bluuebunny/crossref_metadata_2025 huggingface dataset:
International Trade, Wages, and Unemployment
Authors: Jha Priyaranjan
Published: October 2020

Traditional trade theory has focused on the allocation of resources between various sectors of the economy and how it changes in response to trade liberalization while maintaining the assumption of free mobility of resources across sectors within an economy. This simplifying assumption is at odds with empirical evidence which shows considerable frictions in the movement of resources between sectors, at least in the short to medium run. Workers who lose their jobs in the import competing sector may find it hard to find a job immediately in the export sector. This has given rise to a growing literature that incorporates frictions in the mobility of factors of production in general, and labor in particular, in trade models. This article surveys the literature on trade and unemployment where unemployment is caused by search frictions or wage rigidity of some kind such as minimum wage, efficiency wage, or implicit contracts. While the focus is on unemployment, any model studying the impact of trade on labor markets features wage effects, too, and a brief discussion of wage effects is also provided. Trade affects unemployment in these multi-sector models through two main channels: sectoral unemployment rates and intersectoral reallocation of resources. In newer trade models with heterogeneous firms, trade can change unemployment by affecting the allocation of resources within a sector. While the theoretical models in this literature identify various channels through which trade liberalization affects unemployment, many of these channels have opposing implications for unemployment, rendering the net effect of trade liberalization on unemployment ambiguous in many settings. This has also given rise to an empirical literature studying the implications of trade liberalization on unemployment.
Thermal Physics of Cometary Nuclei
Authors: Prialnik Dina
Published: October 2020

Cometary nuclei, as small, spinning, ice-rich objects revolving around the sun in eccentric orbits, are powered and activated by solar radiation. Far from the sun, most of the solar energy is reradiated as thermal emission, whereas close to the sun, it is absorbed by sublimation of ice. Only a small fraction of the solar energy is conducted into the nucleus interior. The rate of heat conduction determines how deep and how fast this energy is dissipated. The conductivity of cometary nuclei, which depends on their composition and porosity, is estimated based on vastly different models ranging from very simple to extremely complex. The characteristic response to heating is determined by the skin depth, the thermal inertia, and the thermal diffusion timescale, which depend on the comet’s structure and dynamics. Internal heat sources include the temperature-dependent crystallization of amorphous water ice, which becomes important at temperatures above about 130 K; occurs in spurts; and releases volatiles trapped in the ice. These, in turn, contribute to heat transfer by advection and by phase transitions. Radiogenic heating resulting from the decay of short-lived unstable nuclei such as 26Al heats the nucleus shortly after formation and may lead to compositional alterations. The thermal evolution of the nucleus is described by thermo-physical models that solve mass and energy conservation equations in various geometries, sometimes very complicated, taking into account self-heating. Solutions are compared with actual measurements from spacecraft, mainly during the Rosetta mission, to deduce the thermal properties of the nucleus and decipher its activity pattern.
Sports Diplomacy: History, Theory, and Practice
Authors: Murray Stuart
Published: October 2020

Sports diplomacy is a new term that describes an old practice: the unique power of sport to bring people, nations, and communities closer together via a shared love of physical pursuits. This “power”—to bring strangers closer together, advance foreign policy goals or augment sport for development initiatives—remains elusive because of a lack of a robust theoretical framework. Four distinct theoretical frameworks are, however, beginning to emerge: traditional sports diplomacy, new sports diplomacy, sport-as-diplomacy, and sports antidiplomacy. As a result of these new frameworks, the complex landscape where sport, politics, and diplomacy overlap become clearer, as do the pitfalls of using sport as a tool for overcoming and mediating separation between people, nonstate actors, and states.

The power of sport has never been more important. So far, the 21st century has been dominated by disintegration, introspection, and the retreat of the nation-state from the globalization agenda. In such an environment, scholars, students, and practitioners of international relations are beginning to rethink how sport might be used to tackle climate change, gender inequality, and the United Nations Sustainable Development Goals, for example. To boost these integrative, positive efforts is to focus on the means as well as the ends, that is, the diplomacy, plural networks, and processes involved in the role sport can play in tackling the monumental traditional and human security challenges of our time.
Reputation in Deterrence and Decision-Making
Authors: Danilovic Vesna , Clare Joe , Tucker Colin
Published: October 2020

Reputation in the context of international relations is an actor’s attribute as assessed by others from its past behavior. Interest in how reputational concerns can affect the dynamics of conflict arose in the canonical works by Schelling and the subsequent wave of deterrence research. Concerned primarily with the Cold War strategic issues, with some exceptions such as Huth who in 1988 analyzed it in the broader historical scope, scholarly attention to the role of reputation declined in the immediate post-Cold War period only to resurge in the 21st century. The last two decades witnessed a renaissance that resulted in unpacking the notion of reputation into several types and examining its influence in a number of areas, ranging from deterrence, compellence, to other types of militarized conflicts, civil wars, alliance choices, and sanctions, as well as issues of compliance with international commitments in institutional and cooperative studies. In such richness of research, the role of reputation in deterrence and strategic conflict in general, where it originated, still draws the largest amount of research as well as controversies. Besides several different conceptual and theoretical approaches, especially in the rationalist and psychological literature, there is methodological diversity as well, encompassing formal-theoretic models, large-N quantitative analyses, and survey experiments.
The International System–International Society Distinction
Authors: Dunne Tim , Little Richard
Published: October 2020

The central feature of the English School is now usually considered to be its commitment to the proposition that international relations (IR) take place within an international society of shared norms and some shared values. However, an exclusive focus on norms has the effect of denuding the school of the more pluralistic dimensions that were advocated by some of the founding members of the British Committee on the Theory of International Politics. Hedley Bull, in particular, stressed that to account for international order it is necessary to view IR from three divergent perspectives: the international system, the international society, and world society. The early British Committee discussions, directed toward delineating the “fundamentals” of international theory, used the terms international society, international system, and states system interchangeably. But the idea of a states system was distinctive to the emerging English School. A distinguishing marker of the English School is the claim that not only is there a need to accommodate societal norms in theoretical accounts of world politics, but that there is also a systemic logic, and that these analytics together have explanatory power in considering how the world hangs together. The essential elements of the school’s thinking were most fully and effectively realized in The Expansion of the International Society, the central work where the international system–international society distinction is employed. This grand narrative represents a crucial contribution to the field of IR but one that has been very generally underappreciated across the discipline. To generate a deeper understanding of the two concepts, it is clear that much more research needs to be carried out on international societies and systems around the world.
Latina/o Politics
Authors: Francis-Fallon Benjamin
Published: October 2020

A national Latina/o politics emerged over a fifty-year period following the Great Depression. It reflected a broad attempt to forge a nationwide pan-ethnic constituency out of a host of political communities that had most often defined themselves by national origin (e.g., Mexican, Puerto Rican, Cuban). In almost every case, a central impulse of Latina/o politics was a faith that the country’s diverse Hispanic or Latina/o people had a natural obligation to unite with one another. Some activists and elected officials envisioned Latina/o political power formed in a coalition of communities that would remain distinct. Still others viewed political unification as a means to make concrete their feeling of primordial sameness and to bring about the transcendence of national origin differences. All expected unity to yield durable influence in national affairs.

The possibilities of a national “Latin American” electorate began to appear sporadically during the 1960s. Mexican American and Puerto Rican politicians and activists, long seen as regional or local forces at best, embraced the nationalizing power of presidential campaigns and civil rights initiatives. Party elites viewed them as a temporary bloc, one that could be mobilized and demobilized quickly. In the 1970s, however, Latina/o politics was institutionalized. The urge to assemble a “Spanish-speaking vote” from coast to coast brought Latina/o political leaders of diverse ethnic and ideological orientations into greater contact with one another and with the major parties. Republicans attempted to fuse Mexican American voters, traditionally Democrats, with an emerging Cuban American vote in a middle-class “Hispanic Republican Movement.” Latina/o Democrats attempted to join Mexican American and Puerto Rican constituencies and thereby force their party to accept “Latina/os” as a permanent feature of the political landscape. This bipartisan competition defined core constituencies in both parties, with roughly two thirds of Latina/os backing Democrats and a third of Hispanic Americans supporting the GOP, numbers that have held steady since the period of consolidation in the 1970s. White elites in both major parties—including US presidents—provided grass-roots activists and elected officials the resources and legitimacy needed to nationalize Latina/o politics. Yet party incorporation has also enabled elites to manipulate the content and possibilities of Latina/o political organizing in ways that frustrated the search for unity. What emerged was, on one hand, the image of a “sleeping giant” poised to transform the country once it awoke, and on the other, a series of fierce counter-mobilizations that conflated Latina/os’ new prominence with illegality.
John Quincy Adams: Architect of American Empire
Authors: Woods Randall
Published: October 2020

John Quincy Adams was one of the most significant statesmen-intellectuals of the Early American Republic. Highly intelligent, well-traveled, and massively educated, Adams was a Christian nationalist who believed that the American Republic was destined to be a shining example of democracy and liberty to the rest of the world. He was profoundly influenced by his parents, John and Abigail, and embraced his father’s political philosophy which was rooted in a written constitution and a strong three branch government constrained by checks and balances. Adams served as US minister to several European nations before becoming secretary of state in 1817 and then the sixth president of the United States in 1824. He began life as a Federalist but strongly supported the foreign policies of the Jefferson and Madison administrations. The three pillars of his foreign policy were neutrality toward Europe, continental expansion, and hemispheric hegemony. Adams chaired the US delegation that negotiated the Treaty of Ghent in 1814 and was the driving force behind the Convention of 1818 and the Transcontinental Treaty of 1819. Adams partnered with President James Monroe in formulating the Monroe Doctrine in 1823, which canonized the principles of the two hemispheres including European non-colonization in the Western hemisphere and US non-interference in European affairs.

Domestically, Adams was a relentless exponent of the American System in which the federal government would fund a system of internal improvements—turnpikes, canals, ports—that would create a national market and bind the various regions together by means of a national economy. In this, he was disappointed in part because he had the misfortune to be president when Jacksonian democracy was taking hold in America and distrust of the federal power was growing. Defeated for re-election by Andrew Jackson in 1828, Adams briefly retired from public life but then accepted election to the House of Representatives in 1830 where he served until his death in 1846. In the House, he proved to be an avid opponent of the further extension of slavery into the territories, and ironically, of further continental expansion. He became convinced that a civil war was inevitable but held abolitionists at arm’s length because of their rejection of the Constitution as a means to achieve racial justice in America. Adams died with a deep sense of failure, believing that his earlier career as an expansionist had produced not an empire of liberty but an empire of slavery.
Insurgent Pernambuco: From the Cabanos War, 1832–1835, to the Praieira Revolution, 1848–1849
Authors: Carvalho Marcus
Published: October 2020

In 1817, and again in 1824, radical liberals took power and proclaimed a republic in Pernambuco. These movements were violently repressed by imperial troops who landed in Alagoas and were supported by large landholders, who mobilized allies while they advanced on Recife and Olinda, where the rebels had most support, including among the black and mixed population. The fall of Pedro I in 1831 reopened these wounds and rekindled the dispute for land in the forests between Alagoas and Pernambuco, where the Cabanos rebels lived—also known as the “people of the forests.” Armed by those who fought against the republicans in 1817 and 1824, the Cabanos defended their right to own the land they held and fought for the return of Pedro I. The people of the forests were a mix of posseiros, Indians, and quilombolas, and in 1833 under the leadership of Vicente de Paula, a poor pardo with an uncertain past, they totally escaped the control of landholders. The Cabanada defeat (1835) coincided with the beginning of the regresso in court, which strengthened the conservatives of Pernambuco, guaranteeing the hegemony of those led by the Cavalcanti clan and by the Marquis of Olinda. This faction only left the Pernambuco government in 1845, during the “liberal quinquennium” (1844–1848), when the Praieiro Party rose to power, bringing together rebels from 1817 and 1824 and rural landholders whose demands had not been met by the hegemonic conservative alliance, which would only return to the provincial government in 1848, after the fall of the Liberal cabinet in Rio de Janeiro. However, the Praieiros refused to give up their positions and their posts in the national guard and civil police, starting the Praieira Rebellion, which had the support of various rural landholders and the free poor urban population mobilized by radical liberals around a nativist demand: the “nationalization of retail trade.” The crushing of the Praieira Rebellion sealed the destiny of the liberal opposition, confirming the conservative dominion in Pernambuco and in the capital of the empire.
The Brazilian Economy in the 19th Century
Authors: Guimarães Carlos Gabriel
Published: October 2020

“The empire is coffee. And coffee is the valley.” This common phrase for a long time dominated the Brazilian imaginary about coffee, but it doesn’t translate the truth of the Brazilian economy of the 19th century. Coffee, the “black gold,” was Brazil’s main export product in the 19th century, and its main producing region was the Paraíba do Sul River Valley, which encompassed the provinces of São Paulo (high Paraíba) and Rio de Janeiro (middle and lower Paraíba).

But the economy of the Brazilian empire cannot be reduced to coffee plantations. In other Brazilian regions, there were other primary products such as livestock products, resources extracted from the Amazon rainforest, and others. Minas Gerais, the largest Brazilian slave province, was not a producer region for export. In addition, there was a transformation in the "secondary" sector, with handicrafts, factories (sets of workshops), and manufacturing, both in the city and in the countryside, with slave and free labor. The political stability and economic growth of the mid-19th century made Brazil a region of foreign direct investment (FDI), mainly British, in sectors such as infrastructure (railways and ports), banks, insurance companies, and industry. In the last quarter of the 19th century, modern textile industries emerged, mainly in the Center-South, alongside the expansion of coffee in São Paulo, Minas Gerais, and Rio de Janeiro (Zona da Mata Mineira).
Concomitant Chronic Lymphocytic Leukemia and Mantle Cell Lymphoma Discovered by Flow Cytometry
Authors: Erickson K M , Lynch D
Published: October 2020

Casestudy: Chronic lymphocytic leukemia (CLL) accounts for about 30% of all lymphoid neoplasms and is the most common adult blood cancer in the Western world. Mantle cell lymphoma (MCL) accounts for only about 6% of all B-cell lymphomas in Western countries. MCL and CLL are both CD5 positive B-cell lymphoproliferative disorders. It is necessary to distinguish these two entities as MCL is a more aggressive disease, and requires specific treatment. MCL and CLL can occur in one patient at the same time and is often termed a composite lymphoma. We present an 84-year-old female with a history of endometrial cancer who was found to have splenomegaly and lymphadenopathy. Flow cytometry was performed upon her peripheral blood specimen which demonstrated two distinct populations of abnormal light chain restricted B-cell populations. One population demonstrated kappa light chain restriction and was positive for CD45, CD19, CD20, CD5, CD38, FMC-7, and CD22, representing MCL. The other population showed dim lambda light chain restriction that was also positive for CD45, CD19, dim CD20, CD5, and CD23, representing CLL. FISH studies demonstrated t(11;14), and four common deletions or chromosome aneuploidy associated with CLL. These findings confirmed the dual populations of CLL and MCL. This is an interesting case because it is a very rare combination with only a few cases having been reported with two distinct cell populations in one patient at the same time.
Papillary Squamous Cell Carcinoma of the Cervix: Human Papillomavirus (HPV) Status and Clinicopathologic Features
Authors: Schechter S A , Elshaikh A , Walline H , Skala S L
Published: October 2020

Introduction/Objective

Papillary squamous cell carcinoma (PSCC) is a rare cervical neoplasm composed of papillae lined by atypical squamous/transitional cells without koilocytosis. It is unclear whether PSCC is related to human papillomavirus (HPV) infection, though rare cases were reportedly associated with HPV type 16. PSCC is thought to be more common in postmenopausal women. Some authors have suggested that PSCC may be understaged due to the prominent exophytic nature of the superficial aspect and relatively deep location of underlying infiltrative nests. It has also been suggested that PSCC has a tendency to recur and/or metastasize late.

Methods

The surgical pathology database of a single large academic institution was searched for squamous cell carcinoma (or squamous cell carcinoma in situ) with papillary features from the cervix, sampled between 1996 and 2018. PCR for human papillomavirus (HPV) L1 protein was run, with sequencing of positive samples.

Results

5 cases diagnosed as “papillary squamous cell carcinoma” were identified. Patient age ranged from 21–63 years (mean 46 years). All tumors showed papillary architecture, often with complex branching and/or fusion. The neoplastic cells had a squamous/transitional appearance with moderate to marked cytologic atypia and at most focal keratinization. Stage ranged from pT1b1 to pT3b (clinical stage IB1 to IVB). HPV L1 PCR was positive in only one case; sequencing confirmed HPV type 16. Upon closer review, the HPV-positive case was from the youngest patient and showed adjacent low-grade squamous intraepithelial lesion (LSIL) as well as focal koilocytic change within the papillary tumor.

Conclusion

Our findings suggest that even in patients with HPV infection, PSCC may be an HPV-independent malignancy. In multiple cases, it was difficult to obtain definitive histologic evidence of invasion prior to resection.
Primary Meningioma of the Middle Ear - A Rare Presentation
Authors: Zaheer S , Kleinman G M
Published: October 2020

Introduction/Objective

Meningiomas are the benign intracranial neoplasm, most commonly occurring in the third and sixth decade of life. The most common intracranial locations for meningiomas are parasagittal sinuses and large dural sinuses. Very rarely extracranial meningiomas can also be observed. We present a case of fibrous meningioma presenting as middle ear mass, in which a 13 years old female was presented with drainage from the left ear. Biopsy showed fibromyxomatous tissue. CT scan of the head showed soft tissue filling the middle ear and extending into the mastoid.

Methods

The mass was resected and sent to pathology, where H&E staining and immunohistochemistry was done for diagnosis.

Results

The H&E stained section showed a spindle-shaped neoplasm with areas of sheet-like growth interspersed with areas showing tumor cell growth in short fascicles, and some areas of decreased cellularity. Tumor cells have moderate cytoplasm, fine nuclear chromatin and inconspicuous nucleoli. The tumor cells were positive for EMA, PR(nuclear staining) and pan-TRK and negative for D-240, SOX-10, S-100 and desmin. These histological features alone with immunohistochemistry profile were consistent with meningioma WHO grade 1.

Conclusion

Primary middle ear meningioma although a rare diagnosis, but should be considered while dealing with middle ear pathologies. Histomorphology and immunohistochemistry play an important role in making diagnosis.
Metastatic Alveolar Soft Part Sarcoma to the Breast: A Case Report
Authors: Cheriyan A , Bousamra A
Published: October 2020

Introduction/Objective

Metastases to the breast are rare (less than 3% of all breast malignancies). In adults, malignant melanoma is the most common type of metastasis followed by carcinomas from various primary sites. Here, we describe a case of metastatic alveolar soft part sarcoma (ASPS) to the breast. Only a handful similar presentations are reported in the literature.

Methods

Here we describe the case of a 43-year-old female patient with a recent diagnosis of left base of tongue alveolar soft part sarcoma (in an outside hospital), presenting with a palpable mass in her left breast. Sonographic study of the left breast demonstrated a 1.4 cm oval hypoechoic mass with partially microlobulated margins at 1 o’clock.

Results

Histopathologic examination of the ultrasound guided core biopsy showed a “pink” neoplasm, composed of plump epithelioid tumor cells with an eosinophilic and granular cytoplasm, round to oval nuclei and conspicuous nucleoli. They are arranged in organoid nests separated by sinusoidal spaces. An immunohistochemical study shows the tumor cells to be negative for keratin AE1/AE3, keratin 7, keratin 5/6, GATA-3, Pax-8, estrogen receptor, HER2, p63, S100 and CD117. FISH test for TFE3 (Xp 11.23) is positive. PAS with diastase staining highlights the intracytoplasmic granules. Theses morphologic, clinical and molecular findings confirm the diagnosis of metastatic ASPS.

Conclusion

The differential diagnosis of “pink” tumors of the breast include primary tumors like secretory carcinoma and apocrine carcinoma and metastatic lesions of renal, thyroid, skin (melanoma), oral cavity and soft tissue. Although extremely rare, in the right clinical context, metastatic ASPS to the breast can occur and should be included in the differential diagnosis.
Ovarian Carcinosarcoma with Malignant Neuroectodermal Components (Teratoid Carcinosarcoma) - A Rare Entity
Authors: Cheriyan A , Liu Y , Patel S , Liang S , Munns S , Krivak T
Published: October 2020

Introduction/Objective

Ovarian carcinosarcoma is an aggressive tumor accounting for 2% of all ovarian malignancies. Ovarian carcinosarcoma with malignant neuroectodermal components is exceedingly rare and only four cases have been previously reported. Here we report a series of three cases in 65(case 1), 61 (case 2) and 72 (case 3) year old females.

Methods

All patients presented with pelvic mass and elevated CA125. They underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy and tumor-debulking, along with lymph node dissection (2,3) and appendectomy (3). The FIGO stages were IIIC (1,3) or IIA (2). Case #2 experienced pelvic recurrence three months after initiating platinum based chemotherapy and was treated with BEP. She died of metastatic disease ten months after initial surgery. Case #3 is a current case and is being treated with chemotherapy. Case #1 was an outside consult and was lost to follow–up.

Results

Grossly the dominant ovarian mass measured 25 (left), 20 (left) and 21 (right) cm. The cut surfaces were hetergenous tan, yellow, partially cystic and solid with hemorrhage and necrosis. Microscopically, they showed mixed morphology of carcinomatous, sarcomatous, and undifferentiated neuroectodermal component. The carcinomatous element showed squamous cell carcinoma and adenocarcinoma. The sarcomatous component included rhabdomyosarcoma, chondrosarcoma and liposarcoma. The undifferentiated neuroectodermal component consisted of nested or solid primitive cells. All three cases showed fetal-appearing teratoid squamous cell epithelium with clear cytoplasm. The contralateral ovary and extraovarian metastatic implants were either carcinosarcoma, carcinoma or contained all three components.

Conclusion

Case #1 and 3 also showed a yolk sac component. All lymph nodes (2,3) were negative for metastatic tumor at the time of initial surgery. Case #2 had first recurrence in retroperitoneal lymph node showing mature neural tissue. Her second recurrence in abdomen was undifferentiated neuroblastoma. Immunohistochemical studies included CK7, CK20, CDX2, NapsinA, S100, GFAP, PAX-8, CK5/6, P63, AE1/AE3, desmin, Myf-4, CD56, glypican3, AFB, CD99, chromogranin, synaptophysin, NF, NeuN, calretinin, and inhibin. The staining pattern was consistent with histologic interpretation. These cases histologically resemble to so-called “teratoid carcinosarcoma” of paranasal sinuses. The histogenesis remains unknown.
Primary Pleural Angiosarcoma With Extensive And Rapid Metastasis To Brain And Bilateral Adrenal Glands
Authors: Ullah A , Mattox S N , Heneidi S , White J , Sinkler M , Wehrle C
Published: October 2020

Casestudy: Angiosarcomas represent 1% of all soft tissue malignancies. Primary pleural angiosarcomas are aggressive and extremely rare. The etiology of pleural angiosarcoma is largely unknown but in the few reported cases it is associated with asbestos exposure. Common presenting symptoms are chest pain, cough, dyspnea, and weight loss. Localized tumors are generally resected, with other options including chemotherapy and radiotherapy. Limited literature describes this rare neoplasm’s metastatic potential and patterns.

We present a 64-year-old male with shoulder pain and chronic cough. CT thorax showed a large 6.7 x 8 cm mass with central necrosis in the left upper lung invading the chest wall with partial destruction of the second and third ribs, and axillary adenopathy. Bilateral adrenal nodules were also identified. Histology of the adrenal lesion reveal sheets of infiltrative polygonal/round cells with large nuclei, prominent nucleoli and eosinophilic cytoplasm. Tumor cells were positive for CD31, CD34, FLI-1, AE1/AE3 and CK7 immunohistochemical stain, correlating with primary epithelioid angiosarcoma. Based on the patients new development of confusion, dizziness and ataxia, an MRI was performed showing multiple metastatic brain lesions. One month after initial presentation, the patient again presented with worsening symptoms. Work up showed enlargement of the bilateral adrenal masses, doubling of the brain lesions and an additional lesion posterior to the left kidney.

This case shows the metastatic potential and pattern of an aggressive primary neoplasm that is not described in current literature. It also highlights the importance of timely intervention based on the rapid metastatic progression of primary pleural angiosarcomas.
Patterns of Cytokeratin 7 Expression in Cervical Squamous Intraepithelial Lesions
Authors: Youssef M , Canete-Portillo S , Yemelyanova A , Ronnett B
Published: October 2020

Introduction/Objective

It has been suggested that cervical high-grade squamous intraepithelial lesions (HSIL/CIN2-3) arise from squamocolumnar junction cells that express cytokeratin 7 (CK7). Significant CK7 expression (gradation or full-thickness) has been proposed as a marker of progression of low-grade squamous intraepithelial lesions (LSIL/CIN1) to HSIL and of persistence of HSIL/CIN2. The goal of the study is to survey patterns of CK 7 expression in the different grades of squamous intraepithelial lesions (SILs).

Methods

65 cervical specimens (biopsies and excisions) containing 95 lesions of different grades were assessed by immunohistochemical analysis (IHC) for CK7 expression. 26 cases contained more one lesion grade. The diagnosis of HSIL (CIN2-3) was confirmed by p16 IHC. CK7 expression was scored negative, patchy, gradation (i.e., top-down), or full-thickness pattern. In cases with heterogeneous staining, the strongest pattern was used for analysis.

Results

There was significant variation in patterns within morphologically contiguous lesional foci; staining heterogeneity was noted in 42% of cases. All patterns of expression were encountered in all lesion grades. LSIL/CIN1 (n=47), either alone (n=27) or in combination with HSIL (n=20), often lacked CK7 expression (53%) or were patchy (17%). The frequency of significant (gradation or full-thickness) CK7 expression in LSIL with concomitant HSIL was greater than LSIL occurring alone (40% vs. 22%, respectively). HSIL/CIN3 (n=19) was dominated by full-thickness expression (57%). HSIL/CIN2 (n=29) had a very heterogeneous spectrum of expression with 34% of cases lacking expression.

Conclusion

CK7 expression is variable across all grades of SILs. LSIL with concomitant HSIL was associated with significant CK7 expression more frequently than LSIL alone. Significant proportion of HSIL, particularly CIN2, lacks CK7 expression. Given this variability, caution is advised regarding the use of CK7 expression as a marker of progression.
Pediatric Acute Hemorrhagic Leukoencephalitis (Weston-Hurst syndrome): A Rare Entity
Authors: Tomac Pavosevic H , Zaheer S , Kleinman G M
Published: October 2020

Introduction/Objective

Acute hemorrhagic leukoencephalitis (Weston-Hurst syndrome) is a rare, fulminant inflammatory hemorrhagic demyelination of the brain white matter, and it is considered to be the most severe form of acute disseminated encephalomyelitis (ADEM). Herein we describe a case of 6-year-old boy presenting with elevated intracranial pressure and uncal herniation. Brain MRI showed a large right temporoparietal T2 hyperintense lesion with edema, abnormal perivascular enhancement and midline shift. Emergent decompressive craniotomy with brain biopsy was performed.

Results

H&E sections of the brain lesion revealed neutrophilic small vessel vasculitis with extravasation of blood and fibrin. Predominantly in a perivascular distribution were infiltrates of neutrophils and in areas foamy macrophages.

Additionally, the white matter was studded with hemorrhages of varying size. Sections stained with Luxol Fast Blue for myelin and with a neurofilament immunostain for axons were compared to reveal selective perivascular loss of myelin with relative sparing of axons.

Conclusion

The constellation of acute hemorrhages, neutrophilic infiltration and selective loss of myelin with relative sparing of axons is characteristic of this exceptional, hyperacute variant of acute disseminated encephalomyelitis.

Histomorphologic diagnosis is characteristic and may be crucial for timely decision for treatment of this often fatal disease.
Exogenous Lipoid Pneumonia Presenting as an Enlarging Lung Nodule in a Patient with a Long-standing Usage of Petroleum Jelly
Authors: Onyenekwu C P , Sheinin Y
Published: October 2020

Introduction/Objective

Lipoid pneumonia is an uncommon inflammatory lung lesion resulting from the aspiration of endogenous or exogenous oily substances. It has no age or sex preponderance, and its mode of presentation is non- specific. Radiologic imaging findings may mimic that of a malignant lung lesion.

Methods

We report a case of a 69-year-old female with a history of chronic obstructive pulmonary disease, rheumatoid arthritis and a 30-pack year smoking. She was being followed for an enlarging PET positive spiculated left upper lung nodule. She underwent a CT-guided core biopsy of the lung nodule.

Results

Biopsy showed histiocytes and multinucleated giant cells with lipid vacuoles and associated marked fibrosis. Review of a percutaneous lung biopsy performed two years prior showed a chronic inflammatory process with associated fibrosis in the presence of nonpolarizable vacuoles, many of which were intracytoplasmic within multinucleate foreign body type giant cells. A re-assessment of the patient with further history taking revealed a longstanding practice of nighttime application of petroleum jelly to nostrils and lips. Together, these findings are consistent with an exogenous lipoid pneumonia.

Conclusion

Lipoid pneumonia although an entity with limited literature description, should be considered in patients presenting with enlarging lung nodules. Early diagnosis of this lesion ensures appropriate treatment and prevents unnecessary invasive procedures.
Prognostic Marker Expression In Microinvasive Breast Cancer
Authors: Dimopoulos Y , Sidawy M
Published: October 2020

Introduction/Objective

Microinvasive breast carcinoma (Mi) is defined as invasive carcinoma (IC) less than 1 mm in greatest dimension. Depletion of the focus during further immunohistochemical investigation is commonly observed. Studies on prognostic marker expression report high concordance between the Mi and concomitant ductal carcinoma in-situ (DCIS). Compared to IC, Mi has a higher rate of Her2 positivity, indicating aggressive phenotype and potential variation in marker expression over time. We aimed to verify the concordance between Mi and DCIS in patients with pure Mi, as well as between foci of Mi and IC in patients with both.

Methods

A total of 21 cases of Mi and 9 cases with both IC and Mi disease were identified and evaluated for pathologic characteristics and ER, PR, and Her2 expression by immunohistochemistry. The rate of Her2 in Mi was compared to national benchmarks for IC.

Results

Mi was associated with high grade DCIS. 100% concordance of Her2 expression between Mi and DCIS was present in 14/21 cases where Mi was not depleted. Discrepancy between ER/PR was seen in two cases (Mi negative/DCIS focally positive). 50% of these Mi cases were Her2 positive, compared to the 13–25% generally reported for IC. Overall, by extrapolating Mi status from the concomitant DCIS when the Mi became depleted, 38% of Mi was positive for Her2. 100% concordance between foci of Mi and IC in patients presenting with both was observed.

Conclusion

Mi had a more aggressive prognostic marker phenotype compared to IC based on Her2 positivity. Concordance of prognostic marker expression between Mi and concomitant DCIS supports reporting of the DCIS status when the Mi becomes depleted, with only rare ER/PR discrepancies observed. Concordance between foci of Mi and IC in patients with both does not support time-based variation in marker expression. However, further investigation is warranted to uncover potential changes.
Isolated Congenital Bronchoesophageal Fistula in a Pediatric Patient: Case Report
Authors: Anderson S A , Liu S , Galliani C , Weaver K
Published: October 2020

Introduction/Objective

Congenital bronchoesophageal fistula (BEF) results from an undue passageway caudal to the foregut lung anlage. BEF may be associated with esophageal atresia and commonly involves the right lung. Herein we present a pediatric case of isolated congenital BEF masqueraded by severe dyspeptic symptoms.

Methods

A five-year-old child with a longstanding history of gastroesophageal reflux was hospitalized because of acute onset sharp lower chest/epigastric abdominal pain associated with emesis. Imaging disclosed a left lung abscess and empyema that responded to intravenous antibiotics, chest tPA instillation and drainage. After resolution of her empyema, she experienced severe dysphagia, chocking sensation, vomiting, and intermittent hematemesis. Esophogram disclosed a fistulous tract to the left lower chest cavity. Esophagoscopy revealed severe esophagitis and a stricture just proximal to a 0.6 to 0.8 cm ostium of a fistulous tract at 26 cm from the incisors, 2 cm above the gastroesophageal junction.

Results

A 103 g, 12 x 7.5 x 5.0 cm thoracoscopic left lower lobectomy showed a focally ulcerated fistulous tract that entered a 1.9 cm in diameter cyst that connected to a basilar-medial segmental bronchus. The passage was lined by stratified squamous epithelium, continuous with columnar ciliated epithelium, and was surrounded by intense chronic inflammation. The fistulous lumen contained partially degraded vegetable matter.

Diagnosing BEF can be clinically challenging. Symptoms are often intermittent, alternating between digestive and pulmonary in nature. Often, cough, gastroesophageal reflux, pneumonia, and bronchopulmonary suppuration can lead to medical management that is only masking, not definitively treating the underlying pathology. While tracheoesophageal fistulas are relatively common in presentation, and usually diagnosed in the newborn period, BEFs are rare and with varied clinical expression, which may explain delayed diagnosis.

Conclusion

BEF is a rare anomaly that may manifest ambiguous symptoms, thus delaying the diagnosis and options for earlier, less invasive curative interventions.
Intraoperative Fine Needle Aspiration Parathyroid Hormone Assay Can Be Used as an Alternative to Frozen Section Analysis for the Identification of Parathyroid Tissue
Authors: Olivas A D , van Wijk X M , Angelos P
Published: October 2020

Introduction/Objective

Histologic frozen section analysis is typically used for parathyroid tissue identification during parathyroidectomy when needed, in conjunction with a rapid intraoperative plasma parathyroid hormone (PTH) assay to confirm falling levels of circulating PTH after parathyroid excision. As an alternative to frozen section consults, we hypothesize that automated analysis of intraoperative fine needle aspiration (ioFNA) tissue samples using a rapid PTH immunoassay can accurately identify parathyroid tissue and reduce the need for frozen section consults.

Methods

A rapid PTH immunoassay (Elecsys PTH STAT; Roche Diagnostics, Indianapolis, IN), currently used for intraoperative plasma samples, was validated for FNA samples on a Cobas® e411 using tissue aspirates of ex vivo parathyroid and control specimens rinsed in 1mL saline. ioFNA PTH results during parathyroidectomy were then prospectively assessed for accuracy over a 4-month period by comparing values to final histopathologic diagnoses. The number of frozen section consults requested was compared to a 5-month period prior to the availability of the ioFNA PTH assay.

Results

Ninety patients underwent parathyroidectomy (128 excised parathyroids) during the study period, performed by a single experienced endocrine surgeon. Indications included primary (81/90), tertiary (5/90), and recurrent (4/90) hyperparathyroidism. Thirty-nine cases (55.5 excised parathyroids) were performed after the availability of the ioFNA PTH assay. ioFNA samples were sent for PTH analysis in 7/39 cases (18%; 12 samples total) and had a sensitivity/specificity of 100% (parathyroid [n=7] PTH values 1968 - >5000pg/mL; non-parathyroid [n=5] PTH values <2 - 16pg/mL). Parathyroidectomies requiring frozen section consult significantly decreased from 41% (21/51 cases; 40 specimens) to 10% (4/39 cases; 9 specimens) with the availability of the ioFNA PTH assay (p< 0.05, Fisher exact test).

Conclusion

Analysis of ioFNA tissue samples using an automated rapid PTH immunoassay can accurately identify parathyroid tissue and can be used as an alternative to frozen section consult when needed.
Pyoderma Gangrenosum as the Initial Presentation of Inflammatory Bowel Disease
Authors: Karimi S S , Guzman G
Published: October 2020

Introduction/Objective

Pyoderma gangrenosum is a neutrophilic dermatosis, commonly associated with arthritis, psoriasis, and systemic lupus erythematosus. It is also an aggressive manifestation of extra-intestinal inflammatory bowel disease affecting less than 5% of patients with ulcerative colitis and Crohn disease. We present a case of pyoderma gangrenosum as an initial and rapidly progressive manifestation of Crohn disease.

Methods

A 35-year-old man presented with fecal urgency, periumbilical pain, and frequent diarrhea, with stool cultures revealing no infectious etiology. Colonoscopy demonstrated active inflammatory bowel disease consistent with Crohn disease. Concurrently, patient developed an ulcer on right lower extremity not otherwise contributed to history of trauma or injury. Biopsy of right lower extremity ulcer revealed histopathologic findings consistent with pyoderma gangrenosum. Despite medical management, and prolonged use of wound care and wound vac, patient’s non-healing ulcer continued to geographically expand, resulting in ankle contracture. A right below the knee amputation was performed and amputation specimen was sent to pathology for further diagnostic evaluation.

Results

Gross examination revealed an extensive cutaneous ulcer measuring 22.1cm x 11.7cm x 0.3cm and involving the anterior medial aspect of the right lower extremity with medial and posterior extension down to the dorsum of the foot with broad deep tissue destruction and exposure of fascia and tendon. Microscopic examination revealed severe ulceration, suppurative necrosis, superficial and deep vasculitis confined to the ulcer bed.

Surrounding soft tissue revealed chronic myopathic changes secondary to ischemia. Foci of commensal filamentous gram-positive bacterial colonization in a nidus of necrosis were also identified. The inflammatory pattern involved predominantly neutrophils with weak recruitment of other inflammatory cells, consistent with pyoderma gangrenosum.

Conclusion

This case highlights the debilitating extent of Crohn disease, its detrimental effects on the patient’s quality of life, and the diagnostic and treatment challenges it poses to clinicians in managing Crohn disease and its complications.
Paraneoplastic Limbic Encephalitis Secondary To Mixed Non-Seminomatous Germ Cell Tumours
Authors: Ullah A , Heneidi S , Biddinger P , Patel N , Wehrle C , Sinkler M , Klaassen Z , Kruse E , Nichols F , Wallace G
Published: October 2020

Casestudy: Testicular tumors account for 1–2% of all tumors in men, with 95% of these being germ cell tumors. The main risk factor for the development of testicular cancer is cryptorchidism. Paraneoplastic limbic encephalitis is a rare sequela of testicular tumor associated with anti-Ma2 and KLH11 antibodies. The most effective treatment for paraneoplastic limbic encephalitis is treatment of the primary malignancy.

We present a 41-year-old male that presented to the emergency department with two weeks of episodic alteration of consciousness and memory disturbances. Negative neurologic evaluation and imaging led to concern for a paraneoplastic process from a distant malignancy. CT imaging revealed an enlarged, necrotic para-aortic lymph node and subsequent ultrasound demonstrated a right sided testicular mass. Right radical orchiectomy was performed.

Microscopically, the mass consisted of mixed respiratory epithelium, gastrointestinal glands and squamous epithelium with keratinization consistent with a post-pubertal testicular teratoma with associated in-situ germ cell neoplasia.

Resection of the para-aortic mass revealed large anaplastic cells with epithelioid features, nuclear pleomorphism and frequent mitoses. Immunostaining was positive for Pan-Keratin and OCT4, consistent with poorly differentiated embryonal carcinoma. Resection of the primary and metastatic disease, as well as treatment with corticosteroids resulted in resolution of the encephalitis.

This presentation of severe neurological disturbances in the setting of a metastatic mixed nonseminomatous germ cell tumor represents a rare presentation of paraneoplastic limbic encephalitis.
Primary Nodal Lymphangioma: A Rare Case Report and Literature Review
Authors: Youssef B I , Wheeler Y Y
Published: October 2020

Introduction/Objective

Lymphangiomas are benign nodal vascular tumors commonly seen in the skin, mucosa, and soft tissue; however, its occurrence in lymph nodes is extremely rare, with only a few cases reported in English literature.

Methods

We report a case of a 20-year-old female who presented with a 6 cm right upper thigh mass below the inguinal region that has been gradually increasing in size over the past three months. Ultrasound showed a cystic appearance. An excisional biopsy was performed to yield a thin-walled cystic mass filled with clear fluid. The mass appeared to be connected to a regional lymph node. Histologic examination revealed a multiloculated thin-wall cyst involving the hilum of the lymph node. The cyst is lined by flat lymphatic endothelial cells with focally disorganized smooth muscle at the wall of large channels and peripheral lymphoid aggregates. The rest of the lymph node shows reactive change with vascular proliferation and congestion.

Results

Lymphangiomas are soft, relatively well-circumscribed hamartomatous malformations due to the failure of the lymphatic system to communicate with the venous system. This leads to abnormal rests of lymphatic tissue that proliferate and accumulate fluid, causing their cystic morphology. Lymphangiomas are classified as capillary, cavernous, and cystic forms. Imaging techniques such as ultrasonography, mammography, and magnetic resonance imaging may aid in clinical diagnosis and follow-up. Histologically, cavernous lymphangiomas show numerous narrow cavernous spaces lined by a single layer of attenuated endothelial cells, and containing amorphous eosinophilic fluid with few lymphocytes. These spaces may contain blood resulting in misdiagnosis of this lesion as cavernous hemangioma; however, increased lymphoid cells in the stroma, more irregular cavernous spaces, support the diagnosis of lymphangioma.

Conclusion

Lymphangiomas are slowly progressive painless lesions that frequently recur in cases of incomplete excision. It is important to identify this primary nodal lymphangioma to avoid misdiagnosis of benign vascular proliferation, benign vascular tumor, or malignant vascular tumor.