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Scientific Reports Apr 2024Parotid mucoepidermoid carcinoma (P-MEC) is a significant histopathological subtype of salivary gland cancer with inherent heterogeneity and complexity. Existing...
Parotid mucoepidermoid carcinoma (P-MEC) is a significant histopathological subtype of salivary gland cancer with inherent heterogeneity and complexity. Existing clinical models inadequately offer personalized treatment options for patients. In response, we assessed the efficacy of four machine learning algorithms vis-à-vis traditional analysis in forecasting the overall survival (OS) of P-MEC patients. Using the SEER database, we analyzed data from 882 postoperative P-MEC patients (stages I-IVA). Single-factor Cox regression and four machine learning techniques (random forest, LASSO, XGBoost, best subset regression) were employed for variable selection. The optimal model was derived via stepwise backward regression, Akaike Information Criterion (AIC), and Area Under the Curve (AUC). Bootstrap resampling facilitated internal validation, while prediction accuracy was gauged through C-index, time-dependent ROC curve, and calibration curve. The model's clinical relevance was ascertained using decision curve analysis (DCA). The study found 3-, 5-, and 10-year OS rates of 0.887, 0.841, and 0.753, respectively. XGBoost, BSR, and LASSO stood out in predictive efficacy, identifying seven key prognostic factors including age, pathological grade, T stage, N stage, radiation therapy, chemotherapy, and marital status. A subsequent nomogram revealed a C-index of 0.8499 (3-year), 0.8557 (5-year), and 0.8375 (10-year) and AUC values of 0.8670, 0.8879, and 0.8767, respectively. The model also highlighted the clinical significance of postoperative radiotherapy across varying risk levels. Our prognostic model, grounded in machine learning, surpasses traditional models in prediction and offer superior visualization of variable importance.
Topics: Humans; Nomograms; Carcinoma, Mucoepidermoid; Parotid Neoplasms; Algorithms; Machine Learning
PubMed: 38561379
DOI: 10.1038/s41598-024-58329-8 -
Journal of Orthopaedic Case Reports Mar 2024Malignant tumors afflicting the sub-condylar area and ascending ramus of the mandible without mucosal involvement are extremely rare. Traditional approaches such as...
INTRODUCTION
Malignant tumors afflicting the sub-condylar area and ascending ramus of the mandible without mucosal involvement are extremely rare. Traditional approaches such as lip-split-cheek flap and Visor flap would prove sub-optimal and excessive for such limited lesions and entail salivary contamination and mental nerve sacrifice. To circumvent these limitations, we developed a surgical approach that achieves wide, extra-oral exposure to the condyle and ascending ramus and permits controlled resection, affording protection to the facial nerve branches and mental nerve, while avoiding salivary contamination.
CASE REPORT
The main features of the approach include a pre-auricular skin crease incision extendable both ways, trans-parotid dissection with protection of facial nerve branches, and controlled bony resection. In all cases, monobloc resection was possible with preservation of the uninvolved facial nerve branches, avoidance of salivary contamination, and prompt healing.
CONCLUSION
An extra-oral non-mucosal surgical approach is described for highly selected cases of mandibular resection.
PubMed: 38560331
DOI: 10.13107/jocr.2024.v14.i03.4328 -
Heliyon Apr 2024Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) ravaged the world, and Coronavirus Disease 2019 (COVID-19) exhibited highly prevalent oral symptoms that had...
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) ravaged the world, and Coronavirus Disease 2019 (COVID-19) exhibited highly prevalent oral symptoms that had significantly impacted the lives of affected patients. However, the involvement of four human coronavirus (HCoVs), namely SARS-CoV-2, SARS-CoV, MERS-CoV, and HCoV-229E, in oral cavity infections remained poorly understood. We integrated single-cell RNA sequencing (scRNA-seq) data of seven human oral tissues through consistent normalization procedure, including minor salivary gland (MSG), parotid gland (PG), tongue, gingiva, buccal, periodontium and pulp. The Seurat, scDblFinder, Harmony, SingleR, Ucell and scCancer packages were comprehensively used for analysis. We identified specific cell clusters and generated expression profiles of SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs) in seven oral regions, providing direction for predicting the tropism of four HCoVs for oral tissues, as well as for dental clinical treatment. Based on our analysis, it appears that various SCARFs, including ACE2, ASGR1, KREMEN1, DPP4, ANPEP, CD209, CLEC4G/M, TMPRSS family proteins (including TMPRSS2, TMPRSS4, and TMPRSS11A), and FURIN, are expressed at low levels in the oral cavity. Conversely, BSG, CTSB, and CTSL exhibit enrichment in oral tissues. Our study also demonstrates widespread expression of restriction factors, particularly IFITM1-3 and LY6E, in oral cells. Additionally, some replication, assembly, and trafficking factors appear to exhibit broad oral tissues expression patterns. Overall, the oral cavity could potentially serve as a high-risk site for SARS-CoV-2 infection, while displaying a comparatively lower degree of susceptibility towards other HCoVs (including SARS-CoV, MERS-CoV and HCoV-229E). Specifically, MSG, tongue, and gingiva represent potential sites of vulnerability for four HCoVs infection, with the MSG exhibiting a particularly high susceptibility. However, the expression patterns of SCARFs in other oral sites demonstrate relatively intricate and may only be specifically associated with SARS-CoV-2 infection. Our study sheds light on the mechanisms of HCoVs infection in the oral cavity as well as gains insight into the characteristics and distribution of possible HCoVs target cells in oral tissues, providing potential therapeutic targets for HCoVs infection in the oral cavity.
PubMed: 38560173
DOI: 10.1016/j.heliyon.2024.e28280 -
Rare Tumors 2024Ewing's sarcoma is a rare malignant entity. Extraosseous Ewing's sarcoma (EES) of the head and neck region is a rare occurrence, and Ewing's sarcoma of the parotid gland...
BACKGROUND
Ewing's sarcoma is a rare malignant entity. Extraosseous Ewing's sarcoma (EES) of the head and neck region is a rare occurrence, and Ewing's sarcoma of the parotid gland is even rarer. To the best of our knowledge, we reported the first case of extraskeletal ES originating from the parotid gland in the Tunisian literature.
CASE REPORT
We report a rare case of EES of the parotid gland in a 35-year-old female. She presented with left parotid tumefaction. Physical examination revealed solid and fixed mass associated with facial paralysis. Magnetic resonance imaging illustrated a left intra-parotid process occupying the entire gland measuring 42 mm infiltrating the masseter and pterygoid muscles. The patient had a total left parotidectomy with ipsilateral triangular lymph node dissection. The definitive pathological examination and the immunohistochemical staining confirmed a primary peripheral neuroectodermal tumor or PNET with the presence of a specific EWING/PNET-type translocation in 60% of the tumor cells. She had an adjuvant chemotherapy (four cycles of vincristine, doxorubicin, cyclophosphamide alternating with ifosfamide and etoposide) followed by external radiotherapy.
CONCLUSION
A clinical and radiological follow-up by cervical MRI was done every 3 months and The 10-month follow-up showed no locoregional and distant recurrence.
PubMed: 38559436
DOI: 10.1177/20363613241242570 -
Journal of Cancer Research and... Jan 2024MALT (mucosa-associated lymphoid tissue) lymphomas are low-grade extra-nodal B-cell lymphomas that may involve various sites in the head and neck including the thyroid,...
MALT (mucosa-associated lymphoid tissue) lymphomas are low-grade extra-nodal B-cell lymphomas that may involve various sites in the head and neck including the thyroid, salivary, and lacrimal glands. Development of MALT lymphoma in the head and neck is often associated with auto-immune diseases such as Sjögren syndrome or Hashimoto thyroiditis. Here, we report a case of a MALT lymphoma of the left buucal mucosa that likely arose in the parotid gland. The patient was successfully treated with surgical excision with chemotherapy and remained disease-free at the 10-year follow-up. Since it was rare in the head and neck region, we present this case.
Topics: Humans; Lymphoma, B-Cell, Marginal Zone; Parotid Gland; Stomach Neoplasms; Lymphoma, Non-Hodgkin
PubMed: 38554366
DOI: 10.4103/jcrt.jcrt_1909_22 -
Cureus Feb 2024Facial nerve palsy (FNP) is a well-recognized complication following parotidectomy, with varying reported incidence rates in the literature. Understanding the incidence...
Facial nerve palsy (FNP) is a well-recognized complication following parotidectomy, with varying reported incidence rates in the literature. Understanding the incidence and factors contributing to FNP is crucial for optimizing patient care and surgical outcomes. A retrospective analysis was conducted on 78 patients who underwent parotidectomy at a tertiary care institution (Hospital de Especialidades Carlos Andrade Marin, Quito) over a 36-month period. Demographic data, preoperative pathology reports, surgical details, and postoperative outcomes, including FNP incidence and severity, were analyzed. The mean age of the cohort was 53 years, with a male-to-female ratio of 0.8:1. Fine needle aspiration revealed benign pathology in 70.5% of cases, with superficial parotidectomy being the most common surgical approach (84.6%). Postoperatively, FNP was observed in 51.2% of cases, with transient paralysis in 62.5% and persistent paralysis in 37.5%. The majority of FNP cases were classified as grade II and III according to the House-Brackmann grading system. A tumor size larger than 4 cm was associated with a higher incidence of FNP (57.5%). This study provides valuable insights into the incidence and severity of FNP following parotidectomy. Despite efforts to standardize surgical techniques, persistent paralysis remains a significant concern.
PubMed: 38550429
DOI: 10.7759/cureus.55045 -
Advances in Radiation Oncology May 2024Multimodality imaging can enhance the precision of tumor delineation for intensity modulated radiation therapy planning. This study aimed to analyze intermodality...
PURPOSE
Multimodality imaging can enhance the precision of tumor delineation for intensity modulated radiation therapy planning. This study aimed to analyze intermodality variation for gross tumor volume (GTV) delineation in locally advanced oropharyngeal carcinomas (LAOCs).
METHODS AND MATERIALS
We examined the pretreatment contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and fluoro-deoxy-glucose-based positron emission tomography (FDG-PET) image data sets of 33 adult patients with primary LAOC. Automatic segmentation method was used to derive PET-based metabolic tumor volumes (MTVs) at 30%, 40%, 50%, 60%, and 70% of the primary tumor's maximum standardized uptake value (SUVmax). The geometric conformality or spatial overlap was assessed using the Dice similarity coefficient (DSC), which ranges from 0 to 1, indicating no overlap to complete overlap.
RESULTS
The size of the tumor in the anteroposterior dimension of the GTV was found to be more on CT than MRI, with a mean difference of 0.29 cm ( value .015). Overall, PET-based MTV volumes were smaller than GTVs on CT and MR. Among various intensities on PET, MTV30 was the closest match with GTV-CT/MR. The mean difference for absolute tumor volumes (GTV-CT, GTV-MR, and MTV30) was not statistically significant; however, spatial overlap by DSC score was average, that is, <0.7. DSC was 0.65 ± 0.15 between GTV-CT and GTV-MR, 0.62 ± 0.15 between GTV-CT and MTV30, and 0.576 ± 0.16 between GTV-MR and MTV30 pairs, respectively. On qualitative analysis, overall tumor extension into adjacent muscles, parotid gland, retromolar trigone, and marrow infiltration of mandible was better appreciated on MRI.
CONCLUSIONS
Given the significant spatial variation, multimodality imaging can serve as an excellent complement for target volume delineation on CT scans during intensity modulated radiation therapy planning for LAOC by harnessing the improved soft tissue definition of MRI and the ability of PET to provide metabolic activity information.
PubMed: 38550372
DOI: 10.1016/j.adro.2024.101453 -
Advances in Radiation Oncology May 2024The head and neck cancer (HNC) literature is rife with reports of differences in planned versus actual radiation doses to the parotid gland (PG) due to changes in...
An Observational Dosimetric Study in Definitively Treated Primary Head and Neck Cancers: To Assess the Effect of Weight Loss and Change in Lateral Neck Dimensions on the Difference Between Dose Planned and Received by the Parotid(s) and Correlation with Adaptive Radiation Therapy.
PURPOSE
The head and neck cancer (HNC) literature is rife with reports of differences in planned versus actual radiation doses to the parotid gland (PG) due to changes in anatomy during the course of radiation therapy. We prospectively studied and quantified changes in planned and delivered doses due to weight loss and changes in lateral neck dimensions.
METHODS AND MATERIALS
Sixty patients were enrolled in this prospective non-randomized observational study. The inclusion criterion was having a newly diagnosed, histologically proven squamous cell carcinoma of HNC. Weight loss (WL) and change in lateral neck dimensions (LND) were assessed weekly, and new hybrid plans were generated using interval replanning CT scans. Dose variations were monitored and extrapolated for replanning CT scans and correlated with WL and change in LND.
RESULTS
The Pearson correlation coefficients for WL and difference in Dmean of ipsilateral and contralateral PG was 0.3292 ( = .0124) and 0.4232 ( = .0010), respectively. There was significantly higher change in the Dmean of bilateral PG (Ipsilateral(I) > contralateral(C)) in patients who experienced WL of >5%. Change in LND correlated with difference in Dmean of ipsilateral PG at 0.4829 ( = .0001) and difference in D50 at 0.4146 ( < .0013). Contralateral PG correlated with difference in Dmean at 0.5952 ( < .0001). The difference in Dmean for ipsilateral PG was 1.8535 Gy for those showing reduction in LND of >1 cm compared with 0.8596 Gy ( = .0091) for those who had ≤1 cm reduction in LND.
CONCLUSIONS
Either WL of >5% or reduction in LND of >1 cm can be used as an external parameter to help select patients who might benefit most from replanning and adaptive radiation therapy.
PubMed: 38550366
DOI: 10.1016/j.adro.2024.101446 -
Radiation Oncology Journal Mar 2024To assess the interobserver delineation variability of radiomic features of the parotid gland from computed tomography (CT) images and evaluate the correlation of these...
PURPOSE
To assess the interobserver delineation variability of radiomic features of the parotid gland from computed tomography (CT) images and evaluate the correlation of these features for head and neck cancer (HNC) radiotherapy patients.
MATERIALS AND METHODS
Contrast-enhanced CT images of 20 HNC patients were utilized. The parotid glands were delineated by treating radiation oncologists (ROs), a selected RO and AccuContour auto-segmentation software. Dice similarity coefficients (DSCs) between each pair of observers were calculated. A total of 107 radiomic features were extracted, whose robustness to interobserver delineation was assessed using the intraclass correlation coefficient (ICC). Pearson correlation coefficients (r) were calculated to determine the relationship between the features. The influence of excluding unrobust features from normal tissue complication probability (NTCP) modeling was investigated for severe oral mucositis (grade ≥3).
RESULTS
The average DSC was 0.84 (95% confidence interval, 0.83-0.86). Most of the shape features demonstrated robustness (ICC ≥0.75), while the first-order and texture features were influenced by delineation variability. Among the three observers investigated, 42 features were sufficiently robust, out of which 36 features exhibited weak correlation (|r|<0.8). No significant difference in the robustness level was found when comparing manual segmentation by a single RO or automated segmentation with the actual clinical contour data made by treating ROs. Excluding unrobust features from the NTCP model for severe oral mucositis did not deteriorate the model performance.
CONCLUSION
Interobserver delineation variability had substantial impact on radiomic features of the parotid gland. Both manual and automated segmentation methods contributed similarly to this variation.
PubMed: 38549385
DOI: 10.3857/roj.2023.00605 -
The American Journal of Case Reports Mar 2024BACKGROUND A mass in the parotid gland usually indicates parotid gland neoplasia. Warthin tumors or pleomorphic adenomas are common differential diagnoses. Less... (Review)
Review
BACKGROUND A mass in the parotid gland usually indicates parotid gland neoplasia. Warthin tumors or pleomorphic adenomas are common differential diagnoses. Less frequently, other differential diagnoses and sites of origin are considered. Schwannomas are rare, benign tumors in the head and neck region. Even more rarely, these tumors occur in the intraparotid course of the facial nerve. In the following, we report about 2 patients in whom a mass in the right parotid gland was found incidentally during magnetic resonance imaging (MRI). CASE REPORT We reviewed data from the literature on intraparotid facial nerve schwannomas (IPFNS) and compared them with those from our cases. The focus was on data such as clinical history, clinical symptoms, electroneurography, and various imaging modalities, such as ultrasonography and MRI combined with diffusion-weighted imaging. CONCLUSIONS It is challenging to distinguish facial nerve schwannomas from other neoplasms. Patient's history, clinical symptoms, MRI examination with diffusion-weighted imaging, and high-resolution ultrasound imaging are decisive factors for diagnosis and should be performed when IPFNS is suspected. Diagnosis and therapy for IPFNS remain challenging. A wait-and-scan approach could be an option for patients with small tumors and good facial nerve function. On the other hand, patients with advanced tumors associated with limited facial nerve function can benefit from surgical approaches or stereotactic radiosurgery.
Topics: Humans; Facial Nerve; Cranial Nerve Neoplasms; Parotid Gland; Parotid Neoplasms; Neurilemmoma
PubMed: 38549237
DOI: 10.12659/AJCR.942870