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Article ; Online: Microsecretory Adenocarcinoma of Salivary Glands.

Bishop, Justin A / Sajed, Dipti P

2022 Volume 30, Issue 2, Page(s) 130–135

Abstract: Salivary gland classification has benefitted immensely from the growing field of molecular diagnostics. Microsecretory adenocarcinoma, a novel salivary gland malignancy recently included in the fifth edition of the World Health Organization ... ...

Abstract	Salivary gland classification has benefitted immensely from the growing field of molecular diagnostics. Microsecretory adenocarcinoma, a novel salivary gland malignancy recently included in the fifth edition of the World Health Organization Classifications of Head and Neck Tumours, is one such example. This novel entity was discovered among the umbrella category of adenocarcinoma, not otherwise specified, using a combination of careful histologic analysis and advanced molecular techniques. Its strikingly characteristic histologic features including subtle infiltration, flattened tubules, and abundant blue secretions highlight the necessity of meticulous morphologic observation, even in the age of increased molecular testing. It harbors a recurrent novel MEF2C::SS18 gene fusion, which is amenable to fluorescence in situ hybridization analysis. It presents predominantly in the oral cavity with a propensity for the palate and the majority are thus far low grade, clinically indolent tumors. The recent discovery of a cutaneous corollary to this tumor suggests that the spectrum of its presentation has not entirely been delineated. In the context of expanding molecular testing, pathologists are tasked to sift through constantly evolving molecular data to incorporate diagnostically relevant tests into their practice. In salivary gland pathology, the example of microsecretory adenocarcinoma demonstrates that primary histologic assessment, with sensible use of immunohistochemistry, can lead to accurate diagnosis. Molecular testing is beneficial in cases with significant diagnostic challenges.
MeSH term(s)	Humans ; Adenocarcinoma/diagnosis ; Adenocarcinoma/genetics ; Adenocarcinoma/pathology ; Biomarkers, Tumor/genetics ; Head and Neck Neoplasms ; In Situ Hybridization, Fluorescence ; Salivary Gland Neoplasms/diagnosis ; Salivary Gland Neoplasms/genetics ; Salivary Gland Neoplasms/pathology ; Salivary Glands/pathology
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2022-12-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1212493-x
ISSN	1533-4031 ; 1072-4109
ISSN (online)	1533-4031
ISSN	1072-4109
DOI	10.1097/PAP.0000000000000385
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Article ; Online: Transoral Robotic Surgery for a Parapharyngeal Space Tumor.

Miller, Jessa E / Sajed, Dipti P / Mendelsohn, Abie H

JAMA otolaryngology-- head & neck surgery

2023 Volume 149, Issue 7, Page(s) 645–646

MeSH term(s)	Humans ; Robotic Surgical Procedures ; Parapharyngeal Space ; Pharyngeal Neoplasms/surgery
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701825-8
ISSN	2168-619X ; 2168-6181
ISSN (online)	2168-619X
ISSN	2168-6181
DOI	10.1001/jamaoto.2023.0904
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Article: A 22-year single institution review of 119 cases of salivary duct carcinoma.

Han, Ethan J / Mukdad, Laith A / Alhiyari, Yazeed / Nakhla, Morcos N / Sajed, Dipti P / St John, Maie A

Laryngoscope investigative otolaryngology

2024 Volume 9, Issue 2, Page(s) e1234

Abstract: Objective: Salivary duct carcinoma (SDC) is a rare and aggressive salivary gland malignancy. Herein, we present the largest single-institution review of SDC to date.: Methods: This is a retrospective cohort study of all histologically confirmed cases ...

Abstract	Objective: Salivary duct carcinoma (SDC) is a rare and aggressive salivary gland malignancy. Herein, we present the largest single-institution review of SDC to date. Methods: This is a retrospective cohort study of all histologically confirmed cases of SDC seen at our institution from January 1, 2002, to August 1, 2022. Patient demographics, treatment, histological characteristics, tumor staging, and outcomes were extracted from the electronic medical record. Kaplan-Meier and Cox regression survival analyses were performed. Results: This study included 119 patients with a mean age of 66.2 years. Most primary tumors arose from the parotid gland (72.3%), and 23.5% were noted to be carcinoma ex-pleomorphic adenoma. 57.1% of patients presented with regional lymph node metastasis, whereas 23.5% presented with distant disease. Kaplan-Meier analysis demonstrated a 62.4% 5-year overall survival (OS) and a 69.0% 5-year disease-specific survival (DSS). Univariate analyses indicated that presence of regional lymph node disease ( Conclusion: Our patients had more favorable survival rates compared to prior studies, which may be due to lower incidence of nodal disease. Factors associated with worse survival included nodal and distant metastases, perineural invasion, lymphovascular invasion, and tumor size. Level of evidence: Level 3.
Language	English
Publishing date	2024-03-23
Publishing country	United States
Document type	Journal Article
ISSN	2378-8038
ISSN	2378-8038
DOI	10.1002/lio2.1234
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Article: Multidisciplinary care improves outcomes for patients with carotid body paragangliomas-The UCLA experience.

Wong, Kirsten / Tam, Kenric / Tran, Eric K / Sajed, Dipti / St John, Maie

Laryngoscope investigative otolaryngology

2023 Volume 8, Issue 5, Page(s) 1203–1209

Abstract: Objective: To evaluate the effects and outcomes of multidisciplinary surgical approaches in the management of carotid body tumors (CBT).: Methods: A single-center retrospective study at the University of California-Los Angeles Medical Center was ... ...

Abstract	Objective: To evaluate the effects and outcomes of multidisciplinary surgical approaches in the management of carotid body tumors (CBT). Methods: A single-center retrospective study at the University of California-Los Angeles Medical Center was conducted on patients who presented with CBTs and underwent surgical resections from 1998 to 2020. Statistical analysis was performed using IBM SPSS v27 and Excel. Results: A total of 75 patients with 79 CBT resections were included. Operating surgical subspecialties included: 41.8% vascular surgery, 24.1% otolaryngology head and neck surgeons (OHNS), and 31.6% combined OHNS and vascular. 68.4% of tumors underwent preoperative embolization. EBL was directly correlated with tumor size. CBT size was similar for OHNS (30 mm) and vascular (31 mm) but was significantly larger for combined OHNS and vascular cases (38 mm). EBL was higher in combined cases (301 mL) compared to OHNS (124 mL) or vascular (203 mL) alone. Incidence of postoperative cranial nerve deficits was 7.8%, with combined OHNS and vascular cases having an incidence of 4.0% when compared to OHNS (5.3%) versus vascular surgery alone (12.1%). Conclusion: CBTs can be managed effectively by single surgical specialties with similar outcomes between vascular surgery and OHNS. In larger, higher grade tumors, however, a combined vascular and OHNS approach had lower incidence of postoperative cranial nerve injuries when compared to single specialty resections, despite a larger EBL. Thus, a multidisciplinary surgical approach suggests favorable outcomes with fewer incidence of cranial nerve deficits for larger, more complex CBT resections. Level of evidence: 2b-Individual retrospective cohort study.
Language	English
Publishing date	2023-08-23
Publishing country	United States
Document type	Journal Article
ISSN	2378-8038
ISSN	2378-8038
DOI	10.1002/lio2.1130
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Article ; Online: Sinonasal Papillomas: 10-Year Retrospective Analysis of Etiology, Epidemiology, and Recurrence.

Archang, Maani / Chew, Leila / Han, Albert Yoon-Kyu / Sajed, Dipti / Vorasubin, Nopawan / Wang, Marilene

American journal of rhinology & allergy

2022 Volume 36, Issue 6, Page(s) 827–834

Abstract: Objectives: To examine the epidemiology, subtypes, trends over time, and predictive factors for recurrence and malignant transformation of sinonasal papillomas.: Methods: A retrospective chart review of 118 patients with sinonasal papillomas from ... ...

Abstract	Objectives: To examine the epidemiology, subtypes, trends over time, and predictive factors for recurrence and malignant transformation of sinonasal papillomas. Methods: A retrospective chart review of 118 patients with sinonasal papillomas from 2009 to 2019 was conducted at the University of California, Los Angeles. This study is a follow-up to a previously published study from 2000 to 2009 at the same academic center. Results: The mean age was at presentation was 58.5 years, with a 2:1 male to female ratio, and average follow-up of 30.1 months. The rate of recurrence after complete resection was 19% with an average of 32.6 months to recurrence. The time to recurrence followed a bimodal distribution with 57% of cases recurring within 24 months (mean = 10) and 43% from 40 to 103 months (mean = 61). The proportion of the inverted papillomas rose from 38% in 2000-2004 to 89.6% in 2015-2019. Patients presenting at a younger age had a higher chance of recurrence (mean age 52 with recurrence vs. 61 without recurrence). Age did not correlate with histopathologic transformation in surgical pathology. Furthermore, histopathological transformation did not raise the chance of recurrence. Smoking, alcohol use, chronic rhinosinusitis, and allergic rhinitis were not associated with any of the outcome measures in this study. The most significant factor predicting recurrence, beside age at presentation, was the history of two or more prior sinus surgeries for papillomas or other reasons (OR = 3.52 and 5.81). Conclusion: This study explored the features of sinonasal papillomas as well as the risk factors for recurrence and transformation. Younger age at presentation and two or more prior surgeries for papillomas were associated with recurrence. Time to recurrence followed a bimodal distribution, with late recurrences happenning from 40 to 103 months after surgery, emphasizing the importance of long-term follow-up for timely resection of tumors and prevention of malignancy.
MeSH term(s)	Cell Transformation, Neoplastic ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Nose Neoplasms/epidemiology ; Nose Neoplasms/pathology ; Nose Neoplasms/surgery ; Papilloma, Inverted/epidemiology ; Papilloma, Inverted/pathology ; Papilloma, Inverted/surgery ; Paranasal Sinus Neoplasms/epidemiology ; Paranasal Sinus Neoplasms/pathology ; Paranasal Sinus Neoplasms/surgery ; Retrospective Studies
Language	English
Publishing date	2022-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2482804-X
ISSN	1945-8932 ; 1945-8924
ISSN (online)	1945-8932
ISSN	1945-8924
DOI	10.1177/19458924221116441
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Article ; Online: Anaplastic Transformation of Differentiated Thyroid Carcinoma.

Yu, Alice C / Han, Albert Y / Cronkite, David Alex / Sajed, Dipti / St John, Maie A

The Laryngoscope

2022 Volume 133, Issue 2, Page(s) 437–442

Abstract: Objectives: Anaplastic thyroid carcinoma (ATC) is a rare but highly aggressive form of thyroid cancer. Increasingly, patients with ATC present with concurrent foci of well-differentiated thyroid carcinoma (WDTC); however, the significance of these ... ...

Abstract	Objectives: Anaplastic thyroid carcinoma (ATC) is a rare but highly aggressive form of thyroid cancer. Increasingly, patients with ATC present with concurrent foci of well-differentiated thyroid carcinoma (WDTC); however, the significance of these pathologic findings remains unclear. The objective of this study is to determine whether the presence of WDTC within anaplastic tumors is a prognosticator of survival. Methods: A retrospective cohort study of all cases of biopsy-proven ATC managed at a tertiary care academic medical center from 2002 to 2020 was performed. Mean age at diagnosis, median survival time, and locations of distant metastases were assessed. The impact of clinical markers such as presence of differentiation, demographic variables, and oncologic information on overall survival was also determined via univariate and multivariate analysis. Results: Forty-five patients were included in this study. The mean age at diagnosis was 69.1 years. Median survival time was 6.1 months after diagnosis. The most common location of distant metastases was the lung (40%). The presence of limited areas of WDTC in patients with predominantly anaplastic thyroid tumors was not significantly associated with improved outcomes (p = 0.509). Smaller tumor size and use of chemotherapy in ATC patients were significantly associated with prolonged survival (p = 0.026 and 0.010, respectively). Conclusions: Clinical outcomes for ATC remain poor. The presence of foci of differentiation within anaplastic thyroid tumors does not appear to improve overall survival-the anaplastic component evidently drives outcomes. Further studies into novel therapies are needed to improve survival in ATC. Level of evidence: 4 Laryngoscope, 133:437-442, 2023.
MeSH term(s)	Humans ; Aged ; Retrospective Studies ; Thyroid Neoplasms/pathology ; Thyroid Carcinoma, Anaplastic/pathology ; Thyroid Carcinoma, Anaplastic/secondary ; Adenocarcinoma ; Biopsy ; Prognosis
Language	English
Publishing date	2022-07-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30277
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Article: Cutaneous head and neck angiosarcoma: The 30-year UCLA experience.

Evans, Lauran K / Sutton, Sarah / Echanique, Kristen / Armaneous, Michael / Palacios, Victoria / Sajed, Dipti / St John, Maie

Laryngoscope investigative otolaryngology

2023 Volume 8, Issue 6, Page(s) 1557–1563

Abstract: Background: Cutaneous angiosarcoma is an aggressive tumor commonly found in the head and neck region. There is no consensus regarding the definitive treatment for angiosarcoma.: Methods: This was a retrospective chart review that evaluated 64 ... ...

Abstract	Background: Cutaneous angiosarcoma is an aggressive tumor commonly found in the head and neck region. There is no consensus regarding the definitive treatment for angiosarcoma. Methods: This was a retrospective chart review that evaluated 64 patients from 1983 to 2019. Demographic and clinical variables were examined for impact on recurrence using the time to recurrence and the overall survival in Kaplan-Meier curves. Results: Average age at diagnosis was 71 (32-95) years, with a 2.8 male: female ratio. Surgery was utilized in 62% of patients, with mean defect size of 11.4 ± 8.1 cm. Recurrence was found in 70% of patients, and mean time to recurrence was 15.3 ± 12.3 months. Decreased recurrence was associated with use of intraoperative frozen section analysis ( Conclusions: Negative margins are associated with decreased recurrence, and intraoperative frozen section analysis may be considered to obtain preliminary surgical margins.Level of Evidence: 4.
Language	English
Publishing date	2023-10-17
Publishing country	United States
Document type	Journal Article
ISSN	2378-8038
ISSN	2378-8038
DOI	10.1002/lio2.1173
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Article ; Online: Extent of Surgery for Medullary Thyroid Cancer and Prevalence of Occult Contralateral Foci.

Mao, Yifan V / Hughes, Elena G / Steinmetz, David / Troob, Samantha / Kim, Jiyoon / Tseng, Chi-Hong / Fishbein, Gregory A / Sajed, Dipti P / Livhits, Masha J / Yeh, Michael W / Lee, Denise / Angell, Trevor E / Wu, James X

JAMA otolaryngology-- head & neck surgery

2024 Volume 150, Issue 3, Page(s) 209–214

Abstract: Importance: Standard treatment for patients with medullary thyroid cancer (MTC) consists of total thyroidectomy with central neck dissection, but the rationale for bilateral surgery in patients with unilateral disease on ultrasonography remains unclear.! ...

Abstract	Importance: Standard treatment for patients with medullary thyroid cancer (MTC) consists of total thyroidectomy with central neck dissection, but the rationale for bilateral surgery in patients with unilateral disease on ultrasonography remains unclear. Objective: To determine the presence of occult contralateral disease (lesions not seen on preoperative ultrasonography) in patients with MTC as a rationale for total thyroidectomy. Design, setting, and participants: This multi-institutional, retrospective cohort study was conducted from September 1998 to April 2022 in academic medical centers and included patients with MTC who underwent thyroidectomy with preoperative imaging. Main outcomes and measures: The primary end point was the prevalence of sonographically occult foci of MTC in the contralateral lobe among patients with sporadic MTC. Results: The cohort comprised 176 patients with a median age at diagnosis of 55 years (range, 2-87 years), 69 (57.6%) of whom were female. Genetic testing was performed in 109 patients (61.9%), 48 (27.5%) of whom carried germline RET variants. Initial surgical management consisted of total thyroidectomy (161 [91.0%]), lobectomy followed by completion thyroidectomy (7 [4.0%]), and lobectomy alone (8 [4.5%]). Central and lateral neck dissections were performed as part of initial therapy for 146 patients (83.1%). In the entire cohort of 176 patients, 46 (26.0%) had contralateral foci disease and 9 (5.1%) had occult contralateral foci that were not identified on preoperative ultrasonography. Among 109 patients who underwent genetic testing, 38 (34.9%) had contralateral disease, 8 (7.3%) of whom had occult contralateral disease not seen on preoperative ultrasonography. Patients with sporadic MTC experienced a 95.7% reduction in the odds of having a focus of MTC in the contralateral lobe compared with patients with a germline RET variant (odds ratio, 0.043; 95% CI, 0.013-0.123). When adjusting for age, sex, tumor size, and lymph node involvement, the odds ratio of having contralateral MTC in patients with sporadic disease was 0.034 (95% CI, 0.007-0.116). Among patients who underwent lobectomy alone with postoperative calcitonin levels, 5 of 12 (41.7%) achieved undetectable calcitonin levels (<2.0 pg/mL; to convert to pmol/L, multiply by 0.292). Conclusions and relevance: The results of this cohort study suggest that a staged approach involving initial thyroid lobectomy could be considered in patients with sporadic MTC and no contralateral ultrasonography findings, with no further surgery if calcitonin levels became undetectable. Further work using prospective randomized clinical trials to evaluate lobectomy as a biochemical cure in patients presenting with unilateral disease is warranted.
MeSH term(s)	Humans ; Female ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Male ; Thyroidectomy/methods ; Calcitonin ; Cohort Studies ; Retrospective Studies ; Prospective Studies ; Prevalence ; Carcinoma, Medullary/genetics ; Carcinoma, Medullary/pathology ; Carcinoma, Medullary/surgery ; Thyroid Neoplasms/diagnostic imaging ; Thyroid Neoplasms/surgery ; Thyroid Neoplasms/genetics ; Carcinoma, Neuroendocrine
Chemical Substances	Calcitonin (9007-12-9)
Language	English
Publishing date	2024-01-25
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701825-8
ISSN	2168-619X ; 2168-6181
ISSN (online)	2168-619X
ISSN	2168-6181
DOI	10.1001/jamaoto.2023.4376
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Article ; Online: Systemic light-chain amyloidosis incidentally diagnosed after subtotal parathyroidectomy and thyroid lobectomy.

Tsai, Karen / Yu, Alice Chen / Livhits, Masha J / Sajed, Dipti / Leung, Angela M / Cheung, Dianne S

BMJ case reports

2021 Volume 14, Issue 4

Abstract: A 74-year-old woman with a history of primary hyperparathyroidism, thyroid nodules, atrial fibrillation and pacemaker placement for sick sinus syndrome presented with fatigue, constipation and persistent lower extremity oedema. She underwent subtotal ... ...

Abstract	A 74-year-old woman with a history of primary hyperparathyroidism, thyroid nodules, atrial fibrillation and pacemaker placement for sick sinus syndrome presented with fatigue, constipation and persistent lower extremity oedema. She underwent subtotal parathyroidectomy and left thyroid lobectomy. Histopathology revealed amyloidosis affecting the thyroidand parathyroids confirmed by Congo Red Staining with Mayo Clinic subtyping of light chain kappa-type amyloidosis. She was found to have combined systolic and diastolic cardiac dysfunction, carpal tunnel neuropathy and pre-diabetes suggestive of systemic amyloidosis with involvement of the heart, nerves and pancreas. Congo red stain was positive for amyloidosis on bone marrow biopsy suggestive of a diagnosis of systemic amyloidosis. She was treated with daratumumab with good clinical response. This case illustrates the necessity of considering systemic amyloidosis in patients with incidentally discovered diffuse amyloid deposits on biopsy of an endocrine organ, as endocrine effects are a rare but likely underdiagnosed consequence of systemic amyloidosis.
MeSH term(s)	Aged ; Amyloidosis/complications ; Amyloidosis/diagnosis ; Congo Red ; Female ; Humans ; Immunoglobulin Light-chain Amyloidosis/complications ; Immunoglobulin Light-chain Amyloidosis/diagnosis ; Parathyroidectomy ; Thyroid Gland
Chemical Substances	Congo Red (3U05FHG59S)
Language	English
Publishing date	2021-04-19
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2020-241282
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Article ; Online: PathAL: An Active Learning Framework for Histopathology Image Analysis.

Li, Wenyuan / Li, Jiayun / Wang, Zichen / Polson, Jennifer / Sisk, Anthony E / Sajed, Dipti P / Speier, William / Arnold, Corey W

IEEE transactions on medical imaging

2022 Volume 41, Issue 5, Page(s) 1176–1187

Abstract: Deep neural networks, in particular convolutional networks, have rapidly become a popular choice for analyzing histopathology images. However, training these models relies heavily on a large number of samples manually annotated by experts, which is ... ...

Abstract	Deep neural networks, in particular convolutional networks, have rapidly become a popular choice for analyzing histopathology images. However, training these models relies heavily on a large number of samples manually annotated by experts, which is cumbersome and expensive. In addition, it is difficult to obtain a perfect set of labels due to the variability between expert annotations. This paper presents a novel active learning (AL) framework for histopathology image analysis, named PathAL. To reduce the required number of expert annotations, PathAL selects two groups of unlabeled data in each training iteration: one "informative" sample that requires additional expert annotation, and one "confident predictive" sample that is automatically added to the training set using the model's pseudo-labels. To reduce the impact of the noisy-labeled samples in the training set, PathAL systematically identifies noisy samples and excludes them to improve the generalization of the model. Our model advances the existing AL method for medical image analysis in two ways. First, we present a selection strategy to improve classification performance with fewer manual annotations. Unlike traditional methods focusing only on finding the most uncertain samples with low prediction confidence, we discover a large number of high confidence samples from the unlabeled set and automatically add them for training with assigned pseudo-labels. Second, we design a method to distinguish between noisy samples and hard samples using a heuristic approach. We exclude the noisy samples while preserving the hard samples to improve model performance. Extensive experiments demonstrate that our proposed PathAL framework achieves promising results on a prostate cancer Gleason grading task, obtaining similar performance with 40% fewer annotations compared to the fully supervised learning scenario. An ablation study is provided to analyze the effectiveness of each component in PathAL, and a pathologist reader study is conducted to validate our proposed algorithm.
MeSH term(s)	Humans ; Image Processing, Computer-Assisted ; Male ; Neoplasm Grading ; Neural Networks, Computer ; Prostatic Neoplasms/diagnostic imaging
Language	English
Publishing date	2022-05-02
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	622531-7
ISSN	1558-254X ; 0278-0062
ISSN (online)	1558-254X
ISSN	0278-0062
DOI	10.1109/TMI.2021.3135002
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