures. In this case report, a 19-year old male presented with left facial swelling and pain. He underwent sclerotherapy and bleomycin treatment for a presumed lymphatic malformation. Initial imaging demonstrated a rim-enhancing lesion within the left buccal space with no muscle invasion or bony erosion present. Two years later, imaging identified an enlarging buccal mass with destruction of the zygomatic arch and inferolateral orbital wall. The patient underwent surgical resection of the mass. Pathology confirmed the mass to be a small round blue cell tumor and FISH testing confirmed the presence of the EWSR1 gene arrangement that is consistent with EES. The patient tolerated the procedure well and underwent chemoradiation therapy. At three years postoperatively, the patient remains disease free. The presented case demonstrates an unusual presentation of a buccal space EES as a rim-enhancing, centrally hypointense mass with no bony erosion or muscular invasion. The location and atypical imaging appearance of this case offer insight for future diagnosis of EES.
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http://dx.doi.org/10.1016/j.clinimag.2020.12.004DOI Listing
May 2021

Metastatic thyroid carcinoma to the parapharyngeal and retropharyngeal spaces: Systematic review with seven newly reported cases describing an uncommon presentation of a common disease.

Head Neck 2021 04 9;43(4):1331-1344. Epub 2020 Dec 9.

Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA.

Background: Metastatic thyroid carcinoma to retropharyngeal and parapharyngeal (RP/PP) lymph nodes is rare. Literature suggests previous lateral neck dissection (LND) may alter patterns of lymphatic drainage in the neck, predisposing to these less common sites of spread.

Methods: PRISMA-guided systematic search for all published cases detailing RP/PP metastases of well-differentiated thyroid carcinoma from 1970 to 2019.

Results: Seventy articles were identified and 44 were included, along with seven cases treated at our institution, totaling 239 cases. Cases represented both retropharyngeal (60.7%) and parapharyngeal (39.3%) metastases identified in the initial (27.6%) and recurrent (72.4%) setting.

Conclusion: RP/PP metastases generally present in the recurrent setting. RP/PP metastases often represent high-risk disease, and surgical treatment is recommended.
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http://dx.doi.org/10.1002/hed.26572DOI Listing
April 2021

Oral squamous carcinoma: Aggressive tumor pattern of invasion predicts direct mandible invasion.

Head Neck 2020 11 25;42(11):3171-3178. Epub 2020 Jul 25.

THANC (Thyroid, Head and Neck Cancer) Foundation, New York City, New York, USA.

Background: Aggressive histologic worst pattern of invasion (WPOI) in surrounding soft tissue has been shown to be predictive of higher local recurrence and poorer survival in oral cavity squamous cell carcinoma (OCSCC) patients. This study investigates whether aggressive WPOI can predict the mandibular invasion phenotype.

Methods: Patients consecutively diagnosed with OCSCC undergoing a mandibulectomy (marginal or segmental) between 2013 and 2018 were reviewed. Senior physicians re-reviewed radiologic scans and pathologic slides of 44 cases.

Results: Aggressive WPOI (WPOI-4, 5) is significantly associated with infiltrative bone invasion. Non-aggressive WPOI (WPOI-1, 2, 3) is significantly associated with the absence of bone invasion.

Conclusions: WPOI has become a useful tool that further characterizes the biologic behavior of OCSCC. Potentially, planned surgery may escalate from a marginal to segmental mandibulectomy based on aggressive WPOI for patients with radiographically uncertain cortical status. Further studies are needed to validate the relationship between OCSCC WPOI and mandible status.
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http://dx.doi.org/10.1002/hed.26360DOI Listing
November 2020

A novel approach to neurologic function sparing surgical management of vagal schwannomas: Continuous intraoperative nerve monitoring of the laryngeal adductor reflex.

Head Neck 2019 09 6;41(9):E146-E152. Epub 2019 May 6.

THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.

Background: Vagal schwannomas are rare, benign tumors of the head and neck. Nerve damage during surgical resection is associated with significant morbidity. A new technique of continuous intraoperative nerve monitoring (IONM) that allows for real-time intraoperative feedback has recently been used for thyroid and cervical spine surgeries but has not previously been used in vagal schwannoma surgery.

Methods: Case series of three patients who underwent vagal schwannoma excision utilizing this novel IONM technique. The recurrent laryngeal and vagus nerves were monitored via the laryngeal adductor reflex (LAR) using an electromyographic endotracheal tube.

Results: Three patients with suspected vagal schwannomas were treated surgically using the intracapsular enucleation approach with a combination of intermittent IONM and continuous IONM of the LAR.

Conclusion: This combination of continuous and intermittent IONM can be used to preserve vagal laryngeal innervation and function and may represent the future standard of care for vagal schwannoma excision.
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http://dx.doi.org/10.1002/hed.25793DOI Listing
September 2019

Vagal schwannomas of the head and neck: A comprehensive review and a novel approach to preserving vocal cord innervation and function.

Head Neck 2019 07 7;41(7):2450-2466. Epub 2019 Apr 7.

THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.

Background: Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges.

Methods: A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed.

Results: Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low.

Conclusion: The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment.
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http://dx.doi.org/10.1002/hed.25758DOI Listing
July 2019

A rare invasion route for differentiated thyroid carcinoma: The tracheoesophageal common party wall.

Laryngoscope 2019 12 12;129(12):E455-E459. Epub 2019 Mar 12.

Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai West, New York, New York, U.S.A.

Thyroid carcinoma can infiltrate the aerodigestive tract. Invasion via the common party wall of the tracheoesophageal groove (TEG) is rare. A review of patients with thyroid cancer invading the aerodigestive tract was performed. We describe three cases of invasive thyroid cancer presenting 4 to 6 years after the initial thyroidectomy. Original pathology showed positive margins near the recurrent laryngeal nerve and TEG. A partial tracheal resection with a stair-step reconstruction was performed in one case; the other cases required total laryngopharyngectomy. Surgeons should be prepared to perform oncologically complete resections at the primary surgery to avoid potentially significant clinical consequences requiring aggressive surgery. Laryngoscope, 129:E455-E459, 2019.
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http://dx.doi.org/10.1002/lary.27915DOI Listing
December 2019

Osteoradionecrosis of the hyoid bone complicated by pharyngocutaneous fistula: A case report and literature review.

Am J Otolaryngol 2019 Mar - Apr;40(2):314-318. Epub 2018 Dec 7.

THANC (Thyroid, Head and Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 5B, New York, NY 10003, USA.

Background: Osteoradionecrosis (ORN) is a well-known complication following irradiation of head and neck malignancies. ORN commonly occurs in the mandible but is rarely reported in the hyoid bone.

Case Presentation: A 76-year-old female with a history of oropharyngeal squamous cell carcinoma presented with pharyngocutaneous fistula 14 years after primary chemoradiation. Imaging showed necrosis of the hyoid bone. She underwent excision of the hyoid to rule out malignancy. Pathology was negative for carcinoma, but did show extensive fragmentation and bony necrosis consistent with ORN. The patient's clinical course, surgical treatment, and management considerations are discussed here.

Conclusions: Hyoid ORN should remain in the differential during diagnostic workup of previously irradiated head and neck cancer patients. The presentation of a pharyngocutaneous fistula should prompt workup to rule out malignancy before assigning a diagnosis of ORN.
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http://dx.doi.org/10.1016/j.amjoto.2018.12.006DOI Listing
June 2019

Septic arthritis of the sternoclavicular joint: A unique late complication after tracheostomy.

Am J Otolaryngol 2018 Sep - Oct;39(5):646-648. Epub 2018 May 16.

THANC (Thyroid, Head and Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY 10003, USA; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 5B, New York, NY 10003, USA.

Background: Septic arthritis of the sternoclavicular joint is a rare infection associated with significant morbidity and mortality. Several risk factors for septic arthritis have been reported in the literature ranging from immunodeficiency to intravenous drug use.

Case Presentation: A 63-year-old male previously treated for synchronous squamous cell carcinomas of the epiglottis and floor of mouth presented with tenderness and swelling of the sternoclavicular joint two months after tracheostomy decannulation. Computed tomography and bone scans confirmed the diagnosis of septic arthritis of the sternoclavicular joint. The patient's clinical course, surgical treatment, and management considerations are discussed here.

Conclusion: Septic arthritis of the SCJ is a rare but serious infection. Once diagnosed, septic arthritis of the SCJ should be promptly treated to prevent further morbidity and mortality.
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http://dx.doi.org/10.1016/j.amjoto.2018.05.005DOI Listing
January 2019

Primary mucinous eccrine carcinoma of the buccal space: A case report and review of the literature.

Am J Otolaryngol 2018 Mar - Apr;39(2):242-246. Epub 2018 Jan 5.

Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Importance: Mucinous eccrine carcinoma is a rare entity that most commonly affects the head and neck. Due to its low frequency of occurrence, review of its etiology, histopathology, and treatment strategies is beneficial to all clinicians who may encounter similar appearing masses.

Observation: An 84-year-old male presented with a blue mass on the left cheek. This mass started as a small bump and grew significantly over one year. His primary care physician monitored its growth and ultimately referred to an otolaryngologist. Imaging findings revealed a multi-lobular solid and cystic left buccal lesion. FNA was suggestive of low grade mucoepidermoid carcinoma.

Intervention: Patient underwent surgical excision with primary closure of the defect. Frozen section was consistent with low grade salivary malignancy. Final pathology revealed primary mucinous eccrine carcinoma of the skin.

Conclusions And Relevance: Mucinous eccrine carcinoma is a rare entity commonly seen in the head and neck region. Mucinous deposits to the skin from primaries elsewhere in the body are much more common than primary lesions of the skin. Histology is a key component of the diagnosis but full oncologic workup is required. Treatment typically includes wide local excision with possible adjuvant chemotherapy or radiation for high risk features.
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http://dx.doi.org/10.1016/j.amjoto.2017.12.020DOI Listing
September 2018

Ipsilateral Ophthalmic and Cerebral Infarctions After Cosmetic Polylactic Acid Injection Into the Forehead.

J Neuroophthalmol 2017 03;37(1):77-80

The Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.

A 55-year-old woman developed no light perception vision in her right eye 5 days after an injection of polylactic acid cosmetic filler into her right forehead. Diffuse corneal edema and anterior chamber inflammation prohibited any view to the posterior segment to identify the cause of her profound vision loss. MRI of the orbits with diffusion-weighted imaging showed hyperintensity of the right optic nerve with signal reduction on apparent diffusion coefficient mapping, consistent with ischemia. Our patient also was found to have acute infarctions in the distribution of the right anterior cerebral artery on MRI of the brain despite having no permanent focal neurologic deficits aside from vision loss.
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http://dx.doi.org/10.1097/WNO.0000000000000459DOI Listing
March 2017

Leiomyoma of the sternothyroid muscle.

Am J Otolaryngol 2016 May-Jun;37(3):217-20. Epub 2016 Jan 22.

Mount Sinai, Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, 10 Union Square East Suite 5b, New York, NY, 10003. Electronic address:

Background: Leiomyomas are benign cutaneous tumors of smooth muscle origin. Only a small percentage of leiomyomas arise in the head and neck region. We present the first case of leiomyoma arising in the sternothyroid muscle of the neck.

Case Report: We analyze the clinical presentation, pathology, and histology for a single case study. The histologic findings of the tumor located in the sternothyroid muscle support the diagnosis of leiomyoma.

Discussion: This is the first case of leiomyoma arising in the sternothyroid muscle, and only the second reported case of leiomyoma in the strap muscles of the neck.

Conclusion: Leiomyoma should be included in the differential diagnosis of soft tissue tumors in the head and neck region. A histological analysis is essential in determining both tumor type and subtype, which will inform the proper course of treatment.
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http://dx.doi.org/10.1016/j.amjoto.2016.01.012DOI Listing
October 2017

Management algorithm for HIV-associated parotid lymphoepithelial cysts.

Eur Arch Otorhinolaryngol 2016 Oct 16;273(10):3355-62. Epub 2016 Feb 16.

Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA.

We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control (p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.
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http://dx.doi.org/10.1007/s00405-016-3926-4DOI Listing
October 2016

Oral cavity squamous cell carcinoma metastatic to central compartment (level 6) lymph nodes.

Laryngoscope 2016 08 22;126(8):1803-5. Epub 2015 Oct 22.

Department of Otolaryngology, Mount Sinai Beth Israel, New York, New York.

Alterations to drainage pathways in the head and neck as a result of surgical manipulation are not well understood. We present two unusual cases of oral squamous cell carcinoma metastatic to the level 6 nodal compartment following extensive treatment. Both oral squamous cell carcinoma cases exhibited metastases to the central neck compartment following extensive surgery and radiation. Each patient had prior history of multifocal oral cavity disease and recurrent neck metastases requiring salvage lymphadenectomy. Surgical interventions may alter the usual lymphatic drainage patterns. In cases of extensive treatment, all levels of the neck should be monitored for lymph node recurrence. Laryngoscope, 126:1803-1805, 2016.
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http://dx.doi.org/10.1002/lary.25740DOI Listing
August 2016

Intraoral sebaceous carcinoma metastatic to the lung and subcutis: Case report and discussion of the literature.

Head Neck 2016 Jan 18;38(1):E20-4. Epub 2015 Jul 18.

Department of Pathology, Mount Sinai Beth Israel, New York, New York.

Background: Intraoral sebaceous carcinoma is a rare form of sebaceous carcinoma with only 9 published cases in the world literature to date. We present a 10th case of intraoral sebaceous carcinoma located in the anterior maxillary gingiva with metastases to the lung and subcutis and discuss 3 possible etiologies for this unique presentation.

Methods: We analyze the clinical presentation, pathology, histology, and genetic testing for a single case study and review relevant literature.

Results: The histologic findings of the lung tumor and surgical excisions of the tumors in the gingiva and subcutis suggest the gingiva is the primary site. There is no evidence for the genetic abnormalities consistent with Muir-Torre syndrome.

Conclusion: The histologic findings suggest the oral cavity is the most likely site of tumor origin. This is the first case of intraoral sebaceous carcinoma reported to arise in the gingiva as well as to spread to cutaneous sites.
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http://dx.doi.org/10.1002/hed.24091DOI Listing
January 2016

Pediatric odontogenic fibromyxoma of the mandible: Case report and review of the literature.

Head Neck 2016 Jan 18;38(1):E25-8. Epub 2015 Jul 18.

Department of Otolaryngology, Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York.

Background: Odontogenic fibromyxoma is an uncommon benign tumor arising from the maxillofacial bones. Fibromyxomas are rare in children under 10 years of age. Although this tumor is reported most frequently in the mandible for the general population, it has rarely been reported in the mandible in children <10 years of age.

Methods: We reviewed the 39 reported cases of odontogenic fibromyxoma in children under the age of 10. We add 1 case to the literature.

Results: This case represents the seventh case of odontogenic fibromyxoma of the mandible in a child under the age of 10 years reported in the English literature.

Conclusion: A case of pediatric odontogenic fibromyxoma in the mandible is described. Although rare in the pediatric population, odontogenic fibromyxomas should be included as a differential diagnostic consideration when evaluating tumors of the maxillofacial skeleton. Accurate pathologic diagnosis is critical to ensure proper management.
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http://dx.doi.org/10.1002/hed.24090DOI Listing
January 2016

Extramedullary plasmacytoma of the cricoid cartilage with solitary plasmacytoma of the rib.

Am J Otolaryngol 2015 Jul-Aug;36(4):598-600. Epub 2015 Feb 23.

Department of Radiology, Mount Sinai Beth Israel, 10 Union Square East, New York, NY, USA. Electronic address:

Background: Extramedullary plasmacytoma is a rare plasma cell neoplasm of the soft tissues characterized by the presence of a single, discrete lesion without evidence of systemic disease. Extramedullary plasmacytoma may disseminate into multiple myeloma, a systemic plasma cell disease.

Methods: A rare case of extramedullary plasmacytoma of the cricoid cartilage with solitary plasmacytoma of the rib was reviewed.

Results: The patient was found to have two discrete lesions; one of the cricoid cartilage and one of the lateral left fifth rib. Despite the presence of multiple tumors, the patient was not diagnosed with multiple myeloma as the bone marrow appeared normal.

Conclusions: Due to the rarity of these neoplasms and the unusual localization of the extramedullary plasmacytoma tumor, a definitive diagnosis was difficult to make in this case. This case may be instructive for the differential diagnosis of laryngeal lesions.
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http://dx.doi.org/10.1016/j.amjoto.2015.02.010DOI Listing
March 2016

Growing mass on the right side of the neck.

JAMA Otolaryngol Head Neck Surg 2014 Nov;140(11):1085-6

Department of Radiology, Mount Sinai Beth Israel, New York, New York5Department of Radiology, Albert Einstein College of Medicine, New York, New York.

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http://dx.doi.org/10.1001/jamaoto.2014.2302DOI Listing
November 2014

Postoperative radiation therapy for parotid pleomorphic adenoma with close or positive margins: treatment outcomes and toxicities.

Anticancer Res 2014 Aug;34(8):4247-51

Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, New York, NY, U.S.A.

Aim: To evaluate the locoregional control and treatment toxicity of patients with pleomorphic adenoma after resection with close or positive margins followed by postoperative radiation therapy (PORT).

Patients And Methods: Between 2002 and 2011, twenty-one patients underwent PORT at the Mount Sinai Beth Israel Medical Center for pleomorphic adenoma of the parotid with close or positive margins. Four out of the 21 patients (19%) had recurrent lesions. The median dose was 57.6 Gy (range 55.8-69.96) delivered at 1.8-2.12 Gy/fraction. Treatment and follow-up data were retrospectively analyzed for locoregional control as well as acute- and late-treatment toxicities. Actuarial survival analysis was also performed.

Results: Twelve women and 9 men with a median age of 46 (26-65) at PORT were included in this study. Eighty-one percent of the cohort had positive resection margins while 19% had close margins. At a median follow-up of 92 months, 19/21 patients (90%) had locoregional control. Two patients who failed had primary lesions which recurred locally, and initially had positive margins. The two recurrences occurred at 8 months and 12 months. Acute Radiation Therapy Oncology Group (RTOG) grade 1 and 2 toxicities were experienced by 11 (52%) and 4 (19%) patients, respectively, while 2 (10%) experienced late RTOG grade 1 toxicities. No patients experienced any grade 2-4 late toxicities. Actuarial survival was 100%.

Conclusion: PORT for patients with pleomorphic adenoma of the parotid gland after resection with close or positive margins results in excellent locoregional control and low treatment-related morbidity.
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August 2014

Initial experience with oropharynx-targeted radiation therapy for metastatic squamous cell carcinoma of unknown primary of the head and neck.

Anticancer Res 2014 Jan;34(1):243-8

Department of Radiation Oncology, Beth Israel Medical Center (BIMC), Continuum Cancer Centers of New York (CCCNY), 10 Union Square E. Suite 4 G, New York, NY 10003, U.S.A.

Aim: Metastasis of unknown primary (MUP) is commonly treated with radiation therapy (RT) to the entire mucosal surfaces and bilateral neck nodes (LN). We report outcomes of oropharynx-targeted RT, retropharyngeal nodes (RPN) and bilateral LN in this context.

Patients And Methods: Single-Institution retrospective study of 68 patients. Forty percent were treated with intensity-modulated radiation therapy (IMRT). Fifty-six percent received concurrent chemoradiotherapy (CCRT). The median age was 58 years, 82% were Caucasian, and 75% males. Stage III disease was present in 9%, stage IVA in 75% and IVB in 16%.

Results: At a median follow-up of 3.5 years, the actuarial locoregional control was 95.5%. The emergence of primary developed in 1patient (1.5%) and 2patients (3%) failed in the neck. The median time-to-locoregional failure (LRF) was 18 months. Actuarial long-term RT toxicity was grade 1 xerostomia (68%), dysphagia (35%), neck stiffness (15%) and trismus (6%).

Conclusion: RT to the oropharynx, RPN, and bilateral neck provides excellent oncological and functional outcomes in MUP in non-Asian patients. Sparing the mucosal surfaces of the nasopharynx, hypopharynx, and larynx seems reasonable without impacting on survival and locoregional control.
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January 2014

Long-term outcome of seropositive HIV patients with head and neck squamous cell carcinoma treated with radiation therapy and chemotherapy.

Anticancer Res 2013 Dec;33(12):5511-6

Department of Radiation Oncology, Beth Israel Medical Center (BIMC), Continuum Cancer Centers of New York (CCCNY), 10 Union Square E. Suite 4 G, New York, NY, 10003, U.S.A.

Aim: To report the outcome of radiation therapy (RT) +/- chemotherapy in HIV-seropositive patients with Head and Neck Squamous Cell Carcinoma (HNSCC).

Patients And Methods: This is the largest single-Institution retrospective study to date, consisting of 73 HIV patients with HNSCC treated from January 1997-2010. The median age at RT, HIV diagnosis and the duration of patients being HIV seropositive were 51, 34, and 11 years, respectively. Seventy patients had SCC and one had submandibular salivary duct carcinoma. Stages I-II, III and IVA/B were: 22%, 27% and 51%, respectively. Primary cancer sites comprised the larynx (37%), oropharynx (32%), oral cavity (13%), hypopharynx (7%), nasopharynx (4%), unknown primary (MUP) (4%), nasal cavity (3%), and submandibular salivary duct (1%). All patients had an ECOG performance scale of ≤1 and were treated with RT +/- chemotherapy. Fifty patients (70%) were on highly active anti-retroviral therapy (HAART) during treatment, and the median CD4 count was 290 (range: 203-1142). Median dose of 70, 63, and 54 Gy were delivered to the gross disease, high-risk neck, and low-risk neck respectively. Median duration of treatment was 52 (range: 49-64) days. Twelve patients (17%) underwent neck dissection for N3 disease.

Results: After a median follow-up of 47 months (range: 7-140), the 4-year locoregional control (LRC) and overall survival (OS) were 69% and 55% respectively. Seven patients (10%) developed second primary sites within the first 5 years of completing RT (2 anal SCCs and 5 HNSCCs). The LRC for Stages III/IV larynx and oropharynx SCC (which represent the majority of the cohort) were 76% and 70%, respectively. Chemo/RT-related late toxicities were dysphagia of grade≤2, 3, and 4 found in 74%, 15% and 11% of patients, respectively. Hoarseness (grade 1) was reported in 10% of patients; no patient experienced grade ≥2. Xerostomia grade ≤2, and 3 was found in 77% and 23% of patients, respectively. A Chi-square test and univariate analysis showed statistically significant relationships between LRC and duration of RT (p<0.001), as well as positive trends for weight loss (<10%) and absence of second malignancy.

Conclusion: Definitive RT +/- chemotherapy for HIV-seropositive patients with HNSCC appears to be less effective compared to the observed rates of LRC and OS of other HNSCC without HIV. Due to advances in the HAART which prolongs HIV patients' survival, it is extremely important to establish better treatment strategies to improve therapeutic ratio in this growing patient population.
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December 2013

Comprehensive head and neck radiotherapy dose-volume constraints do not apply to smaller volumes.

Anticancer Res 2013 Oct;33(10):4483-9

Department of Radiation Oncology, Beth Israel Medical Center, New York, NY, 10 Union Square E. Suite 4 G, New York, 10003, NY, U.S.A.

Aim: To investigate the impact of definitive radiation therapy (RT) in the management of early glottic cancer on clinical RT-induced dysphagia (RID) and carotid vasculopathy (RICV).

Patients And Methods: This is a single-institution retrospective study. From January 1997 to 2010, 253 patients, with early glottic cancer, underwent RT with (60)Co or LINAC-6 MV photons. RT fields with wedge pair and daily 5-mm bolus were applied in all patients treated with 6-MV photons to avoid under-dose of the anterior laryngeal structures. The whole larynx (LX), pharyngeal constrictors (PCs), and carotid arteries (CA) were contoured and dose-volume histograms (DVHs) were generated to assess the delivered dose. The median age of patients was 65 years (range; 28-93), Caucasians were 80%, males were 87%, and 23% had T2 lesions.

Results: After a median follow-up of seven years (range; 1.5-12), the median dose and fraction size delivered to the LX were 63 and 2.25 Gy, respectively. The mean doses to the LX, PC, and CA were 57 Gy delivered to 34 cm(3), 54 Gy to 15 cm(3), and 60 Gy to 4 cm(3), respectively. The LX, PC and CA V60 and V65 were (77 and 71), (70 and 52) and (84 and 51), respectively. Patients with acute dysphagia grades 1, 2, and 3 or more were 81, 19%, and zero, respectively; none had clinically RID or RICV.

Conclusion: Small-volume RT up to 67.5 Gy at 2.25 Gy per fraction, is not a predictor of RID or RICV. Separate delineation of the aforementioned critical structures, as well as others, may better identify dose tolerances to maintain function and further prioritize the importance of structures in RID and RICV.
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October 2013

Fibular flap reconstruction of the cervical spine for repair of osteoradionecrosis.

Spine J 2013 Nov 8;13(11):e17-21. Epub 2013 Aug 8.

Radiology, Beth Israel Medical Center, First Ave. at 16th St., 2 Karpas, New York, NY 10003, USA. Electronic address:

Background Context: Although cervical spine reconstruction with osteocutaneous fibular flap microvascular grafting has been described, simultaneous reconstruction of the cervical vertebral column and laryngectomy have not been described.

Purpose: To present a unique case of combined cervical spine and laryngectomy reconstruction.

Study Design: Case report.

Methods: We modified a previously reported procedure reconstituting the cervical spine and pharynx with a single fibular flap in a case of posterior pharyngeal ulceration and osteomyelitis/osteoradionecrosis without spinal deformity.

Results: We present a case of simultaneous cervical stabilization and pharynx reconstruction with a fibular graft in a life-saving treatment of osteoradionecrosis complicated by acute cervical kyphosis and spinal cord compression in a 55-year-old patient with extensive head and neck cancer history and recent recurrence of hypopharyngeal cancer.

Conclusions: Rigid anterior plate fixation and subsequent posterior fixation were required after corpectomy and total laryngectomy in our patient with extensive surgical scarring and radiation history because of severe spinal deformity secondary to osteoradionecrosis. We achieved successful preservation of neurologic function and resolution of pain.
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http://dx.doi.org/10.1016/j.spinee.2013.06.004DOI Listing
November 2013

Chondromyxoid fibroma of the mastoid portion of the temporal bone: MRI and PET/CT findings and their correlation with histology.

Ear Nose Throat J 2013 Apr-May;92(4-5):201-3

Department of Radiology, Beth Israel Medical Center, 10 Union Square East, New York, NY 10003, USA.

We report a very rare case of a chondromyxoid fibroma of the mastoid portion of the temporal bone in a 38-year-old woman who presented with left-sided hearing loss. Magnetic resonance imaging identified an expansile mass in the left mastoid bone with a heterogeneous hyperintense signal on T2-weighted imaging and peripheral enhancement. Subsequent positron emission tomography/computed tomography identified erosive bony changes associated with hypermetabolism. The patient underwent an infratemporal fossa resection with a suboccipital craniectomy/cranioplasty. We briefly review the aspects of this case, including a discussion of the differential diagnosis and the correlation between histologic and imaging findings.
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http://dx.doi.org/10.1177/014556131309200412DOI Listing
February 2014

Society of Interventional Radiology position statement on injection safety: improper use of single-dose/single-use vials.

J Vasc Interv Radiol 2013 Jan 28;24(1):111-2. Epub 2012 Nov 28.

Department of Radiology, Beth Israel Medical Center, New York, NY 10003, USA.

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http://dx.doi.org/10.1016/j.jvir.2012.09.031DOI Listing
January 2013

Adenoid cystic carcinoma of the trachea metastatic to the nasal cavity: a case report.

Ear Nose Throat J 2009 Dec;88(12):E9-11

Department of Radiology, Beth Israel Medical Center, First Ave at 16th St, New York, NY 10003, USA.

Cases of carcinoma metastatic to the nasal cavity are rare. We report the case of a 63-year-old woman with a metastasis to the nasal cavity from a primary tracheal adenoid cystic carcinoma (ACC). The nasal tumor was treated with surgical resection. No evidence of any local recurrence was observed at 4 years of follow-up. To the best of our knowledge, no case of a tracheal ACC metastatic to the nasal cavity has been previously reported in the literature. Although rare, metastatic disease to the nasal cavity should be considered in patients who have a known primary carcinoma elsewhere and who present with nasal symptoms.
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December 2009

Asymptomatic lower extremity deep venous thrombosis resulting in fibula free flap failure.

Laryngoscope 2009 Jun;119(6):1085-7

Department of Otolaryngology-Head and Neck Surgery, Institute for Head, Neck, and Thyroid Cancer, Beth Israel Medical Center, New York, New York, USA.

Objectives/hypothesis: The successful harvest and transplant of a fibular flap depends on many factors, including healthy inflow and outflow systems. A contraindication to harvesting a fibular flap is disease of the lower extremity arterial system; therefore, preoperative evaluation of the arterial system is routine. Preoperative evaluation of the venous system is not routine, unless there is clinical suspicion of venous disease.

Methods: Retrospective chart review.

Results: Two cases of occult deep venous thrombosis (DVT) were encountered intraoperatively resulting in nontransplantable flaps.

Conclusions: This finding represents a serious concern, and we believe that venous imaging should be considered in patients with significant risk factors for harboring an occult DVT. Laryngoscope, 2009.
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http://dx.doi.org/10.1002/lary.20227DOI Listing
June 2009
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