bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Integration of VizitAR for Enhanced Destination Engagement
Authors: Messaoudi Daniela Carvalho , Mayr Sarah
Published: May 2024

This case study investigates the transformative potential of VizitAR's technology on transforming tourism experiences. As an innovative platform, it provides augmented reality solutions that redefine how tourists interact with destinations. This analysis aims to explore the relevance of Augmented Reality technology and explain key principles for successful implementation. The theoretical framework covers the integration of augmented reality in the tourism industry, user experience and engagement, innovation and implementation strategies, economic considerations, as well as destination management. The detailed case study offers insights into implementing VizitAR in different tourism settings, assessing its influence on destination experiences and tourist engagement. By combining academic perspectives with practical implications, this chapter presents a nuanced understanding of how VizitAR can change tourist interactions by highlighting both benefits and challenges associated with using Augmented Reality technology to improve destination engagement.
Homestays as Agents for Responsible Tourism
Authors: Tantia Veerta , Rishikesh K. B. , Biju Diya Susan
Published: May 2024

The significance of implementing sustainable tourism practices has grown in light of the challenges of climate change and the diminishing availability of resources. Responsible tourism practices prioritize proactive engagement over mere adherence to sustainable practices. Therefore, the importance of responsibility cannot be overstated with the recovery and conservation efforts within the tourism sector. Responsibility should extend to the guests and encompass the environment, staff, and residents. Therefore, the present study aims to examine the potential for homestays to implement responsible tourist practices and maintain resilience. To accomplish the study's objective, an interview was conducted with a homestay owner in Shimla and Ratnari. Based on the author's understanding and the available literature on responsible tourism, there appears to be a dearth of studies about applying responsible tourism principles within the context of homestays. Therefore, the present study is of significant importance.
An API Recommendation Method for Querying Mobile Computing Problems
Authors: Wen Wanzhi , Zhang Bin , Hu Yitao , Zhu Xingyu , Wang Zelin
Published: May 2024

Nowadays mobile computing has penetrated into our lives and work. Major companies have invested a lot of material and financial resources in the development of mobile terminals. For developers, querying the right API is extremely important. However, finding the right APIs can be time-consuming and laborious. In this paper, to solve the problems developers may face in the actual development process and improve the development efficiency, we propose RAMC (Recommendation APIs for Mobile Computing), an API recommendation approach leveraging word embedding technique and the information crawling from Stack Overflow posts and Java core packages, to recommend appropriate APIs for developers. Furthermore, RAMC also provides developers with label words, similar questions and relevant code. To evaluate the effectiveness of RAMC, we decided to analyze our system by simulating an instance. By testing a problem encountered during mobile computing development, the RAMC can effectively output the much-related API and tags for developers.
Role of Readiness to Change in the Relationship Between Workforce Agility and Digital Transformation
Authors: Sharma Kritika , Nigam Namrata , Jha Jatinder Kumar , Xu Xiamin
Published: May 2024

This paper uses dynamic capabilities theory to explore the role of readiness to change as mediator in the intricate relationship between workforce agility and digital transformation. A total of 161 usable responses were gathered in two-waves of surveys from Indian organizations. Structural equation modelling was utilized to rigorously test the research hypotheses. The results unearthed a noteworthy positive link between workforce agility and the readiness to change, and this readiness, in turn, significantly influenced digital transformation. Intriguingly, the study also unveiled a direct relationship between workforce agility and digital transformation. The findings contribute a valuable thread to the literature, as it seamlessly weaves the concept of workforce agility into the fabric of digital transformation with Industry 4.0 context. This study would empower HR managers with a deeper understanding of the workforce's mindset and their preparedness to navigate technological changes. Such insights are indispensable, as effective change implementation hinges on insightful leadership.
An entomological survey of phlebotomine sand flies (Diptera: Psychodidae) in different areas of Thailand
Authors: Polseela Raxsina , Vitta Apichat , Thammeepak Rapee , Thanwisai Aunchalee
Published: May 2024

Sand flies (Diptera: Psychodidae) are significant medical vectors of pathogens that cause illness in humans and animals. The most significant of these is the genus Leishmania (Kinetoplastida: Trypanosomatidae). Leishmaniasis is an important vector-borne disease. They are spread throughout the Old and New Worlds by the bites of female phlebotomine sand flies. Despite this importance, certain provinces where autochthonous leishmaniasis has historically existed and is re-emerging are lacking current data regarding their sand fly fauna. To provide a current update on the local sand fly fauna, a comprehensive entomological survey encompassing eight provinces was conducted subsequent to an analysis of past data regarding the species composition and distribution of sand flies in the area. Thus, the purpose of this study was to ascertain the species composition in various locations across eight provinces spread across four regions in Thailand. In order to gather information about the distribution of the phlebotomine sand fly, researchers used modified Centers for Disease Control and Prevention light traps between February 2021 and February 2022. At these 30 trappings in each province, we conducted 240 trapping nights in total. Collected sand flies were morphologically identified. The adult sand flies collected in this study were 8314 and represented 24 species of four genera, including 16 of Sergentomyia, 6 of Phlebotomus, 1 of Idiophlebotomus, and 1 of Chinius. Among these species, Sergentomyia anodontis had the largest population (25.71%), and population peaks were observed in Uthaithani province (51.81%). The collected sand flies’ male-to-female ratio was 1.21:1.00 (4,556:3,758). The study also discovered that Phlebotomus argentipes, a vector of Leishmania spp., was captured in Phayao province, and Phlebotomus major major was majorly found in Uthaithani province. The widespread distribution of sand fly populations in this study may indicate the epidemiologic importance of vector ecology in this habitat. Our results confirm the presence of several sand fly species in different provinces of Thailand and provide valuable information about the distribution and behavior of phlebotomine sand flies, which can be used to develop effective control strategies for the prevention of sand fly-borne diseases. In several Thai provinces, the study also tracked the nocturnal movements of both male and female sand flies. The results showed that phlebotomine sand flies are more active at night, peaking just after dusk.
Patients as friends - awkward or advantageous?
Authors: Moosa S.A.H.
Published: May 2024

Rural General Practitioners often find themselves in a small community having patients as friends. This can lead to difficulty in the relationship. This is a reflection on the family friends where I missed the youngest child's diagnosis of myoclonic epilepsy in the social context and which lead to a crisis in the relationship. This lead me to reflect on acknowledging mt needs, defining the roles and relationships and being explicit and honest with the patient cum friend in the structuring of the dual relationship in various ways. I, as doctor, have learnt to continuously reflect on objectivity and comfort in the care of patient cum friend.
Using Network Pharmacology and Molecular Docking Tools to Investigate the Potential Mechanism of Ephedra-Gypsum in the Treatment of Respiratory Diseases
Authors: Huang Can , Yuan Ling , Niu Yang , Yang Ya-Ting , Yang Yi-Fan , Nan Yi , Dou Hong-Li , Japhet Joanna
Published: May 2024

Objective:

The objective of this study was to investigate the potential mechanisms of ephedra-gypsum in the treatment of respiratory diseases (RDs) using network pharmacology and molecular docking techniques.

Materials and Methods:

The TCMSP and UniProt databases were used to mine the active components and targets of ephedra-gypsum, and the targets of RD were screened using the Online Mendelian Inheritance in Man (OMIM) and GeneCards databases. The protein-protein interaction network graph was created using the drug-disease intersection targets in the STRING database. The network diagram was analyzed using Cytoscape 3.9.1's topology function. The gene ontology (GO) and KEGG enrichment analyses were performed using the DAVID platform. Molecular docking bioactivity validation of the main active components and core targets was performed using AutoDock and PyMOL software.

Results:

Twenty-four compounds were screened, and 113 drug-disease targets overlapped. In total, 358 biological processes, 67 molecular functions, 38 cellular components of GO, and 139 pathways were identified. Molecular docking analysis demonstrated the strong binding ability of tumor protein 53 (TP53)-luteolin.

Conclusion:

The core components of ephedra-gypsum, such as quercetin, luteolin, kaempferol, and CaSO4·2H2O, act on key targets, such as tumor necrosis factor (TNF), interleukin-6 (IL-6), TP53, and IL-1 β through cytokine-mediated signaling pathways, inflammatory responses, cell proliferation, and apoptosis. This could be useful for the treatment of RD.
Distribution of Non-thyroid Neck Swellings according to Tissue of Origin and Their Radio-pathological Correlation
Authors: Tiwari Himani , Patel Bhupesh , Doria Grishma , Mehta Rina Girish , Chaturvedi Chandrashekher , Damor Paresh Kumar
Published: May 2024

Introduction:

Neck swellings are commonly found and can be presented as simple benign to malignant. Due to extensive differential diagnosis and similar presentation, the evaluation of neck swellings is more challenging. Most of the cases can be diagnosed after a detailed history and clinical examination of the head and neck, but the final diagnosis will be achieved by histopathological examination.

Materials and Methods:

The study was conducted from February 2020 to February 2023 on the basis of retrospective and prospective sampling. This study included all the patients with neck swellings, excluding thyroid, who had undergone excisional or incisional biopsy. The present study was carried out on 74 patients with non-thyroid neck swellings, which were classified five into main headings, i.e. lymph node swelling, salivary gland swellings, adipose tissue, neural tissue and skin and soft-tissue swellings as miscellaneous. Data were collected from patient records for retrospective sampling and radiological investigation, and ultrasonography (USG) and excisional or incisional biopsy were done for prospective sampling. A radiological and pathological correlation was analysed as benign and malignant.

Results:

Out of the 74 patients, n = 60, 81% were benign and n = 14, 19% were malignant. The most common swelling according to the tissue of origin was lymph node (n = 31, 41.9%) followed by salivary gland n = 15 (20.3%), adipose tissue (n = 7, 9.5%) and neural tissue (n = 6, 8.1%) origin. Other soft-tissue swellings were 20.3%. The overall sensitivity, specificity, positive predictive value, negative predictive value and radiological (USG) diagnosis accuracy to differentiate between benign and malignant are very similar to gold standard histopathological examination.

Conclusion:

Lymph node swellings were the most common swelling involving the neck region. USG diagnosis is highly sensitive for diagnosing malignant swellings but less good at confirming benign swellings. Radiological diagnosis is not a substitute for conventional surgical histopathology but is regarded as a precious complement in diagnosis. Newer diagnostic techniques are required to be infallible and accurate for further management.
Upper bullous rhegmatogenous retinal detachment
Authors: Eissa Ahmed M. , Abouelkheir Hossam Y. , El-Kannishy Amr M. , El-Wehedy Ahmad S. , Abd El-Wahab Amal A.
Published: May 2024

Purpose

To find a standard surgical plan for management of upper bullous retinal detachment in one step.

Patients and methods

This was a comparative study on 50 patients who were divided randomly between two study groups, with each containing 25 patients: one group was treated by scleral buckling and the other was treated by 23-G vitrectomy using gas tamponade (air and sulfur hexafluoride).

Results

A total of 50 cases with upper bullous retinal detachment were chosen. The cases were randomly divided into two groups: one of them underwent scleral buckling, whereas the others underwent par plana vitrectomy using gaseous tamponade (air and sulfur hexafluoride); each group consisted of 25 patients. The final success rate was the same, with a statistically insignificant higher incidence of delayed absorption of subretinal fluid and also statistically low significance higher recurrence with scleral buckling. Choroidal detachment happened only with vitrectomy, whereas suprachoroidal hemorrhage occurred solely with scleral buckling. Epiretinal membrane and advancement of cataract occurred with vitrectomy, whereas myopic shift occurred with scleral buckling.

Conclusions

The results of our study showed that there is no perfect surgery to be used as a final standard management, and each procedure has its benefits and drawbacks. The final decision is left to the surgeon to decide according to personal experience and the case scenario.
Obstructive Jaundice with skin involvement - An unusual presentation of Myeloid Sarcoma
Authors: Jeji Pukhraj S. , Patnaik Swarup K. , Behera Manas K. , Narayan Jimmy , Sahu Manoj K. , Mishra Debakanta , Singh Ayaskanta , Pati Girish K.
Published: May 2024

Biliary obstruction secondary to malignancy is a common clinical problem. Rarely, biliary obstruction is due to leukemia, and obstructive jaundice in these patients usually presents late in the course of the disease. We present a rare case of a patient who presented with fever, jaundice, and pruritus with multiple nodular swellings in the left shoulder, left thigh, and lower back. Magnetic resonance cholangiopancreatography (MRCP) revealed periampullary mass lesion causing dilated common bile duct (CBD) and intrahepatic bile ducts; hence, endoscopic retrograde cholangiography with plastic stenting was done. Biopsy from the shoulder lesion revealed a mesenchymal tumor, and immunohistochemistry (IHC) confirmed the lesion as myeloid sarcoma. Myeloid sarcoma is an extramedullary tumor, a subtype of acute myeloid leukemia, and presentation as biliary lesions with multiple anatomical sites is very rare. The patient was started on chemotherapy after the normalization of bilirubin. The patient showed improvement of skin lesions and normalization of liver function test (LFT) after 3 weeks of chemotherapy.
Histological and immunohistochemical characteristics and p16 status studied by FISH in six incidentally detected cases of well-differentiated papillary mesothelioma of the peritoneum
Authors: Fujishima Fumiyoshi , Konosu-Fukaya Sachiko , Nabeshima Kazuki , McNamara Keely M. , Sakamoto Kazuhiro , Sakurada Junko , Sasano Hironobu , Nakamura Yasuhiro
Published: May 2024

Well-differentiated papillary mesothelioma (WDPM) is an uncommon mesothelial neoplasm, which is generally regarded as benign or indolent in terms of its clinical behavior. However, details about WDPM have remained relatively unknown. Therefore, in this study, we examined six incidentally detected cases of WDPM of the peritoneum. All six cases were surgically excised, without any additional therapeutic measures. None of the cases showed recurrence. All six cases presented single lesions and the tumor sizes ranged from 2 to 10 mm. Histologically, all six cases exhibited papillary proliferation of cytologically bland mesothelial cells with a fibroconnective tissue core. One of the cases (Case 6) presented small invasive foci in the stalk. The tumor cells were immunohistochemically positive for mesothelial markers and negative for GLUT-1, p53, and CD146. The Ki-67 labeling index of the tumor cells was lower than 5% at the hot spots. All samples were BAP1-positive. None of the samples presented p16 homozygous deletion, as assessed by fluorescence in situ hybridization (FISH). None of the patients deceased due to WDPM. However, in Case 3, death occurred due to pancreatic cancer. The results of this study indicate the importance of analyzing immunohistochemical markers and p16 status to diagnose WDPM accurately.
Myelomatous pleural effusion developing after autologous stem cell transplantation in a patient with multiple myeloma: A rare case
Authors: Ak Müzeyyen Aslaner , Barut Figen
Published: May 2024

Myelomatous pleural effusion (MPE) is a very rare condition with a poor prognosis. In our case of multiple myeloma (MM) with early recurrence presenting with a MPE, management of the treatment is discussed together with the case presentation. A 35 year old female patient with a diagnosis of lambda light chain MM presented with complaints of dyspnea and pain in the left shoulder 2 months after autologous transplantation. On physical examination, respiratory sounds were decreased in the lower lobe of the left lung and there was dullness. Pleural effusion and plasmacytoma, more prominent on the left, were detected on chest X ray and thorax computed tomography (CT). The pleural fluid collected during therapeutic thoracentesis was examined by flow cytometry, cytology, and peripheral smear examination and as a result, the patient was considered to have early recurrence after autologous transplantation, DRd chemotherapy was immediately started, and clinical and radiological improvement was observed. Pleural effusion developing in patients with MM should be evaluated in terms of MPE. In the presence of MPE, the duration of response to treatment is short, thus effective and dynamic treatment methods for bridging should be used before referral of the patients to clinical trials and hematopoietic stem cell transplantation.
Acute rheumatic fever – A pathological analysis of clinically missed cases
Authors: Goyal Ashutosh , Vaideeswar Pradeep , Daga Pawan , Bhargav Rishi
Published: May 2024

Background:

Acute rheumatic fever (ARF) and its post-inflammatory sequel chronic rheumatic heart disease (RHD) are endemic in the Indian setting. Despite the updated Jones criteria, many cases of ARF remain undiagnosed or are missed.

Aims:

This study aims to analyze pathological profiles of such cases and their importance in context of clinical presentation and Jones criteria.

Materials and Methods:

A 22-year retrospective observational study of ARF was conducted in the Department of Pathology in a tertiary care institute. The cases were categorized as 1. Those fulfilling and 2. those partially or not fulfilling the Jones Criteria. Based on the autopsy findings, the lesions were classified as categorized mitral stenosis and/or regurgitation (MS ± MR) and pure mitral regurgitation (MR).

Statistical Analysis:

Nil.

Results:

In 22 years, among 697 cases of autopsied cases of RHD, there were 59 cases (8.5%) of ARF. Among them, seven cases fulfilled the Jones criteria; five of them were clinically diagnosed. The remaining 52 cases (88.1%, 34 with MS ± MR and 18 with MR) did not fulfill or partially fulfilled the Jones criteria and were not diagnosed. A total of 18 patients (30.5%) had the first attack of ARF, whereas recurrences were noted in the remaining patients (69.5%).

Conclusions:

The study indicates that the typical manifestations of ARF under Jones criteria may not be present, especially in cases with recurrence. Hence, a presumptive or possible diagnosis of ARF can be made with presence of minor criteria or strong clinical suspicion in such cases.
Histomorphology of the lesions of the umbilicus
Authors: Singaravel Saranya , Yadav Poonam C.
Published: May 2024

Context:

Twelve-year retrospective study of surgically excised umbilical lesions received for histopathology in a pediatric tertiary care hospital.

Aims:

To study histopathology of the umbilical lesions and review pertinent literature on the embryological basis of these lesions.

Subjects and Methods:

We reviewed cases of umbilical lesions and classified them as “developmental” and “others.” Developmental cases were sub-classified based on the mechanism as those due to defect in the closure of body wall, defect in the closure of the umbilical ring, persistence of embryonic remnants, or failure of epithelization. Persistent embryonic remnants were subdivided into fistula, sinus, and cyst. Histology of all the cases was studied and the different types of tissue in omphalomesenteric ducts (OMD) remnants were identified.

Statistical Analysis Used:

Descriptive statistics were used as required.

Results:

Seventy-one cases in the age range of 1 day to 13 years were studied and male preponderance was noted. The developmental lesions included 4 omphalocele sacs with dense acute inflammation, 2 umbilical hernial sacs with fibrocollagenous tissue, 30 OMD remnants, 10 allantoic duct remnants, 19 umbilical granulomas, and 2 cases showing more than one developmental mechanism. Four cases were classified as “others” including 3 epidermal inclusion cysts and 1 skin tag. Among OMD remnants, sinuses (arising from the distal tract) were found to be the most common. Histological examination of the OMD remnants showed enteric (18), enteric and gastric (5), colonic (4), enteric and colonic (2), and pancreatic and enteric and gastric mucosae (1).

Conclusion:

Accurate diagnosis is essential for definite treatment of these lesions.
Sporadic pediatric colorectal carcinoma without known genetic predisposition - Defying the dictum
Authors: Agrawal Ranjan , Garg Cheena , Babuta Sacheeta , Mohan Nitesh , Agarwal Arjun
Published: May 2024

Pediatric colorectal carcinomas are extremely rare with an incidence of nearly 1.3 per million. Diagnosis is usually delayed following a lack of suspicion at this age. Increasing incidence as well as awareness provides an insight into the disease entity. Two cases of childhood colorectal carcinoma, one in an 11 and another in a 19-year-old boy are presented. However, they have been reparted to carry a forarable outcome. Both the cases showed mucin and signet ring cells which indicates an aggressive behavior. The presentation highlights the clinical characteristics and genetic implications in most of the patients. However, both our cases did not show any predisposing or genetic predisposition. These cases are presented to make aware the readers as to how the common dictum can be reversed and adolescents can also be affected by cancer, a disease of the elderly. Early diagnosis can provide a better management and prognosis.
A tale of monoclonal immunoglobulin
Authors: Maity Priyanka , Dasgupta Saugat , Basu Keya , Sengupta Moumita , Chowdhury Arpita Roy , Bandopadhyay Manimoy
Published: May 2024

Background:

Proliferative glomerulonephritis with monoclonal immunoglobulin deposit (PGNMID) is an entity with a variable clinical and histological spectrum, which mimics immune-complex mediated glomerulonephritis on light microscopy. In this article, we aim to describe the clinical and pathological features of six cases of PGNMID that we encountered during our routine practice.

Materials and Methods:

The study was of the prospective type carried out from February 2018 to August 2019. The renal biopsies that we received in our department, were processed for light microscopy, immunofluorescence microscopy, and electron microscopy. Light microscopic findings were carefully re-evaluated by two experienced renal pathologists. Key diagnostic features were 1) Monoclonal staining of glomeruli for one immunoglobulin (Ig) subclass and single light chain, 2) Membranoproliferative glomerulonephritis (MPGN) pattern (rarely membranous or crescentic), 3) Subendothelial and mesangial (rarely subepithelial) deposits.

Results:

We diagnosed five cases of IgG PGNMID and one case of IgA PGNMID with a mean age 53 ± 10.33 years. The most common histological pattern, seen in three cases was MPGN. IgG3 deposits were identified in five cases out of which k light chain restriction was present in four cases and λ light chain restriction was present in one case. IgA deposits were identified in one case that had λ light chain restriction. One patient suffered from multiple myeloma.

Conclusions:

The renal biopsy especially immunofluorescence analysis is the key modality for diagnosis of PGNMID where it shows staining of the glomerulus for a single heavy-chain subclass and a single light-chain isotype. Electron microscopic evaluation is necessary to differentiate PGNMID from other renal diseases with monoclonal immunoglobulin deposits.
Phenotyping of lymphocyte subsets, Th-1/Th-2 cytokines and other parameters in high-risk contacts of SARS-CoV-2
Authors: Chandra Kailash , Das Ayan Kumar , Banday Sumeera , Dhyani Neha , Upadhyay Bhumika , Dang Arjun , Joshi Santosh , Dudeja Mridu
Published: May 2024

Background:

The information on the pathophysiology of infection in high-risk contacts of SARS-CoV-2 is limited.

Aims:

The aim of the present study was to assess the various factors and their elucidation in the protection of SARS- CoV-2 infection in high-risk contacts.

Settings and Design:

Cross-sectional descriptive clinical study.

Materials and Methods:

A total of 136 subjects were recruited in the present study including 100 high-risk subjects and 36 control subjects. Out of 100 high-risk subjects, 44 subjects were found positive for SARS-CoV-2 RNA. Further, absolute blood counts of total T-cells (CD3+), T-helper cells (CD4+), T-cytotoxic cells (CD8+), B lymphocytes (CD19+) Natural Killer (NK) Cells (CD16+, CD56+), cytokines, and other parameters were measured in the samples of study subjects.

Statistical Analysis Used:

The continuous variables were analyzed by unpaired ‘t’ test, analysis of variance and ‘Tukey test’ for multiple comparisons.

Results: A significant reduction of total leukocyte counts and absolute lymphocyte count was found in the acute SARS-CoV-2 positive group as compared to control group (<0.05). Interestingly, IL-4 level was significantly elevated in SARS-CoV-2 negative high-risk subjects as compared to control and acute SARS-CoV-2 positive group (p < 0.05). A significant decrease of T-cytotoxic, B-cells, and NK cells were found in acute SARS-CoV-2 positive subjects as compared to control groups.

Conclusion:

The findings of this study may augment our knowledge about the pathogenesis of SARS-CoV-2 infection that could help in making future strategies to control its infection.
Differentiating biliary atresia from other causes of infantile cholestasis: An appraisal of the histomorphological changes on liver biopsy
Authors: Halder Aniket , Patra Sabita , Mandal Bappa , Ray Gautam , Ghosh Ranajoy , Mukherjee Suchandra , Chatterjee Uttara
Published: May 2024

Background:

Cholestatic disorders are a significant cause of morbidity and mortality in infants. Characterization of these disorders and differentiating biliary atresia (BA) from other causes of intrahepatic cholestasis is an age-old problem.

Objectives:

To study the spectrum of different infantile cholestatic disorders in our population, to differentiate BA from other causes of neonatal cholestasis (NC) on a liver biopsy, and validation of the available scoring system for the characterization of these disorders.

Materials and Methods:

This is an observational cross-sectional study performed over a period of 3 years between 2018 and 2021, done on neonates and infants presenting with cholestatic jaundice. The changes on liver biopsy were evaluated by different histological parameters and available scoring systems to differentiate BA from non-BA causes. Correlation with clinical, biochemical, and imaging findings was done in all cases.

Results:

This study included 87 cases of NC, of which BA comprised 28 cases (32%), whereas idiopathic neonatal hepatitis (INH) comprised only 12 cases (14%). Portal neutrophilic inflammation (P = 0.000053), ductal cholestasis (P < 0.001), neoductular bile plugs (P < 0.001) and bile ductular proliferation (P < 0.0001) were significantly more in BA, whereas lobular lymphocytic inflammation (P = 0.001) and giant cell transformation of hepatocytes (P = 0.0024) were more frequent in the non-BA group. Using the Lee and Looi scoring system, a histologic score ≥7 was helpful in identifying BA with 85.7% sensitivity, 92.6% specificity, and 90.6% accuracy.

Conclusion:

BA is the commonest cause of NC in neonates, whereas the frequency of INH is declining. Detailed histomorphologic analysis of liver biopsy, aided with IHC, is the cornerstone for the diagnosis of these disorders.
The impact of SARS-CoV-2 infection on term placentae
Authors: Karthikeyan T. M , Sundari Abinaya A , Veenaa N. N , Shivapriya R , Prema N
Published: May 2024

Background:

Coronavirus 2019 infection (COVID 19) is an ongoing pandemic caused by pathogenic RNA viruses called severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). It has affected people of all ages, with high morbidity and mortality among the elderly and immunocompromised population. Limited information is available on the effects of COVID-19 infection on pregnancy.

Aim:

To describe the histopathological changes in the placental tissue of SARS-CoV-2 infected term mothers with no comorbidities and to correlate with neonatal outcome.

Materials and Methods:

This observational study was conducted in the Department of Pathology, KMCH institute of health sciences and research, Coimbatore from May 1, 2020 to November 30, 2020 for 6 months. Placental tissues of all COVID-19-positive term mothers with no comorbidities were included in this study. Histopathological examination of placentae was carried out and clinical data of mothers and newborn babies were obtained from medical records.

Results:

Histopathological examination of 64 placental tissue of COVID-19 mothers showed predominantly the features of fetal vascular malperfusion like stem villi vasculature thrombus, villous congestion, and avascular villi. No significant correlation was obtained in comparison with parity and symptomatic status of the mothers. However, histopathological changes were more prominent among symptomatic patients. The newborn babies born to these mothers showed no adverse outcome.

Conclusion:

This study concluded that though COVID-19 infection in normal term pregnant women was associated with increased prevalence of features of fetal vascular malperfusion, there was no significant morbidity in the health status of both COVID-19 mothers and their neonates.
The role of cyclin D1, BCL-2, p53 and Ki-67 in epithelial cells in the etiopathogenesis of pterygium
Authors: Süren Elçin , Nergiz Döndü , Bilgin Burak , Çoban Deniz Turgut , Akgündüz Zelal , Sadullahoğlu Canan , Süren Dinç
Published: May 2024

Context:

Pterygium is a degenerative disease that consists of conjunctival epithelia and fibrovascular tissue. Some studies suggest that there is a defect in the regulation of apoptosis in the epithelial cell cycle characterized by the development of the disease. But, still this matter being debated.

Aims:

In this study, the clinical, histopathological data, and the expression of the cell cycle regulator Cyclin D1, anti-apoptotic BCL-2, tumor suppressor p53, and cell proliferation marker Ki-67 were searched in pterygium samples.

Subjects and Methods:

The study enrolled 62 cases of primary pterygium who underwent excision between 2014 and 2017. Recurrent and pseudo-pterygium cases were excluded from series. The clinical data were obtained from the patient files and the slides were reevaluated for the histopathological data. Slides of all were stained by Cyclin D1, BCL-2, and Ki-67 by the immunohistochemical method. For each immunohistochemical marker, first the staining was determined as negative or positive. Then if there is a staining, the hot zone (the area containing more positive cells) was determined and staining percentage (SP) was assessed by counting positive cells/100 epithelial cells).

Results:

Solar elastosis, edema, inflammation, and epithelial dysplasia were found statistically different between the control group and the patient group (P value <0.001, <0.001, <0.001 <0.001, respectively). A significant difference was found for staining percentage (SP) of Ki-67, p53, BCL-2 between the control group and the patient group (P values <0.001, 0.002, <0.001, respectively). There were no significant differences in the SP of Cyclin D1 between the two groups (p: 0,133).

Conclusions:

Our results indicate an abnormal expression of p53, BCL-2 and elevated proliferation measured by Ki-67 in pterygium samples when compared to normal conjunctiva. Besides the mesenchymal changes, the increased proliferation and the failure of apoptosis in the epithelial cells participate in the development of pterygium, as well.
FISH for EWSR1 in Ewing's sarcoma family of tumors
Authors: Murthy Sudha S. , Gundimeda Sandhya Devi , Challa Sundaram , Manjula V , Fonseca Daphne , Rao Vishal B. , Rajappa Senthil J. , N Raju K. V. V. , Rao T. Subramanyeshwar
Published: May 2024

Background:

Molecular confirmation of histologic diagnosis has become mandatory for the diagnosis of Ewing sarcoma family of tumors (ESFT).

Aim:

To validate the diagnosis made by morphology and immunohistochemistry (IHC) by fluorescence in-situ hybridization (FISH) for EWSR1 rearrangement on formalin fixed paraffin embedded (FFPE) tissues. Settings and design: A retrospective and prospective observational study. Material and methods: All patients who had FISH studies for EWSR1 rearrangement for small round cell tumors during 10 years period were included. Demographic, clinical and radiological details were obtained from medical records. Morphology was reviewed with IHC by CD99, FLI1 and others. FISH studies were performed using the break apart probe. Additional molecular studies and IHC were done to resolve the diagnosis in EWSR1 rearranged tumors. Final diagnosis was made by integrating clinical, morphology, IHC and molecular features.

Results:

There were 81 patients (M: F 45:36, median age 21 years) with 32 skeletal and 49 extra skeletal tumors. CD 99 was positive in 94.52%. FISH for EWSR1 were positive in 59, negative in 13 and failed in 9. The final diagnosis was made as ESFT in 67, angiomatoid fibrous histiocytoma in 3, desmoplastic small round cell tumor in 3, myxoid chondrosarcoma in 2, unclassified in one, synovial sarcoma in 3, and one each of lymphoma and small cell neuroendocrine carcinoma. FISH was positive for ESFT in 89.83% of EWSR1 rearranged tumors. FISH validated the diagnosis made on IHC in 79.10%. FISH resolved the diagnosis in 1.49% CD99 negative tumors.

Conclusion:

FISH is a reliable ancillary technique for the diagnosis of ESFT on FFPE tissues.
Peritoneal sarcomatosis due to undifferentiated pleomorphic sarcoma
Authors: Sogutcu Nilgun , Kavak Seyhmus , Gumus Serdar
Published: May 2024

Undifferentiated pleomorphic sarcoma (UPS), which was previously known as malignant fibrous histiocytoma (MFH), rarely presents in the abdomen, and sarcomatosis due to UPS has not yet been reported in the literature. Here, we present a 62-year-old man who had abdominal sarcomatosis due to UPS with a poor prognosis.
Modified improvised pre-embedding method for core needle biopsies
Authors: Sunny Nikita , Thomas Anupa , Manjunath Suraj , Kini Usha
Published: May 2024

Background:

An optimal core needle biopsy (CNB) is expected to balance between tissue diagnosis, the accuracy of negative sampling, and concordance with reports from resected specimens to select the appropriate treatment. Though various techniques for CNBs are available, no guidelines exist for processing CNB, with practices varying from lab to lab for transport and processing. This prospective study aims to design a cost-effective, user-friendly pre-embedding method for CNBs to yield intact cores.

Objective:

To compare the outcomes of CNBs by a conventional method with those processed by the modified pre-embedded processing protocol over 2 years.

Material and Methods:

Presurgical CNBs from SOL in various organs were subjected to the conventional free-floating method in formalin (control) for histopathology diagnosis. CNBs from the corresponding, freshly resected SOLs (test) were taken, inked with coloring inks if multiple, placed between two 2 × 2 cm polyurethane foam meshes fitted inside cassettes, fixed in formalin, and transported to the laboratory. The two CNB groups were coded and scored independently for intactness, tissue processing, ease of embedding, and ease of cutting sections. Data obtained were statistically analyzed.

Results:

Test CNB cores were better processed, intact, linear, and aligned, compared to control CNBs. With four CNBs in one block, the number of blocks and sections were cut-down by one-fourth.

Conclusion:

CNBs processed using polyurethane foam and coloring inks were superior and economical against conventional free-floating CNBs. This technique can be practiced by surgeons at the bedside.
Hepatoid adenocarcinoma of lung
Authors: Pasricha Sunil , Grover Shrruti , Kamboj Meenakshi , Bansal Divya , Batra Ullas , Gupta Gurudutt , Sharma Anila , Durga Garima , Jajodia Ankush , B. Koyyala Venkata P. , Mehta Anurag
Published: May 2024

Hepatoid adenocarcinoma of lung is a rare entity, accounting for 5% of all hepatoid adenocarcinoma. Distinguishing it from metastatic hepatocellular carcinoma is essential, but occasionally can be very challenging, especially with concurrent liver mass. A judicious immunohistochemical panel is warranted for accurate diagnosis and subsequent preservation of tissue for molecular testing. There is limited data on the mutational status, behavior and management strategies of this type of lung adenocarcinoma. We report largest series of six cases of hepatoid adenocarcinoma of lung citing the clinical, histopathological, immunohistochemical and molecular parameters including PD-L1 immunoexpression as a predictive biomarker for immunotherapy. None of the evaluated cases showed targetable mutation; however, four out of six cases showed significant PD-L1 expression. All the cases presented with advanced stage and received chemotherapy, however overall prognosis was dismal. In view of significant PD-L1 expression in these tumors and poor response to conventional chemotherapy, these cases might be considered for upfront immunotherapy.
Intravascular papillary endothelial hyperplasia
Authors: Agarwal Shilpi , Gaur Kavita , Arya Vishakha
Published: May 2024

Intravascular papillary endothelial hyperplasia (Masson's tumor) is a reactive vascular lesion of obscure etiopathogenesis, often seen in the head and neck. Its presentation as a scalp swelling, however, is extremely uncommon. We describe the first report in an adult, being treated for bipolar illness. A young male presented with a right frontotemporal scalp swelling since 3 weeks. He was also being treated for bipolar illness with olanzapine. Examination revealed a soft, non-pulsatile swelling. After inconclusive aspiration results, a complete excision was performed. Histopathology revealed proliferating endothelial cells arranged as papillary fronds confined to vessel lumina, devoid of atypia, accompanied by thrombosed vessels facilitating a diagnosis of Masson's tumor. The patient is free of recurrence five months after surgery. Further studies on a possible effect of olanzapine on vascular proliferation in experimental in vivo and in vitro models would definitely aid in elucidating clinical relevance, if any.
Disorders of sexual differentiation
Authors: Correya Mary Anelia , Babu Ramesh , Archana B , Ravirajendiran Samson
Published: May 2024

Gonadal dysgenesis is a distinct variety of Disorders of Sexual Differentiation (DSD) characterised by incomplete or defective formation of the gonads due to either structural or numerical anomalies of the sex chromosomes or mutations in the genes involved in the development of the gland. Here we present two such rare cases that presented during childhood. Both patients presented with ambiguous genitalia with a 45XO/46XY mosaic chromosome pattern. First case, an infant underwent laparoscopic excision of streak gonad, and a single stage hypospadias repair later. Second case, an adolescent who underwent gonadectomy as a child, presented with a mass which was excised and found to contain uterine and ovarian tissue; second stage hypospadias repair is being planned. Mixed gonadal dysgenesis usually presents with a unilateral testis, a streak gonad on the contralateral side and persistent mullerian structures. The most common karyotype noted is 45XO/46XY. These cases are known to have ambiguous external genitalia. The streak gonads have an increased malignant potential and thus, these patients should be carefully screened and followed up for gonadoblastoma.
STRN-ALK rearranged malignant peritoneal mesothelioma—Presenting with bilateral extensive pelvic masses in a young woman
Authors: Bulutay Pinar , Vatansever Dogan , Taskiran Cagatay , Mericoz Cisel A. , Tokat Fatma , Kapucuoglu Nilgun , Kulac Ibrahim
Published: May 2024

Malignant peritoneal mesothelioma (MPM) is an exceptionally rare tumor type. Although some somatic/germline genetic alterations including BAP1 loss have been identified in some cases, the molecular properties of MPMs are remained poorly understood. In recent years, anaplastic lymphoma kinase (ALK) gene rearrangement was revealed in a subset of (3.4%) MPMs. Low-grade serous carcinomas (LGSCs) are a rare subtype of ovarian carcinoma and have some morphologic and immunophenotypic overlapping features with MPMs and this may cause misdiagnosis in daily practice. Here, we report a case of 18-year-old women with STRN-ALK-rearranged MPM and no previous exposure to asbestos. This case was presented with bilateral pelvic masses and histologically was displaying pure papillary morphology with mild-to-moderate nuclear atypia, psammoma bodies, and diffuse PAX8 expression as LGSCs. With the detection of ALK alteration in some of the MPMs, a targeted treatment option has emerged for these unusual tumor types.
The Ring-and-Sling complex – Does it “Ring” true?
Authors: Ray Manjusha , Sathe Pragati , Vaideeswar Pradeep , Marathe Supreet P
Published: May 2024

Background:

The “Ring-and-Sling” complex (RSC) comprises congenital tracheal stenosis and an abnormal origin/course of the left pulmonary artery. Based on clinical and imaging studies, the luminal narrowing is assumed to be as a result of rings cartilage (forming an “O”).

Aims:

This is a postmortem based study of tracheal histology in infants after an autopsy encounter of a case of RSC.

Subject and Methods:

RSC was identified in an infant at autopsy. The tracheal histomorphology revealed the presence of cartilaginous plates (instead of rings) and fibro-elastotic proliferation at the site of trachealis muscle. These changes prompted a study on variations in the histology of the trachea (with no known anomaly) in 35 autopsied neonates and infants. The transverse sections of the trachea were taken at one or more levels (Level 1 – at the level of the thyroid, Level 2 – midway between the thyroid and the carina, and Level 3 – just above the carina.

Statistical Analysis:

Epi-info software (v1.4.3, CD, US).

Results:

On histology, 83 sections showed the trachealis muscle on the posterior aspect. A single semicircular cartilage was identified in only 17 of the 83 sections studied (20.5%, 6 in level 1, 9 in level 2 and 2 in level 3). In the remaining 66 sections (79.5%), the cartilage was disposed as multiple plates, ranging in number from 2 to 10. No significant association was found between semicircular cartilage rings and age, sex, gestational age, and level of section (P < 0.05). However, 14 cases with sectioning at all three levels were taken into account; all levels showed more cartilaginous plates compared to single rings, which were more common at level 1 (P > 0.05).

Conclusions:

The “ring” in RSC and normal infantile tracheas show cartilage plates with intermittent semicircular cartilage rings. These findings may have surgical implications for tracheal anomalies and bode favorable surgical outcomes.
Hemophagocytic lymphohistiocytosis secondary to Candida albicans and reactivated EBV infections
Authors: Yang Wenyan , Liu Keyu , Zou Fengling , Wang Xueqin , Yin Junping , Wu Yifeng , Chai Xiaolei , Zheng Liheng
Published: May 2024

Hemophagocytic lymphohistiocytosis (HLH) has been recognized as a potentially life-threatening syndrome. This is the first case of acquired HLH caused by dual infections with Candida albicans and reactivated EBV infections, which focuses on the importance of morphological awareness of peripheral blood and bone marrow because sometimes they are the only locations that HLH and fungal microorganisms can be diagnosed. A 29-year-old woman with a history of abdominal distension and 9 months of intermittent fevers ($38.8°C) was admitted to the hematology department with treatment for leukopenia and thrombocytopenia. Severe infection of bilateral pulmonary and marked hepatosplenomegaly were detected by computed tomography. EB virus-CA IgG, EB virus-NA IgG and EB virus-CA IgM were positive. Scattered yeast-like fungi were found on peripheral blood and bone marrow (BM) smears. BM smears indicated prominent hemophagocytosis. Cultures of bronchoalveolar lavage and BM confirmed the growth of C. albicans. A diagnosis of HLH caused by dual infections with Candida albicans and reactivated EBV infections was established based on the clinical features of the patient because 7 of the 8 diagnostic criteria were met. She was treated with etoposide, dexamethasone for HLH, as well as highly active antifungal and antiviral therapies for the underlying etiology of dual infections. The patient eventually recovered following the effective treatment. A timely and accurate diagnosis is crucial to the prognosis of the dangerous disease.
Histiocytic and follicular dendritic cell sarcoma
Authors: Patra Sanjiban , Trivedi Priti , Kaur Kanwalpreet
Published: May 2024

Background:

Follicular dendritic cell sarcomas (FDCSs) and histiocytic sarcomas (HSs) are exceedingly rare tumors. Most of the data on those entities are based on case reports or small case series. The natural history and response to different treatment modalities have not been well established.

Aims:

To analyze the clinicopathologic features, immunophenotypic profile, treatment responses and to add to the existing data on FDCS and HS.

Study Design:

Retrospective descriptive study.

Materials and method:

The study was conducted at the department of Oncopathology at a tertiary care cancer hospital in India, retrospectively within the time period of four years (2016-2019). Total eight (8) cases were diagnosed: four cases of FDCS and four cases of HS involving nodal and extra-nodal sites. Clinical, histopathological, immunohistochemistry (IHC) and therapeutic data of the eight cases were retrieved and analyzed.

Statistics:

Descriptive statistics.

Result:

Among the four patients of FDCS, two had nodal and two had extra-nodal disease. Mean tumor size was 6 cm. Tumor cells expressed CD23, CD21, CD45, CD68 and S100. One patient received adjuvant chemotherapy (Gemcitabine and Docetaxel). Median survival was 36 months. None of them developed distant metastasis. Two of the patients having HS, developed bone metastasis. Median survival was 8.5 months. CD68 was consistently expressed in all cases of HS. Other applied IHC markers were negative in all the eight cases.

Conclusion:

FDCS and HS are under-recognized and easily prone to a wrong diagnosis. Therefore, considering these rare entities in differential diagnoses and inclusion of proper IHC biomarkers are necessary to avoid potential misdiagnosis.