Unexpected Detection of Parotid Gland Malignancy during Primary Extracapsular Dissection

Objective To evaluate the oncologic and functional outcome in cases in which a false preoperative working hypothesis “benign parotid tumor” led to a primary extracapsular dissection being performed rather than a traditional, more radical surgical modality. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects and Methods The records of all patients treated for malignant tumors of the parotid gland between 2006 and 2012 were retrospectively studied. Patients were excluded from our study sample for insufficient data or if their histories indicated manifestation of malignant tumors without primary parotid origin (squamous cell carcinomas, lymphomas, melanomas), revision surgery, as well as concomitant or past malignant tumors. Consequently, a total of 29 patients with 30 primary malignant tumors of the parotid gland formed our study sample (14 men, 15 women; male:female ratio, 0.93:1; mean age, 55.4 years; range, 14-85 years). Results Of 30 cases, 22 had low-grade tumors. Further tumor cells were detected in only the histology specimens of the parotid in 3 of the 25 cases treated subsequently with completion parotidectomy. Five patients received adjuvant radiation. Five-year disease-specific survival was 100%; local disease control was 96.6%. Of 30 cases, 28 had House-Brackmann I after tumor treatment; the other 2 cases had a slight paralysis (House-Brackmann II). Conclusion Beginning with the “false” working hypothesis and performing an extracapsular dissection in unsuspected cases seems to have no adverse impact on patients’ survival and postoperative quality of life in cases in which definitive histology reveals malignancy

Unexpected Detection of Parotid Gland Malignancy during Primary Extracapsular Dissection

Objective To evaluate the oncologic and functional outcome in cases in which a false preoperative working hypothesis “benign parotid tumor” led to a primary extracapsular dissection being performed rather than a traditional, more radical surgical modality. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects and Methods The records of all patients treated for malignant tumors of the parotid gland between 2006 and 2012 were retrospectively studied. Patients were excluded from our study sample for insufficient data or if their histories indicated manifestation of malignant tumors without primary parotid origin (squamous cell carcinomas, lymphomas, melanomas), revision surgery, as well as concomitant or past malignant tumors. Consequently, a total of 29 patients with 30 primary malignant tumors of the parotid gland formed our study sample (14 men, 15 women; male:female ratio, 0.93:1; mean age, 55.4 years; range, 14-85 years). Results Of 30 cases, 22 had low-grade tumors. Further tumor cells were detected in only the histology specimens of the parotid in 3 of the 25 cases treated subsequently with completion parotidectomy. Five patients received adjuvant radiation. Five-year disease-specific survival was 100%; local disease control was 96.6%. Of 30 cases, 28 had House-Brackmann I after tumor treatment; the other 2 cases had a slight paralysis (House-Brackmann II). Conclusion Beginning with the “false” working hypothesis and performing an extracapsular dissection in unsuspected cases seems to have no adverse impact on patients’ survival and postoperative quality of life in cases in which definitive histology reveals malignancy

Management of a Buccal Space Mass: A Clinical Case Report

Background. Buccal space tumors constitute rare pathologies with significant histological diversity. They may pose serious diagnostic and therapeutic challenges for the head and neck surgeon. Methods. A case of buccal space tumor diagnosed and treated in a tertiary center is presented. Clinical presentation, imaging, and surgical approach are discussed, followed by review of the literature. Results. A 79-year-old male patient with a slowly growing painless mass on the right cheek presented to a head and neck reference center. Imaging revealed a tumor of the right buccal space with nonspecific characteristics. Imaging studies revealed extended infiltration of the masseter muscle as well as the anterior border of the parotid gland. FNA biopsy was performed but was nondiagnostic. The decision of surgical excision with a modified parotidectomy incision was taken. The lesion was completely excised with preservation of neighboring facial nerve branches and ipsilateral Stensen’s duct. The postoperative course was uneventful. Histological examination showed CLL/Lymphoma, and the patient was referred to the hematology department for staging and further management. Conclusion. Differential diagnosis of buccal space masses is very diverse. Despite challenges in the diagnostic and therapeutic approach, these entities may be managed surgically with minimal morbidity

Recurrent Desmoid Tumor of the Neck: A Case Report of a Benign Disease with Aggressive Behavior

We present a case of a desmoid tumor recurrence in a patient with a history of a resected desmoid tumor of the right neck area with free surgical margins six months earlier. The neoplasm was found to invade the parapharyngeal space, and wide excision was performed including most of the sternocleidomastoid muscle (SCM), the thrombosed internal jugular vein (IJV), and the infiltrated spinal accessory nerve (SAN). The histopathologic findings displayed free microscopic margins, with close margins at the site of the parapharyngeal space extension. After 3 months, there was no sign of tumor recurrence. After 6 months, local tumor recurrence was identified on clinical examination and imaging. The decision of the Oncology Board was further treatment with radiotherapy (RT). Response to treatment was satisfactory, and the patient was on close follow-up for twelve months. Desmoid tumors are very rare benign neoplasms of mesenchymal origin with negligible mortality but high morbidity, due to their high recurrence rates, local tissue infiltration, and unpredictable disease course and response to treatment. No universally acceptable treatment protocols have been introduced to date. Appropriate patient counseling and close follow-up are warranted in all cases

Marine conservation challenges in an era of economic crisis and geopolitical instability: The Mediterranean Sea case

In the Mediterranean Sea, socio-economic drivers may accelerate the process of Exclusive Economic Zone (EEZ) declarations. Despite the challenges, the EEZ declarations may provide important opportunities for leveraging change to national policy towards the development of large-scale conservation of marine ecosystems and biodiversity in this zone. Using the Mediterranean Sea as a case study, we aim to highlight a set of best practices that will maximize the potential for the development of large-scale marine conservation initiatives. These include a range of approaches, such as using surrogates to fill the many biodiversity data gaps in the region, further the development of consistent and open access databases, and the utilization of technological developments to improve monitoring, research and surveillance of less accessible and under explored marine areas. The integration of Mediterranean-wide and local conservation efforts, the facilitation of transboundary collaboration, and the establishment of regional funds for conservation will further enhance opportunities for marine conservation in this region.JRC.H.1-Water Resource

Mutational Analysis Mapping on The Molecular Structure of The ACVRL1 Protein and Implications For Rendu-Osler-Weber (ROW)

About 80% of Rendu-OslerndashWeber (ROW) patients carry mutations in endoglin (ENG) or activin receptor-like kinase1 (ACVRL1 ALK1) genes. In order to investigate the molecular mechanisms that govern the pathogenic effect of the mutations in ACVRL1, we have collected and analyzed the mutational effect of over 80 different predominant mutations, as well as their location, on the 3D molecular structures of N- and C-terminal domains of ACVRL1. We have used macromolecular modeling on the protein structural components of ACVLR1 and structural component interface analysis to locate position and interaction of point mutations. Specific mutations were identified using genomic DNA sequencing from blood leucocytes. Out of the 151 point mutations reported for the ALK1 gene, the majority are located on the surface of the ARD and PK structural domains, with some on the interaction interface. New observed mutation Cys90Phe found in two Cretan ROW patients, located on loop F4 of ARD, introduces conformational steric hindrance and disruption of stability. We have mapped point mutations on the structural domains of ACVLR1, correlating location and severity of ROW. In addition, we report the identification and location of a novel missense mutation, Cys90Phe, which has not yet been described. It is identified in a Cretan ROW patient, and associated with severe clinical appearance according to the Curacao criteria