Olfactory neuroblastoma: the 22-year experience at one comprehensive cancer center.

BACKGROUND: Olfactory neuroblastoma (ONB) is a rare tumor arising from the olfactory neuroepithelium. There is no universally accepted staging system, and treatment approaches lack uniformity. We present one institution's experience with this tumor and the results of therapy. METHODS: Thirty patients treated for ONB at The University of Texas M. D. Anderson Cancer Center between 1979 and 2002 were retrospectively reviewed. The diagnosis of ONB was histologically confirmed for each patient. RESULTS: The mean follow-up was 7.32 years. In 77% of cases, patients received treatment with surgery followed by postoperative radiation therapy. Sixteen percent received chemotherapy as part of their initial treatment. Overall 5-year and 10-year survival rates were 89% and 81%, respectively. Nine patients whose disease was initially stage C had a recurrence. The mean time for recurrence was 4.67 years. CONCLUSIONS: The M. D. Anderson Cancer Center approach to ONB is complete surgical resection, usually involving a craniofacial approach, with postoperative radiation therapy. This approach seems to be curative in early-stage disease. Late recurrence warrants long-term follow-up.

Molecular and clinicopathologic comparisons of head and neck squamous carcinoma variants: common and distinctive features of biological significance.

To investigate, for the first time, the events associated with the phenotypic and clinical diversities of head and neck squamous carcinomas (HNSC), we performed molecular analyses on 92 primary tumors representing the entire spectrum of the morphologic subtypes using microsatellite markers at chromosome 3p, 4p, 8p, 9p, 11q, 17p, and 18q regions and correlated the results with the clinicopathologic features and patients' survival. Loss of heterozygosity (LOH) at D9S168 and D9S171 markers on chromosome 9p regions was commonly identified in all subtypes. Distinctive alterations in certain subtypes were noted at chromosomes 3p, 4p, 8p, and 11p regions. In general, less aggressive types (verrucous, papillary, and well-differentiated conventional) had a significantly lower LOH incidence than the more aggressive (basaloid, sarcomatoid, and high-grade conventional squamous carcinoma) categories. Significant association between LOH and age, stage, nodal status, and patient outcome was found. Survival analysis revealed that pathologic categorization (less versus more aggressive) and LOH at marker D11S4167 and D3S2432 are independent predictors of patients' survival. Our analysis also defined a set of limited markers that account for most of alterations within and across these tumor subtypes. Our study indicates that 1) certain genetic markers are common to all subtypes of HNSC supporting their early involvement in tumorigenesis, 2) inter- and intratumoral genetic differences evolve subsequently and may underlie their morphologic heterogeneity, 3) high incidence of LOH in certain regions characterizes aggressive tumors, 4) categorical classification and LOH at 11p and 3p regions independently correlated with patient survival, and 5) a limited set of markers identify the majority of genetic alterations in these tumors.

Community-acquired methicillin-resistant Staphylococcus aureus in children and adolescents: changing trends.

OBJECTIVE: To identify current trends in antibiotic sensitivity patterns of community-acquired methicillin-resistant Staphylococcus aureus (CA MRSA) infections of the head and neck in children and adolescents and evaluate outcomes after therapy. DESIGN: Retrospective review of cases consisting of a medical record review with telephone follow-up. SETTING: Two tertiary university medical referral centers. PATIENTS: Pediatric patients (age <18 years). MAIN OUTCOME MEASURES: Number of cases, sensitivities of cultured organisms, treatments used, and outcome of treatments. RESULTS: Seven patients were identified with CA MRSA in a 4-month period. Superficial abscesses (3 patients [43%]) and suppurative lymphadenitis (3 patients [43%]) were the most common causes. An erythromycin-resistant, clindamycin-sensitive pattern was observed in 6 (86%) of the 7 isolates. All infections resolved with prescribed treatments; there were no complications. CONCLUSIONS: A high prevalence of erythromycin-resistant, clindamycin-sensitive CA MRSA was noted. This new resistance pattern is indicative of inducible macrolide-lincomycin-streptogramin-B resistance. Basic science data suggest that these strains of bacteria could develop resistance to clindamycin during therapy despite appearing susceptible on initial laboratory testing. In our small series, clindamycin was used alone and effectively in 2 such cases. This appears to support its continued use as initial, empiric therapy in suspected cases of CA MRSA.