Foamy gland carcinoma, an unusual variant of prostate carcinoma, is characterized by abundant xanthomatous cytoplasm. We studied 38 needle biopsies in which at least one core contained cancer with >20% foamy morphology. On average, each cancer was 72% foamy, and 11 cancers were entirely foamy. In addition to the characteristic cytoplasm, 20 cases had abundant intraluminal dense pink amorphous secretions. Nuclear enlargement and prominent nucleoli were either absent of rare in 23 (61%) and 27 (71%) of foamy gland carcinomas, respectively. High-molecular-weight cyto-keratin stains were done in 20 cases; 19 foamy gland carcinomas were negative, confirming the diagnosis of carcinoma and one case had keratin staining inconsistent with a known benign pattern. Of the 27 cases with associated ordinary gland carcinoma on needle biopsy, 26 (96%) were Gleason sum greater than 4. Subsequent radical prostatectomy (RP) and transurethral resection demonstrating cancer were available in 17 cases. Of the 15 subsequent RPs, only five were organ-confined and only one was Gleason sum less than 5. The cancers in the RP group ranged from 1 to 90% foamy (mean, 39%). Foamy gland carcinoma must be recognized as carcinoma by its abundant foamy cytoplasm, its architectural pattern of crowded or infiltrative glands, and frequently present pink acellular secretions. The more typical features of adenocarcinoma, nuclear enlargement and prominent nucleoli, are frequently absent. Its relatively benign cytology makes this lesion difficult to recognize as carcinoma; 74% of our cases were seen in consultation. Despite its benign cytology, foamy gland carcinoma is best classified as intermediate-grade carcinoma.

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Objectives: Law enforcement authorities are often charged with controlling resisting suspects. These encounters sometimes result in the sudden and unexpected death of the suspect. Drug intoxication, excited delirium syndrome, or excessive uses of force are factors that are often blamed, but sometimes the mechanism of these deaths is not fully understood. It is possible that worsening acidosis or excessive catecholamine release play a part. The objective of this study was to determine the effect on markers of acidosis and catecholamines of various tasks intended to simulate common arrest-related situations.Methods: Subjects were assigned to one of five task groups: 1) a 150-meter sprint and wall hurdle (simulated flight from arrest); 2) 45 seconds of striking a heavy bag (simulated physical resistance); 3) a 10-second TASER X26 electronic control device exposure; 4) a fleeing and resistance exercise involving a law enforcement dog (K-9); or 5) an oleoresin capsicum (OC) exposure to the face and neck. Baseline serum pH, lactate, potassium, troponin I, catecholamines, and creatine kinase (CK) were evaluated. Serum catecholamines, pH, lactate, and potassium were sampled immediately after the task and every 2 minutes for 10 minutes posttask. Vital signs were repeated immediately after the task. Serum CK and troponin I were evaluated again at 24 hours posttask.Results: Sixty-six subjects were enrolled; four did not complete their assigned task. One subject lost the intravenous (IV) access after completing the task and did not have data collected, and one subject only received a 5-second TASER device exposure and was excluded from the study, leaving 12 subjects in each task group. The greatest changes in acidosis markers occurred in the sprint and heavy bag groups. Catecholamines increased the most in the heavy bag group and the sprint group and increased to a lesser degree in the TASER, OC, and K-9 groups. Only the sprint group showed an increase in CK at 24 hours. There were no elevations in troponin I in any group, nor any clinically important changes in potassium. Conclusions:The simulations of physical resistance and fleeing on foot led to the greatest changes in markers of acidosis and catecholamines. These changes may be contributing or causal mechanisms in sudden custodial arrest-related deaths (ARDs). This initial work may have implications in guiding applications of force for law enforcement authorities (LEAs) when apprehending resisting subjects. ACADEMIC EMERGENCY MEDICINE 2010; 17:E60-E68 ª