Background: Head and Neck Squamous Cell Carcinoma (HNSCC) causes half a million deaths each year; therefore, it is essential to understand the factors that affect patient prognosis. Many studies fail to investigate the biological drivers behind survival disparities, especially sex-specific differences within racial groups. This study serves as a foundational project to begin elucidating biological differences in the tumor microenvironment between male and female African American HNSCC patients. Methods: A total of 111 patients who were diagnosed with HNSCC and identify as African American were grouped by sex. Analyses of socioeconomic status, co-morbidities, tumor characteristics, and treatment were conducted. Spatial transcriptomic analysis was performed on four randomly selected primary HNSCC tumor tissues. Results: No sex-based differences were observed in socioeconomic measures, treatments, tumor stage, follow-up, recurrence, or cause of death (all p > 0.15), though females had higher median income than males (p = 0.035). Comorbidity profiles were also largely comparable between males and females. Evaluating tumor microenvironments, we found that male tumors were dominated by malignant cells and fibroblasts, with limited adaptive immune infiltration. By contrast, female tumors displayed markedly higher proportions of immune cells, including T cells and B cells. Male tumors harbored sparse T cells, largely skewed toward exhausted phenotypes while female tumors displayed abundant T cell infiltration consistent with immunologically active tumor microenvironment. Conclusions: Clinical and demographic factors showed minimal sex-based differences among African American HNSCC patients, spatial transcriptomic profiling revealed strikingly distinct immune microenvironments by sex. These findings suggest that biological, rather than simply clinical, differences may drive survival disparities. This project serves as a novel and foundational study promoting the use of spatial transcriptomics to evaluate possible survival disparities within HNSCC populations to alleviate survival disparities.

The limited understanding and literature concerning somatic symptom and related disorders (SSRDs), especially in older adults, further complicates accurate and sensitive diagnosis and assessment for this growing and specialized population. As the population of older adults is expected to grow exponentially, the purposes of this paper are to identify and elucidate key diagnostic and assessment challenges for SSRDs among older individuals to inform further research and guide practice. This paper also describes common self-report measures for SSRDs and describes the psychometric evidence for the use of these measures with older adults. Regarding diagnosis, older adults have higher rates of somatic multimorbidity and can incorrectly attribute somatic symptoms to normal aging. Furthermore, cognitive impairment rates are higher in older adults, impacting the accuracy of reporting SSRD symptoms. Regarding assessment, there are no elder-specific measures of SSRDs. Moreover, few of the current SSRD measures have been specifically validated for use with older adults. In addition, due to lack of education and awareness, mental health clinicians and medical providers may hold stigmatizing views of older adults with SSRD symptoms. The complex symptom presentation of SSRDs in older adults also complicates the efficacy of assessments. The paper concludes with suggestions for further research on SSRDs with diverse older adult populations.

Crouzonodermoskeletal syndrome (CDSS) is a rare condition characterized by premature fusion of the coronal sutures, midface hypoplasia, beaked nasal deformity, mandibular prognathism, and proptosis. A specific mutation in the Fibroblast Growth Factor 3 (FGFR3) gene causes CDSS (Ala391Glu) and thus provides a diagnostic marker for early identification. Beyond the Crouzon syndrome-like craniofacial appearance, the CDSS phenotype includes acanthosis nigricans, choanal stenosis/atresia, hydrocephalus, Chiari malformation, and achondroplasia, although presentations vary substantially throughout the literature. In this article, we consolidate and summarize features of previously reported cases of CDSS, and we report the presentation and management of an infant with CDSS at our center. Prior reports of CDSS were sought using a combination of relevant keywords. Selection was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Publications reporting patient-specific data for at least one case of CDSS were included. We identified 74 cases of CDSS among 32 publications from 1985–2023. Most patients were identified at birth with craniofacial abnormalities. Many developed acanthosis nigricans in early childhood. Patients underwent multiple surgeries, including cranial vault reconstruction, cerebrospinal fluid diversion, airway maintenance, and nutrition management. Our patient presented at 4-months-of-age with hydrocephalus, choanal atresia, tracheostomy dependence, proptosis, Chiari malformation, and multi-suture craniosynostosis. Genetic analysis identified the heterozygous FGFR3 Ala391Glu variant diagnostic for CDSS. Over an eleven-month period, he underwent numerous surgeries to address his head shape and associated comorbidities. There was significant variability in clinical presentations, treatments, and outcomes across cases in our review. Early diagnosis of CDSS is essential to anticipate complex medical needs, develop individualized treatment plans, and ultimately to improve patient outcomes. Our review emphasizes the importance of a collaborative, patient-centered approach between plastic surgery, neurosurgery, ophthalmology, otolaryngology, and pediatric general surgery teams to manage the complexities of patients with CDSS.

Background: A vascular neoplasm linked to HHV-8 infection, Kaposi sarcoma (KS) is common in immunocompromised patients, notably people living with HIV. Isolated external ear involvement is uncommon and may present clinically as keloids, cysts, or infections. Case Presentation: A 31-year-old man presented with a one-month history of ipsilateral dacryocystitis and a rapidly growing, painful right auricular mass. The auricular lesion was initially presumed to be a sebaceous cyst during his emergency room evaluation, with actively draining purulent material. Labs showed severe pancytopenia with anemia of chronic disease, and his HIV screening test was newly reactive. Otolaryngology described an exophytic mass on the superior pinna with concern for superinfection. Local wound care was recommended, with excision planned once inflammation improved. CT showed a heterogeneous, exophytic soft-tissue mass measuring 2.2 × 1.9 cm involving the pinna. The lesion was excised, and pathology was consistent with classic KS morphology. Pathology showed a single 2.5 cm spindle cell lesion. Immunohistochemistry supported the diagnosis of KS, with tumor cells positive for HHV-8, CD31, and CD34. Mitotic activity was 21 per 10 highpower fields. Margins were negative, and no lymphovascular invasion was seen. The dacryocystitis resolved with antibiotics. Conclusion: Kaposi sarcoma of the ear is uncommon and often appears without systemic symptoms, which can delay diagnosis. Purulence and tenderness may be mistaken for a simple infection, and a keloid-like morphology can also mislead clinicians. This case highlights the similarity of these lesions, making biopsy essential to differentiate Kaposi sarcoma from more common benign or infectious ear conditions. Clinicians should consider Kaposi sarcoma of the external ear when evaluating persistent or unusual ear masses, especially in patients with weakened immune systems. Early tissue diagnosis and teamwork among specialists may lead to improved outcomes.

BACKGROUND: Dermal sinus tracts (DSTs) are rare congenital anomalies resulting from incomplete closure of the skin and neural tube. While most occur along the spinal midline, cranial DSTs are less common and typically found in midline occipital or nasofrontal regions. Lateral cranial DSTs, especially those involving the temporal bone, are extremely rare and poorly explained by current embryological models. OBSERVATIONS: The authors conducted a scoping review identifying 19 publications describing 23 unique cases of lateral cranial DSTs. The patient in this exemplary case is a 20-month-old female who presented with a right temporal dimple identified at birth. MRI confirmed a deep DST extending to the bone without intracranial extension or infection. The patient experienced one episode of fluid drainage but was otherwise asymptomatic. Excision via craniectomy removed a 3.5-cm tract and associated dermoid cyst en bloc. Recovery was uneventful, and 5-month follow-up imaging showed no recurrence. LESSONS: This case adds to the limited literature on lateral cranial DSTs and highlights that even benign dermoid cysts can enlarge and compromise adjacent neurovascular structures. Early excision remains crucial, and clinicals should consider atypical DST locations in infants with congenital skin dimples outside the midline. https://thejns.org/doi/10.3171/CASE25745