We studied the cases of 353 patients with lymphoma involving the ocular adnexa diagnosed at the Massachusetts General Hospital between 1974 and 2005. The patients included 153 males and 200 females, aged 7 to 95 years, with a mean age of 64 years. In 277 cases, there was no known history of lymphoma. Seventy-six patients had a history of lymphoma, with the ocular adnexa being involved at relapse or with progression of the previously diagnosed lymphoma. The patients had marginal zone lymphoma (182 cases), follicular lymphoma (80 cases), mantle cell lymphoma (18 cases), small lymphocytic lymphoma/chronic lymphocytic leukemia (13 cases), lymphoplasmacytic lymphoma (4 cases), splenic marginal zone lymphoma (2 cases), low-grade B cell, not subclassified (19 cases), precursor B lymphoblastic lymphoma (3 cases), diffuse large B-cell lymphoma (26 cases), and 1 case each of high-grade B-cell lymphoma, not subclassified, peripheral T-cell lymphoma, unspecified type, extranodal NK/T-cell lymphoma, nasal type, and Hodgkin lymphoma, nodular sclerosis type. Almost all marginal zone lymphoma patients (168 of 182, 92%) had primary ocular adnexal lymphoma. Fourteen marginal zone lymphoma patients (8%) had a prior history of lymphoma, usually arising in another extranodal site. Twenty-five of 80 (31%) follicular lymphoma patients had a prior history of lymphoma, usually arising in lymph nodes. Patients with mantle cell lymphoma, chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, and splenic marginal zone lymphoma almost always had a prior history of lymphoma or were known to have widespread disease at the time of diagnosis of ocular adnexal lymphoma. A subset of the diffuse large B-cell lymphomas were associated with large destructive masses involving adjacent structures such as paranasal sinuses, raising the possibility that they may have arisen from one of the adjacent structures and involved the ocular adnexa by direct extension. The relatively high proportion of low-grade lymphoma, not subclassified, highlights the difficulty that may arise in distinguishing different types of low-grade lymphoma, particularly when biopsies are small and artifactually distorted. Ocular adnexal lymphoma is primarily a disease of older adults, with a slight female preponderance. Most lymphomas are low-grade B-cell lymphomas, with marginal zone lymphoma being by far the most common type. Marginal zone lymphoma typically involves the ocular adnexa primarily, whereas other types of low-grade B-cell lymphoma often involve the ocular adnexa secondarily. High-grade B-cell lymphomas only occasionally involve the ocular adnexa, and T-cell lymphoma, NK-cell lymphoma, and Hodgkin lymphoma are only rarely encountered in this site.

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How does language reliably evoke emotion, as when reading a favorite novel or listening to a skilled orator? Recent evidence suggests that comprehension involves a mental simulation of sentence content that calls on the same neural systems used in literal action, perception, and emotion. Here we demonstrate a causal role of involuntary facial expression in the processing of emotional language. Subcutaneous injections of botulinum toxin-A (BTX) were used to temporarily paralyze the facial muscle used in frowning. We found that BTX selectively slowed the reading of sentences with content that normally requires the paralyzed muscle for expression of a congruent emotion. This finding demonstrates a role of peripheral feedback in language processing, supports facial feedback theories of emotional cognition, and raises questions about effects of Botox on cognition and emotional reactivity. We account for the role of facial feedback in language processing by considering neurophysiological mechanisms and reinforcement learning theory.Is language comprehension the manipulation of abstract symbols by rules of syntax (e.g., Chomsky, 1959)? Recent behavioral and neuroscientific evidence suggests that comprehension involves a mental simulation of sentence content (Barsalou, 1999) that calls on the same neural systems used in literal action, perception, and emotion (Glenberg & Kaschak, 2002;Havas, Glenberg, & Rinck, 2007;Niedenthal, 2007;Pulvermüller, 2005). Here we demonstrate a causal role of involuntary facial expression in processing of emotional language. Havas et al. (2007) provide evidence for emotion simulation in language. Participants read and judged the valence of sentences describing pleasant situations ("You execute the difficult dive flawlessly") and unpleasant situations ("The police car pulls up behind you, siren blaring") while reading times were measured. Participants were instructed to hold a pen either in the teeth (to produce a smile) or in the lips (to prevent a smile) while reading. This procedure reliably induces emotional states in participants in the absence of awareness (Strack, Martin, & Stepper, 1988). As predicted, reading times for sentences describing pleasant situations were faster while participants were smiling than while they were prevented from smiling, and the reverse was found for unpleasant sentences. Thus, facial As a prelude to the current research, previous work (e.g., Niedenthal, Winkielman, Mondillon, & Vermeulen, 2009) has demonstrated that reading words describing emotions selectively activates facial muscles: Negative emotion words activate corrugator supercilii and positive emotion words activate zygomaticus. In addition, in an unreported experiment using the sentences described below, we verified that our happy sentences activated zygomaticus more than did sad and angry sentences, whereas sad and angry sentences more strongly activated corrugator supercilii than did happy sentences (see supporting information available on-line).The question we tested here is whether th...

We update the medical literature with 13 MAC cases treated by MMS. To our knowledge there have been 148 cases of MAC reported in the world literature. Including our series, there have been 73 cases of MAC treated with MMS. There were only four treatment failures. Regional and/or distant metastasis from MAC is rare, with only one reported death. Following MMS, the 2-year success rate was 89.7% (35 of 39). The accumulated data continue to confirm that when MAC is discovered early and is readily accessible to excision by MMS and other subspecialty support, a favorable outcome can be expected.

We present nine new cases of SC. The age, sex, and site distribution are compatible with other SC cases reported in the literature. We reviewed the medical literature and compiled 49 cases of SC treated by Mohs surgery. Intraepithelial spread was discovered in 50% of the cases. Multifocal disease or discontinuity was present in 6% (3 of 49). Mohs surgery appears to be an effective method for excising the microscopic ramifications of primary SC. When feasible, we recommend in SC cases where intraepithelial pagetoid spread has been observed, that removal of another Mohs layer should be considered in order to provide an additional assurance layer against local tumor recurrence.