We appreciate the time, energy, and space Hoover (2015) has devoted to our paper. While we find his discussion interesting, much of it has little bearing on what we sought to accomplish. Hall and Hart (2012) was not about the 'nuance' or the 'context' that motivated Samuelson and Solow (1960), or about debating just how 'critical' the Samuelson and Solow Phillips curve was to policymakers during the 1960s (it was surely important).

Metastatic carcinomas involving the testis and testicular adnexa occur only rarely. It is even more unusual when the metastasis is associated with an occult primary tumor. In these circumstances, the correct diagnosis may not be made. The purpose of this report is to describe an asymptomatic primary adenocarcinoma of the cecum that presented as a testicular adnexal mass and to demonstrate that histochemical, immunohistochemical, and ultrastructural features may be of great value in arriving at the diagnosis of metastatic adenocarcinoma.

The notion of the Phillips curve as a policy tool was first advanced in 1960 by Paul Samuelson and Robert Solow. Despite their pointing out features of the curve that would later become prominent, (that is, that the curve could shift), it helped create the environment that allowed inflation in the United States to accelerate during the 1960s. Ironically, Samuelson and Solow never estimated their Phillips curve, but instead hand-drew it to fit the data for the twenty-five year period from 1934 to 1958. Using the data and econometric techniques available to them at the time, we estimate the Samuelson–Solow Phillips curve, find that it bears little resemblance to their hand-drawn curve, and discuss the policy implications of the two curves.

This prospective case study documents the development of invasive squamous cell carcinoma (SCC) almost 40 months after initial diagnosis and treatment by wide local excision of squamous vulvar intraepithelial neoplasia (VIN) of simplex (or differentiated) type. A 52-year-old woman had no history of a prior or synchronous SCC, nor did she have lichen sclerosus. Simplex VIN involved the margin of the excision specimen, leading to local recurrences and progression into invasive SCC of the conventional keratinizing type. This study conclusively demonstrates that simplex VIN is a distinct type of squamous intraepithelial carcinoma (ie, carcinoma in situ) and a direct precursor of keratinizing SCC.

A series of 48 excised thin (<= 5 mm in tumor thickness) invasive squamous cell carcinomas (SCCs) of the vulva in 44 patients were studied to determine the interrelationships of tumor type with type of adjacent vulvar intraepithelial neoplasia (VIN) and lichen sclerosus. The SCCs were of conventional keratinizing type in 38 tumors (79%), warty type in 6 (13%), and basaloid type in 4 (8%). VIN adjacent to SCC was found in 37 (77%) of the tumors. Of these, 19 were classic VIN (51%) and 18 were simplex (differentiated) VIN (49%). All 10 warty and basaloid SCCs had adjacent classic VIN. Of the 38 keratinizing SCCs, 27 (71%) had adjacent VIN, consisting of simplex VIN in 67% and classic VIN in 33%. The median age of the patients with classic VIN, simplex VIN, and no VIN were 62, 78, and 75 years, respectively. In the overall statistical analysis, the differences between the VIN types and the types of SCC were highly significant. In pairwise comparisons, significant differences in SCC type were found when the classic VIN group was compared with the simplex VIN group and when the classic VIN group was compared with the no VIN group. In contrast, no difference was found when the simplex VIN group was compared with the no VIN group. Lichen sclerosus (LS) was present in 14 of the 44 patients (32%). All SCCs in patients with LS were of keratinizing type. Of the 30 patients without LS, the SCCs were of the keratinizing type in 20 patients (67%), the warty type in 6 patients (20%), and the basaloid type in 4 patients (13%). Only 1 of the 19 (5%) patients with classic VIN had LS compared with 9 (56%) of the 16 patients with simplex VIN and 4 (44%) of 9 patients with no adjacent VIN. Atypical LS occurred in 8 of 14 patients with LS (57%); 4 of these (50%) also had simplex VIN and none had classic VIN. Significant differences in the overall comparison were found when comparing the percentage of keratinizing SCC and percentage of LS between the groups with classic VIN, simplex VIN, and no VIN. Pairwise comparisons revealed the similarity of features between the simplex VIN group and the no VIN group, and the distinction of both of these groups from the classic VIN group. Both the simplex VIN group and the no VIN group have a significantly greater association with keratinizing SCC and LS (including atypical LS) than does the classic VIN group. Strong staining for p53 with a high labeling index was commonly found in atypical LS and simplex VIN and may be of value in confirmation of these lesions. These findings support the theory that simplex VIN is the most likely precursor of conventional keratinizing SCC, the most common type of vulvar invasive carcinoma. Atypical LS may be closely related to simplex VIN.

An 18-month-old girl was referred for evaluation of vaginal bleeding and a renal mass. Ultrasonography and computed tomography revealed multiple simple cysts within the left kidney and a normal right kidney. At vaginoscopy, a 1-cm frond-like papillary lesion overlying the cervix was identified. The pathologic diagnosis was müllerian papilloma, a rare benign tumor of the vagina and uterine cervix. None of the approximately 40 previously reported cases have been associated with renal anomalies, despite the historical classification of these lesions as mesonephric papillomas. We report the first patient with both a renal anomaly and müllerian papilloma of the uterine cervix.

Letters from doctors to the BRAC Commission regarding the Armed Forces Institute of Pathology and urging the BRAC to remove it from the list of military facilities to be targeted for closure.

Secondary (metastatic) neoplasms to the ovary often cause diagnostic problems, especially those tumors that produce large, symptomatic ovarian tumors that masquerade clinically and pathologically as primary ovarian tumors of surface epithelial type. Most of these tumors arise from organs of the digestive system. Except for typical Krukenberg tumors, which usually originate in the stomach and generally are easily recognized, the most diagnostically problematic secondary ovarian tumors are those that originate in the large intestine, appendix, and pancreas. Metastases from these sites typically produce histologic patterns resembling primary ovarian endometrioid carcinoma or mucinous epithelial neoplasms of borderline and malignant types. This review focuses on the diagnostic challenge of distinguishing these secondary ovarian tumors from primary ovarian neoplasms. Studies on useful or potentially applicable immunohistochemical stains are also detailed.

The concept and terminology of borderline epithelial tumors of the ovary have been controversial for over a century, in spite of the acceptance of a borderline category in almost all current classifications of ovarian tumors. Typically, borderline tumors are noninvasive neoplasms that have nuclear abnormalities and mitotic activity intermediate between benign and malignant tumors of similar cell type. Borderline tumors of all surface epithelial cell types have been studied. The most common and best understood are serous borderline tumors and mucinous borderline tumors of intestinal type, which are the subject of this review. Some of the most challenging issues for serous tumors include: the criteria and clinical behavior of stromal microinvasion; the high prevalence of synchronous extraovarian disease; the classification and histopathologic features of associated peritoneal tumor implants, especially invasive implants; and, the prognostic significance of micropapillary tumors. The mucinous borderline tumors of intestinal type have a different set of considerations, including: their frequently heterogeneous composition with coexisting benign, borderline and malignant elements; the classification and significance of accompanying noninvasive carcinoma; the recognition of stromal invasion, including microinvasion and expansile invasion; and, the historically misunderstood relationship to pseudomyxoma peritonei. All of these issues are discussed in this presentation, as are the important gross and microscopic features of serous and mucinous borderline tumors and pertinent information on their treatment and prognosis.

In recent years, uterine artery embolization (UAE) has gained popularity as an alternative to surgery for the treatment of symptomatic uterine leiomyomas. Polyvinyl alcohol (PVA) particles have been the principal agent used for UAE. Recently, trisacryl gelatin microspheres (TGM) have been advocated as a preferable occlusive material for UAE. It is the first embolic agent to be cleared specifically by the United States Food and Drug Administration for this use. To date, information on the tissue effects, distribution, and morphology of UAE with TGM in resected human organs is very limited. Herein, we document the pathologic findings in a 46-year-old woman who underwent hysterectomy and bilateral salpingo-oophorectomy and omentectomy for metastatic colonic adenocarcinoma 19 months after UAE with TGM (microsphere size = 500-700 micron) for uterine leiomyomas. Histologically, a submucosal leiomyoma and an intramural uterine leiomyoma showed massive coagulative necrosis of the infarct-type with a peripheral zone of hyalinized fibrous tissue. Aggregates of TGM were within the necrotic leiomyomas and throughout the myometrium. Non-targeted extrauterine sites also contained TGM, including the paracervical soft tissue and the mesosalpinx as well as the ovaries and omentum where they were adjacent to metastatic colonic carcinoma. Other than the myomas, none of the embolized organs showed ischemic necrosis. Although some TGM were intravascular, most were extravascular. Typically, the microspheres were adjacent to muscular arteries from which they appeared to have been extruded following localized dissolution of the arterial wall. A thin rim of foreign body-type giant cells and mononuclear macrophages surrounded many of the TGM and focally involved the arterial wall. No vascular thrombosis was seen. TGM are believed to have advantages over PVA emboli for UAE. Hence, additional examples of surgical specimens following treatment of leiomyomas with TGM can be expected. Pathologists should be aware of the morphology of TGM in resected genital tract tissues. Although TGM are easily distinguished from embolic PVA particles, they may be mistaken for PVA microspheres if not carefully studied. Elastic stains are useful in the differential diagnosis of embolic agents.

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