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The case of a 76-year-old white woman with squamous cell carcinoma of the thyroid gland arising in a background of Hashimoto's thyroiditis is presented. Squamous cell carcinoma of the thyroid gland is a very rare and aggressive tumor, and only a few cases are reported as arising in Hashimoto's thyroiditis. Although Hashimoto's thyroiditis alone does not necessarily predispose patients to malignancy, the finding of a prominent nodule in such a patient should suggest the possibility of malignancy, and an aggressive search and treatment regimen, including surgical intervention, should be pursued.

OBJECTIVE To learn about the effects of cranial base surgery. DESIGN Cohort study with a mean follow-up of 30 months. SETTING Population-based. PATIENTS A consecutive sample of 183 patients who underwent cranial base surgery; 118 patients had malignant skull base tumors, the majority of which were previously treated; 50 had benign tumors; 9 had congenital malformations of the skull base; 3 had inflammatory lesions, and 3 had traumatic defects of the skull base. MAIN OUTCOME MEASURES Disease-free interval, overall survival, and rate of complications and functional status. INTERVENTION Cranial base surgery was followed by radiotherapy (in previously untreated patients). RESULTS After completion of follow-up (mean, 30 months), 30 (25.4%) patients had died of their malignant tumors and 8 (6.8%) had died of other causes. One patient (0.84%) was lost to follow-up. The overall cancer survival rate without regard to histologic type was 67% (63% with no evidence of disease). Among the patients who were treated for benign neoplasm, 72% had no evidence of disease at a mean follow-up of 39 months. The group of patients with congenital malformations and inflammatory and traumatic lesions demonstrated successful correction of their presurgical problem with skull base surgery. One patient (who had invasive aspergillosis) died of disease. The overall surgical-medical mortality rate was 2%; the complication rate was 33%, and the Karnofsky performance score was improved or unchanged after surgery in 83% of patients. The average duration of surgery, number of blood transfusions used, and length of the hospital stay were 10 hours, 3 units, and 15 days, respectively. CONCLUSIONS Cranial base surgery is a valid surgical technique for treatment of cranial base afflictions. In this study it was found to be beneficial in controlling benign and malignant disease and to be the treatment of choice for selected congenital malformations, trauma, and inflammatory lesions.

We studied the application of statistical reconstruction algorithms, namely maximum likelihood and least squares methods, to the problem of event reconstruction in a dual phase liquid xenon detector. An iterative method was developed for in-situ reconstruction of the PMT light response functions from calibration data taken with an uncollimated gamma-ray source. Using the techniques described, the performance of the ZEPLIN-III dark matter detector was studied for 122 keV gamma-rays. For the inner part of the detector (R, 8 pages, 7 figures, in the Conference Record of IEEE NSS 2011, accepted for publication in IEEE Trans. on Nuc. Sci

Plastic scintillators are widely used in industry, medicine and scientific research, including nuclear and particle physics. Although one of their most common applications is in neutron detection, experimental data on their response to low-energy nuclear recoils are scarce. Here, the relative scintillation efficiency for neutron-induced nuclear recoils in a polystyrene-based plastic scintillator (UPS-923A) is presented, exploring recoil energies between 125 keV and 850 keV. Monte Carlo simulations, incorporating light collection efficiency and energy resolution effects, are used to generate neutron scattering spectra which are matched to observed distributions of scintillation signals to parameterise the energy-dependent quenching factor. At energies above 300 keV the dependence is reasonably described using the semi-empirical formulation of Birks and a kB factor of (0.014+/-0.002) g/MeVcm^2 has been determined. Below that energy the measured quenching factor falls more steeply than predicted by the Birks formalism., 8 pages, 9 figures

ZE3RA is the software package responsible for processing the raw data from the ZEPLIN-III dark matter experiment and its reduction into a set of parameters used in all subsequent analyses. The detector is a liquid xenon time projection chamber with scintillation and electroluminescence signals read out by an array of 31 photomultipliers. The dual range 62-channel data stream is optimised for the detection of scintillation pulses down to a single photoelectron and of ionisation signals as small as those produced by single electrons. We discuss in particular several strategies related to data filtering, pulse finding and pulse clustering which are tuned using calibration data to recover the best electron/nuclear recoil discrimination near the detection threshold, where most dark matter elastic scattering signatures are expected. The software was designed assuming only minimal knowledge of the physics underlying the detection principle, allowing an unbiased analysis of the experimental results and easy extension to other detectors with similar requirements.

Develop a computer simulation model that uses daily meteorological data and farm management practices to predict populations of Trichostrongylus colubriformis, Haemonchus contortus and Teladorsagia (Ostertagia) circumcincta and the evolution of anthelmintic resistance within a sheep flock. Use the model to explore if increased refugia, provided by leaving some adult sheep untreated, would delay development of anthelmintic resistance without compromising nematode control.Compare model predictions with field observations from a breeding flock in Armidale, NSW. Simulate the impact of leaving 1-10% of adult sheep untreated in diverse sheep-grazing systems.Predicted populations of Tr. colubriformis and T. circumcincta were less than those observed in the field, attributed to nutritional stress experienced by the sheep during drought and not accounted for by the model. Observed variation in faecal egg counts explained by the model (R(2) ) for these species was 40-50%. The H. contortus populations and R(2) were both low. Leaving some sheep untreated worked best in situations where animals were already grazing or were moved onto pastures with low populations of infective larvae. In those cases, anthelmintic resistance was delayed and nematode control was maintained when 1-4% of adult stock remained untreated.In general, the model predicted that leaving more than 4% of adults untreated did not sufficiently delay the development of anthelmintic resistance to justify the increased production risk from such a strategy. The choice of a drug rotation strategy had an equal or larger effect on nematode control, and selection for resistance, than leaving 1-10% of adults untreated.

We report experimental upper limits on WIMP-nucleon elastic scattering cross sections from the second science run of ZEPLIN-III at the Boulby Underground Laboratory. A raw fiducial exposure of 1344 kg⋅days was accrued over 319 days of continuous operation between June 2010 and May 2011. A total of eight events was observed in the signal acceptance region in the nuclear recoil energy range 7–29 keV, which is compatible with background expectations. This allows the exclusion of the scalar cross-section above 4.8 × 10 − 8 pb near 50 GeV / c 2 WIMP mass with 90% confidence. Combined with data from the first run, this result improves to 3.9 × 10 − 8 pb . The corresponding WIMP-neutron spin-dependent cross-section limit is 8.0 × 10 − 3 pb . The ZEPLIN programme reaches thus its conclusion at Boulby, having deployed and exploited successfully three liquid xenon experiments of increasing reach.

ZEPLIN-III is a two-phase xenon direct dark matter experiment located at the Boulby Mine (UK). After its first science run in 2008 it was upgraded with: an array of low background photomultipliers, a new anti-coincidence detector system with plastic scintillator and an improved calibration system. After 319 days of data taking the second science run ended in May 2011. In this paper we describe the instrument performance with emphasis on the position and energy reconstruction algorithm and summarise the final science results., Comment: Submitted to PSD9 conference proceedings

The ZEPLIN-III experiment is operating in its second phase at the Boulby Underground Laboratory in search of dark matter WIMPs. The major upgrades to the instrument over its first science run include lower background photomultiplier tubes and installation of a plastic scintillator veto system. Performance results from the veto detector using calibration and science data in its first six months of operation in coincidence with ZEPLIN-III are presented. With fully automated operation and calibration, the veto system has maintained high stability and achieves near unity live time relative to ZEPLIN-III. Calibrations with a neutron source demonstrate a rejection of 60% of neutron-induced nuclear recoils in ZEPLIN-III that might otherwise be misidentified as WIMPs. This tagging efficiency reduces the expected untagged nuclear recoil background from neutrons during science data taking to a very low rate of ~0.2 events per year in the WIMP acceptance region. Additionally, the veto detector provides rejection of 28% of gamma-ray induced background events, allowing the sampling of the dominant source of background in ZEPLIN-III - multiple scatter gamma-rays with rare topologies. Since WIMPs will not be tagged by the veto detector, and tags due to gamma-rays and neutrons are separable, this population of multiple scatter events may be characterised without biasing the analysis of candidate WIMP signals in the data.

A redescription is provided of Spirura infundibuliformis from the stomach of ground squirrels, Spermophilus richardsonii, in southern Alberta, Canada; Spirura leucurusi Babero, 1973 is regarded as a synonym. Spirura infundibuliformis is distinguished from most members of Spirura by the presence of 9–13 pairs of preanal papillae; 20 other species described in the genus have only 4, rarely 5, pairs. Spirura infundibuliformis developed at ambient temperatures (20–30 °C) to the infective stage in 11–12 days in grasshoppers common on the prairies (Melanoplus infantilis, Aeropedellus clavatus, Aulocara elliotti, and Camnula pellucida), where the ground squirrels were collected, as well as in laboratory-reared crickets (Acheta pennsylvanicus).

From the 1950s through the 1960s, an unknown number of oropharyngeal squamous cell carcinomas (SCCs) presented with metastases to cervical lymph nodes from an unknown primary (SCCUP) and were not recognized as oropharyngeal in origin. At present, pathologic evaluation of SCCUP for human papillomavirus (HPV) improves discovery of occult oropharyngeal SCC and may partially explain increased incidence of HPV-positive oropharyngeal SCC.Retrospective cohort study.A retrospective study of 13 cases of SCCUP diagnosed from 1956 to 1969 was performed. The probability of these cases of metastatic SCC to originate from the oropharynx was assessed by characterizing their morphology (keratinizing vs. nonkeratinizing) and HPV status by in situ hybridization and p16 immunostaining.Two cases of nonkeratinizing SCC positive for HPV by in situ hybridization and p16 immunohistochemistry were identified. These cases were most likely of oropharyngeal origin.These two cases can be added to the other 15 cases of HPV-positive primary oropharyngeal SCC identified in our department from 1956 to 1969. When determining the incidence of HPV-positive oropharyngeal SCC before the 1970s, a correction factor of about +13% (2/15) accounting for modern pathologic workup of SCCUP during the last couple of decades may be appropriate.

Clear cell carcinoma or hyalinizing clear cell carcinoma (CCC) and clear cell odontogenic carcinoma (CCOC) are rare, low-grade and typically indolent malignancies that can be diagnostically challenging. In this study the clinicopathologic, histologic, and immunohistochemical features of 17 CCCs and 12 CCOCs are examined. The differential diagnosis of clear cell malignancies in the head and neck is discussed. The relationship of CCCs and CCOCs to other clear cell tumors on the basis of their immunohistochemical staining patterns is postulated.

Oncocytic mucoepidermoid carcinoma poses diagnostic challenge because of its histologic overlap with other oncocytic salivary gland lesions, including Warthin tumor. Although the prognostic value of the t(11;19) MECT1-MAML2 fusion gene has been established in mucoepidermoid carcinoma, its diagnostic use in discriminating oncocytic mucoepidermoid carcinoma from histologic mimics is unexplored. We evaluated the translocation status in 14 cases of oncocytic mucoepidermoid carcinoma using a MAML2-11q21 break-apart probe spanning the entire chromosome region of the MAML2 gene and correlated these findings with clinicopathologic parameters including age, sex, stage, predominant growth pattern, grade, and p63 immunostaining pattern. All oncocytic mucoepidermoid carcinomas were parotid tumors with a mean patient age of 54.6 years (range, 9-85) and a female to male ratio of 5:2. Grade distribution was as follows: low grade, 9; intermediate grade, 2; and high grade, 3. The histologic patterns observed were as follows: solid, 4; cystic, 8 (of these, 5 had Warthin-like lymphoid stroma); and mixed, 2. Solid oncocytic mucoepidermoid carcinomas showed a diffuse p63 staining pattern, whereas cystic oncocytic mucoepidermoid carcinomas showed staining of the outer layer of intermediate cells ranging from a bilayer to areas of complex multilayering and plaque-like proliferation. Ten (71%) of the 14 cases showed a MAML2 rearrangement by fluorescence in situ hybridization. No correlation was seen between rearrangement status and histologic grade, growth pattern, or p63 staining pattern. However, we demonstrate that the presence of MAML2 rearrangement can be used as supportive evidence to distinguish oncocytic mucoepidermoid carcinoma from other oncocytic lesions.

The design, optimisation and construction of an anti-coincidence veto detector to complement the ZEPLIN-III direct dark matter search instrument is described. One tonne of plastic scintillator is arranged into 52 bars individually read out by photomultipliers and coupled to a gadolinium-loaded passive polypropylene shield. Particular attention has been paid to radiological content. The overall aim has been to achieve a veto detector of low threshold and high efficiency without the creation of additional background in ZEPLIN-III, all at a reasonable cost. Extensive experimental measurements of the components have been made, including radioactivity levels and performance characteristics. These have been used to inform a complete end-to-end Monte Carlo simulation that has then been used to calculate the expected performance of the new instrument, both operating alone and as an anti-coincidence detector for ZEPLIN-III. The veto device will be capable of rejecting over 65% of coincident nuclear recoil events from neutron background in the energy range of interest in ZEPLIN-III. This will reduce the background in ZEPLIN-III from ≃0.4 to ≃0.14 events per year in the WIMP acceptance region, a significant factor in the event of a non-zero observation. Furthermore, in addition to providing valuable diagnostic capabilities, the veto is capable of tagging over 15% for γ-ray rejection, all whilst contributing no significant additional background. In conjunction with the replacement of the internal ZEPLIN-III photomultiplier array, the new veto is expected to improve significantly the sensitivity of the ZEPLIN-III instrument to dark matter, allowing spin-independent WIMP-nucleon cross sections below 10-8 pb to be probed. © 2010 Elsevier B.V. All rights reserved.

Objective To reappraise the clinical and histologic variables associated with a more aggressive outcome in polymorphous low-grade adenocarcinoma (PLGA). Design Retrospective cohort. Setting University hospital. Patients Twenty-four patients with PLGA treated from January 1, 1973, through December 31, 2005. Main Outcome Measure Analysis of clinical and pathologic variables in 30 biopsy or resection specimens from 24 patients. Results Only 4 PLGAs were not initially diagnosed as such. However, 8 non-PLGAs (thus excluded) were incorrectly diagnosed as PLGA. Most carcinomas (14 of 24 [58%]) were palatal. Recurrent carcinomas had a significantly higher mitotic rate (2.7 mitoses per 10 high-power fields) compared with primary tumors (1.2 mitoses per high-power fields, P = .046), and 3 of 7 (43%) recurrences showed progression to an intermediate-grade histologic type. No patient died of disease. Median disease-free survival was 12.8 years. Four of 24 patients (17%) had regional lymph node metastases, 3 with carcinomas of the base of the tongue. One PLGA metastasized to the subcutaneous tissue of the face, orbit, and lungs at 19.6 years. An extrapalatal site was the only significant determinant of disease-free survival ( P = .03). Conclusions Diagnosis of PLGA remains a challenge. Extrapalatal carcinomas appear to behave in a more aggressive fashion than those of the palate, and cancer arising from the base of the tongue frequently metastasizes to the cervical lymph nodes, suggesting a role for neck dissection in these patients. Recurrent cancers show evidence of histologic progression, justifying an aggressive approach to achieving initial complete excision.

We present limits on the WIMP-nucleon cross section for inelastic dark matter derived from the 2008 run of ZEPLIN-III. Cuts, notably on scintillation pulse shape and scintillation-to-ionisation ratio, give a net exposure of 63 kg.days in the range 20-80keV nuclear recoil energy, in which 6 events are observed. Upper limits on signal rate are derived from the maximum empty patch in the data. Under standard halo assumptions a small region of parameter space consistent, at 99% CL, with causing the 1.17 ton.year DAMA modulation signal is allowed at 90% CL: it is in the mass range 45-60 GeV with a minimum CL of 88%, again derived from the maximum patch. This is the tightest constraint on that explanation of the DAMA result yet presented using a xenon target., 4 pages, 5 figures. Updated with 1.17 ton.year DAMA results.

Objective Basal cell adenocarcinoma of a minor salivary gland is extremely rare. The goal of this report is to increase awareness of this rare disease and to review and discuss the differential diagnosis and important considerations in treatment. Study Design Case report and review of the literature. Methods Case report of a basal cell adenocarcinoma of a hard palate minor salivary gland and review of the literature of basal cell adenocarcinoma. Results Basal cell adenocarcinomas are slow-growing tumours that most commonly involve the parotid gland and very rarely involve minor salivary glands. Although recurrence rates for these tumours are high, mortality rates are low. Histological diagnosis is important to distinguish this tumour from adenoid cystic carcinoma given the significant difference in disease prognosis. Conclusions Diagnosis of these tumours must be made histologically. Recommended treatment options include wide local excision with radiotherapy reserved for close surgical margins or for local recurrence.

A method is described that allows calibration and assessment of the linearity of response of an array of photomultiplier tubes. The method does not require knowledge of the photomultiplier single photoelectron response model and uses science data directly, thus eliminating the need for dedicated data sets. In this manner all photomultiplier working conditions (e.g. temperature, external fields, etc) are exactly matched between calibration and science acquisitions. This is of particular importance in low background experiments such as ZEPLIN-III, where methods involving the use of external light sources for calibration are severely constrained., Comment: 15 pages, 6 figures

Aims: To describe seven cases of sinonasal seromucinous hamartoma. Materials and results: The clinicopathological and immunohistochemical features of seven seromucinous hamartomas were analysed. There were four men and three women. Six lesions involved the posterior nasal septum and one the lateral wall. Size ranged from 6 to 40 mm. Four patients had no recurrences. One patient had local recurrences 24 and 60 months after diagnosis. The masses were covered by respiratory epithelium. Their stroma was oedematous to fibrous and contained invaginated respiratory epithelium forming glands and cysts, cysts with cuboidal to flat epithelium, and small serous glands, ducts and tubules with lobular and irregular haphazard patterns. One case had numerous glands surrounded by hyalinized basement membrane with features of respiratory epithelial adenomatoid hamartoma (REAH). One case had focal REAH-like changes. Both respiratory and serous components were positive for cytokeratin (CK) 7 and CK19. The serous component lacked myoepithelial cells when stained for CK14, p63, calponin and muscle-specific antigen in five cases. Conclusions: Seromucinous hamartomas show a broader histopathological appearance than previously reported. The serous proliferation in these lesions lacks myoepithelial cells. The presence of occasional REAH-like features and common location in the posterior nasal septum suggest a spectrum from pure seromucinous hamartoma to REAH.

We present new experimental constraints on the WIMP-nucleon spin-dependent elastic cross-sections using data from the first science run of ZEPLIN-III, a two-phase xenon experiment searching for galactic dark matter WIMPs based at the Boulby mine. Analysis of $\sim$450 kg$\cdot$days fiducial exposure revealed a most likely signal of zero events, leading to a 90%-confidence upper limit on the pure WIMP-neutron cross-section of $\sigma_n=1.8\times 10^{-2}$ pb at 55 GeV/$c^2$ WIMP mass. Recent calculations of the nuclear spin structure based on the Bonn CD nucleon-nucleon potential were used for the odd-neutron isotopes $^{129}$Xe and $^{131}$Xe. These indicate that the sensitivity of xenon targets to the spin-dependent WIMP-proton interaction is much lower than implied by previous calculations, whereas the WIMP-neutron sensitivity is impaired only by a factor of $\sim$2., Comment: 4 pages, 2 figures

An active veto detector to complement the ZEPLIN‐III two phase Xenon, direct dark matter device is described. The proposed design consists of 52 plastic scintillator segments, individually read out by high efficiency photomultipliers, coupled to a Gd loaded passive polypropylene shield. Experimental work was performed to determine the plastic scintillator characteristics which were used to inform a complete end‐to‐end Monte Carlo simulation of the expected performance of the new instrument, both operating alone and as an active veto detector for ZEPLIN‐III. The veto device will be capable of tagging over 65% of coincident nuclear recoil events in the energy range of interest in ZEPLIN‐III, and over 12% for gamma ray rejection, while contributing no significant additional background. In addition it will also provide valuable diagnostic capabilities. The inclusion of the veto to ZEPLIN‐III will aid to significantly improve the sensitivity to spin independent WIMP‐nucleon cross sections below 10−8 pb.

Three alternatively spliced forms of the amyloid precursor protein (APP), APP-695, APP-751, and APP-770, were expressed in the baculovirus expression vector system. The recombinant proteins were secreted into the culture medium by infected insect cells, and APP molecules were detected in insect cells and medium 2 days after infection with the recombinant APP-baculoviruses. A partial sequence of the NH2 terminus of the secreted protein revealed identity with the native secreted protein and showed that the signal peptide was recognized and properly cleaved in insect cells. Purified secreted recombinant APP-751 comigrated with protease nexin 2 purified from platelets and fibroblasts. A 15-kDa COOH-terminal fragment of APP was also detected in cells infected with recombinant baculoviruses, suggesting that recombinant APP proteins were cleaved at the COOH-terminal end like native APP protein. Recombinant APP-751 and APP-770 formed complexes with epidermal growth factor-binding protein, whereas APP-695 did not. In addition, recombinant APP-751 and APP-770 inhibited trypsin and chymotrypsin activity, whereas APP-695 did not. Growth of a human fibroblast cell line, A-1, that required APP for complete growth, was restored upon addition of secreted recombinant APP-695 or APP-751. Thus, the appropriately sized, secreted recombinant APP proteins produced in this expression system are biologically active.

Background Follicular dendritic cell sarcoma (FDCS) arises from nonlymphatic antigen-presenting cells found in lymph node B-cell follicles. This extremely rare tumor, which usually arises in lymph nodes, does occur in extranodal head and neck sites such as the tonsil and soft palate. Methods A retrospective review of the patient followed at the University of Pittsburgh Medical Center from 1993 to the present was performed. Conclusions This is the first reported case of an FDCS of the thyroid. A review of the literature provides useful information to aid in detection, treatment, and outcome of this unusual soft tissue malignancy. © 1999 John Wiley & Sons, Inc. Head Neck 21: 273–275, 1999.

The ZEPLIN-III experiment in the Palmer Underground Laboratory at Boulby uses a 12kg two-phase xenon time projection chamber to search for the weakly interacting massive particles (WIMPs) that may account for the dark matter of our Galaxy. The detector measures both scintillation and ionisation produced by radiation interacting in the liquid to differentiate between the nuclear recoils expected from WIMPs and the electron recoil background signals down to ~10keV nuclear recoil energy. An analysis of 847kg.days of data acquired between February 27th 2008 and May 20th 2008 has excluded a WIMP-nucleon elastic scattering spin-independent cross-section above 8.1x10(-8)pb at 55GeV/c2 with a 90% confidence limit. It has also demonstrated that the two-phase xenon technique is capable of better discrimination between electron and nuclear recoils at low-energy than previously achieved by other xenon-based experiments., 12 pages, 17 figures

Parathyroid lipoadenomas and lipohyperplasias are rare histologic variants with both an increase in stromal fat and parenchyma. We report the most comprehensive single institution series of lipoadenomas and lipohyperplasias to date and review the literature. Eight lipoadenomas and 3 lipohyperplasias (27 y period) were reviewed. The mean age was 60.3 years (range: 50 to 77 y) with a female predilection (1.75:1). The most common symptoms on presentation were fatigue (55.6%) and bone/joint pain (44.4%). Only 1 patient was euparathyroid. Ultrasound localized lipoadenomas in 50% of tested cases whereas sestamibi was successful in 71.4%. Despite increased stromal fat (median: 50%), the weight and the appearance of large, occasionally nodular expansions of parathyroid parenchyma within the fatty stroma distinguished lipoadenomas and lipohyperplasias from normal parathyroid tissue; none of the cases were misclassified as normal on frozen section. Mean weight for lipoadenomas was 1553 mg (range: 173 to 4587 mg), whereas the mean weight for lipohyperplasia glands was 389.1 mg. Variant morphologies included follicular patterned, oxyphil predominant, and thymic elements (thymolipoadenoma). In 1 lipohyperplasia case, not all glands were involved. Oil Red O stains showed decreased intracytoplasmic lipid in most cases. Median follow-up was 9.2 months (range

High-grade transformation of adenoid cystic carcinoma (ACC) (previously referred to as dedifferentiation) is a rare phenomenon that does not fit into the traditional ACC grading schemes. The importance and minimal criteria for distinction from solid (grade III) ACC are not well established. We report 11 new cases and review the literature to further define the profile of this tumor. The median age was 61 years (range: 32 to 72 y) with a male predominance (male to female ratio of 1.75:1). The most commonly involved sites were sinonasal (4/11) and submandibular (4/11). Lymph nodes were pathologically positive in 4/7 (57.1%) cases. Distant metastases to the lung (n=2) and soft tissue of the shoulder (n=1) were observed. Five of 9 patients (55.6%) died, all within 5 years with a median overall survival of 12 months. Histologically, ACC with high-grade transformation was distinguished from conventional ACC by nuclear enlargement and irregularity, higher mitotic counts, and the loss of the biphasic ductal-myoepithelial differentiation. Useful supportive criteria were prominent comedonecrosis and fibrocellular desmoplasia. The most common morphologies for the high-grade component were poorly differentiated cribriform adenocarcinoma and solid undifferentiated carcinoma. Micropapillary and squamoid patterns were occasionally present. Ki-67 and p53 labeling indices were elevated in the high-grade components, though c-kit and cyclin-D1 were not. ACC-high-grade transformation is a highly aggressive salivary gland tumor with a variety of histologic patterns. The high propensity for lymph node metastases suggests a role for neck dissection in patients with this rare tumor.

Patients with symptomatic metastases referred for outpatient palliative radiotherapy for symptom control at the Rapid Response Radiotherapy Program (rrrp) and the Bone Metastases Clinic (bmc) at the Toronto–Sunnybrook Regional Cancer Centre have a limited life expectancy. Relevant medical information is missing from the files of many referred patients when they arrive at the clinics, potentially causing delayed treatment and ambiguity in the best management of their needs in situations of worsening condition. Clear documentation of the do-not-resuscitate (dnr) order is imperative to avoid panic and the taking of unnecessarily aggressive measures in situations in which cardiopulmonary resuscitation (cpr) has no benefit or is not desired. Here, we report the current practices of cpr code status documentation for patients referred to the rrrp and the bmc for out-patient palliative radiotherapy. We reviewed referral notes and accompanying medical records for 209 consecutive patients seen in the rrrp and the bmc during May–August 2004 for documentation of cpr-related advance directives. Patient demographics and cancer history were also recorded. Only 13 (6.2%) of the 209 patients had any documented reference to cpr code status. Of these 13 patients, 8 were dnr-coded, and 5 were full code. As compared with patients having no documented cpr code status, patients with documented status were significantly older (median age: 77 years; p = 0.0347), had poorer performance status (median Karnofsky performance status score: 40; p = 0.0001), and were more likely to be referred hospital inpatients (69%, p = 0.0004). Only a small proportion of symptomatic advanced cancer patients had any documentation of cpr code status upon referral for outpatient palliative radiotherapy. In future, our clinics plan to request information about cpr code status on our referral form.

1. Joanna E. Durham-Barnes[1][1] 1. 1Middle Tennessee State University, Murfreesboro, USA 1. Joanna E. Durham-Barnes, Middle Tennessee State University, COE Box 69, Murfreesboro, TN 37132, USA. Email: joanna.durham-barnes{at}mtsu.edu Rarely do White, middle-class Americans, the population from which most teachers are drawn, have the opportunity to consider themselves as racialized beings. Although personal experience is usually the best teacher, our increasingly homogeneous teaching population oftentimes lacks experience with diversity, and schools of education often struggle to find appropriate and meaningful diverse field experiences for their teacher candidates. This study uses a documentary in an attempt to provoke thoughtful conversations about race and racism in the United States among the mostly White teacher candidates. The study identifies racial themes that emerge from the conversations, explores the ways the groups’ racial diversity alters conversations on race, and explores how the race of the group’s facilitator may affect the conversations. The study suggested that racially diverse groups are more likely to explore greater numbers of racial themes and engage each other more deeply through polite disagreement. Although racial diversity of any kind seemed to promote deeper conversations, participants reported greater satisfaction from the conversations when the students themselves were racially diverse rather than with the facilitator alone. [1]: #aff-1

Context.—The pathogenesis of respiratory epithelial adenomatoid hamartoma (REAH) and inverted papilloma (IP) is poorly understood, especially compared with sinonasal adenocarcinoma (SNAC). One feature of malignant glandular lesions is loss of the basal/myoepithelial layer. The immunophenotype of the basal/myoepithelial layer has not been fully examined in benign glandular lesions of the sinonasal tract.Objective.—To examine benign and malignant glandular lesions in the sinonasal tract for the immunophenotype of basal/myoepithelial cells, proliferation index, and cytokeratin and intestinal differentiation profiles.Design.—Sinonasal adenocarcinoma (intestinal-type adenocarcinoma [ITAC] and nonintestinal type adenocarcinoma [non-ITAC]), REAH, IP, and chronic sinusitis (CS) were stained for cytokeratin (CK) 7, CK20, 34βE12, CDX-2, p63, Ki-67, smooth muscle actin (SMA), S100 protein, and calponin.Results.—Basal/myoepithelial cells in CS and REAH were positive for p63 and 34βE12 but negative for SMA, S100 protein, and calponin. Proliferative activity was localized to the compartment containing p63-positive cells. Inverted papilloma demonstrated broad areas staining for p63 and 34βE12, with intermediate proliferative activity in these areas. Sinonasal adenocarcinoma had the highest Ki-67 labeling index, and p63-positive SNACs had higher proliferation indices than p63-negative SNACs. REAH, IP, CS, and most SNACs expressed CK7. Only SNAC expressed CK20. Sixty percent of morphologic ITACs expressed CDX-2.Conclusions.—Basal/myoepithelial cells in CS and REAH should be considered basal and not myoepithelial cells. In benign lesions, proliferative activity is limited to the compartments with p63 staining. In SNAC and IP, p63 expression correlates with proliferation index. REAH, IP, and CS share similar immunoprofiles (CK7+, CK20−, and CDX-2−), contrasting with SNAC (CK7+, CK20+/−, CDX-2−/+).

Context.—Nasal chondromesenchymal hamartoma is a benign mass lesion of the nasal cavity predominantly described in young infants. These unusual lesions are composed of a proliferation of mesenchymal and cartilaginous elements. Their pathogenesis is unknown, but they may be derived from embryologic rests. To our knowledge, only 1 case in an older child has been reported, and no cases have been reported in adults. Objective.—To report 4 cases of nasal chondromesenchymal hamartoma occurring in older children and adults, including immunohistochemical analysis of these unusual lesions. Design.—Cases identified from our archives were examined to confirm the diagnosis of nasal chondromesenchymal hamartoma. Immunohistochemical analysis was performed using a panel of antibodies (epithelial membrane antigen, smooth muscle actin, all muscle actin, cytokeratin, S100, and KP1) to evaluate for epithelial, smooth muscle, neural, chondroid, and histiocytic differentiation. Results.—Four cases of nasal chondromesenchymal hamartoma in patients of 11, 69, 17, and 25 years of age demonstrated histologic evidence of mesenchymal and cartilaginous elements underlying a chronically inflamed respiratory mucosa. Bony and adipose elements and rare glandular elements were interspersed. Cartilaginous elements stained strongly with S100, whereas mesenchymal regions showed variable and weaker staining. Smooth muscle differentiation was seen primarily in the mesenchymal areas. Epithelial membrane antigen was focally positive in all cases. Conclusions.—Nasal chondromesenchymal hamartomas can rarely occur in the older child and adult. Mesenchymal areas show both myofibroblastic and cartilaginous differentiation. We speculate that inflammation or a recapitulation of developmental signals may be components in the pathogenesis of these lesions.

Protein products of tumor suppressor genes are often involved in regulating the cell cycle, and aberrant expression can correlate with underlying genetic mutations. Mutations in the p16 gene have been detected at relatively high rates in squamous cell carcinomas of the oral cavity. However, immunohistochemical staining for the protein product has not been examined as a diagnostic tool for identifying dysplastic lesions in the oral cavity. Sixty cases of biopsies of reactive, inflammatory, and dysplastic lesions of all grades were stained with an antibody to p16INK4A and analyzed for which layer of the epithelium had positive cells. Staining was seen only in the basal or lower third in keratoses and mild dysplasias and was seen in the mid and upper thirds in moderate to severe dysplasia. The staining across larger fragments of biopsied epithelium highlighted skip lesions, with strong staining restricted to dysplastic regions. Inflammatory lesions, including chronic ulcers, showed absent or minimal basal layer staining with p16INK4A. In this preliminary study, p16INK4A shows promise as to a potential marker to aid in recognizing the presence of dysplasia in squamous mucosa of the head and neck, particularly in subtle lesions, and in an inflammatory or ulcerated background.

Warthin's tumors are benign lesions of the head and neck that have a characteristic morphologic appearance. The etiology of Warthin's tumors is controversial and whether they are true neoplasms or developmental malformations continues to be debated. In this study, we examined 12 Warthin tumors with a molecular and immunohistochemical approach. Immunostains for p53 and p16ink were performed. The epithelial and lymphoid components of each lesion were microdissected and PCR was performed for 13 microsatellite markers at or near common tumor suppressor genes. The results were analyzed semiquantitatively using capillary electrophoresis. Frequency of allelic loss was calculated. The epithelial component of all tumors was negative for p53 and p16ink. By molecular genotyping there was only one case that had one locus with allelic imbalance, while the remainder had no evidence of clonal allelic loss. The immunohistochemical and molecular results in this study lend support to the hypothesis that Warthin tumors are non-neoplastic, as there was no evidence of aberrant staining for tumor suppressor gene protein products and no evidence of consistent clonal allelic losses.

Primary sclerosing mucoepidermoid carcinomas with eosinophilia (SMECE) of the thyroid gland are rare tumors that can present diagnostic difficulties to the pathologist due to the unusual histologic features. Furthermore, the etiology of these tumors has been debated in the literature, with some authors believing that the tumors arise from remnants of the ultimobranchial body (UBB, solid cell nests) and others proposing that they arise from follicular epithelial cells. Because SMECE often occur in glands with chronic lymphocytic thyroiditis and UBB hyperplasia, and do not stain like follicular or parafollicular cells, it is likely that the tumors do arise from UBB/solid cell nests. In this study, we provide additional evidence for this relationship, by demonstrating that SMECE stain strongly positive for p63, which is a new marker for UBB/solid cell nests.

The relationship between chronic lymphocytic thyroiditis (CLT) and papillary thyroid carcinoma (PTC) is a subject of controversy. Some investigators suggest a causal relationship, whereas others regard the two as only a coincidental occurrence. An additional complicating factor is the presence of atypical nuclei frequently found within lymphoid infiltrates in CLT, which resemble those in PTC. The finding of the RET-PTC translocations in CLT has been reported by two independent groups of investigators, suggesting that the areas of nuclear atypia in CLT are neoplastic rather than reactive. In the present study, we report additional molecular findings that support the hypothesis that the atypical nuclear changes in CLT may be preneoplastic or neoplastic. We microdissected small areas with atypical nuclei in glands with CLT and observed loss-of-heterozygosity mutations of tumor suppressor genes. These genetic mutations are evidence of clonal preneoplastic or neoplastic changes in the follicular cells of CLT. The clinical malignant potential of these minute foci is likely to be very small but remains to be determined.

Eagle syndrome includes elicitation of pain on swallowing, turning the head, or extending the tongue. The syndrome is thought to be caused by irritation of the glossopharyngeal nerve, most commonly caused by its impingement against an elongated styloid process. We present a rare case of a granular cell tumor presenting as Eagle syndrome. Granular cell tumors orignate from Schwann cells and are most common in the subcutaneous tissue of the head, neck, and oral cavity, especially the tongue. A granular cell tumor is typically benign and solitary, rarely malignant. The differential diagnosis, diagnostic algorithm, and treatment are presented.