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Background: Myelodysplastic syndrome (MDS) is a marrow failure disease. As patients often require chronic transfusion, many develop red blood cell (RBC) alloimmunization or immune‐mediated platelet refractoriness. MDS represents a spectrum of diseases with specific categorizations and genetic abnormalities, and we set out to determine if these characteristics predispose patients to antibody formation. Study Design and Methods: A natural language search identified MDS patients with pre‐transfusion testing from 2015 to 2020. Marrow reports, cytogenetic results, and next‐generation sequencing panels were gathered. Transfusion history and testing were collected from the laboratory information system. Results: The group consisted of 226 biopsy‐proven MDS patients. The prevalence of RBC alloimmunization was 11.1% (25 of 226). Half (23 of 46) of all RBC alloantibodies were against Rh (C, c, E, e) and Kell (K) antigens. There was a relative enrichment for JAK2 positivity among the RBC alloimmunized group. A total of 7.1% (16 of 226) of patients had immune‐mediated platelet refractoriness and had increased transfusion requirements (p ≤ 0.01). No disease type or genetic abnormality was significantly associated with alloimmunization or immune‐mediated platelet refractoriness. Discussion: While JAK2 specific mutations were enriched among RBC alloimmunized patients, this association failed to reach statistical significance in our single‐center cohort. Further study using larger patient cohorts is warranted. Overall, this cohort of MDS patients had very similar RBC alloimmunization prevalence and anti‐RBC antibody specificities as other recent literature. Our data reinforce the finding that MDS patients are at greater risk for alloimmunization and support the use of extended phenotype matching for these at‐risk patients. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Albumin is an indicator of nutritional status and has been investigated as a predictor of cancer survival and perioperative outcomes. This study investigated the prognostic value of preoperative serum albumin in surgical patients with head and neck cancer (HNC).Study Design: Retrospective cohort study.Methods: A chart review was performed of patients who underwent HNC resection over a 6-year period at a single institution. Statistical analyses including Cox proportional hazards models, Pearson's correlation, and logistic regression were used to identify relationships between preoperative serum albumin and postoperative outcomes. Albumin was analyzed as a continuous variable.Results: A total of 604 patients were studied representing all cancer types. There was no association between albumin and pneumonia, flap complications, or length of stay. Albumin was found to have statistically significant inverse associations with overall survival (OS) (hazard ratio [HR] = 0.685, P < .001) and postoperative wound infection (HR = 0.455, P = .001). In multivariate analysis of OS, albumin did not achieve significance as an independent predictor (HR = 0.78, P = .064), whereas hemoglobin, age, and cancer stage remained significant. In a subgroup of 280 patients with upper aerodigestive squamous cell carcinoma (SCCA), albumin maintained significance in multivariate analysis of OS (HR = 0.74, P = .046). When controlling for preoperative radiotherapy, salvage surgery, and cancer stage in multivariate analysis, albumin was a significant predictor of wound infection (OR = 0.55, P = .018).Conclusions: In patients with HNC, lower preoperative serum albumin is associated with an increased rate of wound infection and poorer OS. The effect on OS is most pronounced in patients with upper aerodigestive SCCA.Level Of Evidence: 2b Laryngoscope, 126:1567-1571, 2016. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To determine whether blood transfusions are associated with adverse outcomes in patients with head and neck cancer (HNC) undergoing microvascular free tissue transfer. Study Design Retrospective cohort study. Methods The records of all patients who underwent free flaps for reconstruction after HNC resection from July 2007 through February 2013 at a single institution were reviewed. Rates of overall survival (OS), recurrence free survival (RFS), and postoperative wound infection were determined. Statistical analyses included Cox proportional hazards models and chi-square tests. Results Of 167 patients, 90 received 0 to 2 units of blood and 77 received ≥ 3. After controlling for age, preoperative hemoglobin, preoperative albumin, cancer stage, and adverse pathologic features, transfusion of ≥ 3 (versus 0 to 2) units was associated with poorer OS ( P = 0.0006; hazard ratio [HR] = 2.96) and RFS ( P = 0.003; HR = 2.35). The rates of wound infection in patients who received 0, 1, 2, or ≥ 3 units were 13.3%, 21.2%, 33.3%, and 31.2%, respectively. There was a statistically significant difference in wound infection rates between those patients receiving 0 to 1 versus ≥ 2 units ( P = 0.04). Conclusions Patients who receive ≥ 3 units of blood after free tissue transfer for HNC had a significantly increased risk of death after controlling for age, preoperative hemoglobin and albumin, cancer stage, and adverse pathologic features. Increased transfusions are also associated with higher wound infection rates. The increased tendency to transfuse free flap patients in order to maintain a threshold hematocrit may have a detrimental impact on survival and wound infections and should be revisited. Level of Evidence 2b. Laryngoscope, 125:86-91, 2015 [ABSTRACT FROM AUTHOR]

Objective To characterize epidemiologic and clinical features of red primary amelanotic melanomas, an atypical presentation of melanoma that is underemphasized in patient and physician education. Patients and methods Review of a prospectively collected melanoma database identified 46 patients with red amelanotic melanomas, whose clinical features were compared with 329 patients with pigmented melanomas from the same database and same timeframe from January 1964 to September 2005. Results Red amelanotic melanomas represented 3.9% of all melanomas recorded in our database and accounted for nearly 70% of amelanotic melanomas. Melanoma was included in the clinical differential diagnosis in 32% of red amelanotic melanomas vs. 94% of pigmented melanomas ( P < 0.001). Red amelanotic melanomas more commonly underwent shave biopsy (55 vs. 12%, P < 0.001) and more likely had positive deep margins (35 vs. 9%, P < 0.001) but had comparable risks of metastasis and mortality. Conclusion Red amelanotic melanomas are often misdiagnosed clinically but carry a mortality risk comparable to pigmented melanomas. Clinicians screening for melanoma should be more vigilant in considering melanoma in the differential diagnosis of red skin lesions. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine if atypical small acinar proliferation (ASAP) represents minimally sampled prostate cancer not fully evaluated on a biopsy or a distinct pathological entity, by examining prostates removed at radical cystectomy, as a finding of ASAP of the prostate on needle-core biopsy is closely associated with the detection of cancer on subsequent biopsy. PATIENTS AND METHODS In all, 65 consecutive cystoprostatectomy specimens taken from June 1990 to March 2004 had prostatic material reviewed by one genitourinary pathologist (S.E.M.). The presence of high-grade prostatic intraepithelial neoplasia (HGPIN), ASAP, and adenocarcinoma was recorded. Foci of ASAP found in the absence of cancer were assessed with additional sectioning, high-molecular weight keratin (CK903), and α-methylacyl coenzyme A racemase (AMACR) immunohistochemistry. RESULTS In all, 24 of 65 specimens (37%) had adenocarcinoma. Of the 41 without cancer, 18 (44%) had neither HGPIN nor ASAP, 14 (34%) had HGPIN alone, three (7%) had ASAP alone (four foci), and six had both HGPIN and ASAP (15%). Two foci of ASAP were not present on any further sectioning. The remaining eight foci all lacked CK903 stain, indicating disruption of the basal cell layer. Of these eight, only five were present for the AMACR stain, all of which were positive. Two of these five developed into a lesion considered cancer on further sectioning. CONCLUSION ASAP identified in incidental prostates represented marginally sampled cancer in at least two of 10 foci assessed. The remainder could not be resolved as benign on further evaluation, and remained suspicious for malignancy. [ABSTRACT FROM AUTHOR]

It is interesting to think that what used to be considered by many (including myself) as one of the “maximally invasive” procedures, can now be performed laparoscopically or robotically. This procedure is described in a study from the USA using the robot, and there is a review of minimally invasive radical cystectomy from the UK. Finally there is a study from Austria on the use of three-dimensional CT in the preoperative assessment of patients undergoing laparoscopic adrenal-sparing surgery. OBJECTIVE To compare the performance of radical cystectomy with ileal conduit diversion by standard methods with that using the assistance of the daVinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA). PATIENTS AND METHODS From November 2003 to August 2005, we performed 30 radical cystectomies with ileal conduit urinary diversions on patients with bladder cancer. Seven patients (one woman) had a cystectomy with the daVinci system and 23 (nine women) had a standard cystectomy. Data were collected prospectively, including estimated blood loss (EBL), transfusion requirement, operative duration, hospital stay and body mass index (BMI), and compared. RESULTS The mean EBL and transfusion requirements for standard and daVinci-assisted cases was 1109 and 479 mL ( P = 0.002) and 2.7 and 1.6 units ( P = 0.14), respectively. Four of seven patients received a transfusion in the robotic group, and 20 of 23 in the standard group ( P = 0.084). The mean operative duration was 638 and 507 min ( P = 0.005) for the daVinci and standard group, respectively, with respective mean hospital stays of 11 and 13 days ( P = 0.52). There was no difference in patient BMI between the groups ( P = 0.22). CONCLUSION The daVinci-assisted cystectomy appears to offer some advantages over standard cystectomy. Larger randomized studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]