text:
With a dose of bright color and trendy trims, our Allegra Colorblock Clutch will surely make you a happy fashionista! The Allegra has a structured envelope clutch design in pebbled leatherette. Choose your tropical bright hue to colorblock with brown trims and gold hardware studs. Carry this clutch in-hand, or attach the gold chain strap to carry on the shoulder or messenger style. The top flap lifts with the easy turn-lock closure, and reveals an open-top interior lined in coordinating satin. Inside, you will find a small zip-shut pocket, and space for your wallet, phone, and lipstick.
11.5" L x 1" W x 6.5" H
21" drop strap
Additional Information
Size | Medium |
Style | Shoulder Bags |
Closure Type | Lock Closure |
Material | Synthetic PU Leather |
Measurements | 11.5" L x 1" W x 6.5" H |
Strap Length | 21" drop strap |
Details | Gold Accents |
Compare To | Valentino |


text:
Automated Responsive Design Now Available In agileEMAIL
What Used To Take Hours And Days Now Takes Mere Minutes.
Get Responsive TodayMarket to an Audience of One
Test, Target, and Personalize the Moment an Email is Opened.
Learn MoreRecent Blog Posts
In the News
The 35 Hottest Startups in New York
5 Tech Solutions to Boost Your Marketing Efforts
Upcoming Events
Marketing Sherpa Email Summit 2015
Las Vegas, NV
Email Evolution Conference 2015
Miami, FL
We Love Email Innovation Tour: Holiday Edition
Portland, OR
Something we can help with?
Get in touch with any questions / comments you may have.
Sign up for our newsletter
Get the latest news, product releases, research, and best practices guides from Movable Ink delivered straight to your inbox.

subset: commoncrawl


text:
Dr. Shilpa P. Desai, MD
- 1200 12th Ave S Ste G101
Seattle, WA 98144 - 2 Locations
- (206) 326-2400
Dr. Shilpa P. Desai graduated from the Ohio State University College of Medicine in 1999. She works in Seattle, WA and 1 other location and specializes in Gynecology. Dr. Desai is affiliated with Swedish Medical Center - First Hill and Virginia Mason Medical Center.
Medical School: Ohio State University College of Medicine; Graduated 1999
*This physician has multiple office locations. See Office Information for details.


text:
Swimming in the Colorado...but not on purpose!
Trip Start
Aug 18, 2008
Trip End
Oct 01, 2008
Where I stayed
Up the Creek Campsite
We got up early to be the first on the water and avoid the hordes of rafting trips. The water was glassy and the canyon was really beautiful as we paddled through about 2 miles of easy flatwater and took in the scenery around us. There were some strange mosquito-ish bugs (we're not sure what they were!) all over the place, but they didn't bother us and because of the bug swarms at this part of the river there were fish everywhere--we saw literally hundreds of them hovering on the surface of the water to gobble up all the bugs.
We made it through the first few rapids without any problems, including the tricky Rocky Rapid where there was a photographer from a company in town snapping photos so we even have pictures of us making our way through the rapids--we almost look like we know what we're doing!
But then we got to the dreaded White's Rapid. It has a large, nasty hole on the right side that everyone had warned us about. 'Stay left' they all said, or the current will pull you into the hole and you'll be swimming. Well, we stayed left. So far left, in fact, that we hit a rock, got stuck, and then the force of the current pulled us over and into the water. Fortunately, our plan for getting out of the boat worked fine and both Mike and I popped up above water within seconds. But here was where we made our big mistake--instead of staying with the boat (which I should have done), we decided that I should try to swim over to the shore on the right. But the current was too strong and I was swept downstream. Mike stayed with the boat and realized he was too heavy to catch up with me, so he swam it to shore, flipped it over, bailed out the water, and hopped in to paddle after me. I finally managed to grab hold of some rocks on the left shore and he came and picked me up, slogging through the thick, muddy river silt to get to me. We were covered in muddy Colorado River water (I found about a pint of silt in my underwear later!), but we managed to sort ourselves out and then paddled through the last two rapids without a problem.
Even though we were full of adrenaline from our little capsize, we still had a great time and felt really proud of how we'd paddled all the other rapids, scouting them out, following advice from other paddlers, and then finding the right line through the rapid. And we also got to practice our rescue on White's and learned a great lesson--if we tip over, both of us should stay with the boat!


text:
| Caramel Santa'sCaramel Santa's are a perfect Christmas candy for filling your Christmas stockings. Each chocolate candy is in the shape of a Santa face and filled with a creamy caramel. We have all your favorite Christmas candy. Chocolate coal, bubble gum coal, gummy lifesavers, trolli sour brite candy canes, Reese's peanut butter trees and Christmas dots. Each bag is 4 oz. and has approx. 11 caramel Santa's You May Also Enjoy These
| |
Copyright 1996 - 2015 Oryans Village Online Candy Store


text:
Search by
HypnoBirthing Class
This event has already taken place. Click here for the latest events.
Add to Calendar 20-02-2013 20-02-2013 15 HypnoBirthing Class Hypnobirthing® is a relaxing, stress-free method of birthing based on the belief that when a mother is properly prepared for birthing physically, mentally, and spiritually, she can experience the joy of birthing her baby in an easier, more comfortable manner. Over the span of five classes, participants will be introduced to techniques of self-hypnosis utilizing controlled deep breathing, visualization, and imagery to produce deep relaxation. Lectures highlight the birth process, birthing options, exercise, nutrition, anatomy, birth planning, c-section prevention, breastfeeding, and baby care. Classes held through March 13 other than February 13. http://www.nymetroparents.com/2014neweventinfo.cfm?id=125851 BirthingWisdom true DD/MM/YYYYIf you go: Please tell them you saw this event on
Upcoming Events at BirthingWisdom:


text:
Hang tight!
Recipe by Amy Marino
"Chicken breasts in a thyme cream sauce. Serve over bow tie pasta or wide egg noodles. The recipe lists red wine, but you can also use white - either one is fine."
Hmm. None of these ingredients are on sale today.
Show ingredients on sale
Sort stores by
Save money at local stores when ingredients are on sale!
Watch video tips and tricks
2 tablespoons butter
1 tablespoon olive oil
4 skinless, boneless chicken breast halves
1 cup sliced fresh mushrooms
1 cup red wine
1 cup heavy cream
1 tablespoon dried thyme
1 teaspoon salt
1 teaspoon ground black pepper
1 cup seedless red grapes, rinsed and dried
Ok. I really enjoyed this dish. It was simple to prepare, light and flavorful. I would use white wine instead of red, the next time I prepare it. I didn't like the "purple" hue of the chicken. It was a bit watery and I had to add a little flour to help it along. It has a heavy Thyme flavor, so if you don't love Thyme, reduce the recipe to 1/2 tablespoon.
Easy and enjoyable. I used fresh sage instead of dried thyme, and sauteed the sage with the mushrooms. Next time I might use more red wine (or perhaps port wine) to give the sauce a stronger flavor.
32 Ratings
This was delicious -- probably one of the best recipes I've made thanks to Allrecipes! I used more mushrooms than the recipe called for (a whole large container of sliced mushrooms). I also used a little flour to thicken the sauce, as other reviewers suggested; that worked perfectly. I also used white cooking wine instead of red, and I served the dish over egg noodles and with a green veggie side -- yummy!!!
Followed the recipe exactly with the exception of adding some fresh minced garlic. Overall, we enjoyed this meal greatly. Very gourmet "comfort food" if that makes sense. Placed the chicken atop garlic mashed potatoes and ladled the sauce over everything. Nice presentation. My husband said it was one of his all-time favorite chicken recipes (and he hates chicken). Next time, I would like to add a bit more flavor to the chicken while it is cooking.
I took the advice of other users and used white wine and some garlic. It worked, even though I used whole milk instead of heavy cream. I thickened it with flour, as someone else suggested. It was delicious!
First time cooking with grapes! I used half-&-half instead of heavy cream. I added oregano, basil and a dash of curry powder! I don't think the grapes added much flavor but this recipe was interesting to make!
The flavors melded pretty well, but it's also pretty rich. My husband thought it was great!
This is incredibly rich. Almost too delicious! The purple color didn't bother me at all. Makes it seem more gourmet, lol. I might tone down the cream and butter next time for reasons others have also mentioned. But in any case, you gotta try this one. If you're a novice like me, it will take more than 30 min, but totally worth it.
* Percent Daily Values are based on a 2,000 calorie diet.
Chicken with Red Grapes And Mushrooms
Serving Size: 1/5 of a recipe Servings Per Recipe: 5 Amount Per Serving Calories: 402 Calories from Fat: 238
We have over 150 different ways to take chicken from everyday to gourmet.
All the tenderest leaves, baby vegetables, and early fruits are ready for the picking.
Great recipes and cooking tips! For a limited time, get a year of Allrecipes Magazine for $5.99.
Breaded chicken breasts are baked with mushrooms and melty mozzarella.
Make a delicious dinner with just two basic ingredients! Technique is the trick.
Check out this delicious and easy to make homemade chicken curry!


text:
CD/LP/Track Review
- Live at Smalls by Angelo Leonardi
- That Which Is Planted by Mark Corroto
That Which Is Planted
Passin' Thru Records
2014 -
Live at Smalls
Smalls Records
Track Listing: Ghosts; Give It Some Thought; Ecclusiastics Intro.; Ecclusiastics; BK; Midnight Sun.
Personnel: Ku-umba Frank Lacy: trombone, flumpet, voice, percussion; Kevin Ray: bass; Andrew Drury: drums, percussion.
Record Label: Passin' Thru Records
Style: Modern Jazz
comments powered by Disqus


text:
For the past few seasons, there have been two surefire cure-alls for Vancouver struggles: the month of November and the Calgary Flames. Lucky for the Canucks, they kicked off thirty days of the former with sixty minutes of the latter, and the result was that always enjoyable category of game we like to call the laugher. The Canucks ran away with this one early, jumping out to a 3-0 lead with a 14-shot first period, then adding two more in the second while Calgary briefly debated responding. They really never did. Like the Calgary Flames that played in this game, I watched this game.
Continue Reading —›Keep an eye on the upper lips of the Vancouver Canucks over the next month. You may start seeing some facial decoration. That's right, Movember is back.
Continue Reading —›Spitballin' (or Super Pass It To Bulis: All In, if you love adventurous acronymizing) is a feature that allows us to touch on a multitude of things really fast, because in the world of hockey, there are always lots of things to find and colour. Here are a few topics that deserve mention.
Continue Reading —›Pass it to Comics is a biweekly collaboration between PITB and cartoonist Chloe Ezra. It will run on Tuesdays and Thursdays throughout the season. Today, Ryan Kesler makes Dracula look like a chump.
Continue Reading —›The extraordinary finish of game six of the World Series seemed a fitting end for a month of terrific baseball that began with an historic final day of the regular season when four games were played simultaneously to decide the final two playoff participants. Ironically, it was one of those teams that eventually became the [...]
Continue Reading —›


text:
Signs of a two-speed UK housing market have been revealed in official statistics on property prices, showing London homes rising fastest in value. Prices in the capital rose by 4.9% in the year to the end of April, compared with a national average of 1.4%. There was a fall of 1.3% in prices in the North West of England, and Yorkshire and the Humber, the Office for National Statistics (ONS) said. Prices continued to plunge in Northern Ireland, down 8.1% over the year. There were also house price drops of 1.1% in Wales and 0.3% in Scotland over the same period. Average prices Geography has always been a key factor in house prices, but relatively low levels of activity have highlighted the significant differences in prices in different parts of the UK. Annual prices in the UK rose at their fastest rate on average in April than in any month since September. However, this was driven by the increase in London - where properties continue to attract overseas investment and domestic demand remains relatively high - as well as in the South East and South West of England. These regions saw annual prices go up by 2.1% and 1.6% respectively. In April, London continued to be the English region with the highest average house price at £388,000. The North East had the lowest average house price at £145,000. London, the South East and the East of England were the only three regions that had prices higher than the UK average price of £229,000. "If the London property market takes its foot off the pedal even for a second, the national picture will look far less rosy," said Ashley Alexander, managing director of estate agent review website MeetMyAgent.co.uk. Property price differences can be the result of factors ranging from employment levels to schools "The outlook for the rest of the year is a little foggy. The summer months are historically very quiet as families head off on their holidays, but activity levels could be lower than normal with the Euros and Olympics drawing people to their television sets rather than estate agents' windows. "Agents will be hoping for an extra lift in September activity to give the property market some momentum for the rest of the year." Average property prices were £151,000 in Wales, £129,000 in Northern Ireland and £178,000 in Scotland in April, the ONS said. The survey also highlighted the effect of the closure of the stamp duty concession for first-time buyers at the end of March, which had exempted them from paying the 1% tax on properties bought for up to £250,000. In March, 43% of the houses sold were bought by first-time buyers, compared with 32% in April, which was more in line with the long-term average. The house price data is now compiled by the ONS, which took over the task from the Department for Communities and Local Government earlier this year. SOURCE: BBC NEWS
Here you can log in or sign up to the members area of our website. Once you have an account, you can log in to manage your personal details, email alerts and saved properties. Once you have created an alert, properties are sent to your email address at your chosen frequency when a new property is published or a price change made. To manage your account at any time, click on the members icon at the top of the screen, log in using your credentials, then click again to choose what you would like to do.
Cookies We use cookies to ensure that we give you the best experience on our website. To find out more about our cookies policy, see our cookies policy here or in the footer.


text:
Learn more about CTA Digital KIN-SMFB Carrying Case for Portable Gaming Console, Gaming Controller - Nylon:
CTA Digital proudly introduces the Carrying Case for XBOX 360 Slim and Kinect. This luxurious case is specifically designed to accommodate your XBOX 360 Slim (with the power brick), Kinect Camera, games and accessories with the extra padding they need to stay safe during transit. Made with a durable nylon fabric and protective foam padding, the carrying case is the perfect solution for the 'on the go' gamer. The case includes storage for 4 games inside the convenient CD slots, as well as controllers, cables, and whatever else you bring along for those intense gaming sessions. Inside the case, you'll also find a 50-inch adjustable shoulder strap, and a separate foam padded case for the Kinect Camera , which secures to the interior with velcro. So with the Carrying Case for the XBOX 360 Slim and Kinect, your system, games and accessories are always ready to go. |


text:
Home/Overview Reserve habitats Reserve photos Sampling methods General results Guide to insects Springtails Jumping bristletails Dragon- & damselflies Crickets & grasshoppers Termites Earwigs Webspinners Stoneflies Barklice Aphids & planthoppers True bugs Thrips Lacewings Beetles Fleas Flies Butterflies & moths Bees, ants, wasps Other arthropods Related pages About images Reserve Home SBMNH Home SBMNH Entomology Last updated 08/15/2005 |
Insects of Coal Oil Point > Guide > Hymenoptera - Ants, Bees, and Wasps
Hymenoptera - Ants, Bees, and Wasps Hymenoptera is a tremendously diverse order of insects, as well as one of the best known. It includes all ants, bees, wasps, and sawflies. Hymenoptera may have four membranous wings, or in the case of worker ants, be wingless. The female members of this order (apart from sawflies), have a "stinger." The stinger is actually a modified ovipositor (egg-laying organ). It is used both for defense and often to inject venom, to paralyze or kill prey. Adults of this order mostly feed on nectar or honeydew, while their larvae may feed on plant tissue, nectar, or other insects. The majority of Hymenoptera specimens in the collection are parasitic wasps. Most of these are actually considered "parisitoids," because while their larvae will feed on a live host as a parasite does, it will actually kill the host as the wasp reaches maturity as a part of its lifecycle. The Coal Oil Point collection contains over 170 morphospecies of Hymenoptera, most of which are small parasitic wasps. The wasps account for a large portion of the collection's overall diversity. Navigate by family Tenthredinidae | Megaspilidae | Ceraphronidae | Braconidae | Ichneumonidae | Mymaridae | Pteromalidae | Chalcididae | Eucoilidae | Cynipidae | Charipidae | Proctotrupidae | Diapridae | Scelionidae | Platygasteridae | Bethylidae | Dryinidae | Sphecidae | Nyssonidae | Pemphredonidae | Halictidae | Megachilidae | Anthiphoridae | Apidae | Pompilididae | Vespidae | Formicidae


text:
Perineurioma: a distinctive and underrecognized peripheral nerve sheath neoplasm.
* Context.--Perineuriomas are benign peripheral nerve sheath neoplasms composed of perineurial cells with characteristic immunohistochemical and ultrastructural features. They have been traditionally classified into two main types according to their location--intraneural and extraneural--and overlap histologically with many other tumors, which may be diagnostically challenging to general surgical pathologists.Objective.--To review the clinical, morphologic, immunohistochemical, ultrastructural, cytogenetic, and molecular genetic aspects of perineurioma, as well as to discuss its clinicopathologic variants and differential diagnosis.
Data Sources.--English-language literature published between 1966 and 2005 was reviewed.
Conclusions.--The correct identification of perineuriomas is important to avoid unnecessary overtreatment. The histologic diagnosis should be confirmed through immunohistochemical studies (including epithelial membrane antigen, S100 protein, and more recently described antibodies such as claudin-1 and GLUT1) or electron microscopy. Cytogenetic and molecular genetic studies are still of limited value for the diagnosis of perineuriomas but may play a fundamental role in excluding important differential diagnoses and also in helping elucidate the biology of these poorly known neoplasms.
(Arch Pathol Lab Med. 2007;131:625-636)
Described by Lazarus and Trombetta in 1978, (1) perineurioma is an uncommon and underrecognized neoplasm defined as a peripheral nerve sheath tumor composed exclusively of neoplastic perineurial cells that demonstrate ultrastructural and immunohistochemical features similar to those of their normal cell counterpart. (2,3) Normal perineurial cells constitute the perineurium, a protective barrier situated between the epineurium and endoneurium layers of the nerves that surround both myelinated and unmyelinated axon-Schwann cell complexes of peripheral nerve fascicles. The perineurium has direct continuity with the pia-arachnoid membrane of the central nervous system. (4)
In contrast to other peripheral nerve sheath tumors, perineuriomas have not been found to be associated to neurofibromatosis. They mainly affect adults, but some cases have been described in children. (5-7) Two main forms of perineurioma exist: intraneural and extraneural. Intraneural perineuriomas are restricted to peripheral nerve boundaries, while extraneural perineuriomas are found mainly in soft tissues and skin. Extraneural perineuriomas seem to be more common than intraneural perineuriomas, and although they usually have no connection to peripheral nerves, sometimes such an association may be apparent in small lesions. (6,8) In some cases, extraneural perineuriomas and intraneural perineuriomas may contain residual entrapped Schwann cells, axons, and fibroblasts. (6,9) On the basis of different clinical and pathologic characteristics, extraneural perineuriomas are further subclassified into soft tissue, (10) sclerosing, (6) and reticular (retiform) (11,12) subtypes. It is important for pathologists to be familiar with the histopathologic features of perineuriomas so as to avoid getting confused with a variety of malignant mesenchymal tumors and, thereby, avert overly aggressive intervention.
The objective of this article is to review the clinicopathologic subtypes of perineurioma, highlighting their morphologic and immunohistochemical aspects and their main differential diagnoses. Ultrastructural, cytogenetic, and molecular genetic findings of perineuriomas are also reviewed.
Extraneural Soft Tissue Perineurioma
Extraneural soft tissue perineurioma (ESTP) is a benign peripheral nerve sheath neoplasm that often occurs in the subcutaneous tissues of the trunk and limbs as a painless, solitary nodule or mass. Less frequently, it can be restricted to the dermis (13) or occur in deep soft tissues. Some examples have also been described in the head and neck area, retroperitoneum, (14) brain, kidney, and intestines. (15-17) Despite the initial observations suggesting that females were more frequently affected, (9) more recent series have shown that ESTP has no sex or age predilection; it has been observed in both young children and older individuals. (5,14) Macroscopically, the tumors are usually white to gray, are well circumscribed but not encapsulated, and have a firm consistency (Figure 1, A). Most cases range in size from 1.5 to 7 cm, (9) but very large and very small examples measuring 20 and 0.3 cm, respectively, are on record. (14) Histologically, ESTPs are composed of elongated neoplastic cells with wavy-shaped nuclei. However, their cytologic appearance varies; sometimes they are plumper and even epithelioid (Figure 1, B). Their cytoplasm shows slight eosinophilic features and indistinct cell boundaries (Figure 1, B). Characteristic spindle cells with tapering nuclei and elongated and extremely thin, widely separated bipolar cytoplasmic processes are found at least focally (Figure 1, C); these characteristic features can also be appreciated at the ultrastructural level (Figure 1, D). The cells may be disposed in varying manners, such as in a lamellar arrangement, perivascular whorling formation (Figure 2, A and B), or even short bundles with a vague storiform pattern reminiscent of that seen in dermatofibrosarcoma protuberans (Figure 2, C). The intercellular matrix may be abundant or scarce, which gives the lesion a hypocellular or hypercellular appearance, respectively (Figure 2, A and D). The stroma can vary from a more collagenous (Figure 3, A) to a more myxoid or loose appearance (Figure 2, A), and mixed collagenous-myxoid features can often be seen in the same lesion. Tissue cracking artifacts (Figure 3, B) and thick blood vessels (Figure 3, C) are also common. Mitotic figures and necrosis are usually absent, but in larger tumors central ischemic infarcts may be seen. (14)
The classic immunohistochemical profile of ESTP includes positivity for epithelial membrane antigen (EMA) (Figure 3, D), collagen type IV, laminin, and vimentin and negativity for S100 protein. The pattern of EMA expression reflects the elongated bipolar cytoplasmic processes of the tumor cells and varies: it may be strong and diffuse in some cases or just focal and weak in others, so that its detection is possible only at high-power examination in some instances. Hornick and Fletcher (14) have shown that up to 65% of the cases are positive for CD34, but other series have shown negative results for this antigen. (3,13) The causes for these discrepant data are probably related to different anti-CD34 antibodies, immunohistochemical protocols, or inclusion criteria used in these studies. (3,13,14) Although several ESTPs are negative for pan-cytokeratins, (13,16) the expression of cytokeratins has not been widely studied in ESTP. Since their expression has already been detected in perineurial cells of pigs, (18) in meningiomas, (19) in sclerosing perineuriomas, (6) and in reticular perineuriomas, (11) the expression of cytokeratins in at least a subset of ESTP would not be surprising.
Depending on location, ESTPs may mimic other lesions (Table). For those occurring in the superficial locations, the differential diagnosis mainly includes dermatofibrosarcoma protuberans (DFSP), soft tissue meningioma, and myxofibrosarcoma (Table). Dermatofibrosarcoma protuberans grows in a more diffuse storiform pattern, spreading along subcutaneous connective septa and adipose tissue with the characteristic honeycomb pattern. Most DFSPs are diffusely negative for EMA; however, DFSP may rarely express EMA, which can be a diagnostic challenge. (20) In such instances, molecular methods can help because DFSP is characterized by the presence of supernumerary ring chromosomes containing the t(17;22), which leads to the formation of the fusion gene COL1A1-PDGFB. (21) The cytogenetic abnormality can be detected by using conventional cytogenetics on fresh tissues and fluorescent in situ hybridization or reverse transcriptase polymerase chain reaction on paraffin-embedded tissues. The cytogenetic and molecular genetic findings of perineuriomas are discussed later in this article.
The distinction between soft tissue meningioma and perineurioma is quite difficult and of little clinical value. Since perineurial cells and arachnoid cap cells (from which meningioma derives in the central nervous system) share significant morphologic and immunohistochemical similarities, (22,23) both neoplasms have similar morphologic and immunohistochemical features. However, there may be some subtle differences at the ultrastructural level (eg, meningioma lacks pinocytotic vesicles). Moreover, because normal perineurial cells are continuous with the arachnoid membrane cap cells at the intervertebral foramina, some authors view perineurioma as the peripheral counterpart of meningioma.
For deep-seated perineuriomas, the differential diagnosis mainly includes desmoid-type fibromatosis, low-grade fibromyxoid sarcoma (LGFS), solitary fibrous tumor, low-grade leiomyosarcoma, leiomyoma, and myxo-fibrosarcoma (Table). We emphasize here the distinction of ESTP from desmoid-type fibromatosis, LGFS, and solitary fibrous tumor. The other elements of the differential diagnosis can be found in the Table. Fibromatosis is best distinguished by its long fascicles composed of spindle cells with tapering or plump vesicular nuclei, depicting a more homogeneous and dense collagenous matrix, and by diffuse expression of smooth muscle actin and muscle-specific actin; these proteins are usually more focally detected in perineuriomas. (14,24)
Low-grade fibromyxoid sarcoma is a particularly difficult differential diagnosis since it may have overlapping histologic features with perineurioma. In contrast to this, LGFS exhibits alternation of more myxoid zones with more collagenous zones with arcade vessels, and occasionally giant collagen rosettes. Epithelial membrane antigen immunoexpression has been noticed in these tumors. (25) In difficult cases, one can rely on cytogenetics or molecular genetic analysis using reverse transcriptase polymerase chain reaction to detect, respectively, the translocation t(7;16)(q32 [right arrow] 34;p11) or its fusion product FUS/CREB3L2 in LGFS.
In contrast to ESTP, solitary fibrous tumor is composed of bland ovoid-shaped to spindle-shaped cells without the cytologic features of perineurioma, arranged in the so-called patternless pattern, and has blood vessels often showing a hemangiopericytoma-like branching. Immunohistochemically, most solitary fibrous tumors are EMA negative and CD34 positive; however, a subset of cases may show focal EMA expression, which may cause difficulties in the differential diagnosis. (26)
Other differential diagnoses include benign peripheral nerve sheath tumors, such as schwannoma and neurofibroma. However, most cases can be easily differentiated at the morphologic level. In difficult cases, immunohistochemistry is helpful because S100 protein expression is rarely found in perineuriomas. (9,14) Of note, similar to the concept of peripheral nerve sheath tumors with mixed schwannoma-neurofibroma features, (27) benign peripheral nerve sheath tumors with hybrid features of perineurioma-neurofibroma and perineurioma-schwannoma have been recently recognized in small series by Zamecnik and Michal (28) and by Michal et al, (29) respectively. Other groups have encountered similar findings, (30,31) and these neoplasms have been characterized morphologically, immunohistochemically, and in some examples ultrastructurally. (28-30) They have a predilection for the skin and subcutaneous tissues of the trunk and upper extremities, and, in contrast to hybrid schwannoma-neurofibroma tumors, (27) so far no cases have shown association with neurofibromatosis. Perhaps the most reasonable hypothesis for the divergent differentiation seen in peripheral nerve sheath neoplasms is their origin from a pluripotential precursor mesenchymal tissue or cell. (27,32)
Sclerosing Perineurioma
Sclerosing perineurioma is an extraneural soft tissue perineurioma variant first described by Fetsch and Miettinen, (6) who reported 19 tumors, all arising in the hands, mainly of young male adults. Although ordinary ESTP outnumbers published cases of sclerosing perineurioma, the latter seems to be more common than the former in some institutions. (33) However, a direct comparison between the frequencies of these two subtypes has not yet been established in the literature. Sclerosing perineurioma examples are well circumscribed and unencapsulated, have firm consistency, and are small (usually 3 cm or less in diameter). Microscopically these tumors may involve the dermis (Figure 4), dermis and subcutis simultaneously, or the subcutis alone. (6) They are composed of small, plump, spindle-shaped or epithelioid cells with pale cytoplasm, indistinct cell borders, and nuclei presenting slight hyperchromatic features with granular chromatin and occasionally central small nucleoli (Figure 4, inset). These cells demonstrate corded, trabecular, or whorled growth patterns and are intermixed with prominent thick collagen bundles. Occasionally the cells are noted to cord or swirl around the blood vessels within the lesion, as well as around entrapped small nerve twigs (Figure 5, A through C). Capillaries and venules can be relatively numerous, and despite the presence of scattered mast cells and rare lymphocytes, these neoplasms do not feature a prominent inflammatory infiltrate. Tumor necrosis or prominent mitotic activity is not seen. The lesional cells demonstrate an immunoprofile similar to that of ESTP: they coexpress EMA, collagen type IV, and laminin and are negative for S100 protein. However, they usually lack CD34 expression and sometimes express cytokeratins, specifically CAM 5.2 and pan-cytokeratin cocktail. (6) Muscle-specific actin and [alpha]-smooth muscle actin can be detected in a considerable percentage of cases. (6)
The differential diagnosis for sclerosing perineurioma mainly includes fibroma of tendon sheath, epithelioid glomus tumor, epithelioid sarcoma (Table), and highly collagenized examples of giant cell tumor of tendon sheath. Fibroma of tendon sheath is deeper seated than sclerosing perineurioma and is EMA negative. (34) Glomus tumor differs from sclerosing perineurioma in that glomus cells have more abundant cytoplasm and diffusely express actins but not EMA. Giant cell tumor of tendon sheath frequently occurs in the fingers; some cases are extensively collagenized and may pose morphologic difficulties to the differential diagnosis with sclerosing perineurioma. However, giant cell tumor of tendon sheath is EMA negative as well.
Reticular (Retiform) Perineurioma
Reticular (retiform) perineurioma is a rare extraneural perineurioma variant with few examples reported in the literature. Although Michal (12) first reported 4 cases in 1999 and named them retiform perineuriomas, Ushigome et al (35) were the first to describe the reticular pattern in a perineurioma in 1986 (histologically well documented in Figure 4 of that manuscript). More recently, Graadt van Roggen et al (11) described 6 more cases and preferred to name them reticular perineuriomas because, according to these authors, this term better indicates the netlike growing pattern of this neoplasm. The few cases described in these series occurred in adults, mostly women, with ages varying from 31 to 61 years. Most cases were subcutaneous-based lesions affecting the upper limbs (arms, hands, elbow, and fingers), although the occurrence in other anatomic sites, such as the gingiva, axilla, inguinal region, and deep soft tissues has also been documented. (11,36,37) Interestingly, one intraneural example has been recently recorded. (38) Macroscopically, reticular perineurioma is usually a well-circumscribed firm mass whose color varies from yellowish to whitish to tan. Large lesions have been described, but the average size seems to be around 4 to 5 cm. (11) Microscopically, most tumors are surrounded by a hypocellular pseudocapsule, but some examples have shown a poorly defined transition to the adjacent nonneoplastic tissues; a case has also been reported to infiltrate the adjacent muscle fibers. (37) The neoplasm is composed of cells with centrally placed, oval to fusiform nuclei with inconspicuous nucleoli and palely eosinophilic cytoplasm embedded in a prominent myxoid stroma. Characteristically, the spindle cells demonstrate bipolar cytoplasmic processes that are frequently continuous with each other, forming a reticular or netlike growth pattern (Figure 6). Mitotic figures, necrosis, and hemorrhage are usually not identified, although focal slight nuclear atypia and nuclear hyperchromasia may be seen in some cases. The myxoid stroma demonstrates microcystic changes, and areas of stromal hyalinization may be seen. The vasculature is predominantly composed of small capillary-size blood vessels, but occasional large or ectatic vessels are also found within the lesion. Immunohistochemically, most reticular perineuriomas diffusely express EMA and are negative for S100 protein and smooth muscle actin; a subset of cases show focal expression of CD34, desmin, cytokeratin (AE1/ AE3), and pan-cytokeratin (MNF116). (11)
The differential diagnosis mainly includes myoepithelial tumors, myxoid malignant peripheral nerve sheath tumor (MPNST), and myxoid synovial sarcoma (Table). Myoepithelial lesions may have histologic features similar to those of reticular perineurioma, but they often contain an acinar or ductal component and have a different immunophenotypic profile characterized by variable positivity for S100 protein, cytokeratins, glial fibrillary acidic protein, and smooth muscle actin. (39)
In contrast to reticular perineurioma, MPNST frequently demonstrates substantial nuclear atypia, significant mitotic figures, perivascular hypercellularity, and tumor necrosis. The reticular architecture is generally not seen in MPNST. Immunohistochemical studies are less useful in the distinction between these entities because MPNST may exhibit perineurial differentiation. (40) About one half of the cases of MPNST demonstrate focal S100 protein positivity, and they are usually EMA negative. (41)
Synovial sarcoma with extensive myxoid changes can be differentiated from reticular perineurioma by fascicular spindle cell areas, greater nuclear atypia, and higher mitotic index. Within this morphologic context, EMA and cytokeratin positivity, as well as the frequent CD99 and Bcl-2 protein expression, point toward the correct diagnosis. In doubtful cases, molecular techniques may be of help, since cytogenetic procedures and reverse transcriptase polymerase chain reaction are able to detect, respectively, the translocation t(X;18)(p11.2;q11.2) and the corresponding most common chimeric fusion transcripts SYT-SSX1 and SYT-SSX242 in synovial sarcomas.
Intraneural Perineurioma
Intraneural perineurioma is a benign neoplasm composed exclusively of perineurial cells restricted to the boundaries of a nerve. This term was proposed by Emory et al (2) to combine lesions previously classified as localized hypertrophic neuropathy, hypertrophic mononeuropathy, localized hypertrophic neurofibrosis, intraneural neurofibroma, and hypertrophic interstitial neuritis. Intraneural perineurioma primarily affects the extremities of young adults and children, in whom it produces a fusiform expansion of a major nerve (Figure 7, A) with associated motor deficiency and occasional sensory loss. With exception of a case involving the spinal roots of both C8 and T1, (2) the process is limited to a single nerve. It has rarely been described in unusual sites (43) and in smaller, unnamed nerves. (38,44) When occurring in such small nerves, no motor-sensorial disturbances may be clinically apparent. Histologic examination of a cross section of the affected nerve shows irregularly enlarged, hypercellular nerve fascicle (Figure 7, B) containing spindled perineurial cells arranged in pseudo-onion bulb-like whorls around one or more centrally situated Schwann cell and axons in varying stages of degeneration (Figures 7, C, and 8, A). Longitudinal sections may pose diagnostic difficulties because they do not depict the pseudo-onion bulb pattern characteristic of transverse sections. Instead, longitudinal sections show just ill-defined, parallel bundles of perineurial cells surrounding nearly indistinguishable nerve fibers (Figure 8, B). Immunohistochemistry reveals EMA-positive perineurial cells arranged in the pseudo-onion bulb whorls (Figure 8, C) around EMA-negative, S100-positive Schwann cells accompanying axonic structures. (22) It should be differentiated from localized hypertrophic neuropathy (Table), an entity that, as defined by Scheithauer et al, (9) is most likely a reactive condition that affects peripheral nerves, being characterized by nerve fascicle expansion due to the formation of onion bulb-like whorls of uniform S100-positive and EMA-negative Schwann cells (not perineurial cells as in intraneural perineurioma) encircling a variably myelinated axon. (9,45)
The nature of intraneural perineurioma had been a subject of debate,46-48 but the recent identification of clonal cytogenetic abnormalities in these lesions by Emory et al (2) has confirmed its neoplastic nature.
According to some authors, perineurioma variants (ESTP, sclerosing perineurioma, reticular perineurioma, and intraneural perineurioma) can be viewed as part of a spectrum of different presentations of the same entity. Their similar ultrastructural features and the occurrence of rare cases with histopathologic features of more than one subtype (13,38) support this impression. However, preliminary data suggest that there may be different genetic mechanisms for some of the perineurioma subtypes (see following section on cytogenetics and molecular genetics), (7,49) which consequently may have a different pathogenesis. Thus, at the present time, there is some uncertainty as to whether the 4 subtypes of perineurioma are indeed different presentations of the same entity.
Interestingly, other extremely rare histopathologic perineurioma variants have been reported, including perineurioma with granular cells, (50) perineurioma with ossification, (51) perineurioma with adipocytes, (52) plexiform perineurioma, (36) and the controversial cutaneous sclerosing Pacinian-like perineurioma. (53)
In 1978, Lazarus and Trombetta (1) described the first case of perineurioma in the soft tissues of the calf of a 45-year-old man, based on the ultrastructural similarity between the neoplastic cells to the normal perineurial cells, whose features include the presence of elongated, tapered nuclei with delicate chromatin; long thin cytoplasmic processes with pinocytotic vesicles; cell envelopment by basal lamina; and the presence of intercellular junctions, including tight junctions (Figure 1, D). Since then, electron microscopy has been considered the gold standard technique in confirming the diagnosis of perineurioma and its different variants.
With the advent of immunohistochemistry, Pinkus and Kurtin, (54) in 1985, were the first to note EMA expression in perineurial cells. Epithelial membrane antigen is an incompletely characterized antigen that is found in a group of carbohydrate-rich, protein-poor, high-molecular-weight molecules detected on the surface of many types of epithelia. (54) After Pinkus and Kurtin's article, (54) many other reports have shown EMA expression in perineuriomas, turning this marker into an important adjunct in differentiating perineurioma from its morphologic mimickers. (55) Nevertheless, the use of EMA as a perineurial marker presents some drawbacks. First, the cytoplasmic processes of perineurial cells are extremely thin and widely separated, and EMA reactivity may be difficult to demonstrate without using higher antisera concentrations or longer incubation times than routinely employed in the diagnosis of epithelial neoplasms; even when these precautions are taken, sometimes EMA positivity may be focal and weak. (9) The literature contains examples of ultrastructurally well-documented EMA-negative perineuriomas. (10,56) Second, EMA expression in soft tissue neoplasms is not restricted to perineuriomas; it can be detected in neoplasms with (myo)fibroblastic differentiation as well as in synovial sarcomas, in epithelioid sarcomas, (26,42,57) and in other mesenchymal neoplasms. To diminish these problems, two additional protein markers have recently been reported to be helpful in confirming the diagnosis of perineurioma: claudin-1 and human erythrocyte glucose transporter-1 (GLUT-1).
Claudins are a group of 20 homologous transmembrane proteins, of which claudin-1 and claudin-2 were identified as the main integral components of tight junctions in epithelial and endothelial cells. (58,59) Recent studies have shown expression of different claudin proteins in solid tumors, such as ovarian carcinoma (60) and synovial sarcomas. (61) Folpe et al (62) evaluated the expression of different tight junction-associated proteins in nonneoplastic soft tissues, and realized that claudin-1 antibody consistently detected perineurial cells of normal nerves but not other mesenchymal tissues. The explanation for this finding resides in the fact that normal and neoplastic perineurial cells contain tight junctions. (63) Such finding lead Folpe et al (62) to evaluate the expression of claudin-1 in perineuriomas; they found that up to 92% of their cases were positive for claudin-1, and that its membrane pattern of expression was stronger and more diffuse in a given perineurioma case than was EMA expression. Interestingly, other neoplasms with fibroblastic/myofibroblastic differentiation evaluated by these authors (DFSP, LGFS, desmoplastic fibroblastoma, and fibromatosis) did not express this antigen. Claudin-1 was detected focally in presumably perineurial cells in the periphery of neurofibromas as well as in the capsule and perivascular cells of schwannomas. Hornick and Fletcher (14) have reported a lower sensitivity (about 30%) for the expression of claudin-1 in ESTP. The reasons for these heterogeneous results are probably related to the different immunohistochemical protocols used in these studies: Folpe et al (62) used heat-induced epitope retrieval while Hornick and Fletcher (14) did not; the latter used EnVision+ detection system (Dako, Carpinteria, Calif) while the former used a standard avidin-biotin technique.
GLUT-1 is one of several facilitative glucose transporter proteins. (64) It is expressed by many normal cells, such as lymphocytes, erythrocytes, renal tubules cells, and perineurial cells, and it is also expressed by different types of carcinomas (65) and epithelioid sarcoma. (57) Hirose et al (66) studied the pattern of expression of GLUT-1 and other immunohistochemical markers in peripheral nerve sheath tumors and found out that while GLUT-1 was strongly expressed in most perineuriomas of their series, this protein was expressed only in the capsule of schwannomas and by occasional cells in neurofibromas. The cells in neurofibromas and schwannomas that react with claudin-1, GLUT-1, and EMA are, in all probability, residual perineurial cells. These cells can proliferate on a reactive basis under certain circumstances, such as in traumatized nerves, as well as in neurofibromas and schwannomas. In the latter instances, this may not necessarily indicate a combined tumor, but rather a reactive proliferation of residual normal perineurial cells secondary to the tumor presence. Thus, although claudin-1 and GLUT-1 are not absolutely specific for perineurial differentiation, adding these proteins to the panel for the diagnosis of perineuriomas is worthwhile, especially in cases of difficult classification.
Cytogenetic studies have shown that both intraneural and extraneural perineuriomas show chromosome 22 abnormalities, mainly monosomy or deletion of the 22q11~q13.1 bands. (2) Deletions and point mutations of the NF2 gene on 22q12 are frequently found in perineuriomas, but this finding can be seen in schwannomas and several other solid tumors. (49,67) Recent studies have shown that chromosome 10q rearrangements or deletions seem to be a recurrent abnormality in sclerosing perineuriomas. (7) An isolated case of ESTP with loss of the chromosome 13 has also been reported. (68)
Conventional extraneural perineuriomas have thus far followed a benign clinical course, and surgical resection with margins free of neoplasm is typically curative, regardless of subtype. However, malignant perineurioma (also known as MPNST with perineurial differentiation or perineurial MPNST) has recently been recognized as a rare variant of MPNST. (40,69) Hirose et al (40) reported 7 MPNSTs with perineurial differentiation situated in the subcutis of extremities and in the trunk and face, and visceral lesions involving the mediastinum and retroperitoneum of adults. None were associated with neurofibromatosis, and only 1 was associated with a nerve. As with conventional ESTP, the tumors were composed of spindle cells showing elongated and thin bipolar cytoplasmic processes, arranged in intersecting fascicles, whorls, or storiform pattern, sometimes forming perivascular whorls; they were embedded in a variable amount of intercellular stroma. However, malignant histologic features were also detected. Four cases were classified as high-grade by showing tumoral necrosis, exuberant cytologic atypia, or numerous mitotic figures. Three cases were labeled as low-grade malignant (see following discussion). All cases were S100 protein negative and EMA positive and showed ultrastructural features of perineurial differentiation. Malignant perineurioma is very rare, and its diagnosis may be difficult without confirmatory ultrastructural studies (41) because EMA positivity is also seen in other high-grade spindle cell sarcomas (eg, epithelioid sarcoma and monophasic synovial sarcoma), as well as in spindle cell squamous cell carcinoma. Although claudin-1 and GLUT-1 have not been widely studied in malignant perineuriomas, Hirose et al (66) showed that GLUT-1 may be helpful in confirming this diagnosis. In the first series on malignant perineurioma written by Hirose et al, (40) the authors suggested that this tumor would probably be less aggressive than the conventional MPNST, but the number of cases published so far is too limited to allow definitive conclusions.
The concept of "low-grade malignant perineurioma" was first introduced by Hirose et al. (40) These authors found that 3 of their malignant perineurioma cases differed from the conventional perineuriomas by showing scattered cytologic atypia, infiltrative growth pattern, and higher mitotic activity. At the same time, these lesions did not fit the histologic criteria of malignancy found in the high-grade malignant perineurioma. Since none of these cases developed distant metastasis during follow-up periods that ranged from 55 to 75 months, the authors labeled such lesions as low-grade malignant perineuriomas, but they recognized the possibility that these neoplasms could represent "atypical" or "cellular" perineuriomas. Hornick and Fletcher (14) reported 14 perineuriomas with atypical features in their series, 10 of which had clinical follow-up ranging from 12 to 134 months. In this series, the low-grade atypical features included scattered pleomorphic cells, abrupt transition from typical morphology to a markedly hypercellular area with cytologic atypia, and diffuse infiltration of skeletal muscle by tumor cells; of the 10 cases with such features, only 1 recurred locally, but no case metastasized. On the basis of their findings, Hornick and Fletcher (14) suggested that perineuriomas with such features probably would be better called typical perineuriomas instead of low-grade malignant perineuriomas. Nevertheless, one example of perineurioma with low-grade features that behaved in a malignant fashion (with multiple distant metastases) 10 years after the initial presentation is on record. (70) Moreover, only a few examples of such kind of tumor have been described so far and, even though most of those reported cases behaved in a benign fashion, limited follow-up periods are available in most reports. (71-73) If one recalls that low-grade malignant mesenchymal neoplasms may take more than 10 years to metastasize, it becomes clear that additional follow-up is needed before the true potential of these tumors is known. As a result, the term perineurioma of uncertain malignant potential could also be used for cases with atypical but not overtly malignant features.
Intraneural perineurioma is a benign neoplasm, but its treatment is controversial. Put simply, in an attempt to preserve nerve function, some authors advocate diagnostic biopsy followed by neurolysis instead of resection, (2) while others prefer the resection with neural grafting or end-to-end anastomosis because, according to them, intraneural perineurioma is a progressive condition that evolves inexorably to a total loss of nerve function. (74)
Perineurioma is an uncommon and underrecognized benign neoplasm that exhibits histologic features that overlap with those of many other benign and malignant soft tissue tumors. The correct diagnosis relies mainly on histologic findings and immunohistochemical profile, but ultrastructural studies can be used in difficult cases. Cytogenetic and molecular genetic studies are still of limited value for the diagnosis of perineuriomas but may play a fundamental role in excluding important differential diagnostic considerations, such as DFSP and low-grade fibromyxoid sarcoma.
Note.--In this article we state that perineuriomas have never previously been associated with neurofibromatosis. However, after our article was accepted for publication, an article describing the occurrence of a soft tissue perineurioma in the clinical setting of neurofibromatosis type 2 was published. The reference for this recent article is Pitchford CW, Schwartz HS, Atkinson JB, Cates JM. Soft tissue perineurioma in a patient with neurofibromatosis type 2: a tumor not previously associated with the NF2 syndrome. Am J Surg Pathol. 2006;30:1624-1629.
The authors thank the following colleagues from Mayo Clinic: Antonio G. Nascimento, MD, for allowing the corresponding author to use his file cases in order to obtain photomicrographs from extraneural soft tissue perineuriomas and sclerosing perineuriomas; Bernd W. Scheithauer, MD, who kindly provided the illustrations of extraneural perineurioma macroscopy, perineurioma electron microscopy, and intraneural perineurioma; and Mr. Brent T. Vrieze for his computer and digital imaging support. The authors are grateful to Emilio M. Pereira, MD, from the Laboratorio Salomao e Zoppi, Sao Paulo, Brazil, for kindly providing some of the sclerosing perineurioma photomicrographs. They are in debt to Christopher D. M. Fletcher, MD, FRCPath, from the Brigham and Women's Hospital, Boston, Mass, for promptly ceding a histhologic image of reticular perineurioma; and to Mr Marcos Franchi and Mrs Celene Gandin, from the Universidade Estadual Paulista-UNESP, Botucatu, Brazil, for their skilled assistance on immunohistochemistry.
(1.) Lazarus SS, Trombetta LD. Ultrastructural identification of a benign perineurial cell tumor. Cancer. 1978;41:1823-1829.
(2.) Emory TS, Scheithauer BW, Hirose T, Wood M, Onofrio BM, Jenkins RB. Intraneural perineurioma: a clonal neoplasm associated with abnormalities of chromosome 22. Am J Clin Pathol. 1995;103:696-704.
(3.) Mentzel T, Dei Tos AP, Fletcher CD. Perineurioma (storiform perineurial fibroma): clinico-pathological analysis of four cases. Histopathology. 1994;25: 261-267.
(4.) Shanthaveerappa TR, Bourne GH. Perineural epithelium: a new concept of its role in the integrity of the peripheral nervous system. Science. 1966;154:1464-1467.
(5.) Balarezo FS, Muller RC, Weiss RG, Brown T, Knibbs D, Joshi VV. Soft tissue perineuriomas in children: report of three cases and review of the literature. Pediatr Dev Pathol. 2003;6:137-141.
(6.) Fetsch JF, Miettinen M. Sclerosing perineurioma: a clinicopathologic study of 19 cases of a distinctive soft tissue lesion with a predilection for the fingers and palms of young adults. Am J Surg Pathol. 1997;21:1433-1442.
(7.) Brock JE, Perez-Atayde AR, Kozakewich HP, Richkind KE, Fletcher JA, Vargas SO. Cytogenetic aberrations in perineurioma: variation with subtype. Am J Surg Pathol. 2005;29:1164-1169.
(8.) Hirose T, Scheithauer BW. "Sclerosing" perineurioma: a tumor variant? Int J Surg Pathol. 1999;7:133-140.
(9.) Scheithauer BW, Woodruff JM, Erlandson RA. Tumors of the Peripheral Nervous System. Washington, DC: Armed Forces Institute of Pathology; 1999. Atlas of Tumor Pathology; 3rd series, fascicle 24.
(10.) Giannini C, Scheithauer BW, Jenkins RB, et al. Soft-tissue perineurioma: evidence for an abnormality of chromosome 22, criteria for diagnosis, and review of the literature. Am J Surg Pathol. 1997;21:164-173.
(11.) Graadt van Roggen JF, McMenamin ME, Belchis DA, Nielsen GP, Rosenberg AE, Fletcher CD. Reticular perineurioma: a distinctive variant of soft tissue perineurioma. Am J Surg Pathol. 2001;25:485-493.
(12.) Michal M. Extraneural retiform perineuriomas: a report of four cases. Pathol Res Pract. 1999;195:759-763.
(13.) Robson AM, Calonje E. Cutaneous perineurioma: a poorly recognized tumour often misdiagnosed as epithelioid histiocytoma. Histopathology. 2000;37: 332-339.
(14.) Hornick JL, Fletcher CD. Soft tissue perineurioma: clinicopathologic analysis of 81 cases including those with atypical histologic features. Am J Surg Pathol. 2005;29:845-858.
(15.) Giannini C, Scheithauer BW, Steinberg J, Cosgrove TJ. Intraventricular perineurioma: case report. Neurosurgery. 1998;43:1478-1481.
(16.) Hornick JL, Fletcher CD. Intestinal perineuriomas: clinicopathologic definition of a new anatomic subset in a series of 10 cases. Am J Surg Pathol. 2005; 29:859-865.
(17.) Val-Bernal JF, Hernando M, Garijo MF, Villa P. Renal perineurioma in childhood. Gen Diagn Pathol. 1997;143:75-81.
(18.) Ortonne JP, Verrando P, Pautrat G, Darmon M. Lamellar cells of sensory receptors and perineural cells of nerve endings of pig skin contain cytokeratins. Virchows Arch A Pathol Anat Histopathol. 1987;410:547-552.
(19.) Meis JM, Ordonez NG, Bruner JM. Meningiomas: an immunohistochemical study of 50 cases. Arch Pathol Lab Med. 1986;110:934-937.
(20.) Zamecnik M, Michal M, Baumruk L, Mukensnabl P. Dermatofibrosarcoma protuberans with Ema+ cells: report of a case suggesting perineurial cell differentiation. Pathol Res Pract. 2002;198:767-774.
(21.) Sirvent N, Maire G, Pedeutour F. Genetics of dermatofibrosarcoma protuberans family of tumors: from ring chromosomes to tyrosine kinase inhibitor treatment. Genes Chromosomes Cancer. 2003;37:1-19.
(22.) Ohno T, Park P, Akai M, et al. Ultrastructural study of a perineurioma. Ultrastruct Pathol. 1988;12:495-504.
(23.) Gelli MC, Pasquinelli G, Martinelli G, Gardini G. Cutaneous meningioma: histochemical, immunohistochemical and ultrastructural investigation. Histopathology. 1993;23:576-578.
(24.) Peltonen J, Jaakkola S, Virtanen I, Pelliniemi L. Perineurial cells in culture: an immunocytochemical and electron microscopic study. Lab Invest. 1987;57: 480-488.
(25.) Mertens F, Fletcher CD, Antonescu CR, et al. Clinicopathologic and molecular genetic characterization of low-grade fibromyxoid sarcoma, and cloning of a novel FUS/CREB3L1 fusion gene. Lab Invest. 2005;85:408-415.
(26.) Gengler C, Guillou L. Solitary fibrous tumour and haemangiopericytoma: evolution of a concept. Histopathology. 2006;48:63-74.
(27.) Feany MB, Anthony DC, Fletcher CD. Nerve sheath tumours with hybrid features of neurofibroma and schwannoma: a conceptual challenge. Histopathology. 1998;32:405-410.
(28.) Zamecnik M, Michal M. Perineurial cell differentiation in neurofibromas: report of eight cases including a case with composite perineurioma-neurofibroma features. Pathol Res Pract. 2001;197:537-544.
(29.) Michal M, Kazakov DV, Belousova I, Bisceglia M, Zamecnik M, Mukensnabl P. A benign neoplasm with histopathological features of both schwannoma and retiform perineurioma (benign schwannoma-perineurioma): a report of six cases of a distinctive soft tissue tumor with a predilection for the fingers. Virchows Arch. 2004;445:347-353.
(30.) Kazakov DV, Pitha J, Sima R, et al. Hybrid peripheral nerve sheath tumors: schwannoma-perineurioma and neurofibroma-perineurioma: a report of three cases in extradigital locations. Ann Diagn Pathol. 2005;9:16-23.
(31.) Bundock EA, Fletcher CDM. Nerve sheath tumors with hybrid features of perineurioma and schwannoma [abstract]. Mod Pathol. 2004;17:12A.
(32.) Val-Bernal JF, Garijo MF, Val D. Response to "Intratumoral fat in neurofibroma." Am J Dermatopathol. 2003;25:174-175.
(33.) Miettinen M. Nerve sheath tumors. In: Miettinen M, ed. Diagnostic Soft Tissue Pathology. Philadelphia, Pa: Churchill Livingstone; 2003:343-378.
(34.) Pulitzer DR, Martin PC, Reed RJ. Fibroma of tendon sheath: a clinicopathologic study of 32 cases. Am J Surg Pathol. 1989;13:472-479.
(35.) Ushigome S, Takakuwa T, Hyuga M, Tadokoro M, Shinagawa T. Perineurial cell tumor and the significance of the perineurial cells in neurofibroma. Acta Pathol Jpn. 1986;36:973-987.
(36.) Mentzel T, Kutzner H. Reticular and plexiform perineurioma: clinicopathological and immunohistochemical analysis of two cases and review of perineurial neoplasms of skin and soft tissues. Virchows Arch. 2005;447:677-682.
(37.) Shelekhova K, Kazakov DV, Michal M. Infiltrating retiform perineurioma: a case report. Ann Diagn Pathol. 2005;9:293-294.
(38.) de La Jarte-Thirouard AS, Jacquier I, de Saint-Maur PP. Intraneural reticular perineurioma of the neck. Ann Diagn Pathol. 2003;7:120-123.
(39.) Kilpatrick SE, Hitchcock MG, Kraus MD, Calonje E, Fletcher CD. Mixed tumors and myoepitheliomas of soft tissue: a clinicopathologic study of 19 cases with a unifying concept. Am J Surg Pathol. 1997;21:13-22.
(40.) Hirose T, Scheithauer BW, Sano T. Perineurial malignant peripheral nerve sheath tumor (MPNST): a clinicopathologic, immunohistochemical, and ultra-structural study of seven cases. Am J Surg Pathol. 1998;22:1368-1378.
(41.) Graadt van Roggen JF, Hogendoorn PC, Fletcher CD. Myxoid tumours of soft tissue. Histopathology. 1999;35:291-312.
(42.) Lasota J, Jasinski M, biec-Rychter M, Szadowska A, Limon J, Miettinen M. Detection of the SYT-SSX fusion transcripts in formaldehyde-fixed, paraffin-embedded tissue: a reverse transcription polymerase chain reaction amplification assay useful in the diagnosis of synovial sarcoma. Mod Pathol. 1998;11:626-633.
(43.) Huguet P, de la TJ, Pallares J, et al. Intraosseous intraneural perineurioma: report of a case with morphological, immunohistochemical and FISH study. Med Oral. 2004;9:64-68.
(44.) Damm DD, White DK, Merrell JD. Intraneural perineurioma not restricted to major nerves. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96: 192-196.
(45.) Chang Y, Horoupian DS, Jordan J, Steinberg G. Localized hypertrophic mononeuropathy of the trigeminal nerve. Arch Pathol Lab Med. 1993;117:170-176.
(46.) Neary D, Ochoa J. Localized hypertrophic neuropathy, intraneural tumour, or chronic nerve entrapment? [letter]. Lancet. 1975;1:632-633.
(47.) Mitsumoto H, Wilbourn AJ, Goren H. Perineurioma as the cause of localized hypertrophic neuropathy. Muscle Nerve. 1980;3:403-412.
(48.) Bilbao JM, Khoury NJ, Hudson AR, Briggs SJ. Perineurioma (localized hypertrophic neuropathy). Arch Pathol Lab Med. 1984;108:557-560.
(49.) Lasota J, Fetsch JF, Wozniak A, Wasag B, Sciot R, Miettinen M. The neurofibromatosis type 2 gene is mutated in perineurial cell tumors: a molecular genetic study of eight cases. Am J Pathol. 2001;158:1223-1229.
(50.) Diaz-Flores L, Alvarez-Arguelles H, Madrid JF, Varela H, Gonzalez MP, Gutierrez R. Perineurial cell tumor (perineurioma) with granular cells. J Cutan Pathol. 1997;24:575-579.
(51.) Rank JP, Rostad SW. Perineurioma with ossification: a case report with immunohistochemical and ultrastructural studies. Arch Pathol Lab Med. 1998; 122:366-370.
(52.) Zamecnik M. Perineurioma with adipocytes (lipomatous perineurioma). Am J Dermatopathol. 2003;25:171-173.
(53.) Burgues O, Monteagudo C, Noguera R, Revert A, Molina I, Llombart-Bosch A. Cutaneous sclerosing Pacinian-like perineurioma. Histopathology. 2001;39: 498-502.
(54.) Pinkus GS, Kurtin PJ. Epithelial membrane antigen--a diagnostic discriminant in surgical pathology: immunohistochemical profile in epithelial, mesenchymal, and hematopoietic neoplasms using paraffin
sections and monoclonal antibodies. Hum Pathol. 1985;16:929-940.
(55.) Scheithauer BW, Giannini C, Woodruff JM. Perineurioma. In: Kleihues P, Cavenee WK, eds. Pathology and Genetics of Tumours of the Nervous System. Lyon, France: IARC Press; 2000:169-171. World Health Organization Classification of Tumours.
(56.) Kahn DG, Duckett T, Bhuta SM. Perineurioma of the kidney: report of a case with histologic, immunohistochemical, and ultrastructural studies. Arch Pathol Lab Med. 1993;117:654-657.
(57.) Smith ME, Awasthi R, O'Shaughnessy S, Fisher C. Evaluation of perineurial differentiation in epithelioid sarcoma. Histopathology. 2005;47:575-581.
(58.) Furuse M, Fujita K, Hiiragi T, Fujimoto K, Tsukita S. Claudin-1 and -2: novel integral membrane proteins localizing at tight junctions with no sequence similarity to occludin. J Cell Biol. 1998;141:1539-1550.
(59.) Gonzalez-Mariscal L, Betanzos A, Nava P, Jaramillo BE. Tight junction proteins. Prog Biophys Mol Biol. 2003;81:1-44.
(60.) Rangel LB, Agarwal R, D'Souza T, et al. Tight junction proteins claudin-3 and claudin-4 are frequently overexpressed in ovarian cancer but not in ovarian cystadenomas. Clin Cancer Res. 2003;9:2567-2575.
(61.) Billings SD, Walsh SV, Fisher C, Nusrat A, Weiss SW, Folpe AL. Aberrant expression of tight junction-related proteins ZO-1, claudin-1 and occludin in synovial sarcoma: an immunohistochemical study with ultrastructural correlation. Mod Pathol. 2004;17:141-149.
(62.) Folpe AL, Billings SD, McKenney JK, Walsh SV, Nusrat A, Weiss SW. Expression of claudin-1, a recently described tight junction-associated protein, distinguishes soft tissue perineurioma from potential mimics. Am J Surg Pathol. 2002; 26:1620-1626.
(63.) Erlandson RA. The enigmatic perineurial cell and its participation in tumors and in tumorlike entities. Ultrastruct Pathol. 1991;15:335-351. 64. Mueckler M. Facilitative glucose transporters. Eur J Biochem. 1994;219: 713-725.
(65.) Younes M, Lechago LV, Somoano JR, Mosharaf M, Lechago J. Wide expression of the human erythrocyte glucose transporter Glut1 in human cancers. Cancer Res. 1996;56:1164-1167.
(66.) Hirose T, Tani T, Shimada T, Ishizawa K, Shimada S, Sano T. Immunohistochemical demonstration of EMA/Glut1-positive perineurial cells and CD34-positive fibroblastic cells in peripheral nerve sheath tumors. Mod Pathol. 2003;16: 293-298.
(67.) Mertens F, Dal CP, De Wever I, et al. Cytogenetic characterization of peripheral nerve sheath tumours: a report of the CHAMP study group. J Pathol. 2000;190:31-38.
(68.) Mott RT, Goodman BK, Burchette JL, Cummings TJ. Loss of chromosome 13 in a case of soft tissue perineurioma. Clin Neuropathol. 2005;24:69-76.
(69.) Hirose T, Sumitomo M, Kudo E, et al. Malignant peripheral nerve sheath tumor (MPNST) showing perineurial cell differentiation. Am J Surg Pathol. 1989; 13:613-620.
(70.) Karaki S, Mochida J, Lee YH, Nishimura K, Tsutsumi Y. Low-grade malignant perineurioma of the paravertebral column, transforming into a high-grade malignancy. Pathol Int. 1999;49:820-825.
(71.) Rosenberg AS, Langee CL, Stevens GL, Morgan MB. Malignant peripheral nerve sheath tumor with perineurial differentiation: "malignant perineurioma." J Cutan Pathol. 2002;29:362-367.
(72.) Suster D, Plaza JA, Shen R. Low-grade malignant perineurioma (perineurial sarcoma) of soft tissue: a potential diagnostic pitfall on fine needle aspiration. Ann Diagn Pathol. 2005;9:197-201.
(73.) Zamecnik M, Koys F, Gomolcak P. Atypical cellular perineurioma. Histopathology. 2002;40:296-299.
(74.) Gruen JP, Mitchell W, Kline DG. Resection and graft repair for localized hypertrophic neuropathy. Neurosurgery. 1998;43:78-83.
Accepted for publication September 11, 2006.
Ricardo S. Macarenco, MD; Fred Ellinger, MD, PhD; Andre M. Oliveira, MD
From CIPAX-Medicina Diagnostica, Sao Jose dos Campos, SP, Brazil (Dr Macarenco); the Departamento de Patologia, Faculdade de Medicina de Marilia, Marilia, SP, Brazil (Dr Ellinger); and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (Dr Oliveira). Dr Macarenco is currently a visiting pathologist at the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn.
The authors have no relevant financial interest in the products or companies described in this article.
Reprints: Ricardo Silvestre Macarenco, MD, Rua Itatiba, 80 Jd Apolo, Sao Jose dos Campos, Sao Paulo, Brazil (e-mail: firstname.lastname@example.com).
Perineuriomas and Their Potential Differential Diagnoses * Perineurioma Variants Differential Diagnoses ESTP DFSP: Diffuse storiform pattern, infiltrative growth (honey-combing pattern); EMA negative; supranumerary ring chromosomes with t(17;22), fusion gene COL1A1-PDGFB Fibromatosis: Long fascicles, spindle cells with tapering or plump vesicular nuclei, dense collagenous matrix, infiltrative growth pattern, and slitlike vessels; diffuse expression of smooth muscle actin and muscle specific actin Smooth muscle tumors: Blunt-ended nuclei, abundant eosinophilic cytoplasm, intersecting fascicles; positivity for smooth muscle actins (diffuse) and desmin LGFMS: Alternated myxoid/collagenous zones, arcade vessels, giant collagen rosettes; immunohistochemistry not helpful; t(7;16)(g32[right arrow]434;p11) with the fusion gene FUS-CREB3L2 Solitary fibrous tumor: Patternless pattern with dense collagen bundles, hyalinized vessels, staghorn vessels, focal storiform pattern may be present; most are EMA negative and CD34 positive Low-grade myxofibrosarcoma: Higher degree of cytologic atypia and pleomorphism, cells with cytoplasmic inclusions (pseudo-Iipoblasts), curvilinear and thin blood vessels, whorling growth pattern unusual; EMA negative Schwannoma: Antoni A and Antoni B areas, Verocay bodies; diffuse 5100 expression Neurofibroma: Spindle cells with wavy nuclei and poorly defined, slightly eosinophilic cytoplasm and several small nerve twigs embedded in a variably fibromyxoid matrix; extensive 5100 expression; often CD34 positive Sclerosing Fibroma of tendon sheath: Associated with tendons, perineurioma more deeply situated; spindled fibroblasts in a collagenous stroma, no epithelioid and plump cells arranged in linear or corded pattern; slitlike vessels; EMA negative Epithelioid glomus tumor: Cells have abundant cytoplasm, form clusters around blood vessels; diffuse expression of muscle-specific and smooth muscle actins; EMA negative Giant cell tumor of tendon sheath: Deep-seated; admixture of mononuclear histiocytoid, xanthomatous, and osteoclast-like giant cells, tendency of nested growth; CD68 positive, focal desmin positive or negative; abnormalities in chromosome 1 with clustering in the p11[right arrow]13 region. Epithelioid sarcoma: Higher nuclear atypia, cells disposed in micronodules that show central necrosis and perineurial and vascular invasion; immunohistochemistry: cytokeratin positive, CD34 positive in 50%-70% of cases Reticular Myoepithelial tumors: Acinar/ductal component; perineurioma immunohistochemistry: variable 5100, cytokeratin, EMA, GFAP, and smooth muscle actin positivity Myxoid MPNST: Nuclear atypia, mitotic figures, perivascular hypercellularity and tumor necrosis, no reticular architecture; immunohistochemistry less useful, but positivity for 5100 and negativity for EMA may help Myxoid synovial sarcoma: Greater nuclear atypia and higher mitotic index, fascicular spindle cell areas; immunohistochemistry: EMA and cytokeratin positive; translocation t(X;18)(p11.2;g11.2) with the formation of the fusion transcripts SYT-SSX1 and SYT-SSX2 Intraneural Localized hypertrophic neuropathy: Onion bulb-like perineurioma whorls result from Schwann cell (not perineurial cell) proliferation that encircles axon units * ESTP indicates extraneural soft tissue perineurioma; DFSP, dermofibrosarcoma protuberans; EMA, epithelial membrane antigen; LGFMS, low-grade fibromyxoid sarcoma; GFAP, glial fibrillary acidic protein; and MPNST, malignan periperal sheath tumor.
Reader Opinion
Printer friendly Cite/link Email Feedback | |
Author: | Macarenco, Ricardo S.; Ellinger, Fred; Oliveira, Andre M. |
Publication: | Archives of Pathology & Laboratory Medicine |
Article Type: | Disease/Disorder overview |
Geographic Code: | 1USA |
Date: | Apr 1, 2007 |
Words: | 7537 |
Previous Article: | Significance of margin and extent of dysplasia in loop electrosurgery excision procedure biopsies performed for high-grade squamous intraepithelial... |
Next Article: | Adenoid cystic/basal cell carcinoma of the prostate: review and update. |
Topics: |


text:
Star Sailors League 2013 - Miami Bacardi Cup day 2
While Lars Grael and Mario Lagoa (BRA) remain first overall with two points net after adding today's finishes of 12-1 to their win of yesterday's lone race, less than 12 points separate the top-five teams. 'Races were similar to yesterday although the second race overall was more gentle,' said Grael.
'On the first race today we did a wrong jibe and we rounded the mark fifth, closed the downwind leg 25th and finished 12th; it was a difficult race for us. Second race of the day started well, we rounded the mark first and protected the position. While fighting with Xavier Rohart we managed to keep a good gap with the rest of the field. Overall we're happy because competition is tough and we're competing against Augie Diaz who is a local sailor and I believe has the home advantage.'
Diaz, with crew Arnis Baltins, is just three points out of first place and knows winning this championship will come down to more than local knowledge.
'The first race was difficult, but we managed to do well,' said Diaz of the win of today's first race. 'We had better opportunities and with a little bit of luck we were able to round the weather mark third and then take the lead to the end. Second race of the day was more challenging because we decided to go on the right side of the course while the wind went left; I'm therefore happy with a 10th place. I have a lot of respect for Lars because he is very good in all conditions and in all venues. I don't think I have a big edge by being local; really not as big an edge as he might think I have.'
Third overall are the defending champions Xavier Rohart and Pierre Alexis Ponsot (FRA), who placed 6-2 today, a strong recovery from yesterday's finish of 25. They carry eight points and are followed in fourth by the Italian team of Diego Negri and Frithjof Kleen whose scoreline of 13-3-9 totals 12 points. Rounding out fifth in the standings is Irish Olympian Peter O'Leary and Rodney Hagebols who have 13.5 points after finishes of
Miami Sailing Week website


text:
Gift basket
It's a baby girl! Outfit a lovely little lady (and her exhuasted parents) with some much-needed fun and function from the All Girl Baby Wagon gift. Delivered in a mini Radio Flyer, it's one gift they're bound to remember.
About Cashmere Bunny, LLC
The Cashmere Bunny gift basket company is an undeniably unique and premium designer of gifts meant to usher in a new arrival. Its gift compilations usually include pampering items for the new mom as well as clothes, bibs, and teddy bears for the baby.
Cashmere Bunny
Have a question about this product? Ask a Product Expert! The answer will be emailed to you and then posted here.


text:
« Local Home |
Ramada Limited Airport North
Get Driving Directions
Save to Your Address Book
Do you go to this place?
» Save listing» Add a review
Sniffing for more?
See other:» Hotels» See all Oklahoma City listings
» See all OK listings
Attributes [ edit ]
Part of a national chain: | Ramada Plazas |
Travel Information: | Check Rates & Availability |
"The Newly Remodeled Ramada Limited Airport North is conveniently located on Meridian Avenue just 3 miles from the intersection of I-40 at exit 145 and…"
No reviews yet. Be the first to review this listing!


text:
New Delhi: The National Democratic Alliance (NDA) drama played out on Sunday with the Janata Dal United (JDU) giving the Bharatiya Janata Party (BJP) a year-end deadline to declare its Prime Ministerial candidate. By Sunday evening, the BJP hit back saying that the key NDA ally should rather focus on targeting the UPA than its own allies.
Hoping to gain some advantage of this BJP-JD(U) squabble, the Bihar Congress tried to woo the state's Chief Minister Nitish Kumar. Bihar Congress chief Ashok Choudhary said, "When Nitish Kumar will take a stand like they don't want BJP, then there is the question of an alliance with any secular party. But when Nitish Kumar is tied up with BJP in the state, how can he be secular? When Nitishji will leave the BJP, we will ponder over the circumstances and take a decision."
Bihar Chief Minister Nitish Kumar without naming Narendra Modi made his opposition to the Gujarat Chief Minister apparent in his valedictory address at the end of the JD(U) National Council. Nitish minced no words in warning his long standing ally that he would not think twice before pulling out of the NDA if Modi is projected as the PM candidate by the BJP.
"What can be said of life, one day you have power and the next day it is gone. But we won't compromise on principles for the sake of power," Nitish said.
Almost tearing into the political and development model of Narendra Modi assiduously built over the past one month through a media blitzkrieg, Nitish re-iterated that he was not in the PM race, saying, "We do not live in any illusion, we are a small party."
But at the same time, the JD(U) categorically spelt out a benchmark for NDA's PM candidate. In the political resolution, the party demanded that the NDA candidate must be bound by a pre-defined agenda for governance, shouldn't digress from previously agreed alliance stand on the three issues, secular credentials of the candidate must be beyond doubt. It said the PM nominee must support an inclusive model of political and economic development and be committed towards the needs of backward states and most importantly this candidate must be decalred by the NDA before the year end.
"The leader will have to understand the psyche of the people of a diverse multi-religious and multi-lingual country like India. Mere atmospherics would not do.. The Prime Minister should be like Atal Bihari Vajpayee. He always used to talk about following the raj dharma," Nitish said. By talking about inclusive growth, Nitish reached out to potential post poll allies Mamata Banerjee and Naveen Patnaik.
Nitish Kumar has put the ball in the BJP's court making it amply clear that the onus to keep the alliance intact is on the saffron party which can do so by keeping Narendra Modi away from the top job.
BJP also launched a counter attack releasing a statement vetted by its top leaders. "It's unfortunate if they concentrate their energies on our CMs and dilute focus on ousting the UPA. We reject all unfounded inferences against Narendra Modi," BJP spokesperson Nirmala Seetharaman said.
Over 3,600 dead, several injured in Nepal quake but SP MP wants fellow MP's relative to be saved first
Live: Should donate one month's salary to the people of Nepal, says Mulayam Singh
Devendra Fadnavis in Israel to seek collaboration, attract investment


text:
Author: Nick Hornby Written: 2001 Publisher: Riverhead Books/ Penguin Putnam Inc.
Hornby takes a rather dramatic leap from where he left off in About a Boy, not in terms of plot, but in terms of sheer scope and maturity.
The book certainly has it's amount of laughs and quirky details, but it will also do fascinatingly horrifying things to your conscience, your heart, and all of the bits of you which spend time dreaming and caring and thinking.
The main character, Katie Carr, is a doctor. She does her best to heal people, for a living, because she wants to help people. She's a basically good person, in much the way that any of us are good people...we care about world events, we recycle, we donate to charities, canned goods at Thanksgiving, try to think good thoughts about those around us, etc.
And she's having an affair, because she just can't deal with her husband's self-centeredness and vitirol anymore.
And then suddenly, one day, her husband "sees the light", and decides to become good. Entirely good. In that he no longer understands sarcasm, doesn't say bad things about people, give's away the children's computer to a shelter, and starts a program to get the other homes on the street to take in homeless teenagers.
Not to mention bringing the mentor of this "goodness" into their home.
The daughter apes the father in an attempt to one up the brother and irritate him, the brother turns to theivery at school as an attempt to strike back.
And Katie tries to remember what happiness truly is. What marriage means, after you've been doing it a while. What part love has in anything. How selfish we're allowed to be, as civilized people, when people are starving on the streets, and people in Africa don't have dishwashers.
There are no answers in this book. Just a lot of very difficult, but very worthwhile questions.
Is goodness reconcilable with being comfortable, or even happy? Is love really the same thing as charity? Is being good more important than your relationship with your wife, or your children, or other people around you? What is the price of civilization?
Care to be overwhelmed? Pick up this book.
Log in or registerto write something here or to contact authors.
Sign up
Need help? firstname.lastname@example.com


text:
Connect with Us
North Bend hotel decision delayed for public comment
North Bend's Planning Commission has delayed considering a proposed change to development regulations to allow a hotel off Interstate 90's Exit 31 until September.
The commission had been set to consider the change, which has drawn heavy criticism from residents in the adjacent Forster Woods neighborhood, at its Aug. 27 meeting.
The commission wants to wait until residents return from vacations after Labor Day before it considers the proposed amendment, according to Gina Estep, the city's Economic Development Coordinator.
The proposal would allow a hotel to be built on a vacant, undeveloped lot located south of I-90.
Overgrown with weeds from years of sitting idle, the lot is zoned as Interchange Mixed Use. Earlier this decade, the city adopted a provision prohibiting a hotel on the lot. The proposed amendment would remove that prohibition.
Forster Woods residents don't want their neighborhood bordered by a hotel, which, they say, could increase their crime rates, create traffic and public safety problems and lower property values.
George Wyrsch, who submitted the amendment and owns the land that would be affected, said he shares residents' concerns and that his proposed 78-room, four-story hotel would not hurt the neighborhood.
While no other hotel has been proposed in North Bend, hotels could be going up in other places in Snoqualmie Valley.
The city of Snoqualmie has talked to developers about building hotels in two locations on Snoqualmie Ridge. One possible hotel would be close to I-90 and target a similar market to Wyrsch's proposed hotel. The other would be a boutique hotel with retail located closer to the Ridge's center.
Quadrant Homes has expressed interest in the hotel closer to I-90, according to Snoqualmie Mayor Matt Larson. The city is also negotiating with Muckleshoot Tribe-owned Salish Lodge about its expansion.
The Snoqualmie Tribe is exploring building a hotel at the Snoqualmie Casino, which is located on its reservation.
Latest news, top stories, and community events,
delivered to your inbox.
Trending Stories Apr 20 - Apr 27
Read the Apr 22
Green Edition
Browse the print edition page by page, including stories and ads.
Browse the archives.


text:
We will delivery to all cities in
We deliver flowers to the following zipcodes near Crestone Colorado CO: 81131, 81143, 81252, 81136, 81146, 81223, 81222, 81149, 81125, 81233, 81155, 81102, 81101, 81040 We send flowers to these cities near Crestone Colorado CO: Crestone CO, Mirage CO, Moffat CO, Horn Creek CO, Rosita CO, Silver Cliff CO, Tanglewood Acres CO, Westcliffe CO, Hooper CO, Mosca CO, Cotopaxi CO, Texas Creek CO, Coaldale CO, Saguache CO, Center CO, Howard CO, Bonanza City CO, Villa Grove CO, Alamosa CO, Carmel CO We deliver flowers to these hospitals near Crestone Colorado CO: North Colorado Medical Center 1801 16th Street, Greeley, CO, 80631-5199, (970) 352-4121 St Mary's Hospital & Med Ctr 2635 North 7th Street, Grand Junction, CO, 81501-8204, (970) 244-2273 Keefe Memorial Hospital 602 North 6th Street West, Cheyenne Wells, CO, 80810, (719) 767-5661 Swedish Medical Center 501 East Hampden Avenue, Englewood, CO, 80110-0101, (303) 788-5000 Medical Center Of Aurora 1501 South Potomac Street, Aurora, CO, 80012-5499, (303) 695-2600 We deliver flowers to these funeral homes near Crestone Colorado CO: |
Local Crestone CO Colorado Flower Delivery: • Crestone, Colorado Flowers • Crestone, CO Flowers • Crestone Flowers |
Send Flowers with confidence in the USA and Canada. Secure Online Service. |
We deliver through FedEx and UPS delivery services as well as from our own brick and mortar flower shops. Also as a member of FTD and other flower-by-wire associations we have access to floral shops around the world and provide delivery through these networks. This website is a property of Flower Delivery Express ®, a Michigan, USA domiciled business. Copyright(c) 2011-2015 All Rights Reserved. Flower Delivery Express 2985 Haggerty Highway, Commerce Township MI 48390 USA
FLOWERS Crestone | Flower Delivery Crestone CO | FTD Flower Shop Order Flowers Online for Crestone CO, Colorado | Florist Shop | FLORISTS


text:
Laser-induced selective crosslinking for scaling the heterointerfacial domain in polymer blends |
Optics Express, Vol. 21, Issue 21, pp. 24620-24629 (2013)
Enhanced HTML Acrobat PDF (869 KB)
Organic blends containing heterojunction structures at the interfacial phase have been applied extensively in organic optoelectronic devices to modify charge transfer, separation, and recombination processes. Scaling and controlling the transition domains at the hetero-interface are of crucial importance for deep insights into the involved physics and for architecturing the devices with improved performance. However, it is difficult to recognize and characterize these transition domains directly using the conventional microscopic techniques, in particular when different molecules are dissolved in the same solvent with equal solubility. In this work, we introduce a technique defined as laser-induced selective cross-linking to isolate the interfacial phase from other phases into a directly measurable practicity. Thus, the hetero-domains become visualized and directly measurable. Based on the insolubility of the selectively cross-linked molecules in organic solvents, a lift-off process may remove the uncross-linked or incompletely cross-linked molecules, so that the hetero-domain is more clearly visualized and more precisely measured. A transition domain in a scale of about 200 nm is resolved in the F8BT/PFB blend film between their respectively rich phases after the selective cross-linking of the F8BT molecules by a blue laser. Furthermore, hetero-crosslinking between F8BT and PFB molecules was also resolved by both microscopic and near-field spectroscopic investigations.
© 2013 Optical Society of America
OCIS Codes
(160.4890) Materials : Organic materials
(160.6000) Materials : Semiconductor materials
(220.4241) Optical design and fabrication : Nanostructure fabrication
ToC Category:
Original Manuscript: September 12, 2013
Revised Manuscript: September 27, 2013
Manuscript Accepted: September 30, 2013
Published: October 7, 2013
Xinping Zhang and Hongwei Li, "Laser-induced selective crosslinking for scaling the heterointerfacial domain in polymer blends," Opt. Express 21, 24620-24629 (2013)
Sort: Year | Journal | Reset
- C. W. Tang, "Two-layer organic photovoltaic cell," Appl. Phys. Lett.48(2), 183 (1986). [CrossRef]
- F. Yang, M. Shtein, and S. R. Forrest, "Controlled growth of a molecular bulk heterojunction photovoltaic cell," Nat. Mater.4(1), 37–41 (2005). [CrossRef]
- G. Yu, J. Gao, J. C. Hummelen, F. Wudl, and A. J. Heeger, "Polymer photovoltaic cells: Enhanced efficiencies via a network of internal donor-acceptor heterojunctions," Science270(5243), 1789–1791 (1995). [CrossRef]
- P. Peumans, S. Uchida, and S. R. Forrest, "Efficient bulk heterojunction photovoltaic cells using small-molecular-weight organic thin films," Nature425(6954), 158–162 (2003). [CrossRef] [PubMed]
- D. C. Coffey and D. S. Ginger, "Time-resolved electrostatic force microscopy of polymer solar cells," Nat. Mater.5(9), 735–740 (2006). [CrossRef] [PubMed]
- C. W. Tang and S. A. VanSlyke, "Organic electroluminescent diodes," Appl. Phys. Lett.51(12), 913 (1987). [CrossRef]
- S. Berleb, W. Brutting, and G. Paasch, "Interfacial charges in organic hetero-layer light emitting diodes probed by capacitance–voltage measurements," Synth. Met.122(1), 37–39 (2001). [CrossRef]
- R. Capelli, S. Toffanin, G. Generali, H. Usta, A. Facchetti, and M. Muccini, "Organic light-emitting transistors with an efficiency that outperforms the equivalent light-emitting diodes," Nat. Mater.9(6), 496–503 (2010). [CrossRef] [PubMed]
- S. H. Park, A. Roy, S. Beaupré, S. Cho, N. Coates, J. S. Moon, D. Moses, M. Leclerc, K. Lee, and A. J. Heeger, "Bulk heterojunction solar cells with internal quantum efficiency approaching 100%," Nat. Photonics3(5), 297–302 (2009). [CrossRef]
- F. C. Jamieson, E. B. Domingo, T. McCarthy-Ward, M. Heeney, N. Stingelin, and J. R. Durrant, "Fullerene crystallisation as a key driver of charge separation in polymer/fullerene bulk heterojunction solar cells," Chem. Sci.3(2), 485 (2012). [CrossRef]
- A. C. Morteani, A. S. Dhoot, J.-S. Kim, C. Silva, N. C. Greenham, C. Murphy, E. Moons, S. Ciná, J. H. Burroughes, and R. H. Friend, "Barrier-Free Electron–Hole Capture in Polymer Blend Heterojunction Light-Emitting Diodes," Adv. Mater.15(20), 1708–1712 (2003). [CrossRef]
- Z.-L. Li, H.-F. Meng, S.-F. Horng, C.-S. Hsu, L.-C. Chen, and S.-M. Chang, "Strong red emission in heterojunctions of conjugated polymer blends," Appl. Phys. Lett.84(24), 4944 (2004). [CrossRef]
- S. Y. Yang, X. L. Zhang, Y. B. Hou, Z. B. Deng, and X. R. Xu, "Charge carriers at organic heterojunction interface: Exciplex emission or electroplex emission?" J. Appl. Phys.101(9), 096101 (2007). [CrossRef]
- I. Gutiérrez Lezama, M. Nakano, N. A. Minder, Z. Chen, F. V. Di Girolamo, A. Facchetti, and A. F. Morpurgo, "Single-crystal organic charge-transfer interfaces probed using Schottky-gated heterostructures," Nat. Mater.11(9), 788–794 (2012). [CrossRef] [PubMed]
- B. Park, S. Choi, S. Graham, and E. Reichmanis, "Memory and photovoltaic elements in organic field-effect transistors with acceptor/donor planar-hetero junction interfaces," J. Phys. Chem. C116(17), 9390–9397 (2012). [CrossRef]
- C. R. McNeill, H. Frohne, J. L. Holdsworth, and P. C. Dastoor, "Near-Field Scanning Photocurrent Measurements of Polyfluorene Blend Devices: Directly Correlating Morphology with Current Generation," Nano Lett.4(12), 2503–2507 (2004). [CrossRef]
- R. Riehn, R. Stevenson, D. Richards, D. J. Kang, M. Blamire, A. Downes, and F. Cacialli, "Local Probing of Photocurrent and Photoluminescence in a Phase-Separated Conjugated-Polymer Blend by Means of Near-Field Excitation," Adv. Funct. Mater.16(4), 469–476 (2006). [CrossRef]
- I. A. Howard, J. M. Hodgkiss, X. P. Zhang, K. R. Kirov, H. A. Bronstein, C. K. Williams, R. H. Friend, S. Westenhoff, and N. C. Greenham, "Charge Recombination and Exciton Annihilation Reactions in Conjugated Polymer Blends," J. Am. Chem. Soc.132(1), 328–335 (2010). [CrossRef] [PubMed]
- J. Xue, B. P. Rand, S. Uchida, and S. R. Forrest, "A Hybrid Planar–Mixed Molecular Heterojunction Photovoltaic Cell," Adv. Mater.17(1), 66–71 (2005). [CrossRef]
- D. H. Wang, J. S. Moon, J. Seifter, J. Jo, J. H. Park, O. O. Park, and A. J. Heeger, "Sequential processing: control of nanomorphology in bulk heterojunction solar cells," Nano Lett.11(8), 3163–3168 (2011). [CrossRef] [PubMed]
- A. C. Morteani, P. Sreearunothai, L. M. Herz, R. H. Friend, and C. Silva, "Exciton Regeneration at Polymeric Semiconductor Heterojunctions," Phys. Rev. Lett.92(24), 247402 (2004). [CrossRef] [PubMed]
- A. Charas, H. Alves, L. Alcácer, and J. Morgado, "Use of cross-linkable polyfluorene in the fabrication of multilayer polyfluorene-based light-emitting diodes with improved efficiency," Appl. Phys. Lett.89(14), 143519 (2006). [CrossRef]
- S. Inaoka, D. B. Roitman, and R. C. Advincula, "Cross-Linked Polyfluorene Polymer Precursors: Electrodeposition, PLED Device Characterization, and Two-Site Co-deposition with Poly(vinylcarbazole)," Chem. Mater.17(26), 6781–6789 (2005). [CrossRef]
- X. P. Zhang, H. M. Liu, H. W. Li, and T. R. Zhai, "Direct Nanopatterning Into Conjugated Polymers Using Interference Crosslinking," Macromol. Chem. Phys.213(12), 1285–1290 (2012). [CrossRef]
Cited By |
Alert me when this paper is cited |
OSA is able to provide readers links to articles that cite this paper by participating in CrossRef's Cited-By Linking service. CrossRef includes content from more than 3000 publishers and societies. In addition to listing OSA journal articles that cite this paper, citing articles from other participating publishers will also be listed.


text:
Sim2 Domino D80 Projector Brand New High Quality Original Projector Bulb
Item SKU: 9281-356-05390_9Manufacturer:
$ 120.95 $ 169.33
Domino D80 Sim2 Projector Bulb Replacement without cage assembly . Brand New High Quality Original Projector Bulb
Domino D80 Bulb Replacement
Domino D80 Bulb Replacement
Sim2 | |
Domino D80 Bulb | |
90 Days Manufacturers Warranty. Warranty does not cover: shipping costs, improper installation including damages incurred while attempting installation, any installation or labor costs, lamps damaged by TV/projector malfunction, damage due to abuse, light |


text:
home > motorcycle insurance > states > massachusetts
or call 1-866-455-1980
(daily, 5 a.m.–9 p.m. PT)
Good news, Bay State residents: we can steer you toward motorcycle insurance rates in Massachusetts as sweet as your famous Boston cream pie. Built to save you money, every motorcycle policy through Esurance offers a wealth of discounts, plus simple policy management and 24/7 customer service.
Even though we don't insure residents of your splendid state yet, Esurance is committed to nabbing you the best deal on a motorcycle policy.
We're confident you'll be pleased as pie when you get a Massachusetts motorcycle insurance quote with our partner through our award-winning, hassle-free website.


text:
- Prison Planet.com - http://www.prisonplanet.com -
Threats to Assassinate Romney Explode After Debate
Posted By admin On October 17, 2012 @ 8:13 am In Featured Stories,News In Focus,Paul Watson Articles,Tile | Comments Disabled
Obama supporters voice desire to kill Romney over fears food stamps will be taken away
Paul Joseph Watson
Prison Planet.com
October 17, 2012
Despite numerous media outlets attempting to downplay the issue, Twitter exploded last night following the debate with new threats from Obama supporters to assassinate Mitt Romney if he defeats Obama in the presidential race.
As we reported yesterday [1], in addition to threats by Obama supporters to riot if Romney wins [2], innumerable Twitter users are also making direct death threats against Romney.
The primary reason given for Obama supporters wanting to see Romney dead is the fear that he will take away food stamps.
If the tables were turned and conservatives were making death threats against Obama in these numbers, it would be a national news story. Indeed, the mere act of hanging empty chairs from trees as a reference to Clint Eastwood's RNC speech was hyped by the media [3] as a deadly sign that conservatives were out to lynch black people if Obama won.
However, the major networks have remained completely silent on the disturbing trend of Obama supporters threatening to resort to violence if their candidate fails to secure a second term.
Twitchy has compiled a laundry list [4] of assassination threats by Obama supporters made during and after the debate, and more continued to flood in this morning, including the following;
The death threats are being made by both black and white people, emphasizing that merely drawing attention to the issue has nothing to do with "race-baiting," as the Obama front group Think Progress claimed yesterday [5].
It is important to stress that these Twitter accounts are genuine, they are not fakes. Many of them have thousands of previous tweets.
The following Tweets are just some of the ones compiled by Twitchy during and after the debate;
– "If Romney win this election, he might as well wear a shirt that says "Assassinate Me Bitch".
– "Yall ready to assasinate romney?"
– "Somebody needs to asassinate This mofo Romney."
– "Romney make me wanna hop through the tv & just assasinate his ass."
– "I aint gone lie… Food stamps the shit! I mite assasinate romney my damn self if he get elected!"
– "If romney get elected i hope a nigga assasinate his bitchass.
– "No birth control???? Lol rlly Romney the american population is going to overflow and then we'll have to resort to murder and you'll be #1."
– "At this point in time I am completely prepared to MURDER ROMNEY MYSELF!"
– "If Romney win, IM GOING TO JAIL FOR MURDER cuz imma whack his bitch ass ASAP."
– "If Mitt Romney wins, which I doubt, someone should assassinate him before he ruins the lives of our generation & our children."
It is important to emphasize that these are just a selection of scores and scores of threats to assassinate Romney that have exploded on Twitter over the last 12 hours. We didn't even have time to check Facebook or any other social networks.
As Infowars has stressed, we are non-partisan and have encouraged people to vote for neither candidate. However, the hypocrisy of leftists in trying to either downplay or deny this issue altogether is jaw-dropping given how they routinely try to portray conservatives as violent and extremist by pointing to angry comments made online.
Paul Joseph Watson is the editor and writer for Prison Planet.com [6]. He is the author of Order Out Of Chaos. Watson is also a regular fill-in host for The Alex Jones Show and Infowars Nightly News.
Article printed from Prison Planet.com: http://www.prisonplanet.com
URL to article: http://www.prisonplanet.com/threats-to-assassinate-romney-explode-after-debate.html
URLs in this post:
[1] As we reported yesterday: http://www.prisonplanet.com/obama-supporters-threaten-to-kill-romney-if-he-wins-election.html
[2] threats by Obama supporters to riot if Romney wins: http://www.infowars.com/new-threats-to-riot-if-obama-loses-election/
[3] was hyped by the media: http://usnews.nbcnews.com/_news/2012/09/20/13989510-empty-chair-lynchings-anti-obama-protests-gone-too-far?chromedomain=leanforward&lite#__utma=5875948.1140733459.1343330928.1348176479.1348178476.237&__utmb=58759220.127.116.118178476&__utmc=5875948&__utmx=-&__utmz=5875948.1348176479.236.165.utmcsr=google|utmccn=(organic)|utmcmd=organic|utmctr=(not%20provided)&__utmv=5875948.|8=Earned%20By=cable|msnbc|lean%20forward=1%5E12=Landing%20Content=Original=1%5E13=Landing%20Hostname=leanforward.msnbc.com=1%5E30=Visit%20Type%20to%20Content=Earned%20to%20Original=1&__utmk=182696482
[4] Twitchy has compiled a laundry list: http://twitchy.com/2012/10/17/post-presidential-debate-obama-supporters-renew-vows-to-murder-mitt-romney/?utm_source=autotweet&utm_medium=twitter&utm_campaign=twitter
[5] Think Progress claimed yesterday: http://www.prisonplanet.com/obama-front-group-accuses-drudge-infowars-of-race-baiting.html
[6] Prison Planet.com: http://prisonplanet.com/
Click here to print.
Copyright © 2013 PrisonPlanet.com. All rights reserved.