Streptococcus gallolyticus, subspecies gallolyticus (Sgg) is a gram-positive bacterium associated with infective endocarditis and colorectal cancer (CRC). Sgg has features that allow the bacterium to thrive in the colorectal tumor microenvironment and further progress the development of CRC to facilitate its survival. Sgg contains 3 pili that facilitate colonic cell adhesion and translocation through phase variation. Sgg also contains bile salt hydrolase and a bacteriocin called gallocin with substantially increased activity in bile acids, which facilitates its growth in the bile acid-rich adenomatous colorectal microenvironment. Sgg also uses tumor metabolites as an energy source. Sgg also possesses tannase, which metabolizes gallotannin to be used as a carbon source and reduces the anti-apoptotic effects of tannins, driving CRC progression. Sgg also interferes with a variety of oncogenic cell signaling pathways, including the Wnt/β-catenin pathway through mechanisms that are not fully elucidated. Increased β-catenin signaling also enhances adhesion via increased expression of the extracellular matrix and increases bile acid concentrations in the lumen through downregulation of an apical bile acid transporter. Finally, Sgg induces biotransformation of toxic substrates in CRC cells, which leads to formation of toxic intermediates and DNA adducts, promoting further progression of CRC.

Prospective cohort studies suggest that higher intakes of dairy products, in particular milk, are associated with a decreased risk of colorectal cancer (CRC). In Western populations, dairy products are major contributors to dietary Ca, which may have chemopreventive effects in the colon. The pooling of data from prospective studies suggests a significant protective effect of Ca on CRC risk. Randomised controlled trials with Ca supplements have been conducted with both colorectal adenoma and CRC as endpoints. Results suggest that Ca supplementation at a level of 1000–2000 mg/d reduces adenoma recurrence in individuals with a previous adenoma but has no effect on CRC incidence. There is evidence that the risk reduction from dairy foods may not be solely due to their high Ca content. Dairy products contain other potential chemopreventive components such as vitamin D, butyric acid, conjugated linoleic acid, sphingolipids, and probiotic bacteria in fermented products such as yoghurt. The present review will focus on the epidemiological evidence (and in particular prospective cohort studies) investigating the relationship between dairy product consumption and risk of CRC. An outline of the proposed mechanisms responsible for the protective effect of both Ca and other potential chemopreventive components in dairy products will also be presented.

Tubular apocrine adenoma (TAA) is a very rare sweat gland tumour. Comprehensive review of the literature reveals that TAA in the external auditory canal (EAC) has not yet been reported. We report a case of TAA in the EAC, together with characteristic histopathological findings.

Congenital absence of the parotid gland is extremely infrequent. We presenthere a case of unilateral parotid gland agenesis with pleomorphic adenoma of the contralateral parotid gland. Even though pleomorphic adenoma is the most common tumour of the parotid gland, to our knowledge this is the first case of these two conditions being seen together.

This study examines the expression HO-1 and HO-2 isozymes in human parotid pleomorphic adenomas. They are members of the heat shock protein family, and are thought to play a role in the regulation of tumoral blood flow. Immunocytochemistry using antibodies specific for HO-1 and HO-2 were undertaken in 12 pleomorphic adenoma specimens, all sections of which contained adjacent normal salivary tissue. Normal salivary gland acini and ducts displayed significantly stronger immunoreactivity for HO-2 compared to tumour cells (p < 0.001). Expression for HO-1 was minimal in both normal salivary gland acini and tumour cells with no difference (p = 1.000). However, positive staining for HO-1 was seen in normal salivary ducts and in pleomorphic adenomas showing ductal differentiation. In conclusion, this is the first study to examine the expression of HO-1 and HO-2 within normal salivary glands and pleomorphic adenomas. Our findings suggest that HO may be implicated in the pathogenesis of salivary pleomorphic adenomas.

Canalicular adenomas are a rare form of benign tumour that occur in salivary glands, occurring mainly in the upper lip and minor salivary glands of the buccal mucosa. The authors report the fifth case and the first in the otorhinolaryngological literature of a canalicular adenoma of the parotid gland. Its specific histological features are difficult to detect on fine needle aspiration and its multifocal nature can lead to recurrence and this must be considered in the clinical management.

The advantages of endoscopic transnasal pituitary surgery include a panoramic view of the area and easy reoperation. Based on this, we performed a planned staged operation in two cases of large pituitary adenomas, extending to the suprasellar lesion, using the endoscopic transnasal trans-sphenoidal approach via both nostrils. In the initial operation, a tumour mass was from the intrasellar region, however, that part of it in contact with the tumour capsule was left intact for prevention of peri-operative injury. The residual mass descended into the sellar floor at the second operation, and was easily resected with no complications. A staged operation by the endoscopic transnasal approach, although it requires two operations, is thought to be a safe and efficient procedure for the removal of large pituitary tumours.

Middle-ear adenoma has been reported only in small numbers by surgeons. The few large series reported have been presented by histopathologists. We add two cases of middle-ear adenoma to the published literature, together with pre-, per- and post-operative imaging of one case, as a demonstration of this rare clinical entity. We discuss the pathology of middle-ear adenoma, its diagnosis and treatment, and suggest ways of improving its management.

A case of an 87-year-old female with pleomorphic adenoma of the tongue base is reported, with a review of the literature. The tumour had enlarged gradually over a period of three years, causing dysphagia and dysphasia. Computed tomography and magnetic resonance imaging showed that the tumour was exophytic and occupy the oropharynx with little extension into the muscle tissue. The tumour was resected by CO2 laser. Histological examination revealed a benign pleomorphic adenoma that originated from the minor salivary gland of the tongue base.

A rare case of an intratemporal pleomorphic adenoma is presented and the management of such a tumour is discussed. Some anatomical aspects of the facial nerve, pertinent to the pathophysiology of facial paralysis are outlined. This case demonstrates that tumour extension into the temporal bone can be resected successfully at initial surgery with excellent facial nerve functional outcome. We advocate exploration of the fallopian canal to be carried out at primary surgery and be performed by a surgeon familiar with the surgical anatomy of the intratemporal segment of the facial nerve. This approach will reduce the risk of facial nerve injury and palsy both at surgery and subsequently.

A case is reported of a pleomorphic adenoma of the minor salivary glands of the oral cavity presenting with acute airway obstruction. This is the first reported case to our knowledge of a mixed salivary tumour of the upper respiratory tract causing upper airway obstruction and acute respiratory failure. The patient had to be intubated and transferred to the intensive care unit. After an elective tracheostomy was performed, the adenoma was excised from its fibrous capsule. It was found to originate from the soft palate and occupied the parapharyngeal space. A high index of suspicion should be kept in order to diagnose tumours of the parapharyngeal space with unusual presentation. These tumours which are usually benign should be considered in the differential diagnosis from more common infectious or traumatic conditions and surgical morbidity should be minimal.

The brown tumour of hyperparathyroidism is a localized bone tumour and an uncommon manifestation of hyperparathyroidism. A 27-year-old woman presented with a mandibular 8 × 10 cm solid mass diagnosed as central giant cell granuloma. Chemical blood analysis revealed increased serum calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124 pg/dL. The patient underwent surgery with removal of a parathyroid mass. Histologically, this parathyroid tissue was seen to be limited by a fibrous capsule with morphological features consistent with atypical parathyroid adenoma. The mandibular tumour has receded and the patient declined further procedures. This is the first case reported of brown tumour as the primary manifestation of an atypical parathyroid adenoma, a lesion that shares some features with parathyroid carcinoma without the unequivocal properties of malignancy.

A rare case of bilateral basal-cell adenomas in the parotid glands of a 65-year-old woman is reported. There have been only four previous reported cases of bilateral parotid basal-cell adenomas, all of which occurred synchronously with dermal cylindromas. The present lesion is the first case reported in the English literature of bilateral parotid basal-cell adenoma without coexisting dermal cylindroma. Histological examination revealed that the left tumour had adenoid cystic change, which closely resembled adenoid cystic carcinoma. This case is of interest not only because of the raity of bilateral parotid basal-cell adenomas, but also because of the necessity for differentiation from adenoid cystic carcinoma in order to plan appropriate treatment.

Familial autosomal dominant cylindromatosis (FADC, turban tumour syndrome, Brooke-Spiegler-syndrome and many more, MacKusick catalogue numbers 123850, 313100) is a rare hereditary disease usually presenting in the second or third decade. With female preponderance dermal cylindromas predominantly arise in hairy areas of the body with approximately 90 per cent on the head and neck. Transformation to malignancy seems to be scarce. Although cylindromas of the skin resemble basal cell adenomas of the salivary gland, there is usually no salivary gland involvement. On the other hand, patients with basal cell adenomas of a salivary gland usually do not show dermal lesions. We report one of the rare cases of FADC combined with multiple basal cell adenomas of the parotid glands and present a review of the literature.

Radiological findings including ultrasonography, computed tomography (CT) and Tc-99m sestamibi scintigraphy of a patient with multilocular giant parathyroid adenoma which caused hypercalcaemic crisis are presented. The location of the tumour by grey scale sonography, CT and Tc-99m sestamibi scintigraphy was not certain because the tumour was uncommon in shape, location, size and internal structure. Whereas, increased flow in the solid portion of the mass was demonstrated on power Doppler sonography, which proved to reflect abundant vessels in the adenoma in pathological findings.

Spontaneous massive haemorrhage form a parathyroid adenoma is rare. It can cause extensive cervical ecchymosis as well as compression of structures within the neck. We present a case, discuss the diagnostic features and review the literature

An ectopic functioning pituitary in the sphenoid is an extremely rare occurrence, and even rarer is pituitary adenoma causing symptoms of Nelson's syndrome. A case is presented of a young female diagnosed and treated in our clinic. The only functioning hypophyseal tissue was detected inside the sphenoid, as the pituitary gland had been radiated because of Cushing's syndrome 10 years before and imaging studies revealed an empty sella.