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Chronic Lymphocytic Leukemia (CLL) is the most prevalent form of non-Hodgkin’s lymphoma (NHL) in Western countries predominantly affecting adults over the age of 65. CLL is commonly indolent in nature but can present locally and aggressively at extranodal sites. Although CLL may commonly present with cervical lymphadenopathy, manifestation in nonlymphoid regions of the head and neck is not well described. CLL causing upper airway obstruction is even more uncommon. We describe a case of a patient with known history of CLL and stable lymphocytosis that developed an enlarging lymphoid base of tongue (BOT) mass resulting in rapid airway compromise.

Breast cancer rarely metastasizes to the muscles, and it is even more unusual for this phenomenon to result in airway compromise. We present a unique case of an 84-year-old female who presented with neck swelling and upper airway obstruction due to metastatic breast cancer invading the sternocleidomastoid muscles. After establishing the diagnosis and discussing possible treatment options, the patient elected for antiestrogen therapy, palliative tracheostomy, radiation therapy, and hospice services.

Objectives Performance status (PS) scales such as the Eastern Cooperative Oncology Group (ECOG) PS and the Karnofsky Performance Index have limited utility in selecting therapies and predicting related adverse events in older patients with cancer. In July 2016, medical oncologists at our institution adopted the Cancer and Aging Research Group toxicity prediction score (CARG), a toxicity prediction tool, to identify patients who are \"fit\" for chemotherapy versus those who are \"frail\" and may experience severe complications. Methods Our retrospective review included referrals of beneficiaries 75 years of age and older who received standard systemic therapy and patients of the same age whose treatment was modified due to CARG. We compared the score's utilization six months before and after its incorporation and then assessed how its application impacted admissions, emergency department (ED) visits, and medical management. Results Thirty-eight patients with a mean age of 81 years met the inclusion criteria. Their diagnoses included gastrointestinal (37%), lung (21%), hematologic (18%), breast (10.5%), genitourinary (3%), and other (10.5%) malignancies. CARG was documented for 12.5% of systemic therapy recipients before its adoption and 41% of recipients after adoption. Its use was limited by the reliance on physicians to perform scoring during time-constrained patient encounters. Patients had fewer mean inpatient admissions (0.7 versus 2.3), admission days (4.3 versus 8), and ED visits (1.1 versus 2.5) when management was modified based on the score. Conclusion CARG assessment may facilitate a safer and more tailored approach to cancer care in older patients than conventional PS scales alone. Its integration into patient screening would increase its application and better define its potential predictive capacity to decrease risks for hospitalization.

Aim  To examine the association between genitourinary infection during pregnancy and cerebral palsy (CP) in children. Method  Medicaid and birth certificate data were obtained for 135 835 pregnant women with singleton births paid for by Medicaid from 1996 to 2002. Linked Medicaid billing data were obtained for their children in 2007. The association between maternal genitourinary infection and CP was modeled using generalized estimating equations. Results  Maternal genitourinary infection was significantly associated with CP (odds ratio [OR]=1.27, p=0.007). Additional analyses revealed that the association was strongly significant for preterm or low birthweight infants when maternal infection was diagnosed in the first two trimesters of pregnancy (OR=1.62, p<0.001). This association remained (OR=1.72, p<0.001) when the model was limited to cases of CP diagnosed by at least two different clinicians. Infection was not significantly associated with CP in term or normal‐birthweight infants. Interpretation  Maternal genitourinary infection occurring in the first two trimesters was associated with increased risk of CP in preterm or low‐birthweight children. Additional research is needed to determine whether this association is affected by antimicrobial treatment.