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Objective To characterize the recurrence of head and neck paragangliomas and the factors associated with disease progression after treatment. Study Design Retrospective cohort study. Setting Tertiary care center. Subjects and Methods In total, 173 adults with 189 paragangliomas (41.3% carotid body, 29.1% glomus jugulare, 19.0% glomus tympanicum, and 10.6% glomus vagale) treated between 1990 and 2010 were evaluated to determine the incidence and risk of recurrence using Cox proportional hazards. Results The mean (SD) follow-up duration was 8.6 (9.1) years. The incidence was 2.92 recurrences per 100 person-years. The rate of recurrence was 8.2% (95% confidence interval [CI], 3.7-12.7) after 4 years and 17.1% (95% CI, 10.2-24.0) after 10 years. Glomus jugulare tumors were more likely to recur (hazard ratio [HR], 3.69; 95% CI, 1.70-8.01; P < .001) while carotid body tumors were less likely (HR, 0.44; 95% CI, 0.21-0.97; P = .041). Radiation had a lower risk of recurrence or progression compared to surgical excision (HR, 0.30; 95% CI, 0.10-.94; P = .040). Recurrence was associated with right-sided paragangliomas (HR, 3.60; 95% CI, 1.63-7.75; P = .001). The median time to recurrence was 18.4 years. Six (3.2%) patients developed metastasis, which was more common with local recurrence (9.5% vs 1.4%, P = .015). Conclusions Recurrence is more common with glomus jugulare tumors and less common with carotid body tumors. Radiation may have a lower risk of recurrence or progression than surgery for some paraganglioma types. Metastasis is rare but more likely with recurrent disease. Surveillance neck imaging is recommended every several years for decades after treatment.

Background There are conflicting recommendations and possibly overuse of imaging for surveillance of second primary tumors for patients with a history of head and neck paraganglioma. Methods Retrospective cohort study of 234 adults with head and neck paragangliomas (1990‐2010) followed for a mean of 7.5 ± 8.4 years. Results The rate of second paraganglioma was 1.7% after 5 years and 5.1% after 10 years, yielding an incidence of 6.65 per 1000 person‐years. Only 1.3% of patients (2.59 per 1000 person‐years) ever had a second paraganglioma in the chest, abdomen, or pelvis. Patients with a hereditary paraganglioma (hazard ratio [HR] = 4.84, 95% confidence interval [CI]: 1.52‐15.43) or carotid body tumor (HR = 3.55, 95% CI: 1.15‐10.99) were at greater risk. Conclusions The incidence rate of a second primary paragangliomas is low but increases with hereditary disease. These results question the utility of repeated imaging outside of the neck to screen for second paragangliomas.

PURPOSEMicrosoft HoloLens (HL) mixed reality technology offers students a novel modality to visualize clinically important anatomical structures, such as the breast, which are uniquely challenging to discern with the naked eye in traditional cadaveric dissection. In this study, we developed a 3‐D anatomical model of the breast and integrated it into a dynamic, educational module on the HoloLens. Here, we report the educational outcomes and overall impressions of medical students learning breast anatomy through our module, as compared with traditional dissections.METHODSA mixed reality breast anatomy module was created using AutoDesk 3DSMax and integrated into the HoloLens device. 38 first‐year medical students were then recruited and divided into two groups: one participated in the HL module prior to dissecting the cadaveric breast, and the second dissected the cadaveric breast prior to the HL module. Before and after each teaching modality, participants answered seven comprehension‐based breast anatomy questions and a survey about their experience.RESULTSOur results show that scores on the comprehension‐based questions significantly improved more after the HL module than after the dissection (p=0.0209). Additionally, students appear to react more positively to the HL module than the dissection, regardless of which they were presented with first (p = 0.0008).CONCLUSIONSThe present study demonstrates that students show better comprehension outcomes of breast structures using the HL. This is likely due to the ability to visualize structures that cannot be seen in the cadaver. Additionally, students appear to react more positively about learning breast anatomy through the HL module than through cadaveric dissection. Our results will be important in informing a future technology‐driven medical education, especially in using mixed reality to supplement what a traditional cadaveric dissection may lack.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.