- Head & Neck Pathology
- Fine Needle Aspiration Biopsy
- Anatomic and Clinical Pathology
Clinical Assistant Professor, Pathology
Director of Cytopathology Service, Stanford University School of Medicine, Department of Pathology (2020 - Present)
Associate Director of Cytopathology Service, Stanford University School of Medicine, Department of Pathology (2018 - 2020)
Director of Head & Neck Pathology Service, Stanford University School of Medicine, Department of Pathology (2018 - Present)
Board Certification: American Board of Pathology, Cytopathology (2015)
Fellowship: Massachusetts General Hospital, Department of Pathology (2015) MA
Board Certification: American Board of Pathology, Pathology (2014)
Residency: Johns Hopkins School of Medicine, Department of Pathology (2014) MD
Internship: Johns Hopkins School of Medicine, Department of Pathology (2011) MD
Medical Education: Vanderbilt University School of Medicine (2010) TN
Graduate and Fellowship Programs
Cytopathology (Fellowship Program)
Model for Assessing Cytopathology Workload, Efficiency, and Wellness
NATURE PUBLISHING GROUP. 2020: 1871–72
View details for Web of Science ID 000518328904180
Pilot study of loss of the p53/p63 target gene PERP at the surgical margin as a potential predictor of local relapse in head and neck squamous cell carcinoma.
Head & neck
PERP (p53 apoptosis effector related to PMP22) localizes to desmosomes and suppresses squamous cell carcinoma development. Loss of PERP leads to worse local control in head and neck squamous cell carcinoma (HNSCC), likely by destabilizing desmosomes. We evaluated PERP loss at HNSCC surgical margins as a predictor of local relapse.Combining discovery (n = 17) and validation (n = 31) cohorts, we examined membranous PERP protein expression by immunohistochemistry in surgical mucosal margins with competing risk analysis of the relationship between local relapse and PERP expression.Of the 44 analyzable patients, the 2-year cumulative incidence of local relapse was 44.4% for the PERP-negative group and 16.4% for the PERP-positive group (P = .01). A trend toward worse progression-free survival (P = .09) and overall survival (P = .06) was observed with loss of PERP.PERP loss at surgical margins is associated with higher risk of local recurrence in HNSCC, warranting further evaluation in a larger prospective study.
View details for DOI 10.1002/hed.26358
View details for PubMedID 33034918
Macrocystic (Mammary Analogue) Secretory Carcinoma: An Unusual Variant and a Pitfall in the Differential Diagnosis of Cystic Lesions in the Head and Neck.
The American journal of surgical pathology
Mammary analogue secretory carcinoma (MASC) is a relatively recently described salivary gland adenocarcinoma characterized by ETV6-NTRK3 gene fusion and in most cases indolent clinical behavior. The majority of tumors show an admixture of microcystic, solid, and tubular growth patterns but only a few cases with dominant macrocystic growth have been reported. We report 15 cases of macrocystic MASC. There were 11 men and 4 women (17 to 88y age range, average 47y). The patients presented with a painless cystic mass, the majority in the region of the parotid gland (n=13), as well as in submandibular gland (n=1) and the neck (n=1). All tumors were circumscribed measuring 1.0 to 4.0cm in greatest diameter (mean: 1.75cm). Twelve tumors were unilocular, while 3 were multilocular. The cystic spaces were predominantly lined by a single epithelial cell layer with focal areas in which the epithelium was multilayered with papillary and hobnail features. In 3 of the cases there were more solid foci of intracystic tumor characterized by papillary and/or microcystic growth. The neoplastic cells were round to oval with hyperchromatic to vesicular nuclei with centrally located nucleoli and eosinophilic or vacuolated cytoplasm. Tumor cells showed strong positivity for S100 protein and mammaglobin, while DOG1 was uniformly negative. A minority of cases showed focal p63 reactivity predominantly limited to the periphery of the cystic lining. ETV6 gene rearrangement was identified in 9 cases. Macrocystic MASC can simulate benign and malignant salivary gland lesions and needs to be included in the differential diagnosis of cystic lesions in the head and neck. To the best of our knowledge, our report represents the first series of macrocystic MASCs wholly focusing on this unusual variant.
View details for DOI 10.1097/PAS.0000000000001309
View details for PubMedID 31464708
A Young Woman With a Rapidly GrowingThoracic Tumor.
2019; 155 (5): e145–e148
CASE PRESENTATION: A 38-year-old woman presented with 2months of dry cough, progressiveshortness of breath, central chest pain, nausea, vomiting, and dizziness. She was previously healthy and was not taking any medications. She denied fever, night sweats, or weight loss. She had a two pack-year smoking history and had quit smoking at 27 years of age. She denied drug use and had no recent travel history. Family history was pertinent for ovarian cancer, breast cancer, and colon cancer.
View details for DOI 10.1016/j.chest.2018.12.014
View details for PubMedID 31060712
Diagnostic and Grading Challenges in Oncocytic Cell (OC) and Clear Cell (CC) of Mucoepidermoid Carcinoma (MEC)
NATURE PUBLISHING GROUP. 2019
View details for Web of Science ID 000478081102230
Oncologic management of sinonasal undifferentiated carcinoma.
Current opinion in otolaryngology & head and neck surgery
PURPOSE OF REVIEW: This article reviews the latest treatment paradigms in sinonasal undifferentiated carcinoma (SNUC).RECENT FINDINGS: The aggressive biology and associated advanced presentation of SNUC make successful treatment a challenge shared across medical specialties. Still, studies reporting outcomes in SNUC indicate that an aggressive treatment strategy consisting of surgery, radiation and chemotherapy offers the best chance of prolonged survival.SUMMARY: Successful treatment of SNUC requires highly specialized care at tertiary cancer treatment facilities. A better understanding of the biology of the disease coupled with increasing outcome reporting will lead to optimized treatment regimens.
View details for PubMedID 30507692
Virus-associated carcinomas of the head & neck: Update from the 2017 WHO classification.
Annals of diagnostic pathology
2018; 38: 29–42
Virus-associated carcinomas of the head and neck represent an unusual confluence of infections spread by viral transmission and cellular dysregulation resulting in carcinogenesis. While much remains to be elucidated about the exact progression from infection to cancer, a basic framework of viral biology can complement the pathologist's understanding of morphology. This context informs the pathologist's everyday practice, including selecting ancillary studies, communicating prognostically relevant findings, and participating in treatment planning. By comparing and contrasting the salient features of human papillomavirus-associated oropharyngeal carcinoma and Epstein-Barr virus-associated nasopharyngeal carcinoma, this review summarizes recent evidence to guide current practice.
View details for PubMedID 30415111