bluuebunny/crossref_metadata_2025 huggingface dataset:
Chromosomal Translocations Involved in Non-Hodgkin Lymphomas
Authors: Vega Francisco , Medeiros L. Jeffrey
Published: February 2021

Context.—The discovery that recurrent chromosomal translocations are involved in the pathogenesis of non-Hodgkin lymphomas has greatly improved our understanding of these diseases and revolutionized their diagnosis.

Objective.—To review the mechanisms by which chromosomal translocations occur and contribute to the pathogenesis of various types of non-Hodgkin lymphomas and to review the utility of molecular genetic methods for the assessment of these translocations.

Data Sources and Study Selection.—Primary research studies and reviews published in the English language that focus on chromosomal translocation and non-Hodgkin lymphomas.

Data Extraction and Synthesis.—Chromosomal translocations, which usually result in oncogene activation, occur in many types of B- and T-cell lymphoma, and their detection is helpful for establishing an accurate diagnosis and monitoring disease following therapy. However, the precise mechanisms that explain how translocations occur remain unknown, although for some types of translocations a clear relationship has been established with immunoglobulin gene rearrangement mechanisms. In recent years, a number of genes deregulated by chromosomal translocations have been identified, and the detailed molecular mechanisms by which chromosomal translocations contribute to the pathogenesis of non-Hodgkin lymphoma are beginning to be elucidated.

Conclusions.—Molecular genetic analysis has played a major role in improving our understanding of B- and T-cell non-Hodgkin lymphomas and has allowed more precise definition of lymphoma types. Molecular genetic tests to detect these translocations are important ancillary tools for the diagnosis and classification of malignant lymphomas.
Malignant Papillary Renal Tumors With Extensive Clear Cell Change: A Molecular Analysis by Microsatellite Analysis and Fluorescence In Situ Hybridization
Authors: Salama M. E. , Worsham M. J. , DePeralta-Venturina M.
Published: February 2021

Context.—Histologic subtyping of renal cell carcinomas (RCCs) is based not only on cytoarchitectural pattern but also on distinct cytogenetic abnormalities. Some renal tumors demonstrate overlapping morphologic features, rendering histologic subtyping difficult. One such group of tumors is papillary renal neoplasms with extensive clear cell change. Because histologic subtyping has been shown to be of prognostic value, it is important that malignant epithelial renal tumors be accurately subtyped. It is not known if these tumors should be classified as papillary RCC (PRCC) or as conventional/(clear cell) RCC (CRCC).

Objective.—To ascertain if this subgroup of renal neoplasms demonstrates the cytogenetic abnormalities seen typically in PRCC, that is, trisomy 7 and 17 or CRCC, that is, loss of 3p, using microsatellite analysis for loss of heterozygosity (LOH), and fluorescence in situ hybridization (FISH) for trisomies.

Design.—Seven RCCs from 6 patients that showed more than 75% papillary architecture and more than 75% clear cell change were included in the study. Tumor size ranged from 2.5 to 7.0 cm (mean 4.7 cm) and all were confined to the kidney (stage I). DNA was extracted from formalin-fixed paraffin-embedded tissue. FISH was done using In Situ Kits for centromere probes for chromosomes 7 and 17. For LOH, microsatellite analysis using labeled primers for 4 markers in the 3p13 through 3p24.2 region were used. The amplified polymerase chain reaction products were analyzed using an automated DNA sequencer. As compared with normal DNA, LOH in tumor was recognized as a loss of 1 allele, and microsatellite instability as the addition of an extra allele.

Results.—LOH in at least 1 of the markers spanning for 3pl3 through 3p24.2 was detected in 6 of 7 specimens (86%), of which 1 also showed concomitant microsatellite instability. FISH did not demonstrate trisomy for either chromosome 7 or 17. Instead, monosomy 7 was observed in 4 of 6 tumors (67%) and monosomy 17 in all tumors (100%).

Conclusion.—Because malignant papillary renal tumors with extensive clear cell change show molecular changes identical to CRCC, this subgroup of tumors may have to be classified as CRCC. This study underscores the utility of molecular studies in refining light-microscopic criteria in accurate histologic subtyping of RCCs.
Distribution of Heme Oxygenase-2 in Nerves and Interstitial Cells of Cajal in the Normal Pylorus and in Infantile Hypertrophic Pyloric Stenosis
Authors: Piotrowska Anna Piaseczna , Solari Valeria , Puri Prem
Published: February 2021

Context.—Interstitial cells of Cajal (ICCs) are pacemaker cells, which are of fundamental importance in regulating gastrointestinal motility. Recent evidence suggests that carbon monoxide is a neurotransmitter involved in neurotransmission between ICC and smooth muscle cells. Heme oxygenase-2 (HO-2) is the major physiological mechanism for the generation of carbon monoxide in the enteric nervous system.

Objective.—To investigate the immunocolocalization of HO-2 and ICCs in the normal pylorus and in infantile hypertrophic pyloric stenosis (IHPS).

Design.—Specimens from 18 infants with IHPS and 8 control specimens were examined using double-immunostaining with c-Kit and HO-2 antibodies. The immunolocalization was detected with the help of confocal laser scanning microscopy.

Results.—Abundant HO-2 immunoreactivity was found in ICCs in the smooth muscle layer of normal pylorus. There was a decrease in the number of ICCs and lack of HO-2 immunoreactivity in ICCs in IHPS.

Conclusions.—The results of the present study provide the first evidence for the presence of HO-2 in ICCs in the normal human pylorus. The lack of ICCs and HO-2 in IHPS suggests impaired intracellular communication between ICCs and smooth muscle cells, contributing to motility dysfunction in IHPS.
Distribution of Interstitial Cells of Cajal in the Internal Anal Sphincter of Patients With Internal Anal Sphincter Achalasia and Hirschsprung Disease
Authors: Piotrowska Anna Piaseczna , Solari Valeria , Puri Prem
Published: February 2021

Context.—Interstitial cells of Cajal (ICCs) are pacemaker cells in the smooth muscles of the gut. The internal anal sphincter (IAS) is the most caudal part of gastrointestinal tract. It has the important function of maintaining fecal continence. It has been proposed that ICCs in the IAS mediate the inhibitory innervation of the recto-anal reflexes.

Objective.—To investigate the distribution of ICCs in the normal IAS and in the IAS of children diagnosed with internal anal sphincter achalasia (IASA) and Hirschsprung disease (HD).

Methods.—At the time of IAS myectomy, specimens of the IAS were taken from 8 patients with IASA, 4 patients with HD, and 4 normal controls. All specimens were examined using anti–c-Kit and antiperipherin antibodies; immunolocalization was detected with light microscopy. Density of the ICCs was graded by computerized image analysis.

Results.—There was strong peripherin immunoreactivity in the ganglia cells and nerve fibers in the normal IAS. The number of peripherin-positive nerve fibers was markedly reduced in the IAS in patients with IASA. In HD patients, there was lack of peripherin immunoreactivity in the IAS, but hypertrophic nerve trunks stained strongly. Many c-Kit–positive ICCs were present among the muscle fibers and between the muscle bundles in the normal IAS. In HD and IASA patients, ICCs were absent or markedly reduced.

Conclusion.—Altered distribution of ICCs in the internal sphincter in IASA and HD may contribute to motility dysfunction in these patients.
Lyme-Associated Parkinsonism: A Neuropathologic Case Study and Review of the Literature
Authors: Cassarino David S. , Quezado Martha M. , Ghatak Nitya R. , Duray Paul H.
Published: February 2021

Neurological complications of Lyme disease include meningitis, encephalitis, dementia, and, rarely, parkinsonism. We present a case of striatonigral degeneration, a form of multiple system atrophy, in Lyme-associated parkinsonism. A 63-year-old man presented with erythema migrans rash, joint pains, and tremors. Serum and cerebrospinal fluid antibodies and polymerase chain reaction for Borrelia burgdorferi were positive. Clinical parkinsonism was diagnosed by several neurologists. Despite treatment, the patient continued to decline, with progressive disability, cognitive dysfunction, rigidity, and pulmonary failure. At autopsy, the brain showed mild basal ganglia atrophy and substantia nigra depigmentation, with extensive striatal and substantia nigral neuronal loss and astrogliosis. No Lewy bodies were identified; however, ubiquitin-positive glial cytoplasmic inclusions were identified in striatal and nigral oligodendroglia. There were no perivascular or meningeal infiltrates, the classic findings of neuroborreliosis. To our knowledge, this is the first report of striatonigral degeneration in a patient with B burgdorferi infection of the central nervous system and clinical Lyme-associated parkinsonism.
Molecular Genetic Analysis Excludes Implantation Metastasis of Basal Cell Carcinomas
Authors: Hafner Christian , Hartmann Arndt , Knuechel Ruth , Dietmaier Wolfgang , Landthaler Michael , Vogt Thomas
Published: February 2021

Basal cell carcinoma (BCC) of the skin is the most common tumor in the white population. A 66-year-old man developed 2 BCCs at the left parietal region of the head and at the helix of the left ear. The 2 lesions matched exactly when pressing the ear against the head, suggesting an implantation metastasis mechanism. Molecular genetic techniques were used to confirm or exclude such a mechanism in this rare clinical constellation. Tumor tissues were precisely microdissected for DNA isolation. Exons 5–9 of the p53 tumor suppressor gene were directly sequenced. In addition, loss of heterozygosity analysis of chromosome 9q was performed using 5 polymorphic microsatellite markers. The BCC of the ear revealed a p53 mutation at codon 273, whereas the other one lacked this mutation. In addition, the smaller BCC of the ear showed loss of heterozygosity at 9q33.3, in contrast with the larger BCC. Interestingly, histologically normal skin of the ear distant from the small BCC had the same deletion, indicating a field defect of this skin patch at 9q33.3. Molecular genetic analysis clearly demonstrated different genetic alterations of the two BCCs and therefore most likely excludes a mechanism of implantation metastasis.
Comparison of Epstein-Barr Virus Presence in Hodgkin Lymphoma in Pediatric Versus Adult Argentine Patients
Authors: De Matteo Elena , Barón AnahíVijnovich , Chabay Paola , Porta José , Dragosky Marta , Preciado María Victoria
Published: February 2021

Context.—In developed countries and high socioeconomic groups, Hodgkin lymphoma has an initial peak in young adulthood, whereas in undeveloped countries and low socioeconomic groups, it shows an early childhood peak. In developing countries, 90% of children are infected with the Epstein-Barr virus (EBV) by the age of 6 years, but in developed countries, only 30% to 40% are seropositive by that age. Early childhood EBV infection in 75% of Argentine patients was demonstrated.

Objective.—To explore the epidemiology of Hodgkin lymphoma and its relationship with EBV in Argentine patients.

Methods.—The presence of EBV was assessed by Epstein-Barr encoded RNA in situ hybridization and latent membrane protein 1 immunohistochemistry. We studied 92 pediatric and 42 adult Hodgkin lymphoma cases from a public center as well as 39 adult cases from a private center.

Results.—The mixed cellularity Hodgkin lymphoma had a prevalence of 52% in the pediatric group, while similar frequencies of both nodular sclerosis Hodgkin lymphoma (47%) and mixed cellularity Hodgkin lymphoma (44%) were observed in adults. As for Epstein-Barr encoded RNAs, 55% of the pediatric cases and 31% of the adult cases were positive. Among adult EBV+ cases, 38% were from the public hospital, and 23% were from the private center. EBV was present in 77% of the pediatric mixed cellularity Hodgkin lymphoma cases when compared with the other histologic subtypes of Hodgkin lymphoma. EBV was mainly detected in mixed cellularity cases (39% in the adult group).

Conclusion.—Our findings strengthen the argument that EBV is involved in the pathogenesis of Hodgkin lymphoma in most children younger than 10 years. Our findings of EBV prevalence, along with both childhood and second-decade peaks as well as comparable frequencies for Hodgkin lymphomas of mixed cellularity and nodular sclerosis, distinguish our population from others in developing countries.
Latent Membrane Protein 1, Tumor Necrosis Factor Receptor–Associated Factor (TRAF) 1, TRAF-2, TRAF-3, and Nuclear Factor Kappa B Expression in Posttransplantation Lymphoproliferative Disorders
Authors: Ramalingam Preetha , Chu Wei-Sing , Tubbs Raymond , Rybicki Lisa , Pettay James , Hsi Eric D.
Published: February 2021

Context.—Most posttransplantation lymphoproliferative disorders (PTLDs) are associated with Epstein-Barr virus (EBV) infection. The EBV latent membrane protein 1 (LMP-1) is important in the transformation of B lymphocytes through its interaction with intracellular tumor necrosis factor receptor–associated factors (TRAFs) that, in turn, can activate transcription factors such as nuclear factor kappa B (NFκB) and Jun-N-kinase. Of the 6 members of the TRAF family, TRAF-1, TRAF-2, and TRAF-3 are most commonly associated with LMP-1. Recently, it has been suggested that LMP-1–induced TRAF activation is important in the pathogenesis of PTLDs.

Objective.—To characterize the expression patterns of these proteins in PTLDs, we studied a series of well-characterized cases for expression of LMP-1, TRAF-1, TRAF-2, TRAF-3, and NFκB by immunohistochemical analysis.

Methods.—A total of 27 specimens from 25 patients were analyzed for LMP-1, TRAF-1, TRAF-2, TRAF-3, and NFκB (active form) by immunohistochemical analysis. Expression of EBV-encoded RNA (EBER) was evaluated by in situ hybridization. Correlation between the expression of the different markers was performed using the Mantel-Haenszel χ2 test. Cox proportional hazards analysis and Kaplan-Meier analysis with log-rank testing were used to analyze antigen expression and clinical outcome.

Results.—Ninety-six percent of PTLDs expressed NFκB, 74% to 84% expressed TRAFs, 78% expressed EBER, and 77% expressed LMP-1. TRAF-1, TRAF-2, and TRAF-3 expression did not correlate with either EBER or LMP-1 expression. TRAF-2, but not TRAF-1 or TRAF-3, expression correlated with NFκB expression (P = .02).

Conclusions.—These results suggest that TRAF molecules and active NFκB are expressed in PTLDs regardless of EBV positivity. Given the association of TRAF-2 and active NFκB expression, TRAF-2 may play an important role in regulating this transcription factor in PTLD.
Fatal Dural Sinus Thrombosis Associated With Heterozygous Factor V Leiden and a Short Activated Partial Thromboplastin Time
Authors: Stephan Christina L. , SantaCruz Karen , May Corrie , Wilkinson Steve B. , Cunningham Mark T.
Published: February 2021

Inherited thrombophilia is a risk factor for dural sinus thrombosis (DST). To our knowledge, this is the first description with autopsy findings of a patient with DST associated with heterozygous factor V Leiden and a short activated partial thromboplastin time (aPTT). A 51-year-old woman presented with a 3-day history of headache, nausea, right-sided weakness, and focal motor seizure; she died 3 days after admission. At autopsy, a gross examination showed hemorrhage of bilateral parietal lobes and left primary motor cortex, uncal and tonsillar herniation, and pulmonary embolus of the right upper lobe. A microscopic examination of the brain showed an organizing thrombus in the superior sagittal sinus, diffuse cerebral edema, and extensive venous congestion. Laboratory studies showed heterozygous factor V Leiden by polymerase chain reaction and a very short aPTT of 17 seconds (reference range, 22–30 seconds). The combination of a heterozygous factor V Leiden mutation and a short aPTT may have contributed to the fatal DST in this patient.
Severe Hemolysis Due to Passenger Lymphocyte Syndrome After Hematopoietic Stem Cell Transplantation From an HLA-Matched Related Donor
Authors: Reed Maria , Yearsley Martha , Krugh Dave , Kennedy Melanie S.
Published: February 2021

A 61-year-old white man (group A, Rh-positive) was allotransplanted for acute myelogenous leukemia from his HLA-matched related sister (group O, Rh-positive) in 2 separate infusions. Three days after the second graft infusion, the patient's front blood type converted to O Rh-positive, with a negative direct antiglobulin test and elevated anti-A1 titer. Severe hemolysis developed, and the patient expired 14 days posttransplantation.
Combined Serous Microcystic Adenoma and Well-Differentiated Endocrine Pancreatic Neoplasm: A Case Report and Review of the Literature
Authors: Slukvin Igor I. , Hafez G. Reza , Niederhuber John E. , Warner Thomas F.
Published: February 2021

We report a case of combined microcystic adenoma and pancreatic endocrine neoplasm of the pancreas in a 53-year-old male patient. The pancreatic tumor was an incidental computed tomography scan finding and was not accompanied by gastrointestinal symptoms. The tumor was located in the head of the pancreas and was composed of numerous small cysts lined by uniform clear cells with a centrally located solid endocrine component. Four cases of similar neoplasm have recently been reported, exclusively in women. Literature review and case analysis indicate that combined microcystic adenoma and pancreatic endocrine neoplasm is characterized by the presence of pancreatic endocrine neoplasm within microcystic adenoma in the head of the pancreas, affects women more often than men, and presents at a younger age when compared to microcystic adenoma.
Carcinoembryonic Antigen Elevation Due to Bowel Sequestration With Mucocele Formation Following Colonic Resection
Authors: Haber Marian M. , Leon Marino E. , Bakker Jennifer E. , Nagle Deborah
Published: February 2021

Carcinoembryonic antigen (CEA) is recommended as a serologic marker to monitor colorectal carcinoma recurrence. Elevations of CEA due to causes other than carcinoma exist and may lead to a misdiagnosis of recurrent carcinoma. We report a case of bowel sequestration with mucocele formation at the site of previous colo-colic anastomosis causing a mild elevation in CEA. The patient exhibited increasing CEA levels 6 years after resection of a sigmoid colon carcinoma with end-to-end anastomosis. Subsequently, computed tomographic and positron emission tomographic scans documented the presence of a cystic mass showing increased uptake at the anastomotic site. At exploratory laparotomy a mass lesion with mucus-filled protrusions was resected. Pathologic examination documented the presence of sequestration of a segment of the bowel wall with a mucocele and no overlying defect at the mucosal anastomotic site by demonstrating the presence of all bowel layers. After resection of the lesion, the CEA level normalized.
Intraoperative Testing for Parathyroid Hormone: A Comprehensive Review of the Use of the Assay and the Relevant Literature
Authors: Carter Alexis Byrne , Howanitz Peter J.
Published: February 2021

Objective.—The rapid intraoperative parathyroid hormone assay is transforming the parathyroidectomy procedure. We present a review of the literature on the use of the assay as an adjunct to surgery. To our knowledge, this is the first review of the literature to encompass and compare all known primary studies of this assay in parathyroidectomy patients.

Data Sources.—Articles were collected by searching MEDLINE databases using relevant terminology. The references of these articles were reviewed for additional studies. Supplementary articles pertinent to the parathyroidectomy procedure, preoperative parathyroid localization studies, and intraoperative parathyroid hormone assay development also were examined.

Study Selection and Data Extraction.—One hundred sixty-five references were analyzed and categorized separately into groups.

Data Synthesis.—The primary studies of intraoperative data on patients undergoing parathyroidectomy were compared when possible. Studies were analyzed by type of assay used, where performed, turnaround time, and efficiency of use. Reviews of the types of parathyroid surgery and preoperative localization were included for educational purposes.

Conclusions.—The intraoperative parathyroid hormone assay is a useful adjunct to preoperative imaging and parathyroid surgery because of its unique ability to detect an occult residuum of hyperfunctioning parathyroid tissue. Use of this assay will obviate the need for frozen section in most routine cases. The test facilitates minimally invasive parathyroidectomy for single parathyroid adenomas, which, in turn, improves cost-effectiveness and cosmetic outcome. Its use in patients with known preoperative multiglandular disease is promising but requires further study.
HER-2/neu Status in Breast Cancer Metastases to the Central Nervous System
Authors: Lear-Kaul Kelly C. , Yoon Hye-Ryoung , Kleinschmidt-DeMasters Bette K. , McGavran Loris , Singh Meenakshi
Published: February 2021

Context.—Breast cancer is lethal when it metastasizes; one frequent site for spread is the central nervous system (CNS). Approximately 15% to 30% of breast cancers overexpress the protein HER-2/neu at the primary site, but there are few data on whether metastases from these tumors overexpress HER-2/neu and might be responsive to the potentially toxic anti–HER-2/neu immunotherapy (trastuzumab [Herceptin]) used in patients with disseminated disease.

Objective.—To assess CNS breast cancer metastases for HER-2/neu protein overexpression by immunohistochemistry and gene amplification by fluorescence in situ hybridization (FISH) and to compare the status in primary and metastatic sites in the same patient, whenever possible.

Design.—Central nervous system breast cancer metastases (n = 53) from 33 patients and corresponding primary breast cancer specimens in a subset of these patients (n = 12) were retrospectively identified in surgical pathology and autopsy databases. Fluorescence in situ hybridization analysis using PathVysion probes for HER-2/neu and chromosome enumeration probe 17 (CEP 17) and immunohistochemistry using the c-Erb-B2 antibody (Dako A0485) were compared. Immunohistochemical sections were evaluated by both visual and image analysis techniques.

Results.—Of 31 cases assessable by FISH, 26% showed gene amplification. One hundred percent concordance for HER-2/neu status was detected between the primary and CNS metastatic lesions in 10 of 10 patients analyzed by FISH; lesser concordance was noted in 12 cases compared by immunohistochemistry. In 9 patients with multiple CNS metastases, FISH showed concordance among different lesions within the same patient.

Conclusions.—When FISH is the detection method, CNS metastases accurately reflect the HER-2/neu status of the primary tumor. Central nervous system metastases from breast cancer received as surgical specimens can therefore be used to assess HER-2/neu status in patients in whom the primary tumor is unavailable for analysis.
Interpretation of Skin Biopsies by General Pathologists: Diagnostic Discrepancy Rate Measured by Blinded Review
Authors: Trotter Martin J. , Bruecks Andrea K.
Published: February 2021

Context.—Slide review has been advocated as a means to reduce diagnostic error in surgical pathology and is considered an important component of a total quality assurance program. Blinded review is an unbiased method of error detection, and this approach may be used to determine the diagnostic discrepancy rates in surgical pathology.

Objective.—To determine the diagnostic discrepancy rate for skin biopsies reported by general pathologists.

Design.—Five hundred eighty-nine biopsies from 500 consecutive cases submitted by primary care physicians and reported by general pathologists were examined by rapid-screen, blinded review by 2 dermatopathologists, and the original diagnosis was compared with the review interpretation.

Results.—Agreement was observed in 551 (93.5%) of 589 biopsies. Blinded review of these skin biopsies by experienced dermatopathologists had a sensitivity of 100% (all lesions originally reported were detected during review). False-negative errors were the most common discrepancy, but false positives, threshold discrepancies, and differences in type or grade were also observed. Only 1.4% of biopsies had discrepancies that were of potential clinical importance.

Conclusions.—Blinded review demonstrates that general pathologists reporting skin biopsies submitted by primary care physicians have a low diagnostic error rate. The method detects both false-negative and false-positive cases and identifies problematic areas that may be targeted in continuing education activities. Blinded review is a useful component of a dermatopathology quality improvement program.
Ramipril-Associated Hepatotoxicity
Authors: Yeung Elaine , Wong Florence S. , Wanless Ian R. , Shiota Koji , Guindi Maha , Joshi Supriya , Gardiner Geoffrey
Published: February 2021

Context.—Angiotensin-converting enzyme inhibitors are prescribed for many cardiovascular and renal diseases. Adverse hepatic events, especially cholestasis, have rarely been reported with captopril, enalapril, lisinopril, and fosinopril. To date, hepatic injury associated with ramipril has not been reported.

Objective.—To describe 3 patients who developed hepatitis, with or without jaundice, after receiving ramipril.

Design.—Medical records and liver biopsies of the 3 patients were reviewed. Clinical, laboratory, and histologic findings were compared with findings in other cases of angiotensin-converting enzyme inhibitor–induced liver injury reported in the literature.

Results.—The 3 patients were middle-aged men. In 2 patients, jaundice appeared 4 and 8 weeks after starting ramipril. Bilirubin levels peaked at 15.5 and 5 mg/dL, and alkaline phosphatase values peaked at 957 and 507 U/L. Aminotransferase levels were mildly elevated. Endoscopic retrograde cholangiopancreatography and ultrasonography showed no bile duct obstruction. Liver biopsies from the jaundiced patients were similar, with cholestasis, duct necrosis, and extravasation of bile, ductular proliferation, and portal inflammation. Cholestasis improved in 1 patient 6 weeks after stopping ramipril and was prolonged for 14 months in the other, in whom biliary cirrhosis was present on biopsy. The third patient developed hepatitis without jaundice 3 weeks after starting ramipril; symptoms resolved after stopping the drug. Ramipril-associated liver injury is similar to that seen with other angiotensin-converting enzyme inhibitors, but liver biopsy findings of duct necrosis and extravasation of bile have not been reported previously.

Conclusion.—Prolonged cholestatic hepatitis and biliary cirrhosis may result from the use of ramipril. Monitoring of liver enzymes is advisable for patients starting on ramipril.
Ampullary Pancreatoblastoma in an Elderly Patient: A Case Report and Review of the Literature
Authors: Du Emma , Katz Matthew , Weidner Noel , Yoder Suzanne , Moossa A. R. , Shabaik Ahmed
Published: February 2021

Pancreatoblastoma, generally regarded as a pediatric malignant tumor, is rarely found in the adult population. Only 13 adults with pancreatoblastoma, ranging in age from 19 to 68 years, have previously been reported in the world literature. A diagnosis of pancreatoblastoma relies on characteristic histologic features, including epithelial differentiation and, more importantly, squamoid differentiation. Despite aggressive therapy, adults with pancreatoblastoma have a poor outcome. We describe a 78-year-old woman who presented with painless jaundice and was found on abdominal computed tomographic scan to have a 2.7-cm ampullary mass. The patient underwent successful pancreaticoduodenectomy. Pathologic examination of the resected tumor revealed findings characteristic of pancreatoblastoma. The tumor formed acinar and glandular structures, solid areas, and contained many “squamoid corpuscles,” a defining feature of pancreatoblastoma. The tumor cells also showed acinar and ductal phenotype by immunohistochemistry. To the best of our knowledge, this case represents the oldest patient with pancreatoblastoma to be described in the literature to date and the first to occur in the ampulla of Vater. We review previously published cases and discuss the clinical and histopathologic features of adult pancreatoblastoma.
Metastatic Foci of Signet Ring Cell Carcinoma in a Tubular Adenoma of the Colon
Authors: Bismar Tarek A. , Maluf Horacio , Wang Hanlin L.
Published: February 2021

We describe a case of adenomatous polyp of the colon that harbored small foci of signet ring cell carcinoma. The patient was a 64-year-old woman with end-stage renal disease and sepsis who underwent colonoscopy to evaluate the possibility of pseudomembranous colitis. A polyp was found incidentally in the right colon and a biopsy was performed. Histologic examination of the polyp revealed typical features of tubular adenoma without evidence of high-grade dysplasia. However, 2 small foci of signet ring cell carcinoma were identified that infiltrated the lamina propria. In contrast to adenomatous epithelium, the signet ring cells were immunohistochemically positive for cytokeratin 7 and negative for cytokeratin 20, suggesting a metastasis rather than a primary tumor. Multiple random biopsies from the right and left colon, as well as the ileum, exhibited no histologic evidence of malignancy. Subsequently, signet ring cell carcinoma with similar morphology and identical immunophenotype was detected in biopsies from the endometrium, an unusual location for primary signet ring cell carcinoma. Preliminary workup excluded the breast as a possible primary site, but further investigation was not possible because of the patient's death with no autopsy granted. To the best of our knowledge, this is the first reported case of metastatic signet ring cell carcinoma to an adenomatous polyp of the colon. This case illustrates the necessity of submitting all polyps entirely and the importance of examining them carefully.
Lymphangioma of the Pancreas With “Ovarian-like” Mesenchymal Stroma: A Case Report With Emphasis on Histogenesis
Authors: Gui Lizhen , Bigler Steven A. , Subramony Charu
Published: February 2021

Pancreatic lymphangiomas, which occur predominantly in women, are rare and account for only 1% of all lymphangiomas. The characteristic histologic features include multiple cysts lined by endothelial cells, irregularly distributed smooth muscle cells, and lymphoid aggregates in the wall of the cyst. We describe a 36-year-old woman with lymphangioma of the pancreas with “ovarian-like” mesenchymal stroma in the wall. This stroma, composed of uncommitted mesenchymal cells, has not been described previously in the wall of pancreatic lymphangiomas. Multiple small lymphatic channels that are found in this stroma recapitulate the development of lymphatic channels in the embryo. Lymphangioma of the pancreas may arise from distension of these lymphatic channels. Pancreatic lymphangioma may, therefore, be a developmental anomaly rather than a true neoplasm.
Allelic Losses in Oligodendroglial and Oligodendroglioma-like Neoplasms: Analysis Using Microsatellite Repeats and Polymerase Chain Reaction
Authors: Johnson Mahlon D. , Vnencak-Jones Cindy L. , Toms Steven A. , Moots Paul M. , Weil Robert
Published: February 2021

Context.—Oligodendroglial tumors are heterogenous neoplasms with histologic features shared with other central nervous system tumors, such as dysembryoplastic neuroepithelial tumors.

Objective.—We examined a series of tumors, identified as possessing oligodendroglial components at the time of intraoperative examination, to see if molecular subsets based on the oligodendroglial component could be recognized.

Design.—DNA was extracted from fresh brain tumor tissue and corresponding peripheral blood or normal tissues. Genotypes for multiple loci were determined by polymerase chain reaction amplification using fluorescent-labeled primers for markers on chromosomes 1p, 17p, and 19q.

Results.—Of the 12 oligodendrogliomas, 6 (60%) of 10 informative cases for 1p exhibited loss of heterozygosity (LOH). Six (50%) of 12 informative cases for 19q exhibited LOH. Each case also showed LOH at 1p. Three (25%) of 12 informative cases exhibited LOH at 17p for the dinucleotide repeat within the TP53 gene. In oligoastrocytomas, none of 4 informative cases showed LOH at 1p, 1 (25%) showed LOH at 19q, and 2 (50%) at 17p. One case also displayed microsatellite instability at 3 of 8 markers. In the 3 anaplastic oligodendrogliomas, 1 was not informative for 1p and none of the informative tumors exhibited LOH at 1p or 17p; 1 case (33%) exhibited LOH at 19q. Of the 14 informative anaplastic oligoastrocytomas, LOH was seen in 5 (36%) at both 1p and 19q and in 2 (14%) at 17p. Those with allelic loss at TP53 were astrocytoma predominant. No dysembryoplastic neuroepithelial tumors exhibited LOH at any marker on 1p, 17p, or 19q.

Conclusions.—These findings suggest that routine screening for allelic losses, in samples intraoperatively determined to have an oligodendroglial component, will reveal prognostically or therapeutically relevant information in the majority of cases.
Autopsy-Based Assessment of Extent and Type of Osteomyelitis in Advanced-Grade Sacral Decubitus Ulcers: A Histopathologic Study
Authors: Türk Elizabeth E. , Tsokos Michael , Delling G.
Published: February 2021

Context.—Decubitus ulcers constitute a serious medical problem, often encountered in association with hospitalization or institutionalization in senior citizens' or nursing homes. Potentially life-threatening sepsis has been reported to originate not only from soft tissue infection, but also from osteomyelitis as a complication of involvement of bone tissue in decubitus ulcers.

Objective.—To assess the histopathology of osseous structures involved in grade IV decubitus ulcers.

Design.—Autopsy-based histopathologic assessment of the presence and extent of osteomyelitis on os sacrum specimens from 28 deceased individuals with grade IV sacral decubitus ulcers using an undecalcified preparation following plastic embedding (staining with Goldner, Kossa modification, toluidine blue, and Giemsa).

Results.—The histologic findings were classified in 4 types of pathomorphologic changes: type 1, decubitus ulcer confined to soft tissue, no inflammation (n = 7); type 2, decubitus ulcer involving bone, no inflammation (n = 7); type 3, decubitus ulcer involving bone, inflammation of soft tissue, no osteomyelitis (n = 1); and type 4, decubitus ulcer involving bone, presence of osteomyelitis (n = 13). Type 4 changes are further described as follows: type 4a, chronic osteomyelitis alone (n = 6); and type 4b, chronic and acute osteomyelitic changes (n = 7). More than half of the cases (n = 15) showed no inflammatory reaction within the medullary cavity (types 1–3). In all cases with osteomyelitis, inflammation was exclusively confined to the superficial parts of the os sacrum. Chronic osteomyelitis was seen in all cases in which osteomyelitis was present. In addition, mild acute osteomyelitic changes were observed in 7 cases. Severe liquefying osteomyelitis affecting deeper layers of the os sacrum was not found. Sepsis was present in 2 cases; in one of these cases, the decubitus ulcer was considered a possible source of infection.

Conclusions.—Our results provide evidence that in cases of grade IV decubitus ulcers, the macroscopic aspect and clinical imaging techniques may lead to an overestimation of the extent of osseous involvement. We suggest that the investigation of bone biopsies is not necessary in a considerable proportion of cases of grade IV decubitus ulcers in patients without sepsis, as the minor osseous alterations are of little consequence when establishing a therapeutic approach.
Recurrent Amyloidoma of Soft Tissue With Exuberant Giant Cell Reaction
Authors: Mukhopadhyay Sanjay , Damron Timothy A. , Valente Alfredo L.
Published: February 2021

Amyloidoma (localized tumorlike amyloidosis) in the soft tissues is rare. We present an instructive case of recurrent amyloidoma in the soft tissue of the ankle in a 45-year-old man with multiple surgical procedures and chronic osteomyelitis of the underlying bones. The lesion evaded diagnosis because of a florid giant cell reaction that led to various misdiagnoses, including giant cell tumor of tendon sheath, foreign body reaction secondary to surgery, and pseudogout. This case demonstrates the importance of considering the possibility of amyloidoma when a giant cell–rich lesion is encountered in the soft tissues.
A Tetraploid Liveborn Neonate: Cytogenetic and Autopsy Findings
Authors: Nakamura Yasuhiro , Takaira Michiyo , Sato Etsuko , Kawano Katuichi , Miyoshi Osamu , Niikawa Norio
Published: February 2021

Cytogenetic and autopsy findings of a nonmosaic tetraploid male neonate, alive until shortly after birth at 37 weeks' gestation, are described. Oligohydramnios, intrauterine growth retardation, cranial abnormalities, and Dandy-Walker malformation were noted prenatally. Autopsy findings included cleft lip and palate; overlapping fingers; low-set ears; simian creases; hypoplastic external genitalia with undescended testes; Dandy-Walker malformation; slightly dilated lateral and third ventricles; hypoplasia of the cerebrum, pons, medulla, pituitary gland, thymus, lung, adrenal gland, and kidney; large ventricular septal defect; and enteric cyst behind the urinary bladder. The placenta was hypoplastic and showed no remarkable abnormalities, except for mild syncytial knots. Chromosome analyses of amniotic fluid cells at 31 weeks' gestation and the umbilical cord blood cells at delivery revealed a 92,XXYY karyotype. G-, C-, Q-, and N-banding heteromorphic studies demonstrated duplication of paternal chromosomes 1, 3, and 15, and maternal chromosome 22. In addition, the results of an analysis with 16 CA repeat polymorphic markers were consistent with duplicated inheritance of 1 paternal and 1 maternal haploid sets to the tetraploid patient. Therefore, it is most likely that the tetraploidy was caused by a cytoplasmic cleavage failure at the first mitotic division.
Adenovirus Enterocolitis in Pediatric Patients Following Bone Marrow Transplantation: Report of 2 Cases and Review of the Literature
Authors: Shayan Katayoon , Saunders Fred , Roberts Eve , Cutz Ernest
Published: February 2021

We report 2 cases of adenovirus enterocolitis in pediatric patients who underwent bone marrow transplantation. The first case involved a 17-year-old adolescent boy with combined immunodeficiency and non-Hodgkin lymphoma who developed chronic graft versus host disease and persistent adenovirus duodenitis. Case 2 involved a 3-year-old boy who received a mismatched unrelated bone marrow transplant for metachromatic leukodystrophy; the boy developed severe graft versus host disease and died of multiorgan failure. At autopsy, diffuse hemorrhagic enterocolitis with changes of severe graft versus host disease and extensive mucosal invasion by adenovirus was found. Awareness and early recognition of this uncommon complication of concomitant graft versus host disease and adenovirus infection could impact therapy and outcome of patients with bone marrow transplant.
Human Papillomavirus Testing Methods
Authors: Hubbard Roger A.
Published: February 2021

Testing for human papillomavirus (HPV) relies exclusively on techniques of molecular biology using nucleic acid probes. Tests for HPV using nucleic acid probes have been commercially available since the late 1980s, but early tests were cumbersome, involving the use of nucleic acid probes labeled with radioactive phosphorus (32P). These early HPV tests did not achieve widespread use because they did not detect all oncogenic HPV genotypes. The current commercial HPV detection kit, Digene's Hybrid Capture 2 kit, detects virtually all high-risk oncogenic HPV types, as well as most low-risk nononcogenic HPV genotypes. The Hybrid Capture 2 test format is a proprietary nucleic acid hybridization signal amplification system owned by Digene Corporation. Virtually all test formats for DNA sequence analysis are amenable to applications intended to detect and perhaps quantify the various HPV genotypes. These methods can involve direct hybridization with complementary DNA probes, such as Southern blotting or in situ hybridization, signal amplification, such as the Hybrid Capture 2 method or target nucleic acid amplification, most notably the polymerase chain reaction (PCR). Polymerase chain reaction has been used for HPV detection, genotyping, and viral load determination. General or consensus primer–mediated PCR assays have enabled screening for a broad spectrum of HPV types in clinical specimens using a single PCR reaction. Following amplification using consensus primers, individual HPV genotypes are identified using a variety of methods. Using consensus primers in a test format known as real-time quantitative PCR (RQ-PCR), it is possible to generate viral load (concentration) data from reaction curves generated by monitoring PCR reaction kinetics in real time.
Malignant Rhabdoid Tumor of the Kidney in an Adult: A Case Report and Review of the Literature
Authors: Peng Hong Qi , Stanek Albert E. , Teichberg Saul , Shepard Barry , Kahn Ellen
Published: February 2021

Malignant rhabdoid tumor of the kidney is an uncommon renal tumor in children. The tumor has aggressive behavior and a poor prognosis and is extremely rare in adults; only 3 cases of renal rhabdoid tumors have been reported in adults. We describe here the microscopic, immunohistochemical, and electron microscopic characteristics of another case in a 38-year-old woman. This case reinforces the importance of recognizing this entity in the adult population.
Compliance of bathers to showering before swimming in a public pool in Toronto, Ontario
Authors: Omisakin Oluyemisi , Young Ian
Published: February 2021

Bathers at public swimming pools should shower prior to entering the pool deck to remove organic material (e.g., sweat, lotions, fecal matter) that can increase the risk of recreational water illness and the formation of disinfection by-products. However, little research has been conducted to evaluate bathers’ pre-swimming showering practices. We conducted a cross-sectional study of bathers aged 18 years or older at a public swimming pool in Toronto, Ontario, to evaluate their showering habits. An in-person questionnaire was administered in October and November 2019. Bivariate associations were examined between selected variables and participants’ self-reported showering frequency prior to swimming (often or always vs. never, rarely, or sometimes). A total of 110 bathers agreed to participate. Most participants (63%) were aged 18–34, 56% identified as male, and 78.2% reported always or often showering before swimming. Of these individuals, only 34% reported using soap when showering. Participants that identified as male (vs. female) and an ethnicity other than white were more likely to report often or always showering, as were those that reported reading the pool rules and that observed other bathers taking a shower. Additional efforts are needed to educate bathers about the importance of showering prior to swimming in public pools.
Initial coefficient estimates for a classes of m-fold symmetric bi-univalent functions involving Mittag-Leffler function
Authors: Wanas Abbas , Tang Huo
Published: February 2021

The main object of the present paper is to use Mittag-Leffler function to introduce and study two new classes RSm(g, l, e, d, t ; a) and R * Sm(g, l, e, d, t ; b) of Sm consisting of analytic and m-fold symmetric bi-univalent functions defined in the open unit disk U. Also, we determine the estimates on the initial coefficients |am+1| and |a2m+1| for functions in each of these new classes. Furthermore, we indicate certain special cases for our results.
Common fixed points under strict conditions
Authors: Bouhadjera Hakima , Beloul Said , Tabet Achref
Published: February 2021

In this contribution, three new concepts called reciprocally continuous, strictly subweakly compatible and strictly subreciprocally continuous single and multivalued mappings are given for obtention some common fixed point theorems in a metric space. Our results improve and complement the results of Aliouche and Popa, Azam and Beg, Deshpande and Pathak, Kaneko and Sessa, Popa and others.
Some fixed point theorems for generalized (psi - phi)-weak contraction mappings in partial metric spaces
Authors: Saluja G.S.
Published: February 2021

The aim of this paper is to introduce the concepts of generalized (psi - phi)-weak contraction mappings of type (A) and (B) and establish some fixed point theorems for said contraction mappings in complete partial metric spaces. Our results extend and generalize several results from the current existing literature.
Democracia colapsada e alternativas às utopias do capitalismo pandêmico
Authors: Requena Rachid Raquel
Published: February 2021

Sendo a democracia do capitalismo limitada em sua extensão para a manutenção do sistema que oprime e rompe com o metabolismo do planeta, alternativas sistêmicas devem ser necessariamente anticapitalistas. A partir da experiência de acirramento do capitalismo durante a pandemia de Covid-19, mediada pelo aumento da digitalização e pela tecnologia a serviço de outras formas de exploração, importa reiterar seu caráter distópico – confrontando-o com sua natureza expropriatória. Conformada às entranhas do capitalismo, a tecnologia não proverá outro resultado senão sua reprodução, pois que concebida para operar dentro da racionalidade tecnológica desse sistema nutridor do pensamento unidimensional. Em face desse cenário, o Confederalismo Democrático de Rojava guarda potencialidade para um projeto ecossocialista contra-hegemônico de questionamento às bases do sistema por meio de participação popular e ecologia. Considerando que o ecossocialismo associa a crítica marxista do capital e a alternativa socialista com a crítica ecológica do produtivismo, trata-se de modelo de combate à raiz das agruras do sistema econômico vigente.
Palavras-chave: Capitalismo. Distopias. Democracias Populares.
Meu filho é autista, e agora? Estratégias de enfrentamento familiar perante o diagnóstico do autismo
Authors: Suelem Lima Freitas Ana , Santos de Jesus Karina , Gomes Nascimento Verônica
Published: February 2021

O presente artigo tem como tema central a experiência de famílias com filhos diagnosticados com o Transtorno do Espectro Autista (TEA) e as suas estratégias de enfrentamento diante do diagnóstico. O objetivo geral do estudo foi descrever e analisar, através de entrevistas com três mães, a experiência familiar (impressões, reações e emoções) a partir do momento em que os seus filhos receberam o diagnóstico do TEA. Essas três mães se propuseram a representar suas famílias na pesquisa. Dessa forma, foi realizada a análise do conteúdo das entrevistas, através de uma sistematização temática, para a leitura analítica do tema proposto, tendo como base a literatura científica disponível. Os principais resultados apontam para a busca do conhecimento, por parte da família, como principal estratégia de enfrentamento para lidar com as demandas estressoras diante da experiência mencionada. Assim, foi observado que as famílias buscam estratégias práticas e objetivas, mas também procuram apoio social e religioso. Vale ressaltar que a condição socioeconômica e cultural das famílias pode refletir diretamente na forma como enfrentam o diagnóstico, em função da acessibilidade à orientação especializada e a recursos profissionais. Portanto, compreende-se que a presente pesquisa alcançou o seu objetivo ao descrever a experiência familiar após o diagnóstico do TEA, mas não reflete todas as realidades familiares.  
Palavras-chave: Transtorno do Espectro Autista. Família. Estratégias de Enfrentamento.