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Aims: Recent guidelines have suggested the presence of tumour cell necrosis (TCN), atypia and mitotic index as major features in the distinction of myxoid leiomyosarcomas (MLMSs) from myxoid leiomyomas. The aim of this study was to focus on an invasive growth pattern as a significant feature in this distinction in the absence of TCN., Methods and Results: Twelve uterine smooth muscle tumours with myxoid change in ≥60% of the lesion were interpreted as MLMS on the basis of the presence of focal mild atypia as well as one or more of the following features: (i) infiltrative growth pattern; (ii) vascular invasion; (iii) mitotic index of ≥5 mitotic figures (m.f.)/50 high-power fields (HPFs); and (iv) a combination of at least focal severe atypia and at least 2-4 m.f./50 HPFs. Unequivocal TCN was not evident in any of these tumours. The various morphological features were correlated with outcome. With follow-ups ranging from 19 to 113 months (mean 60 months), five of the 12 women developed recurrences, and two of them died. Nine of the 12 tumours had an infiltrative growth pattern, and all five recurrent tumours were from this group., Conclusion: In the absence of TCN, an infiltrative margin is a major factor related to the potential for aggressive behaviour of MLMS., (© 2011 Blackwell Publishing Limited.)

Objective: Diabetic neuropathy is one of the more common complications plaguing individuals with type 2 diabetes. The development and progression of such complications are responsible for much of the morbidity and mortality related to this disease. Few studies have evaluated age at onset of diabetic neuropathy between genders. A difference in the progression of diabetic neuropathy between men and women may exist. This investigation evaluated gender differences in the age at onset of neuropathy among patients with type 2 diabetes., Methods: The study, a retrospective chart analysis, reviewed 376 inpatient and outpatient medical records between January 2004 and January 2006 from a Cleveland, Ohio, hospital. Onset of neuropathy was determined by the date the neuropathy International Classification of Diseases, Ninth Revision code was first included in the medical chart; for this study, onset was equated with the date of first identification. Data were analyzed via a tailed independent t test., Results: Of the 376 inpatient and outpatient charts reviewed, 156 were for male patients and 220 were for female patients (41% and 59%, respectively). All patients had type 2 diabetes; however, 23% (n=86) required insulin therapy at the time of the study. Males developed neuropathic complications at 63 years, approximately 4 years earlier than did females (at 67 years). The t test revealed a statistically significant difference in age at onset of diabetic neuropathy between the male and female subjects., Conclusions: This study demonstrates that the males in the study population developed neuropathy earlier than did the females. It may then be hypothesized that earlier interventions in the male population may improve disease outcomes.

We describe 13 cases in which the submucosa and muscularis mucosae of the gastrointestinal tract exhibited a focal or diffuse increase of elastin fibers. This elastosis or elastofibromatous change most commonly manifested as a colonic polyp and usually was found during screening colonoscopy. Gastric and small intestinal cases were less frequent and associated with ulcers or an inflammatory process. The literature includes reports of 13 gastrointestinal elastotic lesions with a topographic distribution similar to that in our series. Histologically, elastosis appears as finely granular and/or fibrillar amphophilic material, sometimes with a fibrous component (elastofibromatous change). The changes occasionally appear centered around blood vessels and often are mistaken for amyloid but are negative for Congo red stain and strongly positive for elastin stain. We believe that this lesion might be more underrecognized than rare. In 2 of 26 cases, elastotic lesions also were present in nongastrointestinal sites.