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Objectives: We evaluated whether pancreatic main duct fluid can provide protein biomarkers with prognostic value., Methods: Mass spectrometry proteomics was applied to as little as 20µL of fluid collected at the time of tumor surgical resection. Biomarker proteins identified for 27 patients were correlated with clinical outcomes., Results: Thirteen patients had pancreatic ductal adenocarcinomas, 4 had intraductal papillary mucinous neoplasm with in situ adenocarcinoma, 5 had ampullary adenocarcinomas, 2 had intraductal papillary mucinous neoplasms, and 3 had benign diseases. In pathologic stage II or higher pancreatic ductal adenocarcinoma, moderate or high expression of S100A8 or S100A9 proteins was associated with a median disease recurrence-free survival of 5.8 months compared with 17.3 months in patients with low expression (P = 0.002). Median overall survival was 12.6 versus 27 months for patients with moderate to high versus low S100A8 and A9 expression (P = 0.02)., Conclusions: This analysis suggests distinct proteomic signatures for pancreatic cancer. Patients in our study with elevated levels of S100A8 or A9 in the ductal fluid, a near absence of pancreatic enzymes, and high levels of mucins were found to have significantly worse prognosis. Although further validation is needed to corroborate these findings, analysis of pancreatic ductal fluid is a promising tool for identifying biomarkers of interest.

Purpose: The purposes of this study are to report the first case of parotid gland adenoid cystic carcinoma (ACC) metastatic to the iris and ciliary body and suggest a successful treatment option., Methods: A 64-year-old white man presented with a diffuse multilobulated amelanotic mass involving the peripheral iris and anterior chamber angle. Fine needle aspiration with a 27-gauge needle was performed, disclosing epithelial cells with positive staining for AE1/AE3 and morphologic features consistent with metastatic parotid gland ACC. Treatment with I plaque radiotherapy (40 Gy to the apex) was provided., Results: Five months later, the tumor remained regressed., Conclusions: The systemic prognosis of salivary gland ACC is poor, with frequent local recurrences and late distance metastases. Even though uncommon, ocular metastases should be considered, and plaque radiotherapy may be useful to treat these patients.

Purpose: To report a case of a choroidal melanoma that presented with painful scleritis and choroidal effusion., Methods: Interventional case report with cytopathologic correlation., Results: A 78-year-old otherwise healthy woman presented with sudden, severe painful ocular inflammation and marked injection of the right eye over a 3-day period, consistent with scleritis. Upon referral, 360 degrees of scleral and conjunctival injection and peripheral choroidal effusion were found. In addition, a solid hemorrhagic, choroidal mass was evident, suspicious for melanoma. Fine needle aspiration biopsy of the choroidal mass confirmed necrotic melanoma. The melanoma was treated with iodine 125 plaque radiotherapy, and during surgery, the temporal sclera was markedly edematous and the orbital tissue was fibrotic, presumed related to inflammation. Two months after radiotherapy, the scleritis and choroidal effusion had resolved., Conclusion: Uveal effusion can rarely occur with uveal melanoma, particularly when the tumor is necrotic.

Objectives: There are currently no diagnostic indicators that are consistently reliable, obtainable, and conclusive for diagnosing and risk-stratifying pancreatic cysts. Proteomic analyses were performed to explore pancreatic cyst fluids to yield effective diagnostic biomarkers., Methods: We have prospectively recruited 20 research participants and prepared their pancreatic cyst fluids specifically for proteomic analyses. Proteomic approaches applied were as follows: (1) matrix-assisted laser-desorption-ionization time-of-flight mass spectrometry peptidomics with LC/MS/MS (HPLC-tandem mass spectrometry) protein identification; (2) 2-dimensional gel electrophoresis; (3) GeLC/MS/MS (tryptic digestion of proteins fractionated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and identified by LC/MS/MS)., Results: Sequencing of more than 350 free peptides showed that exopeptidase activities rendered peptidomics of cyst fluids unreliable; protein nicking by proteases in the cyst fluids produced hundreds of protein spots from the major proteins, making 2-dimensional gel proteomics unmanageable; GeLC/MS/MS revealed a panel of potential biomarker proteins that correlated with carcinoembryonic antigen (CEA)., Conclusions: Two homologs of amylase, solubilized molecules of 4 mucins, 4 solubilized CEA-related cell adhesion molecules (CEACAMs), and 4 S100 homologs may be candidate biomarkers to facilitate future pancreatic cyst diagnosis and risk-stratification. This approach required less than 40 microL of cyst fluid per sample, offering the possibility to analyze cysts smaller than 1 cm in diameter.

Purpose: To report bilateral plasmacytoma of the ciliary body in a healthy patient., Methods: Clinicopathologic report., Results: A 55-year-old woman with iritis developed an iridociliary mass in the left eye. Systemic evaluation was normal. Fine-needle aspiration (FNAB) of the mass revealed atypical, binucleate plasmacytoid cells with positive leukocyte common antigen staining, suggestive of plasmacytoma. The tumor was treated with 4000 cGy by using custom-designed plaque radiotherapy. The tumor completely resolved. Two years later, a similar iridociliary mass was noted in the right eye, and FNAB confirmed plasmacytoma. Plaque radiotherapy of 4000 cGy was delivered. At the 3-year follow-up, there has been no local recurrence or evidence of systemic multiple myeloma or monoclonal gammopathy., Conclusions: Extramedullary plasmacytoma can involve the uvea and rarely manifest multiplicity. Long-term monitoring for systemic plasma cell dyscrasia is warranted.

Purpose: To describe an intraocular lacrimal gland choristoma confirmed with fine-needle aspiration biopsy in a child., Methods: Case report., Results: A 6-year-old Asian girl developed a pink, vascularized, cerebriform mass with marked corectopia in the inferonasal iris of the left eye. The differential diagnosis included juvenile xanthogranuloma, nevus, melanoma, medulloepithelioma, lacrimal gland choristoma, and atypical retinoblastoma. Fluorescein angiography was suggestive of a noninflammatory, nonleaking solid mass. Fine-needle aspiration biopsy showed benign epithelial cells consistent with lacrimal tissue., Conclusion: Lacrimal gland choristoma shows notable clinical features and fine-needle aspiration biopsy can be confirmatory.

Purpose: Fiberoptic ductoscopy allows direct visualization of the breast ductal lumen, providing a targeted approach to the diagnosis of intraductal disease. The purpose of this prospective study was to determine whether (1) endoscopic evaluation of the breast could be reliably performed, and (2) ductoscopic data (intraductal distance traveled, visual observations, epithelial and foam cell quantity, cytology) predict whether a woman has breast cancer., Patients and Methods: Ductoscopic information was collected on intraductal distance traveled, visual observations, epithelial and foam cell quantity, and cytology., Results: Ductoscopic samples were successfully collected in 106/108 attempts. The first six specimens collected were acellular. Of the 100 remaining ductoscopic specimens, 37 were from breasts with ductal carcinoma in situ or invasive breast cancer, 10 from breasts with precancerous lesions, 37 duct hyperplasia/papilloma, 11 histologically normal specimens, and five specimens from breasts that did not undergo subsequent surgical excision. The ability to travel intraductally > or = 10 cm was greater in women with hyperplasia and papilloma (with and without atypia) lesions. Intraductal lesions that were visually considered tumors were more often hyperplasia/papilloma and malignant than other lesions. Extrinsic duct occlusion was observed only in malignant lesions. Excluding learning curve samples, 67/100 (45% of normal, 68% of hyperplastic, 90% of precancerous, 82% of ductal carcinoma in situ, and 70% of invasive) fiberoptic ductoscopy specimens had adequate epithelial cells, and all duct cannulation attempts except two were successful. There was one false-positive cytologic result in a woman found to have a papilloma. Foam cell quantity was significantly related to epithelial cell quantity., Conclusion: Fiberoptic ductoscopy is feasible in the vast majority of subjects. Fiberoptic ductoscopy is a specific but not sufficiently sensitive method to be used alone to diagnose breast cancer. The presence of highly atypical epithelial cells in specimens from breasts containing papillomas is a pitfall of this method. Caution must be exercised to avoid a false-positive diagnosis in patients with spontaneous nipple discharge.