Invasive tumor front (ITF) is the deepest three to six cell layers or detached tumor cell groups at the advancing edge of the tumor. Tumor budding is defined as presence of isolated single cells or small cell clusters scattered in the stroma ahead of the ITF and is characteristic of aggressive cancer. It is recognized as an adverse prognostic factor in several human cancers like colorectal, oesophageal, laryngeal cancers and more recently tongue cancers. However, the prognostic value of tumor budding has not been reported in GBCSCC. The aim of our study was to evaluate the role of pattern of invasion (POI) at the ITF, Tumor budding and other clinicopathological parameters in predicting nodal metastases and prognosis in GBCSCC. 33 patients with primary GBCSCC were prospectively evaluated at a tertiary care referral centre. Tumor budding and type of POI was examined in detail and data documented. Statistical analyses were carried out to assess the correlation of tumor budding, POI, and other clinicopathologic parameters (stage, grade of the tumor, tumor thickness, PNI, LVI) with nodal metastases and predict prognosis. Cox regression was used for both Univariate and multivariate analysis. Significant predictors of nodal metastases on Univariate analysis were male gender (p = 0.021), smoking (p = 0.046), Tumor budding (p = 0.014) and diffuse infiltrative/worst POI (p = 0.004), where as on multivariate analysis only worst POI was significantly associated with positive lymph nodes (p = 0.004). Presence of nodal metastases (p = 0.01) and tumor thickness [5 mm (p = 0.009) were independent negative prognostic factors on multivariate analysis. Significant single risk factor predictive of positive lymph nodes is worst POI in GBCSCC. Nodal metastases and [5 mm tumor thickness are independent risk factors for disease free survival.

Resection of advanced gingivo-buccal tumors results in a posterolateral mandibular and large soft tissue defect. Because of large soft tissue requirement, these defects are difficult to reconstruct using a single osteocutaneous flap. A double free flap reconstruction of such defects is recommended. However, double flap may not be feasible in certain situations. In this study, we objectively evaluated functional and cosmetic outcomes following single soft-tissue flap reconstruction in a group of patients where double flap reconstruction was not feasible. Patient and defect characteristics were obtained from charts. The speech and swallowing functions of patients were prospectively assessed by a dedicated therapist. The cosmetic outcome of reconstruction was evaluated by an independent observer. Fifty-six patients with large soft tissue and segmental posterolateral mandible defect, reconstructed with anterolateral thigh or pectoralis major flap from May 2009 till December 2010 were included. In this series, none of the flaps were lost; two patients with pectoralis major flap developed partial skin paddle loss. Most of the patients developed mandibular drift; however, majority of these patients had no postoperative trismus. All patients resumed regular or soft solid oral diet. The mean speech intelligibility was more than 70%. Majority of patients had satisfactory cosmetic outcome. The defects were classified into regions resected to develop a reconstruction algorithm for optimal reconstruction using a free or pedicle flap. In conclusion, patients with large oro-mandibular defect undergoing single soft tissue flap reconstruction have satisfactory functional and cosmetic outcome.

Background. Foods fortified with sodium iron ethylenediaminetetraacetate (NaFeEDTA) (median, 38.4 µg/dL; 25th-75th percentiles, 18.2-67.1 µg/dL) and the control group (median, 33.1 µg/dL; 25th-75th percentiles, 12.4-54.2 µg/dL).Conclusions. Iron fortification of foods with NaFeEDTA does not affect urinary zinc excretion in children.

Clinicopathological factors may inform treatment decisions in patients with stage IV OSCC. Expression patterns of COX-2 and mPGES-1 correlated with outcome and warrant further investigation. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1142-1149, 2015.

CONTEXTPreoperative assessment of adnexal mass aids in appropriate referral and in planning optimal surgery. The risk of malignancy index (RMI) has been shown to be a triage tool for the same. AIMSThis study aimed to evaluate the ability of risk of malignancy risk index 4 (RMI 4) in preoperatively predicting the nature of an adnexal mass and to compare it with risk of malignancy index 2 (RMI 2). SETTINGS AND DESIGNA retrospective study was carried out in 71 women with an adnexal mass requiring operative intervention attending a tertiary care hospital. METHODS AND MATERIALRisk of malignancy indices were calculated based on ultrasound score, menopausal status, serum CA-125 levels and size of the tumour. Histopathological report of the tumour was considered as gold standard. STATISTICAL ANALYSIST test, McNemar's test, Mann-Whitney U test and kappa analysis were used to analyse the data. A p value of < 0.05 was considered significant. RESULTSThirty nine of 71 specimens were malignant. RMI 4 had a sensitivity and specificity of 79% and 81% respectively. RMI 2 had a sensitivity and specificity of 82% and 78% respectively. Measurement of agreement between RMI 2 and RMI 4 was 96%.CONCLUSIONS RMI 4 was a good tool with a balanced sensitivity and specificity. However, RMI 2 was marginally more sensitive among the indices studied; however, less specific than RMI 4. KEYWORDSAdnexal Mass, Ovarian Cancer, Ultrasonography, Risk of Malignancy Index. KEY MESSAGESThe RMI 4 and RMI 2 are tools with balanced sensitivity and specificity to differentiate between benign and malignant ovarian tumours. They are simple methods that could be used in clinical practice to consider referral to a gynaecologic oncologist. HOW TO CITE THIS ARTICLE:Kulkarni KA, Premalatha TS, Acharya G, et al. Evaluation of risk of malignancy index 4 (RMI 4) in the preoperative assessment of adnexal masses.