Objective. To assess the role of Fas‐mediated apoptosis in the salivary glands of patients with primary Sjögren's syndrome (SS). Methods. Expression of Fas, Fas ligand (FasL), and bcl‐2 in salivary gland biopsy material was detected in situ by immunohistochemical staining and reverse transcriptase‐polymerase chain reaction. DNA fragmentation in apoptotic cells was assessed by the enzymatic incorporation of labeled nucleotides (digoxigenin‐dUTP). Results. The acinar epithelial cells in SS were Fas+ and FasL+, and these cells died by apoptosis. The majority of infiltrating lymphocytes in SS were Fas+ and bcl‐2+, while few lymphocytes expressed FasL. In situ detection of apoptosis showed minimal cell death of lymphocytes, particularly in dense periductal foci. Lymphocytic cell death was significantly lower (P < 0.0001) in these foci compared with that in the interstitium. Conclusion. Infiltrating lymphocytes in the focal lesions of the salivary glands of patients with SS are blocked in their ability to commit to apoptosis, even though they may express Fas. The presence of bcl‐2 in these cells may explain their inability to undergo apoptosis. The acinar epithelial cells, in contrast, may undergo Fas‐mediated apoptosis. These results suggest that the Fas death pathway may be an important mechanism leading to the glandular destruction found in SS.

Objective Inter-observer agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy. Study Design Two adjacent serial histological sections of oral lesions from 846 patients were independently scored by two different pathologists from a pool of four. In instances where the original two pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review. Results Individual pathologist pair kappa values ranged from 0.251 – 0.706 (fair – good) before the 3-stage review process During the initial review phase, the two pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). Following the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis. Conclusion The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis.

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Objective: To assess the role of positron emission tomography (PET) in the management of unknown primary carcinoma of the head and neck region. Design and Setting: Prospective case series at an academic medical center. Patients: Twenty-six patients with an open excisional biopsyorafine-needleaspirationbiopsyfindingthatconfirmed squamous cell carcinoma of the cervical lymph nodes and no visible primary tumor (as determined by results of a comprehensive physical examination and computed tomography and/or magnetic resonance imaging) underwent PET. The standard evaluation consisted of a comprehensive head andneckexaminationthatincludedfiberopticlaryngoscopy/ nasopharyngoscopy, computed tomography and/or magnetic resonance imaging, and PET followed by panendoscopy with selected biopsies and tonsillectomy. Main Outcome Measures: Sensitivity, specificity, and positive and negative predictive values of PET to detect an occult primary tumor. (REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 131, JULY 2005 WWW.ARCHOTO.COM 626

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