Noble VV

Purpose: Lymph node yield is an independent prognostic factor for survival outcomes in patients receiving neck dissection for oral squamous cell carcinoma (SCC). This study investigates whether hospital case volume is associated with increased lymph node yield in neck dissection specimens.

Background: Guidelines recommending minimum number of lymph nodes that constitutes an adequate neck dissection have not been established. There is evidence that comprehensive neck dissections with improved lymph node yield ( 18 nodes) are associated with better survival outcomes. Recent studies have proposed this association to be a potential institutional-level quality metric. However, whetherinstitutional experience (reflected by case volume) influences the quality and comprehensiveness of neck dissection (reflected in node yield) remains unknown.

Methods: The National Cancer Database was used to identify 21,150 patients who underwent primary neck dissections for oral SCC diagnosed between 2004 and 2015. Average annual surgical volumes were calculated for each facility to stratify them into quartiles based on highest to lowest case volumes. A multivariable negative binomial mixed model was used to model the number of nodes examined at the patient level, which accommodated the clustering of hospitals and adjusted for clinical and demographic factors.

Results: The median lymph node yield for all hospitals was 27 (Interquartile Range [IQR] 16-40) nodes. Median lymph nodes examined for the quartile of highest volume hospitals was 29 (IQR 19-42). Compared to a lymph node yield of 18 (IQR 9-30) in the 3rd quartile, 17 (IQR 9-27) in the 2nd quartile, and 16 (IQR 8-26) in the lowest quartile. A Dwass, Steel, Critchlow-Fligner procedure indicated that the number of nodes were significantly different for all pairwise comparisons except between the lowest two quartiles.

Conclusions: These data suggest that for patients with oral SCC undergoing neck dissections, increase in hospital case volume is associated with higher lymph node yield. Institutions with greater experience and case volumes are more likely to consistently meet the cutoff value of lymph node yield ( 18 lymph nodes) in neck dissection specimens, that are shown to improve survival outcomes.

Purpose: Lymph node yield is an independent prognostic factor for survival outcomes in patients receiving neck dissection for oral squamous cell carcinoma (SCC). This study investigates whether hospital case volume is associated with increased lymph node yield in neck dissection specimens.

Background: Guidelines recommending minimum number of lymph nodes that constitutes an adequate neck dissection have not been established. There is evidence that comprehensive neck dissections with improved lymph node yield ( 18 nodes) are associated with better survival outcomes. Recent studies have proposed this association to be a potential institutional-level quality metric. However, whetherinstitutional experience (reflected by case volume) influences the quality and comprehensiveness of neck dissection (reflected in node yield) remains unknown.

Methods: The National Cancer Database was used to identify 21,150 patients who underwent primary neck dissections for oral SCC diagnosed between 2004 and 2015. Average annual surgical volumes were calculated for each facility to stratify them into quartiles based on highest to lowest case volumes. A multivariable negative binomial mixed model was used to model the number of nodes examined at the patient level, which accommodated the clustering of hospitals and adjusted for clinical and demographic factors.

Results: The median lymph node yield for all hospitals was 27 (Interquartile Range [IQR] 16-40) nodes. Median lymph nodes examined for the quartile of highest volume hospitals was 29 (IQR 19-42). Compared to a lymph node yield of 18 (IQR 9-30) in the 3rd quartile, 17 (IQR 9-27) in the 2nd quartile, and 16 (IQR 8-26) in the lowest quartile. A Dwass, Steel, Critchlow-Fligner procedure indicated that the number of nodes were significantly different for all pairwise comparisons except between the lowest two quartiles.

Conclusions: These data suggest that for patients with oral SCC undergoing neck dissections, increase in hospital case volume is associated with higher lymph node yield. Institutions with greater experience and case volumes are more likely to consistently meet the cutoff value of lymph node yield ( 18 lymph nodes) in neck dissection specimens, that are shown to improve survival outcomes.

Purpose: Lymph node yield is an independent prognostic factor for survival outcomes in patients receiving neck dissection for oral squamous cell carcinoma (SCC). This study investigates whether hospital case volume is associated with increased lymph node yield in neck dissection specimens.

Background: Guidelines recommending minimum number of lymph nodes that constitutes an adequate neck dissection have not been established. There is evidence that comprehensive neck dissections with improved lymph node yield ( 18 nodes) are associated with better survival outcomes. Recent studies have proposed this association to be a potential institutional-level quality metric. However, whetherinstitutional experience (reflected by case volume) influences the quality and comprehensiveness of neck dissection (reflected in node yield) remains unknown.

Methods: The National Cancer Database was used to identify 21,150 patients who underwent primary neck dissections for oral SCC diagnosed between 2004 and 2015. Average annual surgical volumes were calculated for each facility to stratify them into quartiles based on highest to lowest case volumes. A multivariable negative binomial mixed model was used to model the number of nodes examined at the patient level, which accommodated the clustering of hospitals and adjusted for clinical and demographic factors.

Results: The median lymph node yield for all hospitals was 27 (Interquartile Range [IQR] 16-40) nodes. Median lymph nodes examined for the quartile of highest volume hospitals was 29 (IQR 19-42). Compared to a lymph node yield of 18 (IQR 9-30) in the 3rd quartile, 17 (IQR 9-27) in the 2nd quartile, and 16 (IQR 8-26) in the lowest quartile. A Dwass, Steel, Critchlow-Fligner procedure indicated that the number of nodes were significantly different for all pairwise comparisons except between the lowest two quartiles.

Conclusions: These data suggest that for patients with oral SCC undergoing neck dissections, increase in hospital case volume is associated with higher lymph node yield. Institutions with greater experience and case volumes are more likely to consistently meet the cutoff value of lymph node yield ( 18 lymph nodes) in neck dissection specimens, that are shown to improve survival outcomes.

Background: Prostatic leiomyosarcoma is a rare tumor that accounts for less than 0.1% of all primary prostatic malignancies. This neoplasm is composed of highly aggressive prostatic smooth muscle cells that presents with nonspecific signs and symptoms mimicking other forms of prostatic pathology.

Case Report: A 72-year-old male presented with 6 months of progressive severe lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction. The patient was refractory to medical management and required multiple emergent bladder catheterizations. Workup with urinalysis, blood biochemistry, and PSA levels were persistently normal. He denied hematuria, weight loss, or perineal pain. On rectal exam, a mass like induration was noted along the right upper lobe of the prostate.

The patient was referred for transurethral resection of the prostate (TURP) for suspected severe BPH. Histopathological examination demonstrated atypical cytology consistent with high-grade leiomyosarcoma. A PET scan revealed a 1.9 cm tumor with uptake of 12.6 SUV in the right posterior prostate.

Discussion: Fewer than 200 cases of prostatic leiomyosarcoma have been reported. Patients typically present between 41-78 years of age (mean age of 61 years) with signs and symptoms related to LUTS (89.4%) and perineal or rectal pain (25.6%). Constitutional symptoms, burning on ejaculation, and hematuria are uncommon. PSA levels remain normal, due to its non-epithelial etiology, which may contribute to delays in diagnosis.

Diagnosis is usually achieved after a TURP procedure or transrectal needle biopsy. Pathology demonstrates neoplastic spindle cells with nuclear atypia, multifocal necrosis, and cystic degeneration. Immunohistochemistry is characteristically positive for desmin, smooth muscle actin, and vimentin. Tumors have been reported to range between 2-31 cm in size, frequently presenting with invasion of local structures. The lungs are the most common site of distant metastasis.

Treatment may include a multimodal approach of surgery, radiation, and chemotherapy. Long-term prognosis is poor due to the tumors aggressive nature, and recurrence is common. Median survival is estimated at 17 months and 50-75% of patients die within 2-5 years of diagnosis. Due to the substantially high risk of death, prostatic leiomyosarcoma may be one of the most aggressive and poorly prognostic malignancies involving the prostate.

Background: Prostatic leiomyosarcoma is a rare tumor that accounts for less than 0.1% of all primary prostatic malignancies. This neoplasm is composed of highly aggressive prostatic smooth muscle cells that presents with nonspecific signs and symptoms mimicking other forms of prostatic pathology.

Case Report: A 72-year-old male presented with 6 months of progressive severe lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction. The patient was refractory to medical management and required multiple emergent bladder catheterizations. Workup with urinalysis, blood biochemistry, and PSA levels were persistently normal. He denied hematuria, weight loss, or perineal pain. On rectal exam, a mass like induration was noted along the right upper lobe of the prostate.

The patient was referred for transurethral resection of the prostate (TURP) for suspected severe BPH. Histopathological examination demonstrated atypical cytology consistent with high-grade leiomyosarcoma. A PET scan revealed a 1.9 cm tumor with uptake of 12.6 SUV in the right posterior prostate.

Discussion: Fewer than 200 cases of prostatic leiomyosarcoma have been reported. Patients typically present between 41-78 years of age (mean age of 61 years) with signs and symptoms related to LUTS (89.4%) and perineal or rectal pain (25.6%). Constitutional symptoms, burning on ejaculation, and hematuria are uncommon. PSA levels remain normal, due to its non-epithelial etiology, which may contribute to delays in diagnosis.

Diagnosis is usually achieved after a TURP procedure or transrectal needle biopsy. Pathology demonstrates neoplastic spindle cells with nuclear atypia, multifocal necrosis, and cystic degeneration. Immunohistochemistry is characteristically positive for desmin, smooth muscle actin, and vimentin. Tumors have been reported to range between 2-31 cm in size, frequently presenting with invasion of local structures. The lungs are the most common site of distant metastasis.

Treatment may include a multimodal approach of surgery, radiation, and chemotherapy. Long-term prognosis is poor due to the tumors aggressive nature, and recurrence is common. Median survival is estimated at 17 months and 50-75% of patients die within 2-5 years of diagnosis. Due to the substantially high risk of death, prostatic leiomyosarcoma may be one of the most aggressive and poorly prognostic malignancies involving the prostate.

Background: Prostatic leiomyosarcoma is a rare tumor that accounts for less than 0.1% of all primary prostatic malignancies. This neoplasm is composed of highly aggressive prostatic smooth muscle cells that presents with nonspecific signs and symptoms mimicking other forms of prostatic pathology.

Case Report: A 72-year-old male presented with 6 months of progressive severe lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction. The patient was refractory to medical management and required multiple emergent bladder catheterizations. Workup with urinalysis, blood biochemistry, and PSA levels were persistently normal. He denied hematuria, weight loss, or perineal pain. On rectal exam, a mass like induration was noted along the right upper lobe of the prostate.

The patient was referred for transurethral resection of the prostate (TURP) for suspected severe BPH. Histopathological examination demonstrated atypical cytology consistent with high-grade leiomyosarcoma. A PET scan revealed a 1.9 cm tumor with uptake of 12.6 SUV in the right posterior prostate.

Discussion: Fewer than 200 cases of prostatic leiomyosarcoma have been reported. Patients typically present between 41-78 years of age (mean age of 61 years) with signs and symptoms related to LUTS (89.4%) and perineal or rectal pain (25.6%). Constitutional symptoms, burning on ejaculation, and hematuria are uncommon. PSA levels remain normal, due to its non-epithelial etiology, which may contribute to delays in diagnosis.

Diagnosis is usually achieved after a TURP procedure or transrectal needle biopsy. Pathology demonstrates neoplastic spindle cells with nuclear atypia, multifocal necrosis, and cystic degeneration. Immunohistochemistry is characteristically positive for desmin, smooth muscle actin, and vimentin. Tumors have been reported to range between 2-31 cm in size, frequently presenting with invasion of local structures. The lungs are the most common site of distant metastasis.

Treatment may include a multimodal approach of surgery, radiation, and chemotherapy. Long-term prognosis is poor due to the tumors aggressive nature, and recurrence is common. Median survival is estimated at 17 months and 50-75% of patients die within 2-5 years of diagnosis. Due to the substantially high risk of death, prostatic leiomyosarcoma may be one of the most aggressive and poorly prognostic malignancies involving the prostate.