bluuebunny/crossref_metadata_2025 huggingface dataset:
Fine-Needle Aspiration Cytology in Diagnosis of Tuberculous Lymphadenitis: Experience From a Tertiary Hospital in Tanzania
Authors: Ngimba Caroline , Mwakigonja Amos
Published: September 2019

Objectives

Tuberculous lymphadenitis is among the common causes of lymphadenopathy in low-resource countries. Data regarding diagnosis of tuberculous lymphadenitis based on fine-needle aspiration cytology of the lymph nodes are scant in our setting. The current study was conducted to determine the usefulness of fine-needle aspiration materials in the diagnosis of Tb lymphadenitis among patients who presented with enlarged lymph nodes.

Methods

A prospective study was conducted at Muhimbili National Hospital for the duration of 1 year (April 2016 to March 2017). Patients with enlarged lymph nodes were subjected to fine-needle aspiration cytology and smears were stained with Papanicolaou stain as well as Ziehl Nielsen (ZN). Criteria for diagnosing TB on cytology included granulomas, caseous necrosis, and epithelioid cells. All aspirates were subjected to GeneXpert assay for Mycobacterium tuberculosis. All cases diagnosed with TB based on cytological materials were initiated anti-TB. Follow-up of patients was done and response to treatment was used to confirm the diagnosis.

Results

One hundred sixteen cases were studied. Out of 116 cases of lymph nodes aspirated, 58 cases (50%) were diagnosed as tuberculous lymphadenitis. Females represented the majority of the cases, 31/58 (53%), and the most affected age group was 18 to 35 years. Cytomorphology of TB was found in 40/58 cases (68%) and ZN positivity for acid-fast bacilli (AFB) was found in 14/58 (24%) while Gene Xpert assay was positive in 29/58 (50%) of cases. The response to treatment was 100%.

Conclusion

Fine-needle aspiration cytology (FNAC) has shown to be simple, safe, and with higher accuracy in diagnosis of tuberculous lymphadenitis based on evaluation of cytomorphology with complementation of ZN stain for AFB in TB endemic areas. The diagnostic accuracy can be further increased by GeneXpert analysis, which can test the drug resistance of the Mycobacterium.
Four Cases of Esophageal Diverticulum Presented as Incidentally Discovered Asymptomatic Posterior Thyroid Nodules
Authors: Gao Guofeng , Zhou Chihong
Published: September 2019

Esophageal content in the thyroid by fine-needle aspiration is a rare occurrence. Here are four cases of esophageal diverticulum that presented as incidentally discovered asymptomatic posterior thyroid nodules in four patients (one 85-year-old female, one 85-year-old male, one 57-year-old male, and one 26-year-old female) who underwent ultrasound-guided fine-needle aspiration (FNA). The FNA cytopathological findings include bland mature nonkeratinizing superficial squamous cells, abundant filamentous bacteria, scattered degenerated chronic inflammatory cells, and amorphous debris, consistent with oral pharyngeal contents. These findings in the thyroid FNA biopsy may raise differential diagnoses, including Zenker diverticulum and Killian-Jamieson diverticulum of the esophagus, thyroglossal duct fistula and a third or fourth branchial fistula, and benign epidermal inclusion cyst. Thyroglossal duct fistula appears as a midline tract, which may connect the thyroid gland and the foramen cecum, as well as the branchial fistula usually present in the pediatric population, and it may connect the thyroid gland and the hypopharyngeal piriform sinus, although with an unusual presentation seen in adults. However, all four cases were reviewed with radiologists and confirmed as deep posterior thyroid nodules. The squamous epidermal inclusion cyst is usually in the superficial dermis and has predominantly anucleated squamous cells and very few if any well-preserved nucleated squamous cells. The abundant filamentous bacteria/yeast may represent colonization and no infection, which is confirmed by almost absence of neutrophils. So, the final diagnosis of these four cases is suggestive of esophageal diverticulum and no surgical treatment is necessary with the recommendation of esophagogastroduodenoscopy. As noted above, there is no evidence of malignancy; however, the false-negative rate of FNA diagnosis in a squamous-related entity is reported to be about 2% to 5%, so these patients are deemed appropriate for follow-up. In summary, we presented four cases of incidentally discovered asymptomatic posterior thyroid nodules suggestive of esophageal diverticulum by FNA biopsy.
Cytomorphological Patterns of Palpable Breast Lesions Diagnosed in Selected Teaching and Referral Hospitals in Kenya: A Prospective Study
Authors: Rioki Josephine , Rogena Emily
Published: September 2019

Objective

To study the patterns of breast lesions among women with palpable breast lumps presenting to fine-needle aspiration clinics.

Methods

This study involved 768 women aged 16 to 97 years who presented with palpable breast lumps to fine-needle aspiration clinics (FNACs) at Kenyatta National and Nakuru Teaching and referral hospitals from September 2016 to December 2018. The study was approved by Kenyatta National Hospital–University of Nairobi Ethical Review Committee (KNH-UoN ERC); P 334/16. A structured questionnaire was used to obtain qualitative data. Fine-needle aspiration was performed after obtaining informed consent and smears were stained with both H&E and Papanicolaou stains.

Results

Lesions were categorized as fibroadenoma, 287 (44.1%); ductal carcinoma, 59 (9.1%); breast abscess, 39 (6%); benign cysts, 33 (5.1%); galactocele, 32 (4.9%); fibrocystic changes of the breast, 29 (4.5%); suspicious of malignancy, 27 (4.1%); duct ectasia and inflammatory breast lesions, 24 each (3.7%); atypia, 12 (1.8%); invasive ductal carcinoma, metastatic carcinoma, and lipoma, 4 each (0.6%); anaplastic carcinoma and malignant phylloides, 1 (0.2%); and others. Out of 768 smears evaluated, 117 (15.2%) smears were nondiagnostic. The age group most affected was 20 to 34 years (47.2%) followed by 35 to 49 years (26.2%). Women between 24 and 30 years had the following frequencies: anaplastic cancer (100%), invasive ductal and metastatic cancer (50%), and suspicious of malignancy (56%).

Conclusion

Fibroadenoma was the most frequent lesion followed by ductal carcinoma, breast abscess, benign cysts, and galactocele, respectively. Generally, benign lesions formed the bulk of all lesions diagnosed in the two referral facilities. From this study, it is evident that the young age group (reproductive age) is the one most affected with ductal carcinoma, anaplastic carcinoma, and invasive carcinoma. The number of nondiagnostic category was quite high and this warrants proper training and competence evaluation for the clinicians/health care workers who participate in performing fine-needle aspirate procedures.
Diffuse Large B-Cell Lymphoma of the Cervix Diagnosed on Cervical Screening Cytology
Authors: Needs Todd , Bonneau Peter , Cardoza-Favarato Gabriella
Published: September 2019

Case Presentation

Primary lymphoma of the cervix is an uncommon entity and far more rarely diagnosed on routine screening cervical cytology. We present a case of a 38-year-old female with a 1-year history of heavy cyclical menstrual bleeding and interval spotting. She had no other significant past medical or obstetric history. On cervical exam, obscuring blood was noted without distinct abnormalities of the visualized cervix.

Pathologic Findings

Cervical cytology by ThinPrep (Hologic, Marlborough, MA) liquid-based cytology preparation demonstrated atypical squamous cells of undetermined significance as well as an abundant population of atypical lymphoid-appearing cells. Morphology of this second population was characterized by large cells (2-3 times the size of background inflammatory cells) with high nuclear-to-cytoplasm ratio, vesicular chromatin, occasional nucleoli, marked nuclear membrane irregularities, and scant cytoplasm. A cell block of the specimen was performed and demonstrated a mature but cytologically large and atypical lymphoid population. Immunohistochemistry on the cell block specimen was consistent with a B-cell immunophenotype with strong CD45 and CD20 immunolabeling. Subsequent radiologic workup showed a diffusely enlarged cervix with increased metabolic uptake, as well as bilateral metabolically active pelvic lymph nodes.

Conclusion

Cervical and endometrial curettings obtained at an outside facility confirmed the diagnosis of lymphoma that was further categorized as diffuse large B-cell lymphoma, germinal center B-cell type. This case highlights an uncommon diagnosis found on screening cervical cytology. It reinforces awareness of the potential for lymphoid neoplasms on cervical cytology and the differential diagnosis associated with such cases.
Examination of Clinical Internship Impact on Critical Thinking Utilizing the Health Science Reasoning Test
Authors: Smith Catherine , Key Jason , Anders Michael
Published: September 2019

Introduction

The Health Science Reasoning Test (HSRT) is a validated instrument to assess critical thinking skills and is specifically calibrated for trainees in undergraduate and graduate health science educational programs. The objective of this study was to examine the association of scores on the HSRT with clinical internship education in laboratory science students.

Methods

In March 2019, assessment of clinical reasoning skills by the HSRT was administered to 29 laboratory science students in the following programs: medical laboratory science and cytotechnology. As this was a pretest/posttest design, the HSRT was also administered after the completion of a 5-week clinical internship.

Results

Significant positive correlations were found between clinical internship education and HSRT scores. Changes in the HSRT scores occurred in overall scores and in the subdomains of deduction, evaluation, and inference after the students completed the 5-week clinical internship.

Conclusion

Clinical internships are an opportunity for students to develop critical thinking by participating in higher levels of learning objectives, including application, analysis, synthesis, and evaluation. However, the impact of clinical internships on critical thinking is unknown, and this study has shown a significant improvement in HSRT scores following student participation in a 5-week clinical internship. The HSRT was useful in measuring the association and impact of clinical internship education and critical thinking. Therefore, it is reasonable to conclude clinical internships are valuable educational experiences fostering critical thinking in laboratory science students.
Thinking, Creating, Innovating: Utilizing Algorithms in PBL Setup to Enhance Pathology Education
Authors: Saxena Ritcha , Carnewale Kevin , Saxena Ritwik , Moyer Christopher , Sahota Navjyot , Lamar Gillett Richard , Raj Ananya
Published: September 2019

Objectives

Exponential development in the depth and breadth of information in pathology has been challenging for the learners, because the pressure it creates to move quickly beyond content knowledge, to critical analysis, and to the process of applying pathophysiological concepts to clinical scenarios creates cognitive dissonance that impairs near-term performance and long-term retention. We propose an instructional approach where well-organized information is amalgamated with radiological imaging, immunohistochemistry, and molecular pathology, in the form of executable computer programs, to help students categorize the material and retain it as a way to activate multiple sensory systems.

Methods

A demonstration to convey a basic setup of Java to the students was delivered by IT support in the beginning of the semester. PowerPoint presentations on selective systemic pathology topics were used as an in-class vehicle by the large groups to learn, and by the small groups as a tool to create and design computer algorithms with essential checklists in select pathophysiology topics, like solid tumors. Data comprising gross and microscopic histopathological findings, pathophysiology, and differential diagnoses, woven into correlated clinical vignettes, were then provided to small groups, who worked in a PBL setup using patient cases and the already designed computer algorithms, to present their diagnoses. Continuous faculty assessment of student performance was done.

Results

Overall data analysis of block exams revealed that the mean scores were considerably higher for participants, compared to the average results of nonparticipant batches in the same exam. These participants reported better retention and development of significantly higher levels of interest in the subject.

Conclusion

Our preliminary experience suggests that our new instructional methodology can revitalize pathology education by aligning it better with medical students’ inherent enthusiasm for learning and retention. We will continue developing the computational pathology model in various clinicopathological topics as an undergraduate pathology education strategy.
Flow Cytometry Psychomotor Exercise in Medical Laboratory Science Curriculum Facilitates Correct Interpretation of Lymphocyte Subset Analysis
Authors: Kraj Barbara , Ruffy Cristina
Published: September 2019

Objectives

To effectively include flow cytometry psychomotor objectives in medical laboratory science curriculum as recommended in the entry-level curriculum for MLS published by the American Society for Clinical Laboratory Science.

Until fall 2018, our university-based MLS program’s coursework included one to two lectures by the FC operator from the local hospital, tour of their facility, interpretation of cases using histograms, and occasional observations of analyses during clinical practicum. Hands-on performance by 18 to 20 students annually was not possible. We secured an ASCP Foundation Laboratory Science Program Educational Grant for faculty training in flow cytometry and reached out to flow cytometry core facility on the university campus for permission to use the facility with supervision and at a discounted rate.

Methods

Each group of three to four students spent 120 to 160 minutes at the facility, including instruction by the manager, hands-on contact running the instrument by each student, and observation of other classmates. The activity included whole-blood antibody staining prior entry to the facility and CD3/CD4/CD8 lymphocyte subset analysis using MACSQuant Analyzer 10 (Miltenyi Biotec) to distinguish normal versus abnormal control and to infer the status of an assigned deidentified patient with prior HIV-1 infection (University Biosafety IBC# 18–021). Following the experience, students completed online homework, including multiple-choice and open-ended questions, which required interpretation of images recorded during the exercise.

Results

Blackboard test item analysis revealed that median percent of students correctly answering each question was 88 (n = 17). Students received individual feedback on each missed question. On the final Immunology exam, 100% of students provided correct interpretation (active infection or infection under control/normal result).

Conclusion

The results indicated good comprehension of lymphocyte subset analysis concepts. Additional exercise in immunophenotyping is under way in the Hematology class. We believe that inclusion of the flow cytometry psychomotor objectives in the curriculum will improve the students’ preparation for practice.
Anaplastic Glioneuronal Tumor With KIAA1549/BRAF Fusion
Authors: Xiong Zhenggang , Narayan Prithvi
Published: September 2019

Introduction

Glioneuronal tumors are usually low grade and have a favorable prognosis. The anaplastic glioneuronal tumor with KIAA1549/BRAF fusion has not yet been documented. This article reports a pediatric case of glioneuronal tumor with anaplasia and KIAA1549/BRAF fusion to illuminate the importance of KIAA1549/BRAF fusion in the tumorigenesis and clinical management of high-grade glioneuronal tumors.

Case Presentation

A 10-year-old boy presented with 1 year of headache and 3 months of blurry vision and proptosis. Ophthalmologic evaluation revealed bilateral papilledema. Magnetic resonance imaging showed a large mixed cystic and solid mass in the left frontal lobe of cerebrum. Histologic analysis demonstrated a glioneuronal tumor with papillary/pseudopapillary growth pattern, focal necrosis, microcalcification, and brisk mitotic activity with a high Ki-67 labeling index of focally up to 20%. Immunohistochemical assessment identified a mixed glial and neuronal neoplastic cell population. Molecular studies revealed a KIAA1549/BRAF fusion.

Conclusion

KIAA1549/BRAF fusion may play an important role in the oncogenesis of high-grade glioneuronal tumors. In view of the fact that effective, targeted therapies for the tumors with KIAA1549/BRAF fusion are clinically available, detection of KIAA1549/BRAF fusion for glioneuronal tumors, particularly high-grade glioneuronal tumors, is helpful.
Immunohistochemical Study of M1 and M2 Macrophages Population in Chronic Villitis of the Placenta
Authors: Egal Erika , Rodrigues Natalia de Magalhães , Mariano Fernanda , Souza Reydson , Scarini Joao , Sabino Welligton , Aguiar Leisa , Montalli Victor , Gondak Rogerio , Soares Ciro , Morais Thayná , Altemani Albina
Published: September 2019

Introduction

Villitis is characterized by the presence of inflammatory infiltrate (CD8 lymphocyte) in the placental villous and is classified as to the etiology in known and unknown. In most cases, villitis is idiopathic (villitis of unknown etiology [VUE]) because no microorganisms are evident and there are no maternal symptoms or signs. It has recently been proposed that pregnancy is, in fact, an active and highly regulated immune process in which macrophages play an important role. Macrophages may present with M1 phenotype, important effector cells, or M2 phenotype, capable of suppressing the function of M1 macrophages and influencing immunoregulation and tissue repair. CD68 antibody recognizes macrophages M1 and M2, whereas CD11c and CD163 antibodies are specific for the identification only of M1 and M2 macrophages, respectively. The objective of our study is to characterize in human placentas in the subpopulation of M1 and M2 macrophages in VUE.

Methods

Sixteen cases of chronic villitis (all without an identifiable etiologic agent) and three control placentas were examined using immunohistochemistry with antibodies for CD68, CD11c, CD163, and CD3.

Results

CD68 and CD163 were present in all cases in the normal areas. CD68, CD163, and CD11c were present in the villous stroma and in the intervillous space in the inflamed areas. The percentage of CD68-positive macrophages was higher than CD163- and CD11c-positive macrophages in all specimens studied. A total increase of CD68, CD163, and CD11c with the predominance of CD11c over CD163 in the inflamed areas was observed.

Conclusion

The predominance of M1 macrophages (CD11c) in the inflamed areas suggests the influence of these cells in the pathogenesis VUE. The higher amount of M2 (CD163) in the inflamed villous compared to normal areas suggests a possible immunoregulatory mechanism of the inflammatory process in VUE.
Fibrin-Associated Diffuse Large B-Cell Lymphoma Occurring as a Pararenal Pseudocyst
Authors: Mohlman Jeffrey , Rets Anton
Published: September 2019

A 60-year-old male underwent nephrectomy for a tumor on the posterior aspect of the right kidney. Grossly, a completely encapsulated 8 × 8 × 6.8-cm nodule was found in the perinephric fat adjacent to the renal capsule and indenting the renal surface. The renal parenchyma was microscopically unremarkable. The capsule of the lesion was composed of dense fibrous tissue with chronic inflammation, remote hemorrhage, and prominent calcifications. The nodule/pseudocyst contained predominantly amorphous, eosinophilic material with cholesterol clefts and calcifications. Within the pseudocyst, clusters of large cells were identified. These cells showed abundant amphophilic cytoplasm and large pleomorphic nuclei with dispersed chromatin, prominent nucleoli, and occasional mitotic figures. Immunohistochemical (IHC) staining showed that these cells were positive for CD20, CD79a, IRF4, BCL2 (>90%), C-MYC (70-80%), and EBV-ISH; variably positive for CD30 and PAX5; and negative for CD3, CD10, CD68, CD138, ALK1, and BCL6. MYC FISH break-apart probe demonstrated no rearrangements or copy number changes. Based on the overall features, the diagnosis of fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) was rendered. This entity has been recently recognized under a larger category of diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI). Unlike DLBCL-CI, which is considered clinically aggressive, FA-DLBCL typically demonstrates a favorable outcome with surgical resection alone. FA-DLBCL is usually incidentally found at unusual sites (cardiac myxomas, prosthetic cardiac valves, thrombi, hematomas, and pseudocysts including intracranial, splenic, retroperitoneal, paratesticular, adrenal, and renal). To our knowledge, this is the first report of a FA-DLBCL arising in a pararenal location. In addition, our case demonstrates unusually high MYC IHC positivity. Although rare, this entity should be kept in mind, especially in an appropriate clinical setting, and should not be misclassified into a more aggressive category, such as “double expressor” DLBCL or DLBCL-CI.
Flow Cytometry Signature for Kikuchi-Fujimoto/Lupus Lymphadenitis Derived From 975 Benign and Malignant Lymphadenopathies
Authors: Kumar Jyoti , Scott Gregory , Oak Jean , Raess Philipp , Gratzinger Dita
Published: September 2019

Introduction

Kikuchi lymphadenitis is a benign disease with histologic features that can be challenging to discern from malignant or infectious diagnoses. Furthermore, Kikuchi lymphadenitis and systemic lupus erythematosus–associated lymphadenitis (KD/SLE) show overlapping histologic features. We used flow cytometry to evaluate if KD/SLE has a distinct immunophenotype from other lymphadenopathies.

Methods and Materials

Sixteen cases of KD/SLE were compared to 959 control cases at Stanford by flow cytometry for three scenarios: KD/SLE versus T-cell lymphomas, all benign cases, and all benign and malignant cases. Select cases of KD/SLE and benign lymph nodes were analyzed by immunohistochemistry to evaluate the B-cell characteristics. A test set of five KD cases were compared to five normal controls from an independent institution to evaluate cross-platform reproducibility of the KD/SLE flow cytometry signature.

Results

The most discriminatory signature for KD/SLE versus all other benign cases comprised two surface antigen pairs (high CD38+ CD19+, low large-cell CD57+ CD3+), patient age, lymph node location, and four additional flow antigens (100% sensitivity, 99.6% specificity). The signature for KD/SLE versus T-cell lymphomas consisted of two flow antigens (high CD38+ CD19+ and high CD3) and patient age (100% sensitivity, 100% specificity). Based on the flow data, immunohistochemistry was performed to evaluate the B-cell characteristics. We observed clusters of IgD-positive B cells surrounding activated T-cell foci without IgM expression, suggesting that these cells represent either naive cells or memory IgD-positive B cells. Flow cytometry showed increased CD23 with minimal CD5 expression, supporting the hypothesis of naive functional anergic/autoreactive IgD+ IgM– B cells.

Conclusion

We have identified a signature that can distinguish Kikuchi disease and systemic lupus erythematosus from a large cohort of benign and malignant entities, likely reflecting a shared stable underlying etiology of KD/SLE. Our study provides a valuable tool to enhance the ability to accurately diagnose KD/SLE.
Cytogenetic and Molecular Profile Analysis in Hispanic Chronic Myelomonocytic Leukemia Patients From Puerto Rico
Authors: Matti Nawar , Zheng Ruifang , Algarrahi Khalid , Alhatem Albert , Sun Xinlai , Jiang Jie-Gen , NJMS Rutgers
Published: September 2019

Objectives

Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy with both myelodysplastic and myeloproliferative features. The clinical and pathological features of CMML are highly heterogeneous. It was reported that Hispanic whites had an age-adjusted lower incidence rate of CMML compared to non-Hispanic whites. The aim of this study is to define the cytogenetic and genomic landscape of Hispanic CMML patients and explore their potential clinical significance.

Methods

Clinically relevant cytogenetic results and 40-gene molecular profiles of Hispanic CMML patients in Puerto Rico (PR) from 2009 to 2018 were obtained retrospectively.

Results

Total 111 Hispanic CMML patients from PR were diagnosed in our institute from 2009 to 2018. The age range was from 46 to 96 years with a median age of 74. Sixty-five were male and 46 were female. The epidemiological features are similar to that in a general CMML patient population. In total, 107 patients had karyotypes available; 17 patients had abnormal karyotype (17/107, ~16%). Compared with general CMML patients, Hispanic CMML patients had a significantly lower rate of cytogenetic abnormalities (30% vs 16%). Among total 111 Hispanic CMML patients, 40-gene myeloid molecular profiles were performed in 56 CMML patients. Fifty-five out of 56 patients had mutations identified (~98.2%). The most frequent mutated genes were TET2, SRSF2, ASXL1, NRAS, and ZRSR2. Twenty-six of 56 patients (~46.4%) had mutated TET2/wild-type ASXL1.

Previous studies indicated that mutated ASXL1, NRAS, RUNX1, and SETBP1 likely associate with an unfavorable prognosis in a general CMML patient population. Mutated TET2 with wild-type ASXL1 (muTET2/wtASXL1) may associate with a favorable prognosis. Compared with general CMML patients, Hispanic CMML patients in this study had relatively lower mutational rates in ASXL1 (30.4% vs 37.0%), NRAS (10.7% vs 11.7%), RUNX1 (5.3% vs 7.9%), and SETBP1 (5.3% vs 8.9%) and a higher rate of muTET2/wtASXL1 (46.4% vs 37.8%).

Conclusion

Hispanic CMML patients from PR had a significantly lower rate in cytogenetic abnormalities; relatively lower mutational rates in ASXL1, NRAS, RUNX1, and SETBP1; and a higher mutational rate in muTET2/wtASXL1. The findings raise a possibility of a better prognosis in Hispanic CMML patients and could be one of the explanations of a lower incidence rate of CMML in Hispanic population.
Hepatitis C Virus (HCV) Transmitted Transfusion Risk Among β-Thalassemia Patients in Egypt
Authors: Boraik Ayman , Fyala Amira , Abdelmonem Mohamed , Shedid Mohamed , Naguib Saeed , Mohamed Amira
Published: September 2019

Introduction: β-Thalassemia is an inherited abnormal condition that results in hemolytic anemia. It is the most common monogenic disorder in the world. The Mediterranean countries have the highest prevalence of β-thalassemia (2%-18%), and in Egypt, it is 9% to 10%. Regular multiblood transfusion and iron chelation are the major line of therapy for thalassemic patients. There are relatively low blood transfusion safety standards in the Third World countries. Hepatitis C virus (HCV) has the highest risk of transfusion transmitted diseases and Egypt has the highest HCV prevalence worldwide.

Method: Our study is aimed to assess the risk of HCV transmitted to thalassemic patients that receive regular blood transfusions by focusing on the statistics of this population. The study covered most Egyptian governorates from Nile Delta and Upper Egypt by collecting patients’ data between 2015 and 2018.

Results: Consecutive studies were done on 946 β-thalassemic patients as demonstrated from the following: Cairo (205), Mansoura (36), Tanta (120), Damanhur (125), Alexandria (119), Zagazig (73), AlFayoum (121), and Sohag and Minia (147). Studies showed that the HCV-transmitted infection in thalassemia patients in Upper Egypt were detected at 37%, while some Nile Delta studies illustrated that 20% were infected with HCV from transfused thalassemia patients due to multiple blood transfusions.

Conclusion: Blood transfusion–transmitted hepatitis C virus has a very high rate among Egyptian thalassemic patients compared to the worldwide rate. Common anti-HCV antibody screening assay has a low sensitivity and specificity compared to nucleic acid amplification testing (NAT). Therefore, our study recommends following the American Association of Blood Bank (AABB) guidelines for blood donation screenings and implementation of viral NAT testing to reduce the risk of viral transmission during the “window period.” This will reduce the time for effective detection from 70 to 10 days for HCV.
Ultrasensitive RNA In Situ Hybridization for Kappa and Lambda Light Chain mRNA in Marginal Zone Lymphoma Demonstrates Comparable Performance to Flow Cytometry
Authors: Franklin Michael , Deel Chelsey , Vasef Mohammad
Published: September 2019

Objectives

Evaluation of light chain restriction is critical to establish clonality in B-cell lymphoproliferative disorders (LPDs). Immunohistochemistry (IHC) and in situ hybridization (ISH) are commonly used to assess light chain restriction in formalin-fixed, paraffin-embedded (FFPE) tissues. However, except for cases with plasma cell differentiation, these techniques often fail to identify immunoglobulin light chains. An ultrasensitive technique, RNAscope, has been recently introduced that can identify light chains in cases of B-cell LPDs. We analyzed the utility of this ultrasensitive method in detection of clonality and correlated with flow cytometry results when available.

Methods

A tissue microarray was constructed using 1.6-mm diameter tissue punches of 31 FFPE tissue blocks from 27 cases that were previously characterized as marginal zone lymphoma (MZL) by a combination of morphology, IHC, and/or flow cytometry. Cases included 8 nodal and 19 extranodal MZLs. In two cases, additional blocks were included to assess reproducibility. For ultrasensitive ISH RNAscope assay, 4-µm thickness tissue sections were hybridized using kappa and lambda probes, incubated overnight, counterstained with hematoxylin, cover-slipped, and reviewed blindly without knowledge of prior flow cytometry results.

Results

Of 18 cases with evaluable staining, 15 were clonal and 3 were polytypic. Flow cytometry was available in 14 of these 18 cases with concordance in 13 of 14 (93%). The discordant case was polytypic by flow cytometry but kappa restricted by RNAscope. The false-negative flow results could be due to sampling issues. In six cases, staining failed and could not be evaluated.

Conclusion

Ultrasensitive RNAscope is a reliable assay in the detection of clonality in FFPE tissue, particularly where fresh tissue is not available for flow cytometry. In addition, our results confirm and further expand prior observations that RNAscope is a highly sensitive and specific assay with high concordance with flow cytometry.
Classic Hodgkin Lymphoma With Intrasinusoidal Pattern of Infiltration and Concurrent Plasma Cell Variant of Castleman Disease
Authors: Barrett Sean , Laziuk Katsiaryna , Hammer Richard
Published: September 2019

The relationship between Hodgkin lymphoma and plasma cell variant of Castleman disease is uncommon but has been previously described. Most reported cases were diagnosed concurrently. However, sinusoidal involvement by Hodgkin lymphoma is very rare and morphologically can mimic anaplastic large cell lymphoma. Here we present a case of classic Hodgkin lymphoma with a sinusoidal pattern of infiltration coexisting with the plasma cell variant of Castleman disease. A 16-year-old male presented to clinic with shortness of breath and a worsening cough with yearlong duration. Medical history revealed no autoimmune disease, but there was a prolonged allergy history with chronic sinusitis. Imaging showed a right sided mediastinal mass, supraclavicular lymphadenopathy, and pleural effusion. CBC demonstrated anemia, neutrophilia, lymphopenia, and thrombocytosis. Excision of a supraclavicular lymph node revealed effaced architecture with marked plasmacytosis in the interfollicular areas and permeation of sinusoidal spaces by neoplastic cells with morphological features of classic Reed-Sternberg/Hodgkin cells; histiocytes, neutrophils, and residual follicles with regressed germinal centers were seen in the background. Immunohistochemistry revealed strong positivity for CD30 and CD15 by the neoplastic cells as well as positivity for PAX5, MUM1, and CD200 and faint membrane positivity for CD20. The neoplastic cells were negative for CD79a, CD45, EMA, ALK1, and associated T-cell markers. CD138 highlighted increased plasma cells that were negative for CD56, CD200 and polytypic for kappa and lambda. Concurrent bone marrow biopsy revealed a normocellular bone marrow with mild plasmacytosis and no evidence of involvement by lymphoma. Both lymph node and bone marrow were negative for HHV-8. Flow cytometry of the lymph node revealed no monotypic B-cell population and T cells showed predominance of CD4-positive cells with no aberrant antigen expression. The unusual morphologic pattern of classic Hodgkin lymphoma made the diagnosis challenging, and demonstration of proper immunophenotype is required for diagnosis.
Primary Dural Lymphoma Masquerading as a Meningioma: A Rare Clinical Entity
Authors: Sakshi Sakshi , Bains Ashish
Published: September 2019

Primary dura mater–based lymphomas are extremely uncommon and when detected are often clinically and radiologically misidentified. As per literature search, they account for <0.1% of all non-Hodgkin lymphomas; however, a precise incidence is unknown since only a few cases have been described in the literature.

Here we report a case of a 64-year-old female who presented for evaluation of a newly diagnosed left tentorial tumor, diagnosed as “consistent with meningioma” on imaging studies with significant mass effect on the left occipital lobe and left cerebellum with effacement of the fourth ventricle. She had been experiencing disabling headaches, balance dysfunction, and reduced vision. On examination, the patient had right visual field defect with wide-based gait. No evidence of systemic lymphoma or clinically suspicious lymphadenopathy was documented. An intraoperative consultation revealed sheets of lymphocytes, rather highly concerning for lymphoma. H&E sections showed dense fibroconnective tissue heavily infiltrated by mature small- to intermediate-sized lymphocytes with irregular nuclei and condensed chromatin without a discernible architecture. Only sparse and scattered larger lymphocytes were seen. Flow cytometry identified a subset of B cells with lambda-restricted immunophenotype expressing CD19+, CD20+, CD10+, CD5–, and CD23–. On tissue sections, Ki-67 showed an overall proliferation index of 10% to 20%. However, no residual follicular dendritic cell meshwork was detected by CD21 or CD23. PCR analysis detected clonal B-cell IgH and IgKappa gene rearrangements. A diagnosis of low-grade CD10-positive B-cell lymphoma (likely follicle center-cell origin) was made and the patient was discharged after 3 days of surgery for outpatient follow-up and treatment.

In conclusion, low-grade dural-based lymphomas are extremely rare and often misdiagnosed as meningiomas clinically and radiologically. Additionally, it is important distinguish lymphomas of the dura mater, which are excluded from the definition of primary CNS lymphomas and may have a different clinical management and outcome.
Asymptomatic Malaria Infection and Their Antibodies Against Malaria: A Study in Abra de Ilog, Occidental Mindoro, Philippines
Authors: Ledesma Carlo , Sadang Ma Gina
Published: September 2019

Human malaria, caused by four species of Plasmodium, namely P falciparum, P vivax, P malariae, and P ovale, remains a health problem of global concern, with one to two million deaths annually and risking about two billion people worldwide. Alternative ways of controlling the incidence of malaria through understanding the host’s immune response to monoinfection and the detection of the presence of asymptomatic malaria infection are the factors being addressed in this study. The determination of the possible existence of cross-antigenic stimulation is a matter of great significance for future research and development. The isolation of these antigenic structures may give the first step to the development of better vaccines that may protect the general population who are at risk of developing malaria. Prior to blood collection, a memorandum of agreement was signed between the researcher and the Iraya-Mangyan leaders of Abra de Ilog, Occidental Mindoro. A Certificate Precondition was issued by the National Commission of Indigenous Peoples, which was required by the Graduate School Ethics Review Committee. Determination of the presence of malaria parasite on blood samples of residents of two barangays in Abra de Ilog, Occidental Mindoro, was performed using two methods: microscopic examination of stained blood smears for the presence of malaria parasite and polymerase chain reaction. Blood smears were prepared and eventually stained using Giemsa and Dip Quick stains. The detection of 5 positive cases of malaria infection with ring/schizont stage among the 53 cases was a clear indication of positive asymptomatic cases. Nested PCR using Plasmodium spp.–specific primer as well as P falciparum–specific and P vivax–specific primers showed the absence of bands so that one of the recommendations in this study is the performance of real-time PRC using more sensitive primers. Levels of P falciparum and P vivax–specific immunoglobulin were measured using an enzyme-linked immunosorbent assay revealing a higher level of PF-specific IgG than PV-specific IgG. Whole blood samples were saved for future determinations such as real-time PCR, immunophenotypic analysis, and possible parasitic culture. Further similar studies may also be done by increasing the number of respondents as well as the areas of concern for a more extensive scope.
Association of Submucosal Eosinophilia With Blood and Bronchoalveolar Lavage Eosinophilia in Adults With Severe Refractory Asthma
Authors: Tjota Melissa , Adegunsoye Ayodeji , Husain Aliya
Published: September 2019

Objectives

Asthma is a chronic inflammatory disease of the lungs, and for individuals with persistently uncontrolled symptoms despite maximal medical therapy, an endobronchial biopsy and bronchoalveolar lavage (BAL) may be obtained to guide therapy. Given the invasive nature of this procedure, most patients obtain blood eosinophil counts. The goal of this study was to compare blood, BAL, and biopsy eosinophils to identify whether there is a correlation between these various approaches.

Methods

A retrospective study was conducted in adult patients (n = 220) who had been seen in the Refractory Obstructive Lung Disease clinic over a 10-year period (2008-2017). All the patients had been clinically diagnosed with severe refractory asthma. Clinical data were obtained through review of the electronic medical records.

Results

Patients with submucosal eosinophilia had a greater prevalence of intraepithelial eosinophils (50.9% vs 2.3%, P < .001), intraepithelial neutrophils (36.7% vs 9.3%, P < .001), and intraepithelial lymphocytes (52.5% vs 18.6%, P < .001). In contrast, no significant differences were noted between the samples with submucosal eosinophilia present versus submucosal eosinophilia absent for polymorphonuclear leukocyte (PMN) percent, lymphocyte percent, or macrophage percent in BAL. There was a significant difference in eosinophil percentage between the two groups (8.7% vs 1.1%, P = .004). When submucosal eosinophilia was divided into mild (1-10 eosinophils/HPF), moderate (11-20 eosinophils/HPF), and severe (>20 eosinophils/HPF), mean eosinophilia trended more with eosinophilia in the BAL than with the peripheral blood. There was poor correlation (r = 0.31, P = .0001) between eosinophil levels in the blood and BAL.

Conclusion

Compared to BAL, histopathologic data may more accurately characterize the underlying pathophysiology in severe asthmatics by providing a more detailed quantification of the airway inflammatory infiltrates. Moreover, blood eosinophilia may not be as representative of airway inflammation in patients with severe refractory asthma given the poor correlation between eosinophil levels in the blood and BAL.
Three Cases of Pyogenic Granuloma of the Gastrointestinal Tract
Authors: Nakanishi Yukihiro , Behl Preeti , Crawford Byron
Published: September 2019

Pyogenic granuloma also known as lobular capillary hemangioma occurs commonly in the skin and oral mucosa. This entity has been rarely reported in the gastrointestinal tract. We herein report three cases of pyogenic granuloma, located in the duodenum, ileum, and rectum, respectively. Case 1 is a 54-year-old female with a history of angioimmunoblastic T-cell lymphoma who underwent an esophagogastroduodenoscopy for severe heartburn. The endoscopy showed a 13-mm nonbleeding, pedunculated polyp in the second portion of duodenum, which was removed using a hot snare after injection of epinephrine. The patient had an episode of massive gastrointestinal bleeding postpolypectomy, with a significant drop of her hemoglobin, which was managed with blood transfusion. Case 2 is a 68-year-old male with a history of right hemicolectomy due to trauma who had a colonoscopy for chronic diarrhea. The colonoscopy revealed a 14-mm, nonbleeding, pedunculated polyp in the ileum, located 3 cm from the ileocolonic anastomosis. The polyp was removed with hot snare, without complications. Case 3 is a 44-year-old female with morbid obesity who underwent a colonoscopy for iron-deficiency anemia. The colonoscopy showed an 8-mm multilobulated sessile lesion in the distal rectum, which was completely removed using hot snare. No complications were seen postpolypectomy. Histological examination of all the three polyps showed a proliferation of capillary-sized blood vessels with a mixed inflammatory infiltrate, resembling granulation tissue. Additionally, the ileal polyp in our case had marked eosinophilic infiltrate, the etiology of which remains unknown. In conclusion, pyogenic granuloma, given its vascular nature, can be a cause of bleeding in the gastrointestinal tract. Awareness regarding this rare entity is important for its proper diagnosis and treatment.
A Case of Pseudomelanosis Duodeni: Striking Endoscopic Features With Subtle but Characteristic Pathologic Findings
Authors: Nakanishi Yukihiro , Souers Amber , Shridhar Rachna Jetly , De Felice Kara , Crawford Byron
Published: September 2019

A 72-year-old man was referred to the inflammatory bowel disease clinic for evaluation for possible Crohn disease. The patient was diagnosed with pan-ulcerative colitis in the late 1960s. He had medically refractory disease and required a total proctocolectomy with end ileostomy in the early 1970s. Since surgery, the patient has done well with his end ileostomy and has not required any inflammatory bowel disease medications. Over the past 14 months, he has developed intermittent foul-smelling serosanguinous drainage from his previous drained pilonidal cyst. His local gastroenterologist raised the concern for possible Crohn disease with perianal involvement. He has a significant family history of Crohn disease in his father. Past medical history includes chronic kidney disease, hypertension, diabetes, coronary artery disease, gout, and arthritis. Esophagogastroduodenoscopy (EGD) revealed diffuse brown to black speckled/tigroid spots in the entire examined duodenum. Duodenal biopsy showed scattered clusters of macrophages containing dark pigmented granules within the apical tips of the lamina propria. These pigmented granules were focally positive with iron staining. No villous blunting, intraepithelial lymphocytosis, granuloma, or significant inflammation was identified. The distinctive endoscopic and histologic features are diagnostic of pseudomelanosis duodeni. Pseudomelanosis duodeni is a rare benign entity characterized by diffuse black tigroid spots and aggregates of pigment-laden macrophages in the lamina propria. Results of iron staining are characteristically variable. Pseudomelanosis duodeni is seen in middle-aged to elderly adults. Most of the patients with pseudomelanosis duodeni are asymptomatic. Although the exact etiology remains unknown, pseudomelanosis duodeni has been reported to be associated with several medical conditions such as end-stage renal disease, hypertension, diabetes, heart failure, gastrointestinal hemorrhage, and medications, including oral iron therapy, furosemide, hydralazine, thiazide, and iron sulfate. Pathologists should be aware of this rare condition of the duodenum to make an accurate diagnosis of this rare entity.
The Histopathologic Patterns of Intracranial Neoplasms in the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria: A 10-Year Retrospective Study, January 2008 to December 2017
Authors: Uchime Kasiemobi , Adebayo Luqman , Anunobi Charles
Published: September 2019

Objectives

Intracranial neoplasms have distinct diagnostic histologic features and some are common in certain gender and age groups. The most common intracranial neoplasm worldwide is meningioma, followed by gliomas, most especially astrocytic tumors, and then pituitary adenomas. There are geographical differences in the pattern of occurrence of intracranial neoplasms. Few studies have been done in Nigeria to demonstrate the pattern of occurrence, age, and sex distributions of these neoplasms. The aim for this study is to establish the pattern of occurrence with age and sex distribution of different histologic types of intracranial neoplasm in our environment. This study may help portray the health burden of these tumors and aid in epidemiological studies.

Methods

A total of 296 patients (165 females, 131 males) diagnosed with intracranial neoplasms between January 2008 and December 2017 at Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria, were retrospectively analyzed. Patients’ data were retrieved from the archives of the Department of Anatomic and Molecular Pathology, LUTH, Idi-Araba, Lagos. Histologic patterns with age and gender distribution were noted. The data obtained were analyzed with SPSS version 23.

Results

Majority of the patients diagnosed with intracranial neoplasm were between 41 and 50 years of age. The most frequently diagnosed intracranial neoplasm at LUTH within the study period was meningioma (105 cases, median age of 42 years, male to female ratio of 3:7), followed by pituitary adenoma (78 cases, median age of 47 years, male to female ratio of 3:2), and then gliomas (66 case), most especially the astrocytic and oligodendroglial tumors (median age of 37 years, male to female ratio of 2:3).

Conclusion

The result of the study shows that the pattern of occurrence of primary intracranial neoplasms in our environment is different from that in Caucasians, with meningiomas being the most common, followed by pituitary adenomas and then gliomas.