Search

Background Granular cell tumors are neoplasms of Schwann cell origin. They typically arise in the head and neck of adults, with the tongue being the most common location; granular cell tumors of male genitalia are exceedingly rare. We identified only eight prior cases of scrotal granular cell tumor in the literature, and only one was in a child. Herein, we report a second case of childhood scrotal granular cell tumor and provide a review of the most relevant literature. Case presentation A fifteen-year-old hispanic boy was referred to our hospital's pediatric surgery service for a painless and firm scrotal mass. Clinical impression was that of an epidermal inclusion cyst. There was no evidence of associated medical problems from the clinical history and physical examination. Surgical enucleation of the lesion demonstrated a solid nodule with morphological and immunohistochemical features consistent with a benign granular cell tumor. Conclusions This is the second case reported of a scrotal granular cell tumor in a child. Although genital granular cell tumors are rare, and most are benign, careful clinical examination, complete surgical excision, expert histologic evaluation, and a close follow-up are recommended for accurate diagnosis and to rule out eventual malignancy.

The spectrum of vesiculobullous eruptions of the oral cavity is wide and rich, with different disease entities that encompass different etiologies, pathogenesis, clinical manifestations, treatment plans, and prognostic ends. Trying to present all these entities in a comprehensive fashion is challenging, but in this article, most of the important entities pertaining to this topic have been encompassed in a concise manner.

Oncocytic tumors of the major salivary glands are rare, accounting for less than 1% of all salivary gland tumors. When they do occur, these neoplasms typically present as solitary nodules that affect only one major salivary gland, usually the parotid. Multiple bilateral multinodular tumors are rare. We report the case of a 53-year-old woman with a case of synchronous multiple bilateral multinodular oncocytomas that arose in a background of bilateral oncocytic nodular hyperplasia in the parotid glands. The patient underwent superficial parotid resections, and at the 4-year follow-up, she exhibited no evidence of recurrence.

Purpose To establish the safety and toxicity profile of daily gefitinib with radiation alone or with concurrent chemoradiotherapy in previously untreated patients with locally advanced squamous cell head and neck cancer (LAHNC). Patients and Methods Patients with intermediate-stage LAHNC were treated with concomitant boost radiation (RT) alone with escalating doses of daily gefitinib (250 or 500 mg; cohort I). Once a safety profile was determined with RT alone, patients with high-risk disease were then treated with daily gefitinib (250 or 500 mg), weekly cisplatin (CDDP; 30 mg/m2), and once-daily RT (cohort II). Patients also received post-RT gefitinib at 250 mg daily for a period of up to 2 years. Results Twenty-three patients were enrolled and assessable for toxicity. No dose-limiting toxicities (DLTs) were observed in patients treated in cohort I at either 250 or 500 mg of gefitinib daily with concomitant boost RT to 72 Gy. In patients receiving chemoradiotherapy and gefitinib (cohort II), DLTs included one grade 4 diarrhea and one grade 4 neutropenic fever. Fifteen patients started maintenance gefitinib, and eight (53%) experienced grade 1 to 2 acne-like skin rash and diarrhea, but no grade 3 or 4 toxicity occurred. Conclusion Gefitinib (250 or 500 mg daily) was well tolerated with concomitant boost RT or concurrent chemoradiotherapy with weekly CDDP. Protracted administration of gefitinib for up to 2 years at 250 mg daily was also tolerated well.

Objectives The current study examined the role of estrogen receptors (ER), progesterone receptors (PR) and p53 expression in adenoid cystic carcinoma (ACC) to determine if simple expression or possible overexpression of these products might influence the development and natural course of this cancer. Study Design ER and PR status and p53 overexpression were retrospectively evaluated utilizing immunohistochemical evaluation of 47 ACC specimens. Methods Formalin-fixed paraffin-embedded tissues from 47 ACC specimens and 47 samples of normal salivary gland tissue were evaluated histochemically for the presence of ER, PR and p53. Immunoreactivity was scored using a 0 to +3 scale in which staining was either (0) negative, (+1) spotty, (+2) weakly positive, or (+3) strongly positive. Results ER was expressed in 8 of 47 tumors while PR was expressed in 4 of 47 tumors. p53 aberrations were demonstrated in 26 of 47 tumors. Tumors showed varying degrees of immunopositivity ranging from 0 to +3. Conclusions These studies suggest that p53 aberrations may be involved in ACC tumor progression and that ER and PR may play a role in ACC development.

Adenoid cystic carcinoma (ACC) of the salivary glands exhibits persistent growth, invasion and metastasis. Chromosome 11q13 amplification is a frequent event associated with tumor progression in a number of carcinomas and is associated with poor prognosis. Two genes within the 11q13 amplicon that are overexpressed as a result of 11q13 amplification are the cell cycle regulatory protein cyclin D1 (CCND1) and cortactin (CTTN), a protein involved cell motility and invasion. To determine the expression and gene status of cyclin D1 and cortactin in ACC, we evaluated 39 ACC cases by immunohistochemistry (IHC) for cyclin D1 and cortactin expression. Amplification of CCND1 and CTTN was determined by fluorescent in situ hybridization (FISH). Cyclin D1 overexpression was present in 90% (35/39) and cortactin expression in 62% (24/39) of evaluated cases, although CCND1 and CTTN levels were elevated in only two cases (5%) as determined by FISH. Our results indicate that chromosome 11q13 amplification is uncommon in ACC, but that cyclin D1 and cortactin are frequently overexpressed and may therefore contribute to the growth and invasive potential of ACC.

Background and aims: Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has become the standard of care in the evaluation of solid pancreatic lesions. Limited data exist on interobserver agreement (IOA) among cytopathologists in assessing solid pancreatic EUS-FNA specimens. This study aimed to evaluate IOA among cytopathologists in assessing EUS-FNA cytology specimens of solid pancreatic lesions using a novel standardized scoring system and to assess individual clinical and cytologic predictors of IOA. Methods: Consecutive patients who underwent EUS-FNA of solid pancreatic lesions at a tertiary care referral center were included. EUS-FNA slides were evaluated by four blinded cytopathologists using a standardized scoring system that assessed final cytologic diagnosis and quantitative (number of nucleated/diagnostic cells) and qualitative (bloodiness, inflammation/necrosis, contamination, artifact) cytologic parameters. Final clinical diagnosis was based on final cytology, surgical pathology, or 1-year clinical follow-up. IOA was calculated using multi-rater kappa (κ) statistics. Bivariate analyses were performed comparing cases with and without uniform agreement among the cytopathologists followed by logistic regression with backward elimination to model likelihood of uniform agreement. Results: Ninety-nine patients were included (49 % males, mean age 64 years, mean lesion size 26 mm). IOA for final diagnosis was moderate (κ = 0.45, 95 % confidence interval (CI) 0.4 – 0.49) with minimal improvement when combining suspicious and malignant diagnoses (κ = 0.54, 95 %CI 0.49 – 0.6). The weighted kappa value for overall diagnosis was 0.65 (95 %CI 0.54 – 0.76). IOA was slight to fair (κ = 0.04 – 0.32) for individual cytologic parameters. A final clinical diagnosis of malignancy was the most significant predictor of agreement [OR 3.99 (CI 1.52 – 10.49)]. Conclusions: Interobserver agreement among cytopathologists for pancreatic EUS-FNA specimens is moderate-substantial for the final cytologic diagnosis. The final clinical diagnosis of malignancy was the strongest predictor of agreement. These results have significant implications for patient management and need to be validated in future trials.

Mammary analogue secretory carcinoma (MASC) is a recently described entity in the differential diagnosis of salivary gland tumors. It is notable for a characteristic t(12;15)(p13;q25) translocation that results in a unique fusion protein, ETV6-NTRK3. While several studies have retrospectively identified this translocation in cases previously diagnosed as a different salivary malignancy, there have been relatively few cases where this translocation was identified on initial pathology results, and fewer still in a pediatric population. We present a case of a 15 year old female with a slowly enlarging, painless, left facial mass. MRI demonstrated a cystic mass extending into the deep lobe of the parotid, and she underwent parotidectomy. The tumor cells stained positive for S100 and CK19. ETV6 translocation was present, confirming the diagnosis. Mammary analogue secretory carcinoma is a recently described tumor of the salivary glands, which often masquerades as more common primary salivary gland tumors and cysts. More research is needed to characterize the typical behavior of this neoplasm and the optimal treatment regimen. With identification of its characteristic translocation, mammary analogue secretory carcinoma can be easily differentiated from its more prevalent counterparts, and should therefore remain within the differential of the pathologist and head and neck surgeon.

A 70-year-old woman presented with signs and symptoms consistent with nasolacrimal duct obstruction. MRI revealed a medial canthal mass with orbital and intracranial extension. The patient was treated with wide surgical excision, chemotherapy, and radiation. A diagnosis of malignant hidradenoma of the medial canthus was confirmed by histopathology. Despite aggressive therapy, the patient developed metastatic disease and died within 1 year.

Temporal arteritis, also known more accurately as giant cell arteritis (GCA), is a multisystem vasculitis of elderly people that involves large and medium-sized blood vessels with a particular predilection to the craniofacial branches of the carotid arteries, especially the temporal artery. Symptoms include visual loss, headaches, fever, audiovestibular symptoms, and jaw claudication. Otolaryngologists are consulted to care for these patients to confirm the diagnosis, to rule out other causes of face pain and headaches, to care for patients with audiovestibular manifestations of GCA, and to perform temporal artery biopsies. Consequently, it is important for consultants to understand the signs and symptoms and natural history of GCA and the indications, technique, and complications of temporal artery biopsy. GCA can appear with protean head and neck manifestations. Otolaryngologists should be aware of these and understand the issues concerning maximizing the yield from temporal artery biopsies.

To assess the status of EGFR, HER-2, and CCND1 at the gene and protein levels in esophageal squamous cell carcinoma. Dual-color FISH assays were performed using DNA probes for EGFR/CEP 7, HER-2/CEP 17, and CCND1/CEP 11. The respective proteins, furthermore, was assessed in IHC assays and correlated with patient and tumor characteristics. From 55 ESCCs, 8 (15%) tumors showed gene amplification and 20 (36%) had gene overrepresentation (balanced gene and chromosome 7 polysomy) for EGFR. High-level protein expression was frequent (49%), positively correlated with gene copy numbers (kappa=0.4), and associated with well-differentiated histology (p=0.02). For HER-2, gene amplification was detected in a single tumor (2%) and protein overexpression was rare (9%). CCND1 gene was amplified in 23 (42%) tumors; likewise, CCND1 protein overexpression was common (58%) and prevailed in gene overrepresentation or amplification. Only 1 patient showed gene amplification for both EGFR and CCND1. Survival was not associated with EGFR or CCND1 gene/protein status, whereas negative patients for HER-2 protein had a better survival than positive patients (p=0.04). Frequent overexpression and gene amplification of EGFR and CCND1 make these molecules and their pathways potential therapeutic targets for ESCC. In addition, EGFR and CCND1 appeared to be independently altered suggesting alternative mechanisms for pathway activation. Therapeutic agents targeting these molecules are urged to be tested in clinical trials and comprehensive biological analyses should be included to properly interpret the outcome.

Cavernous hemangiomas are rare lesions that may be difficult to distinguish from acoustic neuromas, schwannomas, or other lesions of the cerebellopontine angle on imaging studies. The clinical history, workup including radiologic evaluation, histologic assessment, and a brief review of the literature are presented.

Objective The incidence of occult nodal metastases associated with head and neck squamous cell carcinoma (HNSCC) and the clinical significance of nodal micrometastases by cytokeratin immunohistochemical analysis are examined. Study Design In all, 1012 lymph nodes from 50 patients treated between 1992 and 2001 at the University of Colorado Health Sciences Center (Denver, CO) were evaluated retrospectively for micrometastases. Methods Serial sectioning in 5-to 6-μm interval specimens stained either with hematoxylin and eosin (H&E) or immunostaining for cytokeratins using the monoclonal antibody cocktail AE1/AE3 was performed in 21 N0, 11 N1, and 14 N2 patient cases. Cases that showed scattered cells with suspect staining qualities but without morphological features consistent with HNSCC were further evaluated by epithelial membrane antigen (EMA) immunohistochemical analysis. Results H&E-stained and cytokeratin-stained sections revealed occult nodal micrometastases in 3.8% of N0 and 5% of N1 cases. Overall, 26 micrometastases were identified in N0 and N1 patients, causing 29% of N0 patients and 45% of N1 patients to be upstaged. Cytokeratin immunostaining detected micrometastases in eight cases that were negative on H&E serial sectioning. Serial sectioning by H&E alone identified three additional micrometastases. Negative EMA immunostaining confirmed the absence of malignant cells in lymph node sections that were equivocal on cytokeratin staining. Conclusions The use of serial sectioning with H&E and cytokeratin immunohistochemical analysis increases the detection of micrometastases that are often elusive by routine processing in patients with HNSCC. Improved methods of detecting micrometastases may provide a basis for improved planning of postoperative therapy for patients already at risk for tumor recurrence.

Primary retroperitoneal mucinous cystadenoma of borderline malignancy is a rare disease, especially in male patients. Often these tumors are not incidentally found due to abdominal symptoms. We present the radiologic abdominal computed tomography scan, surgical, and pathologic images of this unique, rare condition in a male patient. Surgical treatment is recommended to establish diagnosis and treatment.

As only eight cases have been previously reported in the literature, plasma cell granuloma of the thyroid gland is a rare entity. This condition can be confused with a benign or malignant neoplastic thyroid process. In this article, we describe a new case of plasma cell granuloma of the thyroid gland that occurred in a 46-year-old man who also had Hashimoto's thyroiditis. This case represents only the second documented instance of a plasma cell granuloma of the thyroid occurring in the setting of Hashimoto's thyroiditis. Moreover, it is only the second case of a plasma cell granuloma that has been reported in a male.

Kaposiform hemangioendothelioma is a rare, locally aggressive vascular tumor found in infants and children. It is often found on the trunk, extremities, and retroperitoneal regions but has not been previously described to primarily involve the orbital region. This report describes a 6-day-old female infant with an orbital kaposiform hemangioendothelioma and the treatment.

Recurrent metastatic lymph node (LN) disease is common in patients with papillary thyroid cancer (PTC). Novel prognostic markers may be helpful in guiding a therapeutic approach. Our previous studies revealed that immune suppression is evident in PTC and associated with more severe disease.To characterize the immune response to metastatic PTC, we assessed CD4(+) T cell polarization in LN. In addition, we investigated the role of programmed death-1 (PD-1) and T cell exhaustion.Uninvolved (UILN) and tumor-involved lymph nodes (TILN) were sampled ex vivo by fine-needle biopsy. T cell subsets were identified by flow cytometry. In parallel, archived TILN specimens were characterized by immunofluorescence.The study was conducted at the University of Colorado Hospital.Data were collected on 94 LN from 19 patients with PTC undergoing neck dissection.T cell subset frequencies were compared in UILN and TILN and assessed for correlation with recurrent disease and extranodal invasion.Regulatory CD4(+) T cells (Treg) were enriched in TILN compared with UILN and further elevated in TILN from patients with recurrent disease. PD-1(+) T cells were present at high frequency in TILN and markedly enriched in TILN that showed evidence of extranodal invasion. In TILN, Treg frequency correlated with PD-1(+) T cell frequencies. Although PD-1(+) T cells produced interferon-γ, they failed to fully down-regulate CD27 and were not actively proliferating.Increased Treg and PD-1(+) T cell frequencies in LN may be indicative of aggressive recurrent PTC. Future prospective studies are necessary to determine the prognostic and therapeutic value of these findings in PTC.

Background Endoscopic submucosal dissection (ESD) increases en bloc and histologically complete resection rate of neoplastic mucosal tumors but is technically more demanding than EMR. Limited data are available comparing the efficacy and safety of a new ESD designed to overcome these limitations and conventional ESD (C-ESD) techniques. Objective To compare the safety, efficacy, and operation time of the new HybridKnife ESD (HK-ESD) with C-ESD in the esophagus. Design Prospective, randomized, controlled study. Setting Animal research laboratory. Subjects Seventeen anesthetized Yorkshire pigs. Interventions Removal of a 4-cm length of half-circumference esophageal mucosa by C-ESD with Hook knife or Flexknife versus HK-ESD. Main Outcome Measurements Procedure time, en bloc and complete resection rate, and complications (bleeding and perforation). Results All resections were completed en bloc. Procedure time was shorter in C-ESD. However, it was similar after 12 procedures. Significantly more bleeding occurred during C-ESD (28 vs 12, P = .0007). Histological muscularis propria injuries occurred with equal frequency (16 vs 17) and were mostly seen during the first 11 procedures. There were 3 perforations (2 endoscopic, 1 histological), all with C-ESD. Limitations Nonsurvival study, use of 2 conventional knives, no training period for a new procedure. Conclusions The HK-ESD technique was equally effective as the C-ESD technique for successful en bloc resection and was safer with less bleeding and perforation. Although procedure time was longer in HK-ESD, the difference became nonsignificant after 12 procedures.

Context: Ten to 30% of patients with papillary thyroid cancer (PTC) develop recurrent disease and may benefit from innovative adjuvant therapies. Immune-based therapies are under investigation to treat many types of cancer. The role of the immune system in PTC is poorly understood. Objective: We investigated whether tumor-associated lymphocytes (TAL), in the absence of background thyroiditis (LT), contribute to disease severity. We hypothesized that the type of lymphocytes associated with PTC would correlate with parameters of disease. Design: This retrospective study analyzed archived PTC samples for the presence of TAL and/or LT. A group of patients with TAL was evaluated for lymphocyte subsets by immunohistofluorescence. Patients and Setting: One hundred PTC patients were analyzed for LT and TAL, and 10 PTC patients with TAL were assessed for lymphocyte subsets at University of Colorado Hospital. Main Outcome: We assessed correlations between disease and the presence of TAL, LT, and lymphocyte subset frequency. Results: Patients with TAL exhibited higher disease stage and increased incidence of invasion and lymph node metastasis compared with patients without lymphocytes or with LT. CD4+ T cell frequency correlated with tumor size (r = 0.742; P = 0.017). FoxP3+ regulatory T cell (Treg) frequency correlated with lymph node metastases (r = 0.858; P = 0.002), and CD8 to Treg ratio correlated inversely with tumor size (r = −0.804; P = 0.007). Conclusions: TAL and high Treg frequency in primary thyroid tumors correlates with more aggressive disease. Future prospective studies may identify Treg frequency as a predictive factor in PTC, and the suppressive effects of Treg should be considered in the design of immune-based therapies.

This paper presents a new methodology to select test cases from regression test suites. The selection strategy is based on analyzing the dynamic behavior of the applications that written in any programming language. Methods based on dynamic analysis are more safe and efficient. We design a technique that combine the code based technique and model based technique, to allow comparing the object ornieted of an application that written in any programming language. We have developed a prototype tool that detect change and select test cases from test suite.

Leiomyosarcoma (LMS) is a rare soft-tissue cancer of the head and neck, accounting for 1% to 2% of nasal cavity and paranasal sinus tumors. It is more commonly found in the gastrointestinal or genitourinary tract. Leiomyosarcoma of the head and neck is associated with a history of radiation therapy, retinoblastoma, chemotherapy, human immunodeficiency virus, or AIDS. We describe what we believe is the first case of an LMS of the sphenoid sinus in the English-language literature and include a review of the literature on LMS of the paranasal sinuses, which identified approximately 50 cases of primary sinonasal LMS. A patient presented with a sphenoid sinus mass and underwent endoscopic surgical treatment. Pathologic examination demonstrated a low-grade LMS. A recommendation was made to pursue adjuvant radiotherapy, which the patient declined. Surgical excision is the mainstay of therapy for low-grade tumors, but adjuvant chemotherapy with or without radiationtherapyisrecommendedforgrades III and IV LMS. Our aim is to raise awareness of this clinical entity and to suggest a treatment plan based on certain clinical and pathologic features.

Background Radiation is a primary or secondary therapeutic modality for treatment of head and neck cancer. A common side effect of irradiation to the neck and neck region is xerostomia caused by salivary gland dysfunction. Approximately 40,000 new cases of xerostomia result from radiation treatment in the United States each year. The ensuing salivary gland hypofunction results in significant morbidity and diminishes the effectiveness of anti-cancer therapies as well as the quality of life for these patients. Previous studies in a rat model have shown no correlation between induction of apoptosis in the salivary gland and either the immediate or chronic decrease in salivary function following γ-radiation treatment. Methodology/Principal Finding A significant level of apoptosis can be detected in the salivary glands of FVB mice following γ-radiation treatment of the head and neck and this apoptosis is suppressed in transgenic mice expressing an activated mutant of Akt (myr-Akt1). Importantly, this suppression of apoptosis in myr-Akt1 mice preserves salivary function, as measured by saliva output, three and thirty days after γ-radiation treatment. In order to translate these studies into a preclinal model we found that intravenous injection of IGF1 stimulated activation of endogenous Akt in the salivary glands in vivo. A single injection of IGF1 prior to exposure to γ-radiation diminishes salivary acinar cell apoptosis and completely preserves salivary gland function three and thirty days following irradiation. Conclusions/Significance These studies suggest that apoptosis of salivary acinar cells underlies salivary gland hypofunction occurring secondary to radiation of the head and neck region. Targeted delivery of IGF1 to the salivary gland of patients receiving head and neck irradiation may be useful in reducing or eliminating xerostomia and restoring quality of life to these patients.

Background Pyoderma gangrenosum (PG) is a skin condition characterized by necrotic ulcers and most commonly occurs on the legs in association with inflammatory bowel disease and rheumatoid arthritis; however, PG rarely involves the head and neck, and very rarely causes nasal septal perforation. Objective Here, we describe a case report of PG causing nasal septal perforation in a 71-year-old male with truncal lesions in the absence of either inflammatory bowel disease or autoimmune arthritis. Methods Case report with histologic description. Results Histology from nasal mucosal biopsies showed chronic inflammation and reactive change without evidence of malignancy. Together with serologic and nonserologic testing, as well as clinical evaluation, we were able to rule out other causes of septal perforation including Wegener's granulomatosis, lymphoma, and vasculitis, and concluded that the cause of nasal septal perforation was most likely PG. Conclusion Septal perforation etiology should include a complete history and physical to evaluate for systemic etiologies, including rare ones such as PG.

We report the case of a 77-year-old woman who presented with a 6-year history of pleomorphic adenoma with multiple recurrences. Despite the clinical suspicion of a malignant process, the detection of myoepithelial carcinoma ex pleomorphic adenoma was not achieved by means of a preoperative biopsy or a frozen section removed intraoperatively, as the lesion only showed mild cytological atypia with no frank malignant features. Only a thorough evaluation of the resected tumor enabled the diagnosis of a malignancy. We discuss the difficulties that may be encountered in attempting to diagnose these rare myoepithelial lesions by means of small biopsy specimens.

In this retrospective histologic study, galectin-3 had a sensitivity of 92% (22/24) for papillary thyroid carcinoma and 44% (4/9) for follicular thyroid carcinoma. Thyroid peroxidase (TPO) had a sensitivity of 50% (12/24) for papillary and 11% (1/11) for follicular carcinoma. The combination of galectin-3 and TPO had a sensitivity of 96% (23/24) for papillary and 44% (4/9) for follicular carcinoma. From a prognostic standpoint, of patients whose papillary carcinomas expressed both markers, all became free of disease. Of those whose papillary carcinomas expressed galectin-3 but not TPO, 57% (4/7) became free of disease, 29% (2/7) had persistent disease, and 14% (1/7) had progressive disease. This study confirms previous observations that galectin-3 alone is highly sensitive for papillary carcinoma but not adequately sensitive for follicular carcinoma. TPO alone is not adequately sensitive for the evaluation of any thyroid lesion. The combination of galectin-3 and TPO is complementary as a diagnostic and prognostic tool for patients with papillary carcinoma.

Objectives: Keith et al described angiogenic squamous dysplasia (ASD) in the lung epithelium of patients at high risk for the development of lung carcinoma. We have recently observed similar changes in the nasal epithelium of occasional patients undergoing routine sinus surgery. This retrospective study evalautes the demographic characteristics of this small group of patients and compares them to a control series of patients undergoing similar surgery to evaluate whether this lesion is premalignant. Methods: Consecutive sinus and nasal surgical pathological specimens were reviewed for the presence of ASD. Twelve patients with ASD were identified and studied in detail. Their demographic characteristics were compared to a control group found not to have ASD but undergoing similar sinus surgery for similar conditions, using a grid approach to allow consideration of clinical characteristics without violating patient confidentiality. Results: Clear demographic differences between the study and control groups were not identified, and no progression to carcinoma was observed in any patient with ASD. In 1 patient that was re-biopsied in view of other risk factors, the mucosa reverted to normal (absence of ASD). Conclusions: ASD is an identifiable histopathological change that occurs in the sinus epithelium. The presence of this lesion with chronic sinusitis suggests that these aberrent patterns of microvasculature may represent an inflammatory response in the sinus mucosa, rather than true neoplasia at risk to proceed to carcinoma, as occurs in the lung. Additional observations are indicated to evaluate this possibility in a larger group of patients.

Objectives: We report a case of low-grade papillary adenocarcinoma with unique oncocytic features arising in the ethmoid sinus of a 72-year-old female. Methods: A review of the case history, pathological findings, and medical literature is performed. Results: A 72-year-old female presented with a 2-month history of progressive right-sided nasal obstruction. Preoperative nasal endoscopy showed a glistening, pink-red, soft mass arising from the middle meatus suspicious for inverting papilloma. Paranasal CT revealed a soft tissue density opacifing the right ethmoid sinus with ipsilateral maxillary and frontal sinus opacification. Complete endoscopic sphenoethmoidectomy was performed. Pathological examination of the surgical specimen revealed a low-grade papillary adenocarcinoma with oncocytic features. Special staining for MIB-1, p53, and Ki-67 was confirmatory. One year following surgical resection, nasal endoscopy revealed a recurrent mass in the surgical field; paranasal CT was confirmatory. A completion external and endoscopic ethmoidectomy was performed with complete removal of the neoplasm. Pathological examination revealed recurrent low-grade papillary adenocarcinoma. At 3 months postoperatively, the patient remains free from recurrent neoplasm. Conclusion: The management of ethmoid adenocarcinoma is dependent on the extent of disease and its pathological characteristics. Locally aggressive low-grade neoplasms, such as inverting papilloma, have been successfully treated with complete endoscopic resection with good rates of local control. Similarly, low-grade papillary adenocarcinoma has been successfully treated with endoscopic resection. In this case report, a rare oncocytic form of papillary adenocarcinoma is described that behaves similarly to other low-grade sinonasal papillary adenocarcinomas. Meticulous endoscopic surgical resection must be performed as local recurrence is common.

At Denver Health and Hospital Authority (DHHA) all female patients between the ages of 21 and 65 years are screened according to the clinical care guideline/algorithm for cervical cancer screening adopted by the medical staff using recommendations from American College of Obstetrics and Gynecology (ACOG), American Society for Colposcopy and Cervical Pathology (ASCCP), …

As the technology grows scientists and engineers are trying to combine their work to compensate some body parts that is lost. Prosthetic devices grabbed the attention of most of the doctors and engineers working on solution for lost body parts. Generally prosthetic devices are either external wearable devices or internal ones. Such devices may depend on a built on microcontroller or the brain signals from the patient himself. Although it is used for lost body parts it can also be used for rehabilitation, power assistance, diagnostics, monitoring, ergonomics, etc. The currently used devices usually have the disadvantages of big size and high cost. The suggested device in this paper is targeting the design of portable rehabilitation device with light weight and low cost for paralyzed hand people. The suggested device allows the user to train the patient’s hand or perform some needed exercises for his impaired hand. This helps the user to restore the normal hand movement and functionality. The device includes two modes of operation to be chosen by the user through the platform built on a microprocessor which can help controlling the exoskeleton to perform the needed exercises or tasks. Collaboration with several healthcare organizations will be considered to verify or test the effectiveness of this exoskeleton.

Background Metastatic melanoma has a high mortality rate and suboptimal therapeutic options. Molecular targeting may be beneficial using the rexinoid LGD1069, a retinoid × receptor selective agonist, and thiazolidinediones (TZD), PPARγ selective ligands, as novel treatments. Results Mouse xenograft models with human melanoma cell lines [A375(DRO) or M14(5–16)] were treated for 4 weeks with daily vehicle, RXR agonist (rexinoid, LGD1069, 30 mg/kg/d), PPARγ agonist (TZD, rosiglitazone, 10 mg/kg/d) or combination. A375(DRO) tumor growth was significantly inhibited by either ligand alone and the combination had an additive effect. M14(5–16) tumors only responded to LGD1069 100 mg/kg/day. A375(DRO) sublines resistant to rexinoid, TZD and combination were generated and all three sublines had reduced PPARγ expression but preserved RXR expression. shRNA knockdown of PPARγ or RXRγ attenuated the rexinoid, TZD and combination ligand-mediated decreased proliferation in A375(DRO) cells. Rexinoid (LGD1069) and retinoid (TTNPB) treatment of M14(5–16) cells resulted in decreased proliferation that was additive with combination of both rexinoid and retinoid. shRNA knockdown of RXRγ resulted in a decreased response to either ligand. Conclusion A375 (DRO) melanoma cell growth is inhibited by rexinoid and TZD treatment, and this response is dependent on RXR and PPARγ receptor expression. M14 (5–16) melanoma cell growth is inhibited by rexinoid and retinoid treatment, and this response is dependent on RXR expression. These findings may help guide molecular-based treatment strategies in melanoma and provide insight for mechanisms of resistance to nuclear receptor targeted therapies in certain cancers.