In recent years, an abundance of evidence has supported the use of specialized autofluorescence devices to assist in detecting parathyroid glands (PGs) during thyroid surgery. This study compares the "naked eye" (NE) method with an alternative device (IMAGE1 S™ Rubina® -R), primarily designed for ICG (Indocyanine Green) angiography, and a standard autofluorescence device (Fluobeam® Fluoptics LX - F) in terms of parathyroid identification. From 01/01/2024 to 31/08/2025, data from all patients undergoing thyroid-related surgery were collected from a prospectively maintained database. Adult patients who had total thyroidectomy with or without bilateral central neck dissection were included. Patients with concurrent hyperparathyroidism or renal insufficiency were excluded. In the intervention groups, the IMAGE1 S™ Rubina® camera and Fluobeam® LX were used, while no adjunct devices were employed in the control group. Patients were retrospectively matched based on indication for surgery, extent of operation, and operating surgeon. The primary endpoint was the number of parathyroid glands identified intraoperatively. 292 patients were included in the study. Propensity Score Matching yielded 37 patients per group, with no differences in demographic or clinical features. Ordinal logistic regression for the number of parathyroid glands identified showed higher odds of better gland identification with Rubina® versus Naked Eye (OR 2.56, 95% CI 1.10-5.97) and with Fluobeam® versus Naked Eye (OR 4.12, 95% CI 1.71-9.95), while Fluobeam® did not differ significantly from Rubina® (OR 1.67, 95% CI 0.72-3.88). Postoperative PTH levels were 26.63 ± 7.02 pg/ml in the NE group, 30.02 ± 5.70 pg/ml in the Rubina® group, and 33.09 ± 5.32 pg/ml in the Fluobeam® group (NE vs R: p = 0.046, NE vs F: p = 0.0001, R vs F: p = 0.079). No differences were found in postoperative calcium levels, hypoparathyroidism rates, the number of parathyroid glands in the pathology report, or the need for intraoperative PG autotransplantation. Detection rates of parathyroid glands improved with the use of both autofluorescence devices compared to the naked eye, while there was no significant decrease in postoperative hypoparathyroidism rates.
When treating primary hyperparathyroidism (PHPT), surgeons use visual cues to guide decision-making and judge disease extent. We assessed assess whether visual identification of a normal-appearing ipsilateral parathyroid gland (IPG) during parathyroidectomy predicts single-gland disease in patients with PHPT. We retrospectively analyzed patients undergoing parathyroidectomy for PHPT. Diagnostic performance of a normal IPG appearance was assessed, and logistic regression identified independent predictors of single-gland disease. 572 patients were included. Mean age was 59 ± 14 years; 80% were female, 67% White. 311 (54%) had a normal-appearing IPG: 255 (82%) had single-gland disease, 56 (18%) multigland disease. A normal IPG yielded sensitivity 75%, specificity 76%, PPV 82%, NPV 67% for predicting single-gland disease. On multivariable analysis, a normal IPG was the strongest independent predictor (OR 8.50, 95% CI 5.61-12.86; p < 0.001); higher preoperative calcium was also associated. Model AUC was 0.84. A normal-appearing IPG is a strong, independent indicator of single-gland disease but not definitive: 18% of patients with a normal IPG harbored multigland pathology.
To predict the diagnostic value of the fluorescein-assisted labial salivary gland test (FAST) in diagnosing Sjögren disease (SjD) and its correlation with biopsy positivity. Consecutive patients presenting with aqueous-deficient dry eye, that is, dry eye symptoms plus Schirmer less than 10 mm in 1 eye and positive ocular staining, were investigated for SjD using serology and labial minor salivary gland (MSG) biopsy. Using the FAST technique, the number of actively secreting MSGs and the flow rate were calculated in μL/min. Receiver operating characteristic curves, sensitivity, and specificity were calculated. Of 43 patients with aqueous-deficient dry eye, 23 (56.6%) had a focus score greater than 1, and 2 were seropositive for SS-A or SS-B. Twenty-seven (62.8%) reported dry mouth, of which only 14 were biopsy-positive. The median gland number and mean MSG flow rate were 11 (interquartile range, 11) 0.81 ± 0.8 μL/min in biopsy-positive cases, and 18.5 (8) 1.4 ± 0.9 μL/min in biopsy-negative cases, respectively. Receiver operating characteristic analysis demonstrated that both flow and gland number were associated with biopsy positivity. Flow showed moderate diagnostic performance (area under curve (AUC) = 0.68), with an optimal cutoff of <1.21 μL/min yielding 73.9% sensitivity and 73.7% specificity. Gland number demonstrated better discrimination (AUC = 0.73), with a cutoff of <14.5 providing 69.6% sensitivity and 78.9% specificity. There was a moderately positive correlation between the glandular area observed on histology and gland number and flow. FAST can assist in identifying the labial biopsy site containing confluent, actively secreting glands, especially near the lip commissures, and in increasing the glandular area captured on histology in suspected SjD patients.
Trans-sphenoidal surgery is the standard approach to provide direct access to pituitary neuroendocrine tumours (PitNET). Reported outcomes for trans-sphenoidal surgical resection of PitNET were heterogeneous. This work aimed to develop local data for the outcomes of trans-sphenoidal surgery, either via a microscopic or endoscopic approach. We performed a retrospective review of patients with PitNET treated by trans-sphenoidal surgery at Sarawak General Hospital from 2014-2021. We included only cases treated by the senior author (AWSH) to avoid inter-surgeon variability. Demographic, clinical, radiologic, operative, and postoperative outcome data were analysed. There were 60 patients, with 35 patients in the microscopic group and 25 in the endoscopic group. The baseline characteristics were comparable. The rate of gross total resection was similar (34.4% vs 44.0%, p=0.459) in both approaches. The endoscopic approach was observed to have a higher proportion of patients with arachnoid breach than the microscopic approach (p=0.010). However, the endoscopic approach had a significantly higher proportion of patients with improved anterior pituitary gland function than the microscopic approach (p=0.006). There was low morbidity, with a meningitis risk of 2.9% in the microscopic approach vs. 4.0% in the endoscopic approach (p>0.950). There was no mortality observed in our study. During follow-up, we found that 83% of patients with residual volume remained radiologically stable and clinically asymptomatic and did not require a second surgery. Our study showed that trans-sphenoidal surgery, either with a microscopic or endoscopic approach, was safe for the resection of PitNET. The endoscopic approach has a better outcome in anterior pituitary function improvement. There was no difference in the extent of resection and visual improvement. Postoperative meningitis risk was equally low, and there was no mortality in our transsphenoidal series.
Lymphoepithelial carcinoma is an extremely rare malignant tumor in salivary glands, so it is of great significance to understand and summarize the disease characteristics and treatment experience. We reported 3 lymphoepithelial carcinoma cases undergoing surgical treatment and postoperative radiotherapy. All cases were pathologically diagnosed with lymphoepithelial carcinoma of salivary gland after surgery, among which two had cervical lymph node metastasis. 2 cases have been followed up for 15 months without local recurrence or distant metastasis.1 cases has been followed up for 15 months,hepatic metastasis was diagnosed at the 8th month after postoperative radiotherapy, and received surgery for the liver lesion. Lymphoepithelial carcinoma of salivary gland has complex etiology and still needs a combined treatment based on surgery. Targeted therapy and immunotherapy may be used as new treatments in the future.
Endoscopic transsphenoidal surgery is indicated when non-functioning pituitary adenomas (NFPAs) cause visual compromise, but its timing is less certain in patients with preserved vision and intact pituitary function, where the risk of new post-operative pituitary dysfunction influences decision-making. This systematic review aimed to determine the rate of new post-operative endocrine deficits following transsphenoidal surgery for NFPAs and to identify predictive factors. This review followed PRISMA guidelines. Studies reporting predictors of post-operative endocrine deterioration in adults undergoing transsphenoidal surgery for NFPAs were included. Predictors were synthesised narratively, with meta-analysis where at least two studies used comparable definitions. Pooled proportions estimated the overall rate of deterioration. Certainty of evidence was assessed using GRADE. Eleven studies comprising 2,350 patients were included. The pooled proportion developing new post-operative endocrine deterioration was 16% (95% CI 13-20%; I² = 60%). Larger tumour volume was associated with deterioration, and gross total resection with reduced odds compared with subtotal resection. Cavernous sinus invasion and other predictors showed inconsistent associations, while age, sex, comorbidities, apoplexy, pituitary gland or stalk visibility, surgeon experience and surgical approach were not associated with risk. Overall certainty of evidence was low to very low. New post-operative endocrine deficits affect approximately one in six patients after transsphenoidal surgery for NFPAs. Tumour volume was the most consistent predictor of endocrine deterioration, suggesting a potential role for earlier intervention in selected patients, although evidence certainty was low to very low. Standardised reporting and prospective studies are needed to guide risk stratification decision-making.
The NIM TriVantage™ electromyogram endotracheal tube (NIM [Nerve Integrity Monitoring] tube) is positioned at the midline of the mouth, as the electrodes must attach to both sides of the vocal cords for neural monitoring during thyroid surgery. The tube possibly kinks below the slip joint, resulting in ventilatory disturbance. We examined whether kinking of the NIM tube altered ventilation in a simulation model and assessed whether using a tube stand during thyroid surgery prevented such kinking and associated ventilatory instability. We assessed the impact of bending warmed (32°C) NIM tubes (7.0- and 8.0-mm ID, n = 10 per group) on airway pressure and measured tidal volume within a simulator. Additionally, we investigated whether a custom-designed tube stand could mitigate ventilatory impairment when employing a midline-fixed NIM tube in patients undergoing thyroid surgery. In a simulator, 75° bending of the NIM (7.0 mm) tube significantly augmented airway pressure (31 [28 to 34] cmH2O, median [IQR], P < 0.001), and 60° and 75° bending of it caused a slight, but significant decrease in the measured tidal volume compared with 0° bending. Using our custom tube stand prevented kinking of the 7.0-mm NIM tube, with no clinically meaningful changes in airway pressure or delivered tidal volume during surgery. The NIM (7.0 mm) tube is vulnerable to kinking-induced ventilatory impairment in the clinical setting, and a tube stand prevents this issue. We recommend using a tube stand during thyroid surgery to ensure safe and effective neural monitoring.
Maintaining optimal mammoplasty outcomes remains a significant challenge for surgeons. Complaints such as early ptosis, waterfall, and double-bubble deformities can compromise the longevity of aesthetic outcomes. This surgical report describes the split mammary gland retromuscular technique (SMART) mammoplasty, a novel approach aimed at preventing early glandular descent and waterfall deformity and ensuring long-term aesthetic results. This technique involves splitting the mammary gland pillars into deep and superficial layers along the coronal plane in a superior pedicle mammoplasty, transposing the deep layer of the gland into a submuscular pectoralis major strip, and using the superficial layers for breast closure.
Apocrine sweat gland adenocarcinoma is an uncommon feline adnexal neoplasm, and lower-lip involvement is rarely documented. A 14-year-old spayed female Siamese cat was evaluated for a firm 1.3 cm right lower-lip mass at a documented hemorrhagic lesion site. Approximately 1 year earlier, the lesion was fluctuant and superficially erosive to ulcerative; fine-needle aspiration yielded bloody fluid with cytologically nondiagnostic material. The lesion reportedly subsided after empirical treatment, but reassessment, tissue diagnosis, and objective confirmation of resolution were not performed. Cytology of the later same-site mass supported malignant epithelial neoplasia. Contrast-enhanced computed tomography (CT) identified a 12.5 × 13.2 × 16.6 mm rim-enhancing mass without mandibular invasion or distant metastasis; the ipsilateral mandibular lymph node was mildly thickened. Histopathology supported a diagnosis of lower-lip apocrine sweat gland adenocarcinoma with lymphovascular tumor emboli, lymphatic invasion, and nodal metastasis. The diagnosis was supported by superficial dermal/subcutaneous location, adjacent adnexal structures, skeletal-muscle separation from nearby minor salivary glands, epithelial immunoreactivity, periodic acid-chiff (PAS) and Alcian blue findings without distinct intratumoral mucin/mucopolysaccharide-rich material. The cat died without necropsy on postoperative day 87. This case supports tissue-based diagnosis and regional lymph node assessment for suspicious feline lower-lip glandular epithelial lesions.
Mammary tumors in sheep are exceedingly rare, with all reported cases being benign to noninvasive and slow growing. Here, we describe a squamous cell carcinoma (SCC) with widespread metastases presumptively arising from the mammary parenchyma in a 3.5-y-old ewe. Following a history of chronic mastitis and severe swelling of the udder, the udder was removed surgically and submitted for examination. Three weeks after surgery, because of poor prognosis, the animal was euthanized and autopsied. The udder had no cutaneous lesions but had parenchymal disorganization and extensive areas of necrosis delimiting large, fluid-filled cavities. Two cord-like masses extended from the mammary gland into the pelvic cavity and subcutis of the right hindlimb. Numerous nodules were observed within the mammary and abdominal lymph nodes, peritoneum, lungs, and heart. Histologically, mammary and extramammary lesions consisted of neoplastic squamous epithelial cells, often surrounding keratinized cores. Neoplastic cells had diffuse cytoplasmic immunolabeling for pancytokeratin, confirming their epithelial lineage. Non-keratinized neoplastic cells were positive for p63 and, infrequently, for cytokeratin 19, suggesting mammary histogenesis. Considering the lack of a primary extramammary mass and the tumoral immunophenotype, a presumptive diagnosis was made of primary mammary SCC with metastasis to multiple organs. The aggressive clinical behavior of this neoplasm contrasts with that of reported ovine mammary neoplasms and cutaneous SCCs.
The use of intraoperative consultation for indeterminate thyroid lesions is not advocated but is still requested by some surgeons. Obscured cytomorphology and nonrepresentative sampling limit the specificity of intraoperative assessment. Formalin fixation of thyroid glands before sectioning also minimizes artifacts introduced by fresh sectioning. Inking of thyroid may vary based on institutional preferences and information desired by clinical teams. Sectioning may occur in the conventional transverse method or the modified transverse vertical method to more thoroughly evaluate the lesion's periphery. Gross examination of thyroid lesions should always consider possible high-grade features, such as necrosis or extrathyroidal extension.
Preoperative knowledge of inferior parathyroid gland (IPTG) location and vascular supply is critical for in situ preservation, yet evidence on imaging accuracy for IPTG localization remains limited. To evaluate the diagnostic accuracy of an ultrasound classification system for IPTG location guided by the thyrothymic ligament (TTL). This prospective, single-center study enrolled consecutive patients scheduled for thyroidectomy from January 2025 to September 2025. The reference standard was surgical exploration confirmed by negative mitoxantrone hydrochloride staining or frozen section pathology. Concordance between ultrasound localization and surgical findings was assessed, and factors influencing accuracy were analyzed. Among the 158 patients (123 lobectomies and 35 total thyroidectomies, 193 IPTG sides), the TTL was clearly identified intraoperatively in 47.7% (92/193). Ultrasound sensitivity, specificity and accuracy for TTL identification were 94.6% (87/92), 84.2% (85/101) and 89.1% (172/193), respectively. IPTG locations were classified as: dorsal mid-to-lower thyroid (35.2%), within 1 cm of the inferior thyroid pole (13.5%), within the TTL region (43.0%), and ectopic (8.3%). Overall concordance between ultrasound classification and surgical exploration was 81.3% (157/193, 95%CI: 74.6%-86.6%). IPTG within the TTL region (OR = 7.64, 95%CI: 1.22-47.93, P = 0.03) and ectopic IPTG (OR = 0.06, 95%CI: 0.01-0.27, P < 0.01) were independent predictors of ultrasound accuracy. Ultrasound-based TTL identification provides a reproducible and reliable method for classifying IPTG location, which may aid in developing individualized surgical strategies for parathyroid preservation during thyroidectomy.
To evaluate geographic variation in Medicare fee-for-service (FFS) pituitary surgery provider availability, straight-line distance to care, and community-level sociodemographic correlates across the contiguous United States. We performed a cross-sectional ecological geospatial analysis of 3,007 counties grouped into 40 provider catchment areas during 2018-2022. Qualifying providers were identified in CMS Medicare Physician & Other Practitioners data using a claims-based annual volume criterion for CPT codes 61,546, 61,548, or 62,165. County characteristics were aggregated to catchment areas. Outcomes were population-weighted straight-line distance to the nearest qualifying provider and provider density per 100,000 population. Associations were evaluated at the catchment-area level using univariable linear regression. Sixty-four of 88 observed providers (72.7%) met the claims-based criterion. Mean catchment-area provider density was 0.03 ± 0.03 per 100,000 population, and mean distance was 74.48 ± 33.82 miles. In univariable ecological analyses, longer distance was associated with higher proportions of American Indian/Alaska Native residents and with greater prevalence of cognitive difficulty, hearing impairment, vision difficulty, and depression. Provider density correlated positively with population density and the proportion of households without a vehicle, an urbanicity-related pattern, while Latino residential isolation was associated with lower provider density. Medicare FFS claims demonstrate substantial geographic variation and ecological associations between access measures and community characteristics. These findings neither enumerate the national pituitary surgical workforce nor establish individual-level or causal relationships. They support further evaluation of regional referral networks, transportation support, and telehealth as potential access strategies.
IgG4-related disease (IgG4-RD) has long been associated with Th2-predominant immune responses and allergic features. However, the immunological context underlying lesional Th2-like inflammation remains incompletely understood. Bulk RNA-seq data from 49 submandibular gland lesions of IgG4-RD were analyzed. Module scores representing Th2, Tfh/Tph, B cell, germinal center B cell (GC_B), plasma cell, macrophage, and stromal/fibrotic programs were calculated. Correlations between Th2 module scores and other immune/stromal modules were assessed using Spearman correlation analysis. Differentially expressed genes between Th2-high and Th2-low lesions were also evaluated. Th2 module scores were strongly associated with Tfh, Tfh/Tph, and Tph helper T cell programs, as well as with B cell, GC_B, and plasma cell signatures. In addition, Th2 module scores positively correlated with M2 macrophage and fibrosis-associated macrophage (FAM) programs. Differential expression analysis demonstrated increased expression of chronic helper T cell-related genes, including PDCD1, TOX, and MAF, together with plasmablast-associated genes such as JCHAIN, MZB1, and PRDM1 in Th2-high lesions. In contrast, serum IgG4 and IgE levels did not significantly differ between Th2-high and Th2-low groups. Lesional Th2-like inflammation in IgG4-RD was closely associated with chronic Tfh/Tph-germinal center immune programs linked to plasmablast and M2/FAM macrophage responses. No clear association with available systemic allergy-related parameters was observed in this cohort.
Salivary gland carcinoma (SGC), particularly salivary duct carcinoma (SDC), is a rare and aggressive malignancy with no standard systemic treatment. Androgen receptor (AR) expression is frequently detected in SDC, which suggests inhibition of the AR pathway as a therapeutic strategy. We conducted a prospective phase II trial of the efficacy and safety of darolutamide, a second-generation AR signaling inhibitor, as monotherapy or in combination with goserelin, in patients with AR-positive unresectable locally advanced (LA) or recurrent/metastatic (R/M) SGC. DISCOVARY was a multicenter, single-arm, phase II trial conducted in Japan. Patients with unresectable LA or R/M AR-positive SGC were enrolled into two sequential cohorts, a monotherapy cohort (darolutamide 600 mg orally twice daily) and a combination cohort (darolutamide plus goserelin 3.6 mg subcutaneously once every 28 days). The primary end point was objective response rate (ORR). Secondary end points included progression-free survival (PFS), overall survival (OS), safety, and health-related quality of life. Fifty-seven patients were enrolled (monotherapy, n = 24; combination, n = 33). In the monotherapy cohort, the confirmed ORR was 8.3% (90% CI, 1.5 to 24.0) and the median PFS was 5.7 months. In the combination cohort, ORR was 45.2% (90% CI, 29.7 to 61.3) and the median PFS was 13.1 months. Twelve-month OS rates were 91.3% and 87.0%, respectively. Most adverse events were grade 1 or 2 in severity, with no treatment-related deaths. Quality of life was preserved. No clear association between AR expression level or Ki-67 index and treatment response was evident in exploratory analysis. Darolutamide demonstrated antitumor activity in AR-positive SGC, with numerically more favorable outcomes with goserelin. Darolutamide plus goserelin may represent a chemotherapy-sparing option in this rare malignancy.
Fine-needle aspiration (FNA) induced infarction of Warthin tumor is a rare phenomenon with potential to mimic malignancy both radiologically and histologically. We report the case of a 55-year-old woman who initially presented with a painless left parotid mass. Pre-FNA contrast-enhanced CT demonstrated a well-circumscribed, homogeneously enhancing oval mass of 3 × 2.6 × 2.2 cm, and doppler ultrasound confirmed internal vascularity. FNA cytology confirmed a benign Warthin tumor. Fifteen days later, she developed painful swelling and trismus. A follow-up CT revealed complete loss of internal enhancement with no interval change in size, and doppler ultrasound demonstrated absent internal color flow, new from the pre-FNA exam. This constellation of findings was consistent with infarction. The patient was managed conservatively with marked clinical improvement within ten days. Subsequent surgical excision, performed approximately 4 weeks after FNA, confirmed infarcted Warthin tumor with no evidence of malignancy. This case emphasizes the importance of recognizing infarction as a benign post-FNA complication to avoid misdiagnosis and unnecessary aggressive treatment.
Recurrent hemorrhagic pleural effusion presents as a challenge for both the clinician and the patient, with common causes being tuberculosis, malignancy, and collagen vascular diseases. Among uncommon causes of recurrent hemorrhagic effusion is catamenial hemothorax, which is a part of thoracic endometriosis syndrome (TES). Endometriosis is the extrauterine growth of endometrial glands and stroma. It is relatively common among women of reproductive age-group, with reported incidence of around 11%. Although rare, the thorax is the most common extraabdominal site for endometriosis. Here we present a rare case of recurrent hemorrhagic pleural effusion due to thoracic endometriosis in a young female with infertility. A 33-year-old female housewife presented with dyspnea on exertion modified Medical Research Council (mMRC) grade 2 and dry cough occasionally for 6 months. She had a history of tubercular cervical lymphadenopathy for which she was on treatment. Therapeutic thoracocentesis was performed thrice in 4 months. Routine microscopy showed predominantly lymphocytes, mesothelial cells, and numerous foamy histiocytes, some pigment laden. There were no malignant cells or acid-fast bacilli (AFB) detected in the fluid. Pleural fluid amylase and lipase were normal. Contrast-enhanced computed tomography (CT) thorax showed moderate right-sided pleural effusion without any evident parenchymal lesions, pleural lesions, or mediastinal lymphadenopathy. Ultrasonography (USG) abdomen and pelvis showed mild ascites which was nontappable. As we had not reached a definitive diagnosis, medical thoracoscopy was performed. It showed moderate hemorrhagic pleural fluid in the pleural cavity and a small raised erythematous glandular tissue on the parietal pleural surface from which biopsy was taken. Histopathology showed an island of endometrial stroma with a single gland. Immunohistochemistry was performed on this section, which was PAX8 and CD10 positive, confirming the diagnosis of thoracic endometriosis. Pleurodesis with talc slurry was done to prevent further refilling of the effusion. Gynecology opinion was sought, and patient was started on monthly subcutaneous injections of gonadotropin-releasing hormone (GnRH) analogue for 3 months. Chest X-ray after 3 months showed no refilling of pleural effusion. Catamenial hemothorax is the second commonest manifestation of TES, occurring in approximately 14% of cases. It affects the right side in about 80% of the cases. Diagnosis is based on high degree of suspicion and is often delayed. Video-assisted thoracic surgery (VATS) remains the gold standard for diagnosis and management of TES. Medical thoracoscopy is a viable alternative in resource-poor settings or when diagnosis is not confirmed. On histology, diagnosis is confirmed by the presence of endometriotic glands or stroma, which may also show stromal arterioles, erythrocytes, and pigmented histiocytes. In difficult-to-diagnose cases, CD10 immunohistochemical staining can help in diagnosis of endometrial tissue. There are various treatment modalities considered in the management of catamenial hemothorax, like surgical resection, medical management along with pleurodesis, combination therapy, or in some cases, simple observation. Currently, VATS with GnRH analogue therapy is considered the gold standard of management.
Adenoid cystic carcinoma (ACC) is an uncommon malignancy arising from secretory glands. While most commonly involving the parotid and submandibular glands, it can arise from any of the minor salivary gland tissue in the upper aerodigestive tract. This report features a more uncommon presentation of ACC in a 69 y.o. gentleman with a mass in his upper lip. Initial CT scan with contrast was concerning for an invasive lesion which subsequently led to a guideline-driven workup including fine-needle aspiration that was concerning for suspected salivary gland malignancy, most likely ACC. Pre-treatment chest CT was negative for metastatic disease. The patient underwent surgical excision followed by radiation therapy for definitive treatment. Surgical pathology confirmed a diagnosis of ACC with perineural invasion. The patient was treated with radiation therapy to minimize risk of tumor recurrence. Due to high prevalence for late recurrence and lung metastasis in patients with adenoid cystic carcinoma, the patient will be seen for ongoing surveillance including imaging. This case report looks to describe a more uncommon presentation of ACC and reviews the literature for management of ACC involving the minor salivary glands.
Isotretinoin reduces the production and spread of sebaceous glands in the skin but can also affect the sebaceous glands of the eyelids, the meibomian glands, leading to dry eye disease (DED). The purpose of this study is to systematically review the evidence regarding the effects of isotretinoin on ocular surface parameters and its association to DED. A systematic search was conducted in MEDLINE (via Ovid), Embase, Scopus, and the Cochrane Central Register of Controlled Trials databases. Independent screening of titles, abstracts and full-text articles was performed by two authors. A total of 43 articles were included in this review. Across prospective studies evaluating ocular surface parameters, worsening of dry eye symptoms and objective signs of ocular surface disease was frequently reported, particularly for measures of meibomian gland structure and function. Six studies evaluated interventions intended to reduce isotretinoin-associated adverse effects, of which four reported improvements in symptoms or ocular surface parameters. Dry eye disease appears to be a common and potentially serious side effect of isotretinoin. The drug may cause persistent alterations to the sebaceous glands in some patients, although the long-term extent and clinical significance remain uncertain. Patients should be informed about potential ocular complications and screened for symptoms of DED before and during isotretinoin treatment.
To report the management of an advanced cutaneous squamous cell carcinoma (SCC) with parotid gland invasion, emphasizing surgical treatment with facial nerve preservation and reconstruction using a supraclavicular fasciocutaneous flap. A 64-year-old man presented with a rapidly growing ulcerated lesion in the right malar region measuring approximately 5.0 cm × 4.0 cm. Imaging suggested parotid gland involvement without regional lymph node metastasis (cT3N0M0), which was subsequently confirmed histopathologically. The patient underwent wide local excision and parotidectomy extending to the deep lobe following identification of a positive deep margin on frozen-section analysis, while preserving the facial nerve. Reconstruction was performed using a supraclavicular fasciocutaneous flap. Histopathological examination confirmed a moderately differentiated SCC with parotid gland invasion and clear surgical margins. Adjuvant radiotherapy was subsequently administered. Advanced cutaneous SCC of the face requires multidisciplinary management. Radical surgical resection with intraoperative margin assessment may allow preservation of critical structures such as the facial nerve, while the supraclavicular fasciocutaneous flap remains a reliable reconstructive option for extensive cervicofacial defects.