Polymorphous low-grade adenocarcinoma of the major salivary glands: report of three cases in an unusual location.

AIMS: Polymorphous low-grade adenocarcinoma (PLGA) is the second most common type of malignant neoplasm in minor salivary glands. Its origin in major salivary glands is considered exceedingly rare. Herein, we present three cases of de novo PLGA arising in major salivary glands. METHODS AND RESULTS: Three cases of PLGA were identified in a large series of primary tumours of major salivary glands. We investigated their clinicopathological profiles, including immunohistochemical features. The three patients (two men and one woman) were 51, 65, and 79 years old. The tumours were 20-30 mm large; two were in the parotid gland and one in the submandibular gland. Histologically, all the tumours had a polymorphous architectural pattern showing predominantly solid, tubular, and cribriform features and invasive growth. Papillary areas were observed focally in two tumours and an 'Indian-file' array in one. The tumour cells had a bland cytological appearance and low mitotic count. Two tumours showed perineural invasion. No preexisting pleomorphic adenoma component was identified. In all cases, tumour cells were positive for epithelial markers, S100 protein, and vimentin but negative for alpha-smooth muscle actin, muscle-specific actin, and glial fibrillary acidic protein. Proliferative activities assessed with the Ki67 labelling index were 4.3%, 7.1%, and 7.6%; no p53 overexpression was observed. Two patients had local recurrence, but none had metastasis or died of tumour. CONCLUSIONS: PLGAs arising in major salivary glands and those in minor salivary glands have similar clinicopathological and immunohistochemical characteristics. It is important to recognize that PLGA can occur ab initio in the major salivary glands, although it is extremely rare.

Calciphylaxis causing necrotizing mastitis: a case report.

Calciphylaxis is a rare condition most commonly related to ESRD and hyperparathyroidism. We report a case of necrotizing mastitis caused by calciphylaxis following routine breast biopsy for microcalcifications. Early recognition of the potential for this condition should help in clinical management of patients with calciphylaxis.

Puboperineales: muscular boundaries of the male urogenital hiatus in 3D from magnetic resonance imaging.

PURPOSE: The aims of this report are 1) to extend our previous two-dimensional magnetic resonance imaging study to create a three-dimensional image of the pelvic floor, including the puboperinealis, the most anteromedial component of the levator ani; 2) to clarify the historical controversy about this particular component of the levator ani; and 3) to present clinical implications of this muscle with respect to urinary continence and radical prostatectomy. MATERIALS AND METHODS: We reused the axial magnetic resonance imaging series from 1 of 15 men in a previous series. Analyze AVWTM allowed creation of three-dimensional images. Further, a movie clip of all three-dimensional images was developed and placed at the manuscript-dedicated Web site: http://www.mayo. edu/ppmovie/pp.html. RESULTS: Our three-dimensional images show how the puboperinealis portion of the levator ani flanks the urethra as it courses from the pubis to its insertion in the perineal body. CONCLUSIONS: The puboperinealis corresponds to muscles previously designated as the levator prostatae, Wilson's muscle, pubourethralis, and levator urethrae, among others. The images suggest that the puboperinealis is the muscle most responsible for the quick stop phenomenon of urination in the male. Our study supports the suggestion that weakening of the puboperinealis by transection, traction injury, or denervation may affect urinary continence after radical prostatectomy.

Prostate cancer microvessels: a novel method for three-dimensional reconstruction and analysis.

BACKGROUND: Studies of prostate cancer microvessels to date have relied on routine two-dimensional images from histologic tissue sections, and there have been no previous reports of three-dimensional (3D) reconstruction and analysis of prostatic microvessels in benign or malignant specimens. Knowledge about the 3D architecture of microvessels would be useful for determining the utility and limitations of two-dimensional (2D) measures, as well as for determining the usefulness of 3D measures to predict pathologic stage and patient outcome in prostate cancer. However, the ability to study microvessels in 3D must first be demonstrated. METHODS: We developed a novel method to visualize and analyze prostate microvessels in three dimensions from serially-sectioned prostate specimens, including tissue preparation, reconstruction of serial histologic sections into 3D volumes, extraction of vessels from this data set, and calculation of geometric characteristics. Eleven regions of benign and cancer tissue were studied and compared in an effort to validate our methodology. RESULTS: Microvessels and glandular elements from benign and malignant tissue were visualized together in three dimensions. In the 3D visualizations, microvessels associated with cancer were seen to have more arbitrary pathways, increased tortuosity, and a more casual relationship with glandular elements than microvessels associated with benign tissue. A quantitative measure, the volume length density, discriminated between benign tissue and cancer better than simple microvessel density in this exploratory study. CONCLUSIONS: Microvessels in prostate cancer have a more homogeneous distribution and greater tortuosity than those in benign tissue. Volume length density of microvessels shows promise as a 3D marker in prostate cancer.

Occurrence and impact of suspected delirium in hospitalized elderly patients.

The records of 95 consecutive people older than 65 years and admitted to a community hospital were retrospectively reviewed to determine the prevalence of undiagnosed delirium in hospitalized elderly patients. Chart review focused on identification of patients with documented diagnosed delirium according to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) criteria and patients with unrecognized delirium. Unrecognized delirium was considered present when information contained in a patient's chart met some or all criteria for delirium as described in DSM-III-R, but the physician's progress notes failed to indicate delirium as a diagnosed clinical entity. The prevalence of diagnosed delirium was 2%. Thirty-six percent of the patients were suspected of having unrecognized delirium. The mean length of hospital stay and the rate of mortality were significantly higher for patients with suspected delirium than for non-delirious patients. The findings of this study suggest that unrecognized delirium in the hospitalized elderly may occur frequently and is associated with an increased length of hospital stay and increased mortality.