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Primary ovarian melanoma arising from ovarian teratomas are rarely reported and difficult to accurately diagnose. Cases in the literature rely on a diagnosis of exclusion, and cases of primary ovarian melanoma with pathologic evidence of melanoma in situ are exceedingly rare. We report a case of a 66-yr-old female who presented to emergency department with abdominal pain and bloating. Computed tomography scan showed a 21 cm complex pelvic mass. An urgent laparoscopic bilateral salpingo-oophorectomy was performed. Pathologically the mass was identified as a mature teratoma. Within the cystic teratoma, there was an area showing a sheet arrangement of atypical cells. Those atypical cells were positive for Melan A, Sox10, HMB45, and c-KIT, and negative for PD-L1. Melanoma in situ was present in both the squamous and ciliated columnar epithelium. The melanoma was negative for PD-L1, and no BRAF (codon 600, exons 11, 14, and 15) or c-KIT (exons 2, 9, 10, 11, 13, 14, 15, 17, 18) mutations were identified, thus supporting the so-called triple negative malignant melanoma. A thorough dermatologic exam was conducted and only a 3 mm skin basal cell carcinoma was confirmed on biopsy. At 11 mo of follow-up, the patient is disease free and doing well and no metastatic melanoma has been identified. To the best of our knowledge, this is the first documented case of a primary ovarian melanoma arising in a mature teratoma with evidence of melanoma in situ present in both ciliated columnar and squamous epithelium in a patient with synchronous skin basal cell carcinoma. Our case is positive for c-KIT protein (CD117) by immunohistochemistry, but negative for KIT mutation. More case reports are needed to further characterize the disease., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 by the International Society of Gynecological Pathologists.)

Many instruments and techniques to reduce time and effort for deepithelialization have been described, but they are time-consuming and labor-intensive. The VersaJet Hydrosurgery System (Smith Nephew, Hull, United Kingdom) has gained widespread acceptance and use for fast, selective, and easy soft tissue debridement. The authors described the use of the VersaJet Hydrosurgery System for flap deepithelialization. Operative techniques, overall time, and histology are reviewed. Six gluteus maximus myocutaneous V-Y advancement flaps were used in 3 patients who underwent flap insetting with partial deepithelialization by VersaJet. The mean time savings was 12 minutes (range, 10-15 min). The flap deepithelialized by VersaJet shows significantly even and regular surface in gross view. In the histologic study, the thickness of preserved papillary dermis was thicker using the Versajet because it contains much skin appendages when compared with conventional scalpel debridement. No patients developed infection, epidermal cyst, or hematoma. The VersaJet provides safe, effective, and tissue-preserving deepithelialization compared with using scalpel.

Cystic lesions of the spleen represent a rare entity with an overall incidence of 0.5% among splenectomies. They can remain asymptomatic in 30% to 60% of patients or may cause symptoms for secondary compression of adjacent structures. Peripheral cysts may be suitable for conservative treatment whereas splenectomy is the accepted procedure for bulky and/or central lesions. Laparoscopy is the standard approach for elective splenic surgery, but in the last decade, introduction of the da Vinci robotic system has represented a further improvement in minimally invasive surgery, thanks to 3-dimensional vision and more accurate motion control. Herein, we report a case of a mesothelial splenic cysts successfully treated by robotic splenectomy; some anatomical considerations and technical aspects of robotic procedures have been discussed: it is a feasible and safe approach, particularly indicated in the presence of anatomic features such as an enlarged pancreatic tail and a type II vascular pattern of splenic pedicle. In such patients, the choice of a robotic approach may decrease the risk of intraoperative bleeding, thereby representing a further improvement in laparoscopic techniques.

Attempts were made to observe long-term form and function of neoesophagus with three pigs that survived for more than 42 months after Nitinol composite artificial esophagus replacement. The neoesophagus was shorter in length than resected esophagus (shorten rate 13.9 +/- 3.1) and thinner than normal esophagus (thickness rate 53.8 +/- 5.5). Esophagography and endoscopic findings indicated that the neoesophagus was dilatation of cystic form, and there was not autonomic peristalsis or constrictive motion. Microscopical findings showed that the wall of the neoesophagus consisted of fibrous connective tissue and esophageal mucosa.These results suggest that the long-term neoesophagus is a stratified squamous epithelium cover scar tissue tube. Although it does not have peristaltic function, experimental pigs can survive long-term with the neoesophagus.

Background: Flaps and grafts applied to the face from sites below the clavicles are mismatched with regard to their coloration compared with normal facial skin. The color can be improved by removing the epidermis and overgrafting with a thin, split-thickness skin graft of scalp epidermis. This report reviews the authors' clinical experience using this technique., Methods: A retrospective review of 15 consecutive patients who underwent scalp epidermal overgrafting of flaps and grafts to the face from July 1, 1995, through January 1, 2006, was performed. The resulting color was compared with the adjacent facial skin using a digital scale color analysis. Results were subjected to a Wilcoxon signed rank test. Scalp donor sites were evaluated for hair growth and density., Results: Postoperative graft color analysis revealed significant improvement in graft/flap coloration compared with preoperative values. Evaluation of the scalp donor sites revealed no evidence of scarring, hair thinning, or hair loss. There have been no complications to date., Conclusions: This study is the first to demonstrate the feasibility of altering the coloration of flaps and grafts applied from remote body sites to the face using epidermal overgrafting from the scalp in Caucasian patients. Significant improvement in coloration in the treated areas compared with the adjacent facial skin has been demonstrated by this technique. The authors believe that epidermal overgrafting is a useful adjunct for enhancing color aesthetics in facial reconstruction and may well lower the threshold for use of remote flaps and grafts previously ignored because of poor color match.

An enlarged labium minus can be bothersome for functional, aesthetic, and social reasons. Labia minora hypertrophy can be congenital or acquired by chronic irritation, exogenous androgenic hormones, or stretching with weights. This can cause inflammation, poor hygiene, interference with sexual intercourse, or intermittent urinary self-catheterization in myelodysplastic women. Aesthetically, an asymmetric or enlarged labium minus causes self-consciousness sexually and when the subject wears tight pants. Previously, labia minora reduction was performed by amputation of the protuberant segment and oversewing the edge, or a wedge of protuberant labial tissue was excised and reapproximated. However, the former technique removes the natural contour and color of the edge of the labium minus, and the latter can result in an incomplete or tight reduction. Therefore, rather than an amputation or a wedge resection, we preserved the natural contour and anatomy of the labium minus by simply reducing its central width through bilateral deepithelialization and reapproximation of the central portion with preservation of the neurovascular supply to the edge. Six patients have undergone this reduction method with excellent results without specific complications.

Purpose: To describe the clinical features, histopathology, surgical management and possible etiopathogenesis of corneoscleral epithelial cysts., Methods: Three patients with corneoscleral epithelial cysts underwent surgical ablation of the cysts. Material obtained during surgery was subjected to histopathologic analysis., Results: At last follow-up (mean, 6.3 months), none of the cysts had recurred. All patients had improved visual acuity. Histopathology revealed the occurrence of glandular elements suggestive of lacrimal tissue in one of the cysts., Conclusion: The presence of ectopic lacrimal tissue suggests a developmental etiology for such cysts. Marsupialization of the scleral portion of the cyst and chemical ablation of the lining epithelium of the corneal cyst with 20% trichloroacetic acid appears to be a safe and effective technique in the surgical management of corneoscleral epithelial cysts.

Purpose: The corneal epithelium is generally removed before photoablation in photorefractive keratectomy (PRK) because laser transepithelial PRK may result in surface irregularity caused by variability in epithelial thickness and differing ablation rates between epithelium and stroma. We compared the effects of mechanical deepithelialization with chemical epithelial removal by using 50% ethanol on the corneal structure., Methods: Fourteen rabbits underwent corneal deepithelialization by using a blade in the left eye and 24 h later in the right eye. Another 14 rabbits underwent corneal deepithelialization by using 50% ethanol solution. Half of the eyes treated with each technique underwent PRK after deepithelialization. Pachymetry was performed before and after each procedure on right eyes. Keratocyte and neutrophil densities were assessed by light microscopy., Results: Among non-laser-treatment groups, eyes that underwent mechanical deepithelialization had decreased corneal thickness (p = 0.001), increased keratocyte densities (p = 0.03), and no significant difference in neutrophil densities (p = 0.91) compared with chemically treated eyes 24 h after surgery. Among laser-treatment groups, eyes that underwent mechanical epithelial removal had increased keratocyte densities (p = 0.001), decreased corneal thickness (p = 0.03), and increased neutrophil densities (p = 0.03) 24 h after surgery compared with chemically treated eyes., Conclusion: Deepithelialization with 50% ethanol causes more keratocyte loss with perhaps more corneal edema, but less stromal influx of neutrophils, than does a mechanical technique 24 h after PRK in a rabbit model. Corneal deepithelialization with dilute ethanol may be a viable option in PRK. However, further investigation into the safety of this technique is warranted before it can be widely applied clinically.

Purpose: To investigate the participation of interleukin-6 (IL-6) after photorefractive keratectomy (PRK) and its possible roles and sources in corneal wound healing., Methods: IL-6, levels were measured in the tear fluids of patients before and after PRK and in conditioned media of human corneal epithelial cells and keratocytes. Its effects on total collagen and collagen-type synthesis by keratocytes were studied with a 3H-proline incorporation assay and Northern blot analysis. Zymography was used to evaluate the metalloproteinase content in the conditioned medium of IL-6-stimulated keratocytes., Results: IL-6 is present in the tear fluid samples after photorefractive keratectomy, possibly synthesized by epithelial cells and keratocytes., Conclusions: IL-6 stimulates collagen synthesis in general and collagen type I in particular. Furthermore, it reduces the production of MMP-2, the latent form of the metalloproteinase, by cultured keratocytes. The results suggest that IL-6 might be regarded as a mediator involved in corneal healing after excimer laser.

The UltraPulse carbon dioxide laser with CPG scanner was utilized to deepithelialize dermal pedicles in breast reduction inferior pedicle flaps. Clinical advantages include lack of bleeding, markedly shortened time of dissection, and excellent wound healing. Histologic studies confirm that the laser removes epidermis and papillary dermis but leaves undamaged the superficial vascular plexus and reticular dermis.

Reconstitution of the amputated ear remains a challenge to the plastic surgeon. Reattachment as a composite graft of the total or subtotal amputated ear is unreliable. Microsurgical replantation can be performed in a minority of cases; however, difficulty with adequate venous drainage complicates the technical complexity of these cases. To enhance survival of a reattached ear segment, Mladick et al. advocated use of the retroauricular pocket principle. This technique involves deepithelialization of the amputated part, followed by anatomic reattachment to the amputation stump and then burial in a retroauricular pocket. This simple technique increases the surface area of the avulsed segment in contact with surrounding nutrients, maximizing the probability of "take." The relationship between the dermis and cartilage is preserved, thus minimizing the deformity from cartilage warping. The undisturbed dermis on the involved segment can reepithelialize spontaneously, negating the need for a skin graft. We have used this technique successfully in five of six patients.

Association between the use of diclofenac sodium (DfNa) eyedrops and the development of a postkeratoplasty persistent epithelial defect (PED) of the cornea were studied. In 100 consecutive patients undergoing penetrating keratoplasty who had no limbal or conjunctival epithelial abnormalities, 12 (12.0%) developed PED (persistence of epithelial defect for > 8 days after keratoplasty) postoperatively. The use of DfNa eyedrops correlated significantly with the development of PED (p = 0.0001, chi-square test). DfNa eyedrops were used in 19 eyes postoperatively, eight of which (42.1%) showed signs of PED. The type of preservation media, preservation time, indications for keratoplasty, or the surgical procedures performed did not correlate with the development of PED. These results indicate that DfNa eyedrops are toxic to the corneal epithelium postkeratoplasty. The eyedrops should be used with great care in patients with disorders of the corneal epithelium.

Objective: The safe resection margin in esophagectomy for esophageal squamous cell carcinoma (SCC) was determined based on the extent of epithelial and subepithelial accessory lesions from the main lesions of esophageal SCC., Background: There have been many reports on the high incidence of a positive resection margin for esophageal cancer. Although there were some studies on the relationships of the proximal clearance to postoperative local recurrence, no pathologic study on the resection margin has been reported., Methods: Four hundred twenty specimens of a whole resected esophagus were examined histopathologically and the longitudinal length from the main lesion to the five types of accessory lesions was measured on microscopic slides., Results: Contiguous intraepithelial carcinoma existed in 69 (46%) of 150 sites of main lesions restricted to the mucosa or submucosa and subepithelial lesions existed in 131 (54%) of 245 sites and 82 (55%) of 150 sites of main lesions invading an adventitia and into neighboring structures, respectively. The risk of a positive resection margin due to subepithelial lesions was below 5% at 10 mm in the main lesion, restricted to the submucosa or the muscularis propria, and at 30 mm in the main lesion, invading the adventitia in the potentially curative operation cases., Conclusion: These clearances of the resection margin, in which the risk of a positive resection margin is below 5%, are acceptable, although these clearances should only be accepted after the extent of epithelial accessory lesions is accurately determined by the Lugol's stain method.

Photorefractive keratectomy with the 193-nm excimer laser is one of the most promising innovations in refractive surgery. However, routine clinical application is hindered by two main obstacles, i.e., postoperative subepithelial opacity and possible regression of the refractive result. Because we have previously demonstrated beneficial effects of basic fibroblast growth factor (bFGF) on corneal epithelial healing in different in vivo models, we investigated the influence on both epithelial and stromal healing of topical bFGF after excimer laser keratomileusis in a rabbit model. After 7-mm circular deepithelialization, the eyes of 24 New Zealand White rabbits received identical deep stromal laser ablations (depth 50 microns, 6 D, diameter 5 mm) and were randomly assigned to one of four treatment groups [control (phosphate-buffered saline, PBS), bFGF 10 micrograms/application, dexamethasone 0.1%, bFGF + dexamethasone, n = 12 eyes/group]. All treatments were administered four times daily--bFGF until complete epithelial healing, dexamethasone and PBS until 3 months postsurgery. Wound surface regression on time was determined by means of computer-assisted image analysis of fluorescein-stained corneas. Corneal opacity was observed biomicroscopically and graded using a previously established scoring system. After bFGF application for 2-3 days only, a highly significant acceleration in epithelial wound healing speed was found compared with the rate of the other three treatment groups (p < 0.001). A combined therapy (bFGF + steroid) had no effect on the healing rate. Compared with control values, mean scores for subepithelial haze in the other groups were found to be nearly 50% lower during the first 2 postoperative months.(ABSTRACT TRUNCATED AT 250 WORDS)

This study examines corneal ablations produced by the neodymium doped yttrium-lithium-fluoride (Nd:YLF) picosecond laser. The laser delivers a 1-KHz, 40-ps pulsed, 1,053-nm wavelength beam (with energy measured in microjoules) to a 15-microns diameter spot size. The ablation mechanism is by plasma formation, which generates acoustic shock waves. Using enucleated rabbit (n = 25) and human donor eyes (n = 29), corneas were examined after tissue ablation at energies ranging from 40 to 300 microJ per pulse with various programmed ablation depths and patterns. The histologic data were collected using light microscopy and transmission electron microscopy. The tissue effects and Nd:YLF laser functions studied were ablation thresholds, cutting ability, programmed ablation depth accuracy, and acute endothelial effects. Our study showed histologic ablation thresholds for the following human corneal layers: epithelium = 7.15 +/- 0.05 x 10(11) W/cm2 (34.1 +/- 8.1 J/cm2 per pulse, 50 microJ per pulse); Bowman's layer = 1.33 +/- 0.29 x 10(12) W/cm2 (58.5 +/- 3.3 J/cm2 per pulse, 100-110 microJ per pulse); stroma and endothelium = 7.10 x 10(11) W/cm2 (28.4 J/cm2 per pulse, 50 microJ per pulse). Depth of corneal ablation was found to be directly related to energy and independent of programmed ablation depth. This study shows the endothelial loss in rabbit corneas by energy beams (50 microJ per pulse) focused 100 microns from this layer.

Persistent epithelial defects are a common complication after severe alkaline corneal burns. Chemical damage to the limbal area destroys the stem cells that play a key role in corneal reepithelialization. Limbal conjunctival autograft transplantation has been proposed as a treatment to replace damaged limbal stem cells and promote epithelial healing. We report a case of a persistent epithelial defect after a severe alkaline corneal burn that was successfully treated 6 weeks after the injury with limbal autograft transplantation. Impression cytology provided valuable information for locating the healthy and damaged limbal tissue involved in the transplantation. Two weeks postoperatively the epithelial defect was completely healed, stromal vascularization was regressed, and visual acuity was improved.

We studied the recovery of corneal sensitivity and corneal regeneration after excimer laser and manual epithelial debridement. The corneal epithelia of right eyes of New Zealand white rabbits (n = 21) were manually debrided and the corneal epithelia of the left eyes were ablated with the excimer laser (47 mm depth, 5 Hz, and 160 mJ/cm2). The relative density of innervation on the intraepithelial layer was measured using gold chloride staining and light microscopy. Wound healing and corneal sensitivity also were observed. Laser-ablated corneal sensitivity increased rapidly to a normal level by day 5, then increased gradually and reached a maximum at day 42. It remained elevated until 126 days, then returned to normal at 210 days. There were significant differences in the recovery of sensitivity after excimer ablation and manual epithelial removal. At day 35, relative density of innervation in the intraepithelial layer treated with excimer laser ablation was significantly higher than that treated with manual debridement. We observed a correlation between increased sensitivity and increased nerve density after excimer ablation. Compared with manual debridement, laser treatment resulted in an increase in networks of axons with terminal endings. This may not be the only factor correlating directly with hypersensitivity after corneal debridement, but it may indicate a quicker recovery route by using a presurgical manual debridement technique.

Two patients presented with dendritiform epithelial irregularities of the cornea that were unresponsive to topical acyclovir. Both were soft contact lens wearers who had practiced inadequate lens hygiene. Acanthamoeba was cultured from a shallow corneal biopsy of one patient and from the contact lens of the other. Epithelial debridement resolved the condition in both patients without concomitant treatment with antiamoebic agents.

The Argon Fluoride (ArF) Excimer laser is currently used for experimental reshaping of the front surface of the cornea for the correction of myopic refractive error (photorefractive keratectomy, PRK) and for smoothing corneal irregularities (phototherapeutic keratectomy, PTK). Both PRK and PTK are in FDA clinical trials, but are more readily available outside the U.S.A. These techniques have achieved reasonable success in spite of early reports that deeper ablation procedures can cause reduced corneal clarity (haze) or a result which is less accurate or tends to regress. We studied how different depths of excimer tissue removal affect the smoothness of the ablation zone of the rabbit cornea. Dutch belted rabbits were immediately sacrificed by pentobarbital overdose. Their corneas were de-epithelialized with a knife or by the excimer laser and then were photoablated. A 4.5-mm circular ablation beam was delivered to each denuded area, but the beam was masked by positioning a steel blade to partially block the laser beam, thus creating variable ablation depths corresponding to 0.0, 12.5, 37.5, and 62.5 microns. The eyes were fixed in situ by topical and anterior chamber application of glutaraldehyde and the corneas were excised after 5 min and placed in glutaraldehyde for tissue processing. The corneas were whole-mounted and examined by scanning electron microscopy (SEM). The resultant micrographs show increasing irregularity of the ablated surface as a function of depth. The irregularity appeared to be due largely to the inhomogeneities of the anterior stroma, which is known to be layered by alternately directed collagen fibrils.(ABSTRACT TRUNCATED AT 250 WORDS)

To test the effects of different frequencies of a 193-nm excimer laser on the surface smoothness of the ablated materials and the damage to the adjacent structure, four different frequencies (5, 10, 15, and 20 Hz) of a 193-nm excimer laser were used to perform ablations on 20 rabbit corneas and four polymethylmethacrylate blocks at a fluence of 160 mJ/cm2. Each frequency was tested five times on five corneas. The ablated materials were processed and examined with scanning electron microscopy (SEM) and light and transmission electron microscopy (TEM) and a Zygo interference microscope, which quantitatively evaluates the surface smoothness. The results from the Zygo microscope show that there is no statistically significant difference in surface smoothness between any two different frequencies. The SEM reveals similar regularity and uniformity on the ablated surfaces, with no relationship between the laser frequencies and the amount of surface deposits. The TEM demonstrates no correlation between the various frequencies and the thickness of the superficial pseudomembrane and the amount of collateral damage in the adjacent stroma. It appears that the higher frequencies are comparable to the lower one (5 Hz) as to ablation quality, with the benefit of curtailing surgical time and decreasing the chances of eye movement.

Fifteen eyes in 12 patients with Salzmann's nodular corneal degeneration developed symptoms of recurrent erosion, decreased vision, or both. A history or evidence of ocular surface disease was present in 14 of 15 eyes. Removal of the nodule and accompanying pannus or corneal epithelial basement membrane degeneration, provided symptomatic improvement in all patients.

Scleral buckling techniques are effective in treating most eyes with rhegmatogenous retinal detachment, and usually the final visual result is limited only by possible preexisting macular damage due to the detachment. Still, a variety of techniques are used, including exoplant or implant methods for the scleral buckle; cryotherapy, diathermy, or photocoagulation to cause the chorioretinal adhesion; and drainage or nondrainage of subretinal fluid. Also, recent development of alternative surgical techniques such as vitreous surgery and/or intraocular gas injection have raised questions about the current role of scleral buckling methods. This article reviews the principles and techniques of scleral buckling for retinal detachment and describes the methods we have found most useful.

Eleven biopsies in 6 consecutive patients having reduction mammaplasties by a technique which uses a dermal pedicle have established that dermis does remain in the pedicle. The term "de-epithelization" is not correct and should be abandoned in this context.