Two Cases of STAT6-Positive, Primary Conjunctival Giant Cell-Rich Solitary Fibrous Tumour (Giant Cell Angiofibroma) with Some Unusual Histological Features.

An 84-year-old male presented with a history of a slowly growing lesion beneath the right lower lid. Examination showed a right-sided mass in the inferior bulbar conjunctiva, measuring approximately 10 × 6 mm. The lesion was excised and showed a giant cell-rich solitary fibrous tumour (GCR-SFT) with pseudo-vascular spaces with benign cytology, with STAT6, expressed in the spindle, ovoid, and tumour giant cells. A second case, a 26-year-old white female, presented with a 12-month history of a gradually expanding lesion in left inferior bulbar conjunctiva. Examination showed a well-defined, dome-shaped pink fleshy mass of 10 × 7 × 2 mm, on the inferior bulbar conjunctiva and abutting the inferior fornix. Excision followed by histology showed a similar appearance to the first case except that the multinucleate giant cells closely resembled Touton giant cells and did not show the rather hyperchromatic crowded nuclei of the giant cells observed in the first case. No pseudo-vascular spaces were identified. The tumour cells, including the Touton-like multinucleate giant cells, displayed nuclear positivity for STAT6. An unexpected feature was the presence of a Melan A- and Sox10-positive population amongst the GCR-SFT, postulated to be a subepithelial melanocytic nevus colliding with the GCR-SFT.

Objective structured assessment of cataract surgical skill.

OBJECTIVE: To evaluate the Objective Structured Assessment of Cataract Surgical Skill scoring system. METHODS: An objective performance rating tool was devised. This instrument is comprised of standardized criteria with global rating and operation-specific components, each rated on a 5-point Likert scale. The total potential score was 100. Complete phacoemulsification cataract extraction operations were recorded through the operating microscope of surgeons with a range of experience (group A, <50 procedures; group B, 50-249 procedures; group C, 250-500 procedures, and group D, >500 procedures). These were then scored by independent expert reviewers masked to the grades of the surgeons. The U test was used to evaluate statistical significance. RESULTS: We evaluated 38 surgical videotapes of 38 surgeons (group A, 11 surgeons; group B, 10 surgeons; group C, 5 surgeons; and group D, 12 surgeons). Mean +/- SD overall scores were as follows: group A, 32.0 +/- 5.3; group B, 55.0 +/- 12.6; group C, 89.0 +/- 4.7; and group D, 90.0 +/- 11.1. Statistically significant differences were found between groups A and B (P = .002) and groups B and C (P = .003), but not between groups C and D (P>.99). CONCLUSION: The Objective Structured Assessment of Cataract Surgical Skill scoring system seems to have construct validity with cataract surgery and, thus, may be valuable for assessing the surgical skills of junior trainees.

Comparison of modified anchored "hang-back technique (HBT)" with conventional HBT in bimedial rectus recession.

PURPOSE: We conducted a retrospective study to establish whether bimedial rectus recession (BMR) using a modified "hang-back technique" (HBT) is comparable with conventional HBT. METHODS: Consecutive patients younger than the age of 16 underwent BMR during 1999 and 2000 with at least a 6-month postoperative follow-up period were included. In 1999, all patients had operations performed with conventional HBT, whereas those in 2000 were conducted with modified HBT. Angles of strabismus were measured preoperatively and at 2 weeks, 2 months, and 6 months postoperatively. RESULTS: Thirty-nine and 43 patients underwent BMR using conventional and modified HBT respectively. Preoperative angles for near and distance were 43.6 (PD) versus 43.5 PD and 36.4 PD versus 36.8 PD. At 6 months' postop, the mean angles for near and distance were 6.4 PD Eso (range, 35 PD Eso - 40 PD Exo) and 5.4 PD Eso (range, 35 PD Eso - 35 PD Exo) in the conventional group: 8.1 PD Eso (range, 35 PD Eso - 20 PD Exo) and 6.3 PD Eso (range, 35 PD Eso - 25 PD Exo) in the modified group. The overall success rate (alignment to within 10 PD of orthotropia for distance and near) was similar between the two groups (conventional HBT:69.2% vs. modified HBT: 67.4%, P = 0.352). However, modified HBT was found to be associated with significantly lower consecutive exotropia rate postoperatively at 6 months (4.7% vs. 20.5%, P = 0.031). CONCLUSION: BMR using modified HBT is as effective as conventional HBT but with a significantly lower consecutive exotropia rate.

Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy.

PURPOSE: To determine if obesity is associated with higher prostate specific antigen recurrence rates after radical prostatectomy (RP), and to explore racial differences in body mass index (BMI) as a potential explanation for the disparity in outcome between black and white men. PATIENTS AND METHODS: A retrospective, multi-institutional pooled analysis of 3,162 men undergoing RP was conducted at nine US military medical centers between 1987 and 2002. Patients were initially categorized as obese (BMI > or = 30 kg/m(2)), overweight (BMI 25 to 30 kg/m(2)), or normal (BMI < or = 25 kg/m(2)). For analysis, normal and overweight groups were combined (BMI < 30 kg/m(2)) and compared with the obese group (BMI > or = 30 kg/m(2)) with regard to biochemical recurrence (prostate-specific antigen > or = 0.2 ng/mL) after RP. RESULTS: Of 3,162 patients, 600 (19.0%) were obese and 2,562 (81%) were not obese. BMI was an independent predictor of higher Gleason grade cancer (P <.001) and was associated with a higher risk of biochemical recurrence (P =.027). Blacks had higher BMI (P <.001) and higher recurrence rates (P =.003) than whites. Both BMI (P =.028) and black race (P =.002) predicted higher prostate specific antigen recurrence rates. In multivariate analysis of race, BMI, and pathologic factors, black race (P =.021) remained a significant independent predictor of recurrence. CONCLUSION: Obesity is associated with higher grade cancer and higher recurrence rates after RP. Black men have higher recurrence rates and greater BMI than white men. These findings support the hypothesis that obesity is associated with progression of latent to clinically significant prostate cancer (PC) and suggest that BMI may account, in part, for the racial variability in PC risk.