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Introduction: Despite its central role in sexual function, we lack a description of the nerve distribution and histology for the central components of the clitoris., Aim: This study aims to characterize microscopic anatomy of the clitoral-urethral complex (CUC) and aid our understanding of sexual sensation, Methods: The CUC was excised from three female fresh-frozen cadavers en bloc and prepared in 5-μm longitudinal sections with hematoxylin and eosin and S100 immunohistochemistry for neural elements. Approximately 20 sections were obtained from each specimen. On low power microscopy, the 30 most innervated fields on each section were identified. On high power, the total number of nerves per field was quantified, then was averaged. The histologic characteristics of each clitoral component were described. Two investigators evaluated all specimens., Main Outcome Measures: Descriptives of large (≥3 fibers) and small nerves based on location in the CUC., Results: Nerve quantification revealed the glans to be the most populated by small nerves (52.1, standard deviation [SD] 26.2). As slices through each specimen moved caudad toward the urethra, the number of small nerves dramatically decreased from 40.4 (SD 10.8) in the body and 29.8 (SD 8.8) (superior CUC) near the bulb to 23.7 (SD 9.8) in the middle CUC and 20.5 (SD 10.4) (inferior CUC) near the urethra. Although the variation in small nerves was striking, large nerves were somewhat uniform and comprised a minority of the overall quantity. Neuroanatomy was consistent for all cadaver specimens., Conclusions: Our study provided a description of the nerve distribution throughout the central CUC. Increased density of small nerves in the glans suggests this is the location of heightened sensation. Decreasing quantity of nerves in segments closer to the urethra may indicate these zones are less important for sexual sensation. Knowledge of human clitoral innervation is important for understanding the complexities of the female sexual response cycle., (© 2013 International Society for Sexual Medicine.)

Metastatic renal cell carcinoma (RCC) presenting with peritoneal involvement or ascites is rare and has been previously described clinically in the setting of large renal mass or other distant metastases. We report an unusual case of RCC presenting with ascites without large mass or other distant metastases. Advances in cytologic diagnosis of metastatic RCC in serous ascitic fluid is discussed, while a potential mechanism of tumor spread is presented., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: This study aimed to evaluate the histologic and cytologic effects of preoperative vaginal estrogen in women with atrophic vaginitis and pelvic organ prolapse., Methods: Forty-two women with atrophic vaginitis and stage greater than or equal to 2 prolapse were enrolled in this assessor-blinded randomized controlled trial comparing daily vaginal estrogen cream use for 2 to 12 weeks preoperatively versus no intervention. Data were analyzed using t test and analysis of variance., Results: Of these 42 women, 22 received treatment and 20 were controls. After a mean 7 (3) weeks of use, the vaginal maturity index increased 15.5% in the treatment group and declined 1.5% in the control group (P < 0.001). The vaginal epithelial thickness was 339 (96) μm in the treatment group compared to 302 (119) μm (P = 0.275) in the controls., Conclusions: Preoperative vaginal estrogen application for 2 to 12 weeks restores vaginal cytology to premenopausal levels, but does not increase vaginal epithelial thickness in women with prolapse.

Benign peripheral nerve sheath tumors are relatively common. They are mostly characterized by the presence of delicate S-shaped spindle cells and myxoid stroma. Although variants with epithelioid foci can be present, the pure epithelioid variant of benign cutaneous schwannoma is extremely rare. It was first reported as cutaneous epithelial schwannoma by Kindblom et al in 1998. Since then, only six cases have been reported. Care should be taken not to misdiagnose them as malignant neoplasms. Their diagnosis can be problematic as their histopathologic features may overlap with those of other soft-tissue and melanocytic tumors. We report a case of cutaneous epithelioid schwannoma and review of the literature.

We report a case of a 79-year-old Caucasian male who presented with a wrist lesion of combined intraepidermal Merkel cell carcinoma and squamous cell carcinoma in-situ. The two tumors were tightly admixed and distinct, and both were without any dermal or invasive components. No features of transition between the two tumors were seen. We suggest the term Merkel cell carcinoma in situ for tumors that demonstrate exclusive intraepidermal proliferation of neuroendocrine cells.

Objective: Malignant mesenchymoma are rare tumors of the orbit. From 1961 using English-language literature, we present the sixth such case and the first case with three malignant components., Design: Interventional case report., Methods: The clinical presentation, workup, surgical treatment, and pathology of a case of malignant mesenchymoma of the orbit are presented., Results: Although very rare, these tumors should be in the differential diagnosis of any tumor of the orbit. The prognosis is unknown because of the lack of follow-up of reported patients., Conclusions: This malignant orbital mesenchymoma, an entity not accepted by all pathologists, was more complex than cases previously reported in the English literature in demonstrating rhabdomyosarcomatous, chondrosarcomatous, and osteogenic differentiation.

Intraosseous schwannomas are rare benign neoplasms of the bone, of which fewer than 200 cases have been described in the world literature. These tumors are well-defined, lytic lesions, rarely associated with pathologic fracture. The mandible is the most frequently involved bone. We present only the third case of an intraosseous schwannoma involving the humerus.

Premature closure of the foramen ovale, 4-chamber cardiac hypertrophy, and renal vein/vena cava thrombosis were found at autopsy of a stillborn dizygotic twin at 36 weeks gestational age. Review of the original prenatal sonograms showed features suggestive of early closure of the foramen ovale. Homozygosity for the 5, 10 methylene tetrahydrofolate reductase mutation was shown only in the affected twin after the parents were found to be heterozygous for the mutation. The difference in outcome of the twins following prenatal treatment with beta mimetics and corticosteroids for preterm labor may be related to the added susceptibility factor for thromboembolism associated with presumed hyperhomocysteinemia in the proband which was not shared by the surviving healthy twin. The role of premature closure of the foramen ovale and prenatal treatment are discussed but remain uncertain.

Background: Since its initial discovery in the avian intestine, calbindin-D28K has been reported to occur in various species and tissues. Although calbindin-D28K binds calcium ions in the physiologically relevant range of intracellular calcium, its functional role in the various cell types where it has been localized remains unknown., Methods: We examined the occurrence of calbindin-D28K in the brain and kidney of the testudine reptile, Trachemys scripta, by immunoblotting and immunocytochemistry using rabbit anti-sera directed against rat renal calbindin-D28K and chicken intestinal calbindin-D28K., Results: Immunoblotting revealed the presence of calbindin-D28K in the turtle tissues. A single immunoreactive band in the 28,000 relative molecular mass region was visualized in cerebellar and renal homogenates. Immunocytochemistry revealed reaction product for the presence of calbindin-D28K in the Purkinje cells of the cerebellum, and in the distal tubular cells of the nephron. Processes as well as the perikaryon of the Purkinje cell were immunoreactive., Conclusion: This study describes the occurrence and cellular localization of calbindin-D28K in a reptilian cerebellum, and confirms the phylogenetic distribution of renal calbindin-D28K to the oldest major reptilian group.