Efficiency benchmarking of wastewater service providers: An analysis based on the Portuguese case

Sustainability is increasingly important in the wastewater treatment sector, and benchmarking studies are needed to identify the best practices in using resources efficiently. This work addresses this need by characterizing and benchmarking this sector in Portugal. Data from around 120 service providers, from 2015 to 2019, regarding inputs consumption, desirable and undesirable outputs, are used in a data envelopment analysis to benchmark these operators and to determine improvement potentials. A productivity change analysis revealed an increase from 2015 to 2019, essentially due to an increased technical efficiency. On the other hand, no real technological change seems to have occurred. A positive effect of the service providers dimension and certifications (quality, environmental and energy) on efficiency was found. Service providers with concessionary governance models and urban typology presented the highest efficiencies, whereas treatment plants underuse contributed negatively to efficiency. These results can inform the definition of strategic policies for the water sector, namely concerning the aggregation of small providers. The proposed methodology, based on the use of a comprehensive new set of studied variables and explanatory factors, allowed to determine the best characteristics regarding the techno-economic efficiency of Portuguese service providers, and can potentially be applied to identify role models in other countries.

Quantitative image analysis as a robust tool to assess effluent quality from an aerobic granular sludge system treating industrial wastewater

Quantitative image analysis (QIA) is a simple and automated method for process monitoring, complementary to chemical analysis, that when coupled to mathematical modelling allows associating changes in the biomass to several operational parameters. The majority of the research regarding the use of QIA has been carried out using synthetic wastewater and applied to activated sludge systems, while there is still a lack of knowledge regarding the application of QIA in the monitoring of aerobic granular sludge (AGS) systems. In this work, chemical oxygen demand (COD), ammonium (N-NH₄⁺), nitrite (N-NO₂^-), nitrate (N-NO₃^-), salinity (Cl^-), and total suspended solids (TSS) levels present in the effluent of an AGS system treating fish canning wastewater were successfully associated to QIA data, from both suspended and granular biomass fractions by partial least squares models. The correlation between physical-chemical parameters and QIA data allowed obtaining good assessment results for COD (R² of 0.94), N-NH₄⁺ (R² of 0.98), N-NO₂^- (R² of 0.96), N-NO₃^- (R² of 0.95), Cl^- (R² of 0.98), and TSS (R² of 0.94). While the COD and N-NO₂^- assessment models were mostly correlated to the granular fraction QIA data, the suspended fraction was highly relevant for N-NH₄⁺ assessment. The N-NO₃^-, Cl^- and TSS assessment benefited from the use of both biomass fractions (suspended and granular) QIA data, indicating the importance of the balance between the suspended and granular fractions in AGS systems and its analysis. This study provides a complementary approach to assess effluent quality parameters which can improve wastewater treatment plants monitoring and control, with a more cost-effective and environmentally friendly procedure, while avoiding daily physical-chemical analysis.

Assessment of an aerobic granular sludge system in the presence of pharmaceutically active compounds by quantitative image analysis and chemometric techniques

In this study, a sequencing batch reactor (SBR) with aerobic granular sludge (AGS) was operated with synthetic wastewater containing environmental relevant concentrations of 17β-estradiol (E2), 17α-ethinylestradiol (EE2) and sulfamethoxazole (SMX). Despite the presence of the studied PhAC, the granular fraction clearly predominated (TSS_gran/TSS ranging from 0.82 to 0.98) throughout the monitoring period, presenting aggregates with high organic fraction (VSS/TSS above 0.83) and good settling characteristics (SVI₅ ranging from 15 to 39 mL/gTSS). A principal component analysis (PCA) with quantitative image analysis (QIA) based data allowed to distinguish the different operational periods, namely with mature granules (CONT), and the E2, EE2, and SMX feeding periods. It further revealed a positive relationship between the biomass density, sludge settling ability, overall and granular biomass contents, granulation properties, granular biomass fraction and large granules fraction and size. Moreover, a discriminant analysis (DA) allowed to successfully discriminate not only the different operational periods, mainly by using the floccular apparent density, granular stratification and contents data, but also the PhAC presence in samples. The filamentous bacteria contents, sludge settling properties, settling properties stability and granular stratification, structure and contents parameters were found to be crucial for that purpose.

Environmentally-friendly technology for rapid identification and quantification of emerging pollutants from wastewater using infrared spectroscopy

The monitoring of emerging pollutants in wastewaters is nowadays an issue of special concern, with the classical quantification methods being time and reagent consuming. In this sense, a FTIR transmission spectroscopy based chemometric methodology was developed for the determination of eight of these pollutants. A total of 456 samples were, therefore, obtained, from an activated sludge wastewater treatment process spiked with the studied pollutants, and analysed in the range of 200 cm^-1 to 14,000 cm^-1. Then, a k-nearest neighbour (kNN) analysis aiming at identifying each sample pollutant was employed. Next, partial least squares (PLS) and ordinary least squares (OLS) modelling approaches were employed in order to obtain suitable prediction models. This procedure resulted in good prediction abilities regarding the estimation of atrazine, desloratadine, paracetamol, β-estradiol, ibuprofen, carbamazepine, sulfamethoxazole and ethynylestradiol concentrations in wastewaters. These promising results suggest this technology as a fast, eco-friendly and reagent free alternative methodology for the quantification of emerging pollutants in wastewaters.

Quantification of pharmaceutical compounds in wastewater samples by near infrared spectroscopy (NIR)

The quantification of pollutants, as pharmaceuticals, in wastewater is an issue of special concern. Usually, typical methods to quantify these products are time and reagent consuming. This paper describes the development and validation of a Fourier transform near-infrared (FT-NIR) spectroscopy methodology for the quantification of pharmaceuticals in wastewaters. For this purpose, 276 samples obtained from an activated sludge wastewater treatment process were analysed in the range of 200 cm^-1 to 14,000 cm^-1, and further treated by chemometric techniques to develop and validate the quantification models. The obtained results were found adequate for the prediction of ibuprofen, sulfamethoxazole, 17β-estradiol and carbamazepine with coefficients of determination (R²) around 0.95 and residual prediction deviation (RPD) values above four, for the overall (training and validation) data points. These results are very promising and confirm that this technology can be seen as an alternative for the quantification of pharmaceuticals in wastewater.

Use of chemometric analyses to assess biological wastewater treatment plants by protozoa and metazoa monitoring

Protozoa and metazoa biota communities in biological wastewater treatment plants (WWTP) are known to be dependent of both the plant type (oxidation ditch, trickling filter, conventional activated sludge, among others) and the working operational conditions (incoming effluent characteristics, toxics presence, organic load, aeration, hydraulic and sludge retention times, nitrification occurrence, etc.). Thus, for analogous WWTP operating in equivalent operating conditions, similar protozoa and metazoa communities can be found. Indeed, the protozoa and metazoa biota monitoring can be considered a quite useful tool for assessing the functioning of biological WWTP. Furthermore, the use of chemometric techniques in WWTP monitoring is becoming widespread to enlighten interrelationships within the plant, especially when a large collection of data can be obtained. In the current study, the protozoa and metazoa communities of three different types of WWTP, comprising one oxidation ditch, four trickling filters, and three conventional activated sludge plants, were monitored. For that purpose, metazoa, as well as the main protozoa groups (flagellates, free-swimming, crawling and sessile ciliates, and testate amoeba) were determined in terms of contents and relative abundance. The collected data was further processed by chemometric techniques, such as cross-correlation, principal components, multivariate ANOVA, and decision trees analyses, allowing to successfully identify, and characterize, the different studied WWTP, and thus, being able to help monitoring and diagnosing operational problems.

Genetic diversity of Saccharum complex using ISSR markers

Sugarcane (Saccharum sp, Poaceae) is native to Southeast Asia, and due to growing demand as raw material, its cultivation recently expanded to new frontiers. The genetic diversity analysis is essential for targeting strategies in the formation and maintenance of a germplasm. This study aimed to assess the genetic diversity of 26 accessions of sugarcane from the Active Germplasm Bank of Embrapa Coastal Tablelands, using inter-simple sequence repeat (ISSR) molecular markers. Sixteen primers were used, resulting in 87 fragments with 91.13% of polymorphism. The similarity of the individuals ranged between 0.22 and 0.87. Individuals RB867515 and RB92579 were closer genetically, and the most distant ones were PI240785 and NSL 291970. Four distinct clusters were formed, using UPGMA. This information can be used to prioritize the selection of accessions for the conduction of hybridization in breeding and germplasm exchange actions.

Polyhydroxyalkanoate granules quantification in mixed microbial cultures using image analysis: Sudan Black B versus Nile Blue A staining

Polyhydroxyalkanoates (PHA) can be produced and intracellularly accumulated as inclusions by mixed microbial cultures (MMC) for bioplastic production and in enhanced biological phosphorus removal (EBPR) systems. Classical methods for PHA quantification use a digestion step prior to chromatography analysis, rendering them labor intensive and time-consuming. The present work investigates the use of two quantitative image analysis (QIA) procedures specifically developed for PHA inclusions identification and quantification. MMC obtained from an EBPR system were visualized by bright-field and fluorescence microscopy for PHA inclusions detection, upon Sudan Black B (SBB) and Nile Blue A (NBA) staining, respectively. The captured color images were processed by QIA techniques and the image analysis data were further treated using multivariate statistical analysis. Partial least squares (PLS) regression coefficients of 0.90 and 0.86 were obtained between QIA parameters and PHA concentrations using SBB and NBA, respectively. It was found that both staining procedures might be seen as alternative methodologies to classical PHA determination.

Monitoring intracellular polyphosphate accumulation in enhanced biological phosphorus removal systems by quantitative image analysis

A rapid methodology for intracellular storage polyphosphate (poly-P) identification and monitoring in enhanced biological phosphorus removal (EBPR) systems is proposed based on quantitative image analysis (QIA). In EBPR systems, 4',6-diamidino-2-phenylindole (DAPI) is usually combined with fluorescence in situ hybridization to evaluate the microbial community. The proposed monitoring technique is based on a QIA procedure specifically developed for determining poly-P inclusions within a biomass suspension using solely DAPI by epifluorescence microscopy. Due to contradictory literature regarding DAPI concentrations used for poly-P detection, the present work assessed the optimal DAPI concentration for samples acquired at the end of the EBPR aerobic stage when the accumulation occurred. Digital images were then acquired and processed by means of image processing and analysis. A correlation was found between average poly-P intensity values and the analytical determination. The proposed methodology can be seen as a promising alternative procedure for quantifying intracellular poly-P accumulation in a faster and less labour-intensive way.

Quantitative image analysis for the characterization of microbial aggregates in biological wastewater treatment: a review

Quantitative image analysis techniques have gained an undeniable role in several fields of research during the last decade. In the field of biological wastewater treatment (WWT) processes, several computer applications have been developed for monitoring microbial entities, either as individual cells or in different types of aggregates. New descriptors have been defined that are more reliable, objective, and useful than the subjective and time-consuming parameters classically used to monitor biological WWT processes. Examples of this application include the objective prediction of filamentous bulking, known to be one of the most problematic phenomena occurring in activated sludge technology. It also demonstrated its usefulness in classifying protozoa and metazoa populations. In high-rate anaerobic processes, based on granular sludge, aggregation times and fragmentation phenomena could be detected during critical events, e.g., toxic and organic overloads. Currently, the major efforts and needs are in the development of quantitative image analysis techniques focusing on its application coupled with stained samples, either by classical or fluorescent-based techniques. The use of quantitative morphological parameters in process control and online applications is also being investigated. This work reviews the major advances of quantitative image analysis applied to biological WWT processes.

Prediction of intracellular storage polymers using quantitative image analysis in enhanced biological phosphorus removal systems

The present study focuses on predicting the concentration of intracellular storage polymers in enhanced biological phosphorus removal (EBPR) systems. For that purpose, quantitative image analysis techniques were developed for determining the intracellular concentrations of PHA (PHB and PHV) with Nile blue and glycogen with aniline blue staining. Partial least squares (PLS) were used to predict the standard analytical values of these polymers by the proposed methodology. Identification of the aerobic and anaerobic stages proved to be crucial for improving the assessment of PHA, PHB and PHV intracellular concentrations. Current Nile blue based methodology can be seen as a feasible starting point for further enhancement. Glycogen detection based on the developed aniline blue staining methodology combined with the image analysis data proved to be a promising technique, toward the elimination of the need for analytical off-line measurements.

Identifying different types of bulking in an activated sludge system through quantitative image analysis

The present study proposes an image analysis methodology for the identification of different types of disturbances in wastewater treatment activated sludge systems. Up to date, most reported image analysis methodologies have been used in activated sludge processes with the aim of filamentous bulking detection, however, other disturbances could be foreseen in wastewater treatment plants. Such disturbances can lead to fluctuations in the biomass contents, affecting the mixed liquor suspended solids (MLSS), and in the sludge settling ability, affecting the sludge volume index (SVI). Therefore, this work focuses on predicting the MLSS and SVI parameters for different types of disturbances affecting an activated sludge system. Four experiments were conducted simulating filamentous bulking, zoogleal or viscous bulking, pinpoint floc formation, and normal operating conditions. Alongside the MLSS and SVI determination, the aggregated and filamentous biomass contents and morphology were studied as well as the biomass Gram and viability status, by means of image analysis.

Dilution and magnification effects on image analysis applications in activated sludge characterization

The properties of activated sludge systems can be characterized using image analysis procedures. When these systems operate with high biomass content, accurate sludge characterization requires samples to be diluted. Selection of the best image acquisition magnification is directly related to the amount of biomass screened. The aim of the present study was to survey the effects of dilution and magnification on the assessment of aggregated and filamentous bacterial content and structure using image analysis procedures. Assessments of biomass content and structure were affected by dilutions. Therefore, the correct operating dilution requires careful consideration. Moreover, the acquisition methodology comprising a 100× magnification allowed data on aggregated and filamentous biomass to be determined and smaller aggregates to be identified and characterized, without affecting the accuracy of lower magnifications regarding biomass representativeness.

A Comparison between bright field and phase-contrast image analysis techniques in activated sludge morphological characterization

Different approaches using microscopy image analysis procedures were employed for characterization of activated sludge systems. The approaches varied mainly on the type of visualization and acquisition method used for collection of data. In this context, this study focused on the comparison of the two most common acquisition methods: bright field and phase-contrast microscopy. Images were acquired from seven different wastewater treatment plants for a combined period of two years. Advantages and disadvantages of each acquisition technique and the results are discussed. Bright field microscopy proved to be more simple and inexpensive and provided the best overall results.

Monitoring of activated sludge settling ability through image analysis: validation on full-scale wastewater treatment plants

In recent years, a great deal of attention has been focused on the research of activated sludge processes, where the solid-liquid separation phase is frequently considered of critical importance, due to the different problems that severely affect the compaction and the settling of the sludge. Bearing that in mind, in this work, image analysis routines were developed in Matlab environment, allowing the identification and characterization of microbial aggregates and protruding filaments in eight different wastewater treatment plants, for a combined period of 2 years. The monitoring of the activated sludge contents allowed for the detection of bulking events proving that the developed image analysis methodology is adequate for a continuous examination of the morphological changes in microbial aggregates and subsequent estimation of the sludge volume index. In fact, the obtained results proved that the developed image analysis methodology is a feasible method for the continuous monitoring of activated sludge systems and identification of disturbances.

Recognition of protozoa and metazoa using image analysis tools, discriminant analysis, neural networks and decision trees

Protozoa and metazoa are considered good indicators of the treatment quality in activated sludge systems due to the fact that these organisms are fairly sensitive to physical, chemical and operational processes. Therefore, it is possible to establish close relationships between the predominance of certain species or groups of species and several operational parameters of the plant, such as the biotic indices, namely the Sludge Biotic Index (SBI). This procedure requires the identification, classification and enumeration of the different species, which is usually achieved manually implying both time and expertise availability. Digital image analysis combined with multivariate statistical techniques has proved to be a useful tool to classify and quantify organisms in an automatic and not subjective way. This work presents a semi-automatic image analysis procedure for protozoa and metazoa recognition developed in Matlab language. The obtained morphological descriptors were analyzed using discriminant analysis, neural network and decision trees multivariable statistical techniques to identify and classify each protozoan or metazoan. The obtained procedure was quite adequate for distinguishing between the non-sessile protozoa classes and also for the metazoa classes, with high values for the overall species recognition with the exception of sessile protozoa. In terms of the wastewater conditions assessment the obtained results were found to be suitable for the prediction of these conditions. Finally, the discriminant analysis and neural networks results were found to be quite similar whereas the decision trees technique was less appropriate.

Development of an image analysis procedure for identifying protozoa and metazoa typical of activated sludge system

A procedure for the semi-automatic identification of the main protozoa and metazoa species present in the activated sludge of wastewater treatment plants was developed. This procedure was based on both image processing and multivariable statistical methodologies, leading to the use of the image analysis morphological descriptors by discriminant analysis and neural network techniques. The image analysis program written in Matlab has proved to be adequate in terms of protozoa and metazoa recognition, as well as for the operating conditions assessment.

Effect of hyperbaric stress on yeast morphology: study by automated image analysis

The effects of hyperbaric stress on the morphology of Saccharomyces cerevisiae were studied in batch cultures under pressures between 0.1 MPa and 0.6 MPa and different gas compositions (air, oxygen, nitrogen or carbon dioxide), covering aerobic and anaerobic conditions. A method using automatic image analysis for classification of S. cerevisiae cells based on their morphology was developed and applied to experimental data. Information on cell size distribution and bud formation throughout the cell cycle is reported. The results show that the effect of pressure on cell activity strongly depends on the nature of the gas used for pressurization. While nitrogen and air to a maximum of 0.6 MPa of pressure were innocuous to yeast, oxygen and carbon dioxide pressure caused cell inactivation, which was confirmed by the reduction of bud cells with time. Moreover, a decrease in the average cell size was found for cells exposed for 7.5 h to 0.6 MPa CO2.

Development of image analysis techniques as a tool to detect and quantify morphological changes in anaerobic sludge: II. Application to a granule deterioration process triggered by contact with oleic acid

Image analysis techniques are applied to monitor the morphological changes in granular sludge present in an expanded granular sludge blanket (EGSB) reactor fed with oleic acid. Deterioration of granular sludge was monitored along the trial period by measuring the percentage of aggregates smaller than 1 mm (in terms of Feret diameter) either in terms of projected area or in terms of number of aggregates. A good correlation was obtained between these values and the percentage of aggregates smaller than 1 mm were physically sorted and quantified by the volatile suspended solid content. The ratio of total filaments length to cross-sectional area of aggregates defined as LfA, was applied to quantify the dispersion level of the granular sludge, which increased until day 141 and remained almost invariant afterwards. LfA was sensitive to the sludge deterioration process and was able to indicate, with the anticipation of about 1 month, the most significant biomass washout episode that occurred in the trial period. A mechanism of filaments' release, detachment and selective washout was proposed to explain the action of LfA from this viewpoint. The equivalent diameter of the bottom aggregates larger than 1 mm increased with the increase on the amount of long chain fatty acids associated with the biomass by mechanisms of adsorption, precipitation, or entrapment. After a threshold value of about 200 mg COD-LCFA gVSS (COD = chemical oxygen demand; LCFA = long chain fatty acids; VSS = volatile suspended solids), a migration of granular sludge from the bottom to a top-floating layer was evident.

Development of image analysis techniques as a tool to detect and quantify morphological changes in anaerobic sludge: I. Application to a granulation process

Image analysis techniques were developed and applied to quantify the process of anaerobic granulation in an expanded granular sludge blanket reactor (EGSB) fed with a synthetic substrate based on glucose [60-30% COD (chemical oxygen demand)] and volatile fatty acids (40-70% COD) over 376 days. In a first operation period that lasted 177 days, the aggregation of dispersed sludge was quantitatively monitored through the recognition and quantification of aggregates and filaments. A parameter defined as the ratio between the filaments' length and the aggregates projected area (LfA) has proven to be sensitive to detect changes in the aggregation status of the anaerobic sludge. The aggregation time-defined as the moment when a balance between filaments' length and aggregates' size was established-was recognized through the LfA. The percentage of projected area of aggregates within three size ranges (0.01-0.1 mm, 0.1-1 mm, and >1 mm, equivalent diameter) reflected the granular size spectrum during the aggregation process. When sudden increases on the upflow velocity and on the organic loading rate were applied to the previously formed granules, the developed image analysis techniques revealed to be good indicators of granular sludge stability, since they were sensitive to detected filaments release, fragmentation, and erosion that usually leads to washout. The specific methanogenic activities in the presence of acetate, propionate, butyrate, and H(2)/CO(2) increased along the operation, particularly relevant was the sudden increase in the specific hydrogenophilic activity, immediately after the moment recognized as aggregation time.

Automated image analysis to improve bead ingestion toxicity test counts in the protozoan Tetrahymena pyriformis

AIMS

To improve bead ingestion counts in Tetrahymena pyriformis by automated image analysis as an alternative to direct-counts.

METHODS AND RESULTS

Fluorescent latex beads were added to T. pyriformis cultures for ingestion tests. The number of beads ingested by 25 cells was counted directly by epifluorescence microscopy and compared with similar data from image analysis. anova indicated that counts were not significantly different (P < 0.05). The image analysis particularly provided advantages in terms of speed.

CONCLUSIONS

The image analysis is superior to direct beads counting in T. pyriformis particularly in terms of speed of analysis.

SIGNIFICANCE AND IMPACT OF THE STUDY

The image analysis method is very rapid and will allow many more toxicological analyses to be undertaken with less operator error.

Morphological analysis of Yarrowia lipolytica under stress conditions through image processing

Stress conditions (thermal and oxidative) were applied to Yarrowia lipolytica culture. A rearrangement in cell metabolism as well as dimorphism was observed under these conditions. An image analysis procedure was employed for morphology characterization, and a net increase of around 25% on hyphae formation was detected. A significant increment in total hyphal length was detected, compared with the control system. The results obtained lead to the consideration of a possible relationship between dimorphism and a cell response mechanism to stress conditions.

Image analysis, methanogenic activity measurements, and molecular biological techniques to monitor granular sludge from an EGSB reactor fed with oleic acid

Morphological changes in anaerobic granular sludge fed with increasing loads of oleic acid were quantified by image analysis. The combination of this technique with data on the accumulation of adsorbed long chain fatty acid and with the molecular characterization of microbial community gave insight into the mechanisms of sludge disintegration, flotation and washout. It was found that the bacterial domain was more affected than the archaeal domain during this process. However, no acetoclastic activity and onlya residual hydrogenotrophic activity were detected in the sludge at the end of the operation.

[Polyneuropathy deficiency among Xavante indians]

The authors present two cases of polyneuropathy deficiency among Xavante indians where the sole food was rice in case 1 and almost so in case 2. The rice consumed by these indians was processed or hulled. Intoxication by cyanide from maniot or other vegetable was excluded.

CASE REPORT

Two indians aged 18 and 25 years with a progressive history of weaness, decrease in muscular force and thinning were observed in their villages. On removal to the Hospital São Paulo, atrophy of the distal musculature of the upper and lower limbs, motor deficit distally with zero degree in the flexor musculature, abolished deep reflexes, plantar cutaneous reflex without response bilaterally, decreased tactile, painful and pallesthetic sensitivity distally in the lower limbs were noted on neurological examination of case 1. On neurological examination of case 2 proximal hyporeflexia in the upper limbs, areflexia in the distal portions of the upper and lower limbs, tactile and painful hypoesthesia in the feet, right hypoacousis were noted. Electromyography showed abnormalities compatible with symmetric sensorimotor polyneuropathy with an axonal demyelination pattern in case 1 and predominantly demyelinizing in case 2. Cerebrospinal fluid tests were normal.

DISCUSSION

Polyneuropathy was characterized by the clinical history and by neurological, electromyographic and cerebrospinal fluid tests. The diagnosis of polyneuropathy deficiency was established by the clinical history and by electromyography suggesting peripheral polyneuropathy of nutritional origin. This neuropathy deficiency does not fit myeloneuropathies such as ataxic tropical neuropathy, spastic paraparesis and Cuba neuropathy.

CONCLUSION

The Xavante polyneuropathy deficiency is caused by thiamine (vitamin B1) deficiency, that is dry beriberi, owing to consumption of industrially processed rice as sole or almost sole food. The Xavante polyneuropathy is different from the neuropathy observed among Kreen-Akrore indians and from that of adolescent indians in the Xingu Park.

Adenoid cystic carcinoma of salivary glands. A study of 61 cases with clinicopathologic correlation

Sixty-one cases of adenoid cystic carcinoma of the head and neck region, excluding the ear canal, lacrimal glands, larynx, esophagus, and trachea, were studied, and their different clinicopathologic aspects were analyzed. Adenoid cystic carcinoma occurred more commonly in the minor salivary glands; the palate was affected in 31% of the cases. The fifth decade of life was the age at which patients were most commonly affected, and there was a slight predominance of white women. In most patients a mass was the main complaint; in 63% the duration of symptoms was 1 year or less. Forty-one patients had Stages 3 or 4 disease when first seen, and 51.7% of the patients died of disease, with a mean survival period of 35.4 months. Three basic patterns of growth, solid, cribriform, and tubular, were identified in the histopathologic examination of the cases. Other pathologic aspects analyzed were cellular pleomorphism, mitotic activity, necrosis, vascular invasion, and perineural infiltration. The study revealed a positive correlation between location of the tumor, clinical staging, duration of symptoms, and histologic pattern of growth with the prognosis of the lesion. Tumors located in the minor salivary glands, those in which the duration of symptoms was less than 1 year, and those that showed advanced clinical staging and a predominantly solid pattern of growth had an extremely poor prognosis. Surgery is the treatment of choice of adenoid cystic carcinoma, and microscopically free surgical lines of resection must be obtained. Radiation therapy, although not curative, plays an important role in prolonging survival.

Proliferating pilar (trichilemmal) cyst. Report of two cases, one with carcinomatous transformation and one with distant metastases

We examined two cases of proliferating pilar cysts of the inguinal region. One of the cases showed a transformation to epidermoid carcinoma and, despite surgical resection, the patient died by means of distant generalized metastases. The diagnosis of proliferating pilar cyst should be made in pilar cysts with epithelial proliferation that shows well-defined borders and abundant keratinization despite cytologic atypia and mitotic activity. The diagnosis of carcinoma in proliferating pilar cysts should be reserved for lesions showing poorly defined borders and clear-cut infiltrative properties with cytologic evidence of malignancy.

Malignant lymphoepithelial lesion of the submandibular gland

A case of malignant lymphoepithelial lesion of the submandibular gland is reported and the literature is reviewed. This neoplasm has been described frequently in Eskimos and is usually located in the parotid gland. The histogenesis of the lesion is discussed. The tumor shows local aggressiveness, with frequent recurrences and metastases to regional lymph nodes. Surgical treatment consisting of wide resection of the tumor with regional lymph node dissection, with or without radiotherapy, seems to be the most appropriate therapy.