Squamous Cell Carcinoma of the Caruncle.

Squamous cell carcinoma (SCC) of the lacrimal caruncle is a rare entity. The authors report the management and outcomes of 3 cases of caruncle SCC. Case 1 underwent wide margin surgical excision with adjuvant topical chemotherapy for a poorly differentiated SCC. He later developed regional lymph node metastasis and required modified radical neck dissection. Case 2 underwent wide margin surgical excision with cryotherapy and adjuvant topical chemotherapy for an invasive moderately differentiated SCC. She later developed a recurrence and underwent orbital exenteration. Case 3 was a moderately differentiated SCC treated with wide margin excision alone and had no recurrence during 5-year follow up. Careful surveillance of caruncle SCC is required, given the observed propensity for local recurrence and/or regional metastasis.

Bystander Action in Situations of Dating and Sexual Aggression: A Mixed Methodological Study of High School Youth.

Bystander action is a critical component of dating and sexual aggression prevention; however, little is known about barriers and facilitators of bystander action among high school youth and in what situations youth are willing to engage in bystander action. The current study examined bystander action in situations of dating and sexual aggression using a mixed methodological design. Participants included primarily Caucasian (83.0%, n = 181) male (54.6%, n = 119) and female (44.5%, n = 97) high school youth (N = 218). Most (93.6%) students had the opportunity to take action during the past year in situations of dating or sexual aggression; being female and histories of dating and sexual aggression related to bystander action. Thematic analysis of the focus group data identified barriers (e.g., the aggression not meeting a certain threshold, anticipated negative consequences) to bystander action, as well as insight on promising forms of action (e.g., verbally telling the perpetrator to stop, getting a teacher); problematic intervention methods (e.g., threatening or using physical violence to stop the perpetrator) were also noted. Implications for programming are discussed.

Youth Strategies for Positive Bystander Action in Situations of Dating and Sexual Violence: Implications for Measurement and Programming.

Research on bystander behavior in situations of dating violence (DV) and sexual violence (SV) in youth populations is growing; yet, there is a distinct lack of qualitative studies to identify nuances in specifically how and when youth are taking action to help to inform theory, measurement, and programming. The current study examined bystander action plans of high school youth after their participation in a classroom-based, bystander-focused prevention program, to inform bystander behavior measurement and programming within the context of DV and SV research and practice. High school youth (N = 889) from schools across New England completed a bystander-focused violence prevention curriculum and subsequently wrote a bystander plan of action addressing a situation of DV or SV that they had seen before or were likely to see again in the future. The responses were qualitatively coded for type of situation and bystander action, while noting situational aspects (e.g., location, relationship to those involved, engagement of others). Students reported a variety of strategies (ranging from directly telling the perpetrator to stop to creating a distraction) and ways of thinking about situations of DV and SV, and related behaviors (e.g., bullying). Many students listed unique situations and bystander behaviors that were not addressed as part of the curriculum. Bystander action plans also varied as a function of situational variables (e.g., relationship to those involved). These results indicate that measures of bystander behavior for high school students need to look different from established measures for older age groups. Furthermore, bystander programming may be more effective if more thoughtful attention is given to how youth see helping in situations of DV and SV as connected to other problematic behaviors.

Development and Psychometrics of Instruments to Assess School Personnel's Bystander Action in Situations of Teen Relationship Abuse and Sexual Assault.

This article describes recently developed instruments that assess school personnel's bystander barriers and intentions in situations of teen relationship abuse, sexual assault, and sexual harassment, as well as perceptions of school readiness specific to relationship abuse, sexual assault, and sexual harassment prevention and response. Participants were 1,150 high school personnel from 25 schools in New Hampshire, Massachusetts, and Maine. Specific instruments focused on bystander intentions, bystander action, barriers to bystander action, and perceptions of school readiness. Participants were randomly divided into two groups for analysis-the exploratory sample (ES; n = 575) and the confirmatory sample (CS; n = 575). Overall, the measures demonstrated acceptable fit indices. Results suggested that most measures and subscales had adequate reliability, but a few subscales had less than ideal internal consistency, which can likely be attributed to the small number of items. More work is needed, but these measures act as a starting point by which the role of school personnel in prevention initiatives and bystander intervention can be evaluated.

School Personnel's Bystander Action in Situations of Dating Violence, Sexual Violence, and Sexual Harassment Among High School Teens: A Qualitative Analysis.

We examined school personnel's engagement in bystander action in situations of teen dating violence (DV), sexual violence (SV), and sexual harassment (SH). We conducted focus groups with 22 school personnel from three high schools in New Hampshire. School personnel identified their own barriers to intervening in situations of teen DV, SV, and SH (e.g., not having the time or ability to intervene). School personnel also discussed the ways in which they intervened before (e.g., talking with teens about healthy relationships), during (e.g., breaking up fights between dating partners) and after (e.g., comforting victims) instances of teen DV, SV, and SH. These data can be used to support the development of bystander training for school personnel as one component of comprehensive DV, SV, and SH prevention for teens. In addition, these data provide information that can be used to develop measures that assess school personnel bystander action barriers and behaviors in instances of teen DV, SV, and SH.

Synoptic reporting improves histopathological assessment of pancreatic resection specimens.

AIM: We examined whether introduction of a standardised pancreatic cancer minimum data set improved the reporting of key pathological features across multiple institutions. METHODS: From seven different pathology departments that are members of the New South Wales Pancreatic Cancer Network, 109 free text reports and 68 synoptic reports were compared. RESULTS: AJCC stage could not be inferred from 44% of free text reports, whereas stage was reported in all 68 synoptic reports. In the free text reports 28 different names were used to designate margins. All margins were reported in only 12 (11%) of the free text reports compared with 64 (94%) of the synoptic reports (p = 0.0011). The presence or absence of lymphovascular or perineural invasion was reported in 72 (66%) and 92 (84%) of free text reports, respectively. In contrast, lymphovascular space and perineural invasion were reported in all synoptic reports (p = 0.0011 and p = 0.0058). CONCLUSION: We conclude that synoptic reporting of pancreatic resections without any other intervention increases the information contained within histopathology reports. Therefore, the introduction of minimal data set synoptic reports is a simple and feasible mechanism to immediately improve reporting for pancreatectomy specimens.

Measurement Tools to Assess Relationship Abuse and Sexual Assault Prevention Program Effectiveness Among Youth.

OBJECTIVE: This article describes the adaptation, development, and psychometric properties of survey instruments to assess outcomes of bystander-focused violence prevention efforts among high school students, including media literacy, rape myths, bystander readiness, bystander barriers and facilitators of bystander action, bystander intentions, perceptions of school personnel helping, perceptions of peer helping, and victim empathy. METHOD: The study was based on data collected from 3,172 high school students across 25 schools in northern New England. RESULTS: Overall, the measures demonstrated acceptable fit indices in multilevel exploratory and confirmatory factor analyses. Whereas most measures and subscales had adequate reliability, several measures had less than ideal internal consistency, likely because of the limited number of items. CONCLUSION: Although additional measurement work is needed, these measures provide researchers and practitioners with foundational tools for basic research and program evaluation.

Liposarcoma masquerading as an inflammatory pseudotumor: a case report.

BACKGROUND: Distinguishing an atypical lipomatous tumor/well-differentiated liposarcoma from a benign lipomatous tumor on morphology alone can be difficult and there is an established role for MDM2 fluorescent in situ hybridization studies in making this differential diagnosis. There is no literature on the role for MDM2 fluorescent in situ hybridization studies in distinguishing between a well-differentiated liposarcoma with extreme fibrosis and a fibrosing inflammatory pseudotumor. CASE PRESENTATION: We report the case of a 76-year-old Australian woman initially diagnosed by an excision biopsy with a retroperitoneal fibrosing inflammatory pseudotumor. She was then diagnosed 5 years later with a pleomorphic undifferentiated sarcoma. Upon review of the original resection specimen, we were able to show that the tumor demonstrated MDM2 amplification. MDM2 amplification was also present in some adjacent bland adipose tissue, and also in the tumor recurrence as a pleomorphic undifferentiated sarcoma. CONCLUSION: Taken together, our findings provide strong evidence that the original tumor was a misdiagnosed well-differentiated liposarcoma with extreme fibrosis, and the pleomorphic undifferentiated sarcoma represented a recurrence of the same tumor with dedifferentiation.

Benign retroperitoneal cyst of Mullerian type.

Retroperitoneal cysts are rare, usually asymptomatic, lesions. We present the case of a 42-year-old woman with an asymptomatic abdominal mass. The mass excised at our district hospital was found in the retroperitoneum. Histologically, the cyst was lined with benign Mullerian-type epithelium. The classification, aetiology and clinical manifestations of retroperitoneal cysts are discussed. Retroperitoneal cysts present as an acute abdomen in only a minority of cases. Ultrasound is the most reliable test for their detection, usually followed by computed tomography and/or an upper gastrointestinal series. Optimally, these cysts should be completely excised.

The enigma of solitary necrotic nodule of the liver.

BACKGROUND: Solitary necrotic nodule of the liver (SNNL) is a rare benign lesion with an uncertain aetiology. There are no typical diagnostic clinical or radiological features, and this lesion is usually detected incidentally during imaging for other purposes. METHODS: We describe the clinical and radiological findings in three patients with histologically confirmed SNNL. The pertinent presenting features were documented and subsequent serological testing for parasites was performed. RESULTS: All three patients underwent resection because it was not possible to exclude a solitary malignancy on preoperative imaging. All three nodules had a serpiginous shape with areas of necrosis that showed marked staining for eosinophil granules. However, no viable parasites were seen in any specimen. There were no specific radiological features that were present in all three patients. Two patients had travelled to areas where parasitic infections are endemic and one patient had an eosinophilia on presentation. The histopathological findings in conjunction with the clinical presentation suggest that SNNL may be parasitic in origin. CONCLUSION: The diagnosis of SNNL is usually made after surgical excision. A preoperative diagnosis is difficult to make even with the use of multiple imaging modalities. The clinical and histopathological findings described in our three patients suggest that a transient parasitic infection is likely to be the cause in many cases. A history of potential exposure to parasites and serological testing for an eosinophilia or parasitic antibodies may help make the diagnosis of SNNL without the need for resection.

Sisterhood may be powerful for reducing sexual and intimate partner violence: an evaluation of the Bringing in the Bystander in-person program with sorority members.

Sorority members may be at greater risk than other college women for sexual violence and intimate partner violence (IPV). We evaluated the Bringing in the Bystander in-person program with sorority members who participated in the program (n = 30) compared with those who did not (n = 18). Results indicate that program participants showed increased bystander efficacy, likelihood to help, and responsibility for ending violence without unintended "backlash" effects. Implications include a call for future programming with more diverse sorority members over longer time. In addition, we discuss what the findings might mean for formal campus policies and practices for preventing sexual violence and IPV.

Sexual violence prevention: the role of stages of change.

Increasing numbers of empirical studies and theoretical frameworks for preventing sexual violence are appearing in the research- and practice-based literatures. The consensus of this work is that although important lessons have been learned, the field is still in the early stages of developing and fully researching effective models, particularly for the primary prevention of this problem in communities. The purpose of this article is to discuss the utility of applying the transtheoretical model of readiness for change to sexual violence prevention and evaluation. A review of this model and its application in one promising new primary prevention program is provided, along with exploratory data about what is learned about program design and effectiveness when the model is used. The study also represents one of the first attempts to operationalize and create specific measures to quantify readiness for change in the context of sexual violence prevention and evaluation. Implications for program development and evaluation research are discussed.

Engaging intercollegiate athletes in preventing and intervening in sexual and intimate partner violence.

OBJECTIVE: the object of this exploratory evaluation was to evaluate the "Bringing in the Bystander" sexual and intimate partner violence prevention program with a new sample of intercollegiate athletes. PARTICIPANTS AND METHODS: fifty-three male and female athletes participated in the program (experimental group), and 86 were in the control group. All completed pretest, posttest, and 2-month follow-up surveys, including assessment of rape myth acceptance, intent to engage in bystander behaviors, bystander confidence, and bystander behaviors. RESULTS: the program worked overall and for both women and men, improved bystander confidence and intent to engage in bystander behaviors, and did not create significant backlash effects (ie, worsening of attitudes as a result of program). CONCLUSIONS: the program fits with the intent of the National Collegiate Athletic Association CHAMPS/Life Skills program regarding its focus on the overall development of student-athletes and demonstrates the promising bystander approach compatible with the 2007 American College Health Association toolkit, Shifting the Paradigm: Primary Prevention of Sexual Violence.

Immunohistochemistry for PMS2 and MSH6 alone can replace a four antibody panel for mismatch repair deficiency screening in colorectal adenocarcinoma.

AIMS: Currently, testing for mismatch repair deficiency in colorectal cancers is initiated by performing immunohistochemistry with four antibodies (MLH1, PMS2, MSH2 and MSH6). If any one of these stains is negative the tumour is considered microsatellite unstable and, if clinical circumstances warrant it, the patient is offered genetic testing for Lynch's syndrome. Due to the binding properties of the mismatch repair heterodimer complexes, gene mutation and loss of MLH1 and MSH2 invariably result in the degradation of PMS2 and MSH6, respectively, but the converse is not true. We propose that staining for PMS2 and MSH6 alone will be sufficient to detect all cases of mismatch repair deficiency and should replace routine screening with all four antibodies. METHODS: The electronic database of the department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia, was searched for all colorectal carcinomas on which a four panel immunohistochemical microsatellite instability screen was performed. An audit of the slides for concordant loss of MLH1-PMS2 and MSH2-MSH6 was then undertaken. Unusual or discordant cases were reviewed and, in some cases, re-stained to confirm the staining pattern. RESULTS: Of 344 cases of colorectal cancer which underwent four antibody immunohistochemistry, 104 displayed loss of at least one mismatch repair protein. Of these, 100 showed concordant mismatch repair loss (i.e., loss of MLH1 and PMS2 or loss of MSH2 and MSH6). The four discordant cases comprised two single negative cases (1 MSH6 negative/MSH2 positive case, 1 PMS2 negative/MLH1 positive) and two triple negative (both MLH1/PMS2/MSH6 negative). The microsatellite instability (MSI) group showed a relatively high median age (69.3 years) due to the departmental policy of testing all cases with possible MSI morphology regardless of age. CONCLUSIONS: The sensitivity and specificity of a two panel test comprised of PMS2 and MSH6, compared to a four panel test, is 100%. No false negatives or positives were identified. We conclude that the two panel test should replace a four panel protocol for immunohistochemical screening for mismatch repair deficiency.

The role of peribiliary cysts in biliary obstruction.

Peribiliary cysts are cystic dilatations of the extramural glands of the intrahepatic biliary tree. This disorder is uncommon and is usually asymptomatic. However, it may cause extrinsic biliary compression and consequently, obstructive jaundice. This paper describes 2 such cases presenting with jaundice. The etiology, natural history, investigation findings and treatment of this disorder are also discussed.

Immunohistochemistry for SDHB divides gastrointestinal stromal tumors (GISTs) into 2 distinct types.

The Carney triad (CT) is gastrointestinal stromal tumor (GIST), paraganglioma, and pulmonary chondroma. The GISTs of CT show different clinical, molecular, and morphologic features to usual adult GISTs but are similar to the majority of pediatric GISTs. We postulated that these GISTs would show negative staining for succinate dehydrogenase B (SDHB). We performed SDHB immunohistochemistry on GISTs arising in 5 individuals with CT, 1 child, 7 individuals with GIST in young adulthood including 2 with germline KIT mutations, 3 individuals with neurofibromatosis 1, one 63-year-old female with multifocal gastric epithelioid GIST with lymph node metastases, and 104 consecutive unselected individuals with apparently sporadic GIST. The GISTs and paragangliomas arising in CT, the pediatric GIST, and the multifocal gastric GIST from the 63-year-old showed negative SDHB staining. GISTs from the 7 young adults and 3 with neurofibromatosis were SDHB positive. Of the unselected GISTs, 101 (97%) were positive. One of the negative GISTs arose in a 48-year-old female with previous recurrent multifocal gastric GISTs and the other 2 arose in females also in their 40s with gastric GISTs with epithelioid morphology. We conclude that negative staining for SDHB is characteristic of the GISTs of CT and the subgroup of pediatric GISTs which it resembles. Furthermore, when negative staining occurs in apparently sporadic GISTs in adults, the GISTs show morphologic and clinical features similar to pediatric and CT type GISTs. GISTs may therefore be divided into type 1 (SDHB positive) and type 2 (SDHB negative) subtypes.

There is no increase in frequency of somatic mutations in metastases compared with primary colorectal carcinomas with microsatellite instability.

This study investigates the molecular features of metastasis in sporadic colon carcinomas with high-level microsatellite instability (MSI-H). DNA from 51 regions from 10 MSI-H metastatic carcinomas and 26 corresponding metastases was analyzed for mutations in TGFBRII, IGFIIR, BAX, MSH3, MSH6, and TCF4, which are associated with MSI-H carcinomas. In addition, 10 metastatic and 10 non-metastatic MSI-H carcinomas and 10 metastatic microsatellite-stable (MSS) carcinomas were examined for expression of vascular endothelial growth factor (VEGF) and mutant TP53. The frequency of microsatellite instability and somatic mutations was not significantly increased in the metastases compared with the that of primary carcinomas. Although significantly fewer MSI-H carcinomas expressed VEGF (P < 0.01) and mutant TP53 (P < 0.005) than MSS carcinomas, there was no difference in VEGF and mutant TP53 expression in metastatic and non-metastatic MSI-H carcinomas. In conclusion, metastasis does not appear to be associated with an increase in somatic mutation rate in any of the genes examined in MSI-H colon carcinomas. Furthermore, VEGF and TP53 expression did not appear to be involved in metastasis in MSI-H colon carcinomas.