Novel Fusion \u3ci\u3eKTN1-PRKD1\u3c/i\u3e in Cribriform Adenocarcinoma of Salivary Glands Located in the Parotid Gland: Case Report Including Cytologic Findings

Background Cribriform adenocarcinoma of salivary glands (CASG) is a rare, predominantly minor salivary gland tumor first described in 1999. Because the tumor shares morphologic and molecular features with polymorphous adenocarcinoma (PAC), in 2017, the World Health Organization (WHO) included CASG within the spectrum of PAC. Almost 75% of CASG harbor molecular alterations in the PRKD (Protein kinase D) gene family, and some cases show ARID1A (AT-rich interaction domain 1A)-PRKD1 or DDX3X (DEAD-Box Helicase 3 X-Linked)-PRKD1 fusions. Case presentation A 39-year-old man presented with headache and painless right cheek mass of two years duration. Imaging showed a well-circumscribed, lobulated 1.7-centimeter mass located in the superficial lobe of the right parotid gland. Fine needle aspiration (FNA) of the mass revealed a “salivary gland neoplasm of uncertain malignant potential” (SUMP). Histopathology and immunohistochemical features of the resected tumor showed a primary salivary gland neoplasm with perineural invasion suggestive of cribriform adenocarcinoma of the salivary glands (CASG). Whole exome sequencing (WES) and transcriptome sequencing (RNAseq) of the tumor revealed a novel, intrachromosomal gene fusion: KTN1 (Kinectin1)-PRKD1. Sanger sequencing and Florescent insitu hybridization (FISH) break apart probe results subsequently confirmed the presence of the fusion. The patient recovered from surgery without complications. Conclusion We report a novel fusion KTN1-PRKD1 in Cribriform Adenocarcinoma of the Salivary Glands located in the parotid gland. Importantly, this KTN1 fusion partner may account for other reports of intrachromosomal fusions in CASG in which the PRKD1 gene partner was not identified

Bone morphogenetic protein 6 expression in oral cavity squamous cell cancer is associated with bone invasion

Objectives/Hypothesis To evaluate bone invasion, survival, and expression of bone morphogenetic protein‐6 (BMP‐6) in oral cavity cancer in the context of known biomarkers indicative of poor prognosis. Study Design Molecular expression study combined with retrospective chart review of corresponding patients at a tertiary care center. Methods Between 2000 and 2009, a total of 197 patients underwent resection for oral cavity squamous cell carcinoma. Of these, 30 pathologic specimens were chosen for further molecular analysis. These 30 patients were separated into three groups (10 per group) based on American Joint Committee on Cancer (AJCC) staging and staging based on size alone (TAJCC/SIZE). The first group consisted of tumors staged as T2/2 based on size less than 4 cm and that had no evidence of bone invasion. The T2/4 group consisted of tumors that were upstaged from T2 based on bone invasion. The T4/4 group consisted of tumors that were large with and without bone invasion. The expression of extracellular matrix metalloproteinase inducer (EMMPRIN), BMP‐6, and epidermal growth factor receptor (EGFR) was examined using immunohistochemistry techniques. Patient demographics, tumor characteristics, survival, and recurrence were compared. Results Average follow‐up was 21 months. Expression of BMP‐6 was significantly higher in the T2/4 cohort (tumor less than 4 cm with bony invasion) than the larger tumors without bone invasion (T4/4 cohort, P = .05). In addition, increased BMP‐6 expression correlated with aggressive behavior in the smaller tumors. Furthermore, increased EGFR expression positively correlated with increased levels of BMP‐6. Conclusions Increased expression of BMP‐6 in oral cavity cancer may affect bone invasion. Level of Evidence N/A. Laryngoscope, 123:3061–3065, 201

Microvascular Reconstruction of Osteonecrosis: Assessment of Long-term Quality of Life

Objective Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. Study Design Retrospective multi-institutional review. Setting Tertiary care centers. Methods Patients included those undergoing free flap reconstructions for osteonecrosis of the head and neck (N = 232). Data included demographics, defect, donor site, radiation history, perioperative management, diet status, recurrence rates, and long-term quality-of-life outcomes. Quality-of-life outcomes were measured using the University of Washington Quality of Life (UW-QOL) survey. Results Overall flap success rate was 91% (n = 212). Relative to preoperative diet, 15% reported improved diet function at 3 months following reconstruction and 26% at 5 years. Osteonecrosis recurred in 14% of patients (32/232); median time to onset was 11 months. Cancer recurrence occurred in 13% of patients (29/232); median time to onset was 34 months. Results from the UW-QOL questionnaire were as follows: no pain (45%), minor or no change in appearance (69%), return to baseline endurance level (37%), no limitations in recreation (40%), no changes in swallowing following reconstruction (28%), minor or no limitations in mastication (29%), minor or no speech difficulties (93%), no changes in shoulder function (84%), normal taste function (19%), normal saliva production (27%), generally excellent mood (44%), and no or minimal anxiety about cancer (94%). Conclusion The majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life

Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction

Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and outcomes. Multi-institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n = 260). Administration of preoperative antibiotics did not correlate with reduction in postoperative complications. Preoperative alcohol use correlated with higher rates of hardware exposure (p = 0.03) and 30-day readmission (p = 0.04). Patients with FF compromise had higher TSH (p = 0.04) and lower albumin levels (p = 0.005). Prealbumin levels were lower in patients who required neck washouts (p = 0.02) or a second FF (p = 0.03). TSH levels were higher in patients undergoing postoperative debridement (p = 0.03) or local flap procedures (p = 0.04). Malnutrition, hypothyroidism, and substance abuse correlated with a higher incidence of postoperative wound complications in patients undergoing FF reconstruction for advanced osteoradionecrosis. Preoperative antibiotics use did not correlate with a reduction in postoperative wound complications

Perioperative Topical Antisepsis and Surgical Site Infection in Patients Undergoing Upper Aerodigestive Tract Reconstruction

Importance: Surgical site infections (SSIs) after vascularized reconstruction of the upper aerodigestive tract (UADT) are associated with considerable morbidity. The association between perioperative prophylaxis practices, particularly topical antisepsis, and SSIs remains uncertain. Objective: To assess the association between perioperative topical antisepsis and SSIs in patients undergoing vascularized reconstruction of the UADT. Design, setting, and participants: This cohort study included patients from 12 academic tertiary care centers over an 11-month period, from July 1, 2020, to June 1, 2021. Patients undergoing open surgical procedures requiring a communication between the UADT and cervical skin with a planned regional pedicled flap, free flap, or both were included. Patients with an active infection at the time of surgical procedure were excluded. Main outcomes and measures: The primary outcome measure was an SSI within 30 days of surgery. The association of demographic characteristics, perioperative antibiotic prophylaxis, surgical technique, and postoperative care with SSIs was assessed using univariable and multivariable analyses. The relative risk ratio and 95% CIs for developing SSI were calculated for each of the variables based on predetermined categories. Variables for which the relative risk 95% CI did not include the value of zero effect (relative risk = 1.00) were included in the multivariable model. Results: A total of 554 patients (median age, 64 years; range, 21-95 years; 367 men [66.2%]) were included. Cancer ablation was the most frequent reason for surgery (n = 480 [86.6%]). Overall, the SSI rate was 20.9% (n = 116), with most infections involving the head and neck surgical site only (91 [78.4%]). The median time to SSI diagnosis was 11 days (range, 1-28 days). Topical antisepsis mucosal preparation was performed preoperatively in 35.2% (195) and postoperatively in 52.2% (289) of cases. Ampicillin and sulbactam was the most common systemic antibiotic prophylaxis agent used (n = 367 [66.2%]), with 24 hours being the most common duration (n = 363 [65.5%]). On multivariable analysis, preoperative topical antisepsis mucosal preparation (odds ratio [OR], 0.49; 95% CI, 0.30-0.77) and systemic prophylaxis with piperacillin and tazobactam (OR, 0.42; 95% CI, 0.21-0.84) were associated with a decreased risk of a postoperative SSI. The use of an osseous vascularized flap was associated with an increased risk of postoperative SSI (OR, 1.76; 95% CI, 1.13-2.75). Conclusions and relevance: Findings of this study suggest that preoperative topical antisepsis mucosal preparation was independently associated with a decreased risk of SSIs in a 12-center multi-institutional cohort. Further investigation of the association between individual perioperative practices and the incidence of postoperative SSIs is necessary to develop evidence-based protocols to reduce SSIs after UADT reconstruction