bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasminogen Activator Inhibitor-1 Levels and Polymorphisms
Authors: Francis Charles W.
Published: January 2021

Objective.—To review the published evidence of a relationship between levels of plasminogen activator inhibitor-1 (PAI-1) or the 4G/5G polymorphism of the PAI-1 gene and the occurrence of venous thromboembolic disease.

Methods.—Review of the medical literature using computerized databases and a review of secondary sources identified through bibliographies.

Data Synthesis.—Plasminogen activator inhibitor-1 is an important inhibitor of the fibrinolytic system, so it is biologically plausible that elevated levels could suppress fibrinolysis and result in an increased risk of thrombosis. Several small studies reported associations between PAI-1 levels and venous thromboembolism, some of which appear to be familial. Problems with these studies include variations in PAI-1 plasma levels due to circadian changes and the acute phase response, as well as alterations due to common comorbid disease states. More recent investigations have focused on genetic polymorphisms, particularly the 4G/5G insertion/deletion in the promoter region, affecting transcription rates. The relation of 4G/5G to venous thrombosis has been investigated primarily in case-control studies, which have produced inconsistent findings. Most studies, however, have reported higher PAI-1 plasma levels in individuals with 4G/4G.

Conclusions.—The evidence regarding the relationship between an elevated PAI-1 plasma level or PAI-1 genetic polymorphism and the risk of venous thromboembolism is conflicting. There is insufficient information to recommend use of PAI-1 levels or genotype in evaluating thrombophilia.
Adrenal Cortical Adenoma With Adrenalin-Type Neurosecretory Granules Clinically Mimicking a Pheochromocytoma
Authors: Ivsic Tomislav , Komorowski Richard A. , Sudakoff Gary S. , Wilson Stuart D. , Datta Milton W.
Published: January 2021

Adrenal tumors often present with clinical features that are specific and unique to their endocrine metabolism. When these features are in conflict with the pathologic appearance of the tumor, there can be great consternation for both the pathologist and the surgeon. In the case reported herein, an adrenalectomy was performed for clinical features of pheochromocytoma that on gross and histologic examination had the pathologic features of an adrenal cortical adenoma. Electron microscopy subsequently revealed that the tumor cells contained adrenalin-type granules, explaining the clinical outcome. It is crucial for both the surgeon and the surgical pathologist to be aware of this possibility when the clinical and pathologic features of an adrenal tumor are not congruent.
Ectopic Parathyroid Adenoma Initially Suspected to Be a Thyroid Lesion
Authors: Pitsilos S. A. , Weber R. , Baloch Z. , LiVolsi V. A.
Published: January 2021

Considering the variety of aberrant locations in which ectopic parathyroid adenomas may be found, these neoplasms can be difficult to identify and treat surgically. The results of radiographic and cytologic studies may lead to confusion of these neoplasms with lesions of thyroid origin. We present a case of an ectopic parathyroid adenoma for which misleading localization prompted cytologic misdiagnosis and intraoperative suspicion of thyroid carcinoma.
Mature B-Cell Leukemias With More Than 55% Prolymphocytes
Authors: Merchant Shakil , Schlette Ellen , Sanger Warren , Lai Raymond , Medeiros L. Jeffrey
Published: January 2021

Context.—The molecular genetic events involved in the pathogenesis of mature B-cell leukemias with more than 55% prolymphocytes are not well characterized. We have encountered 2 such cases in which conventional cytogenetic analysis identified Burkitt lymphoma–type chromosomal translocations involving 8q24.

Objective.—To assess these 2 cases for involvement of the c-myc gene using fluorescence in situ hybridization analysis with probes specific for the c-myc and immunoglobulin heavy-chain (IgH) genes.

Results.—In both cases, conventional cytogenetic analysis demonstrated complex karyotypes, including chromosomal translocations involving 8q24. In case 1, a case of de novo prolymphocytic leukemia, the t(8;14)(q24;q32) was detected. In case 2, a case of chronic lymphocytic leukemia in prolymphocytoid transformation, the t(8;22)(q24;q11) was identified. Fluorescence in situ hybridization studies showed c-myc/IgH fusion signals in case 1, proving the presence of the t(8;14). Split c-myc signals without fusion to IgH were observed in case 2, proving c-myc gene rearrangement and consistent with the t(8;22).

Conclusion.—These results suggest that c-myc gene alterations may be involved in the pathogenesis of a subset of mature B-cell leukemias with more than 55% prolymphocytes.
Management of Patients Refractory to Platelet Transfusion
Authors: Sacher Ronald A. , Kickler Thomas S. , Schiffer Charles A. , Sherman Laurence A. , Bracey Arthur W. , Shulman Ira A.
Published: January 2021

Objective.—To present a current assessment and practical approach to the diagnosis and management of patients who are refractory to platelet transfusions.

Design.—A task force was convened by the College of American Pathologists under the auspices of the Transfusion Medicine Resource Committee for the purposes of outlining current concepts in the definition and diagnosis of this difficult clinical management problem and selection of the optimal platelet component for these patients.

Results.—This article represents a contemporary approach to the diagnosis and management of patients who are refractory to platelet transfusions. This document is based on a current literature review and dialog among members of the task force convened to address the subject.

Conclusions.—It is hoped that this document will represent a resource and practical approach to the issue of diagnosis and management of patients who are refractory to platelet transfusions.
Mature B-Cell Acute Lymphoblastic Leukemia With Associated Translocations (14;18)(q32;q21) and (8;9)(q24;p13)
Authors: Dunphy Cherie H. , van Deventer Hendrik W. , Carder Kathryn J. , Rao Kathleen W. , Dent Georgette A.
Published: January 2021

The translocation t(14;18)(q32;q21) is most commonly associated with follicular lymphoma but has also been described in acute lymphoblastic leukemia (ALL) of B-cell origin. Although these ALL cases have had a pre-pre-B, pre-B, or mature B-cell immunophenotype and L2 or L3 morphology, all have been associated with an abnormality of 8q24. In fact, 91% (10 of 11) have been associated with t(8;22) or t(8;14), marker chromosomes for Burkitt-type ALL. The other case was associated with del(8)(q24). Thus, Burkitt-type ALL may have various immunophenotypes and morphology when associated with t(14;18). We describe a case of mature B-cell ALL associated with t(14;18) and t(8;9)(q24;p13). The morphology was suggestive but not entirely characteristic of the L3 subtype. However, on the basis of the cytogenetic findings and the review of the literature, perhaps this case represents a variant of Burkitt-type ALL, which would be important to recognize for prognostic and therapeutic purposes. We describe our findings and review the literature to heighten awareness of this group of ALLs associated with t(14;18). Additional cases need to be accrued and documented to determine the significance of an associated abnormality of 8q24 in this setting.
Multilaboratory Evaluation of Serum Analysis for HLA Antibody and Crossmatch Reactivity by Lymphocytotoxicity Methods
Authors: Duquesnoy RenéJ. , Marrari Marilyn
Published: January 2021

Context.—This report presents results of the serum antibody analysis and crossmatch challenges in the proficiency testing program for histocompatibility testing jointly sponsored by the American Society for Histocompatibility and Immunogenetics and the College of American Pathologists.

Objective.—To obtain information about consensus rates among participating laboratories that reported antibody screening and crossmatch results by direct complement-dependent lymphocytotoxicity (CDC) and/or anti-human globulin (AHG)–augmentation methods.

Design.—We analyzed responses from approximately 165 laboratories participating in 32 surveys during 1993–2000. Most of the testing was done by CDC methods, but increasing proportions of laboratories are using AHG augmentation of these techniques; almost one half of the serum screenings and crossmatches were done by AHG.

Results.—A total of 40 serum specimens were screened to determine the percent panel-reactive antibody (PRA) and identify HLA-specific antibodies. Participants often reported very wide ranges of PRA values. Panel-reactive antibody ranges exceeded 60 percentage points for 16 (40%) of the serum screening results by CDC and for 31 (77%) of the results by AHG. The interlaboratory variability of PRA values suggests that in many laboratories, the CDC or AHG procedures were often too insensitive or overly sensitive. The antibody identification results revealed inconsistent patterns among the participants performing CDC or AHG screening. Most participants reported the same primary antibody specificities by both methods. The consensus levels were generally high for the monospecific sera. On the other hand, there was much less agreement among the participants if the sera reacted with 2 or more HLA antigens. Participants using the more sensitive AHG method reported additional antibody specificities in many specimens, but invariably the consensus levels were rather low. A total of 192 serum-cell combinations were used for the crossmatch challenges. There was considerable interlaboratory variability; 21% of the CDC crossmatches and 36% of AHG crossmatches failed to reach the 90% consensus threshold.

Conclusions.—This experience demonstrates considerable inconsistencies in serum screening and crossmatching among laboratories participating in the American Society for Histocompatibility and Immunogenetics/College of American Pathologists surveys. A lack of uniformity in test results may limit the efficient application of these methods in a clinical setting. Standardization of crossmatch and antibody screening techniques is highly desirable.
Low Nuclear Proliferative Activity Is Associated With Nonmetastatic Islet Cell Tumors
Authors: Jorda Merce , Ghorab Zeina , Fernandez Gustavo , Nassiri Mehdi , Hanly Andrew , Nadji Mehrdad
Published: January 2021

Context.—Traditional morphologic features of tumor aggression are of limited value in predicting the malignant behavior of endocrine neoplasms. We explored the potential value of nuclear proliferative activity (using Ki-67 immunostaining with semiquantitative scoring) in predicting the clinical behavior of pancreatic islet cell tumors (ICTs), and we correlated this characteristic with hormone expression.

Objective.—To evaluate whether Ki-67 immunostaining using a semiquantitative scoring system has value in predicting the clinical behavior of pancreatic ICTs.

Design.—We studied 39 pancreatic ICTs from 39 patients. Twenty-two ICTs did not metastasize in a median follow-up period of 91 months. The remaining 17 neoplasms did produce metastases (8 in liver, 7 in regional lymph nodes, and 2 in peritoneum). Immunohistochemistry was performed using antibodies to Ki-67 and pancreatic hormones (insulin, glucagon, gastrin, somatostatin, pancreatic polypeptide, vasoactive intestinal polypeptide, and corticotropin). A semiquantitative Ki-67 grading system was followed. The nuclear proliferative activity, as determined by a positive reaction for Ki-67, was considered low (<5% of cells staining positively), intermediate (5%–25% of cells staining positively), or high (>25% of cells staining positively).

Results.—The majority of the nonmetastatic ICTs (16 cases, 73%) demonstrated either negative or low staining for Ki-67 (P < .001). Conversely, all metastatic ICTs expressed at least an intermediate-grade reaction. High nuclear proliferative activity was only seen in metastatic neoplasms (3 cases, 17%). There was no relationship between immunoexpression of pancreatic hormones and nuclear proliferative activity by either group of tumors.

Conclusion.—An ICT with low nuclear proliferative activity is unlikely to metastasize, whereas high proliferative activity is associated with a metastatic phenotype. Immunohistochemical assessment of Ki-67 using a semiquantitative scoring system is a simple and reliable detection method of cellular proliferative activity in ICTs of the pancreas.
Herpes Simplex Pancreatitis
Authors: Shintaku Masayuki , Umehara Yasushi , Iwaisako Keiko , Tahara Masao , Adachi Yasushi
Published: January 2021

Lesions of the pancreas induced by viral infection have drawn relatively little attention because of their low incidence, and the histopathologic features of viral pancreatitis have not been fully elucidated. We report the autopsy findings of 2 patients, a 59-year-old woman with allergic granulomatous angiitis and a 73-year-old man with invasive pulmonary aspergillosis who had a disseminated visceral herpes simplex virus (HSV) infection. In both cases, the liver was the organ most severely affected by the viral infection. The pancreas showed multiple small foci of hemorrhagic necrosis, which were not accompanied by fat necrosis of the surrounding adipose tissue. Histopathologically, Cowdry type A intranuclear inclusions and a ground-glass appearance of the nuclei were found in many degenerated acinar cells around the necrotic foci. The gross appearance and histopathologic features of HSV pancreatitis were characteristic and, in particular, distinct from those of the more common acute hemorrhagic pancreatitis. Immunohistochemistry using an anti-HSV antibody revealed immunoreactivity in the intranuclear inclusions and ground-glass nuclei, and polymerase chain reaction analysis disclosed that the causative virus in these 2 cases was HSV-1. Herpes simplex virus pancreatitis constitutes a rare, but distinct pathologic entity among a group of acute pancreatitis diseases with diverse etiopathogenesis.
Male Versus Female Breast Cancers
Authors: Muir D. , Kanthan R. , Kanthan S. C.
Published: January 2021

Context.—The rate of male breast cancer is a small fraction of that observed in females, thus severely limiting our understanding of the pathogenesis of this condition. It remains unclear whether the biological behavior and tumor progression associated with male breast cancer parallel that of the female form.

Objectives.—To evaluate the immunohistochemical profile of male breast carcinomas and to compare this profile with that of stage-matched female breast cancers.

Design.—Seventy-five cases of primary male breast cancer were identified using the records of the Saskatchewan Cancer Foundation over a period of 26 years (1970–1996). Fifty-nine of these cases had formalin-fixed, paraffin-embedded tissue blocks available for the purposes of this study. All cases were reviewed and a standardized modified Bloom-Richardson grading criterion was applied. Estrogen receptor status, progesterone receptor status, c-Erb-B2 expression, p53 expression, and Bcl-2 expression were evaluated by immunohistochemistry. Results from 240 consecutive cases of stage-matched female breast cancers analyzed in the same laboratory were used as a standard set for comparison.

Results.—Male breast cancers tended to be high grade (85% grade 3) in comparison with the female breast cancers (50% grade 3). In descriptive analysis across all stages of disease, male carcinomas were more frequently estrogen receptor positive (81% vs 69%) than their female counterparts. Despite their high grade, they were less likely to overexpress p53 (9% vs 28%) and Erb-B2 (5% vs 17%) than the female counterparts. There was no significant difference in either progesterone receptor (63% vs 56%) or Bcl-2 (79% vs 76%) overexpression. Stratified analysis by stage-matched controls showed no statistically significant differences among the men and women with stage I disease. However, in stage II–matched samples, statistically significant differences were observed between the 2 groups. The male cancers were more likely to overexpress estrogen receptor (81.6% vs 64.4%, P = .04), progesterone receptor (71.1% vs 47.5%, P = .01), and Bcl-2 (78.9% vs 69.4%, P = .20). They also showed statistically significant lower expression of p53 (7.9% vs 36.3%, P = .001) and Erb-B2 (5.3% vs 23.8% P = .01).

Conclusion.—Male breast cancers display distinct immunophenotypic differences from those occurring in women, implying a different pathogenesis in the evolution and progression of this disease. Such differences may play key roles in therapeutic management, warranting different treatment strategies in comparison to female breast cancers.
Personnel Standards and Quality Assurance Practices of Biochemical Genetic Testing Laboratories in the United States
Authors: McGovern Margaret M. , Benach Marta , Wallenstein Sylvan , Boone Joe , Lubin Ira M.
Published: January 2021

Context.—It has been suggested that specific regulation of laboratories performing genetic testing may be needed to ensure standards and quality assurance, and to safeguard the rights of patients with regard to confidentiality and providing informed consent. Previously, a comprehensive analysis of current practices of molecular genetic testing laboratories was conducted, the results of which have assisted in the assessment of the need for regulation and its impact on access to testing. However, a study designed to determine clinical laboratory practices with regard to biochemical genetic testing has not been carried out.

Objective.—To collect and analyze data regarding availability of clinical biochemical genetic testing, personnel standards, and laboratory quality assurance practices.

Design.—A mail survey of biochemical genetic testing laboratory directors and assignment of a quality assurance score based on responses to genetic testing process items.

Setting.—Hospital-based, independent, and research-based biochemical genetic testing laboratories in the United States.

Participants.—Directors of biochemical genetic testing laboratories (n = 133; response rate 68.5%).

Main Outcome Measure.—Laboratory process quality assurance score based on the standards defined by the American College of Medical Genetics Laboratory Practice Committee.

Results.—Personnel qualifications varied, although all directors had doctoral degrees. The mean quality assurance score was 77% (range 28%–100%). Higher scores were associated with the following variables: test director having an MD degree versus PhD degree (P = .002), director board certification in biochemical genetics (P = .002), research and hospital laboratory versus independent laboratory setting (P < .001), and participation in a proficiency testing program (P = .03). Twelve percent of participants had a confidentiality policy, and 19% required informed consent before testing.

Conclusion.—The finding that a number of laboratories had quality assurance scores that may reflect suboptimal laboratory practices, particularly with regard to reporting practices, suggests that personnel qualification and laboratory practice standards may be in need of improvement to ensure quality in clinical biochemical genetic testing laboratories, as well as the appropriate clinical use of the test results.
Disappearance of Meconium Pigment in Placental Specimens on Exposure to Light
Authors: Morhaime Jacquelyn L. , Park Kay , Benirschke Kurt , Baergen Rebecca N.
Published: January 2021

Context.—Meconium discharge has been associated with fetal distress and poor neonatal outcome; thus, its presence is of clinical importance.

Objective.—Loss of meconium pigment in histologic sections from light exposure has been described. We sought to confirm this finding and to measure this loss quantitatively.

Design.—Sections of umbilical cord, fetal membranes, and fetal surface from 11 grossly meconium-stained placentas were processed swiftly to minimize light exposure. Two serial sections from each block were cut and stained; one set was reviewed immediately, and the other was exposed to 8 hours of direct fluorescent lighting. Each site and exposure was scored for pigment intensity (0, no staining; 1, weak expression; and 2, moderate/strong expression) and number of meconium-laden macrophages per 10 high-power fields (HPF). Results were compared on the same specimen using the χ2 and the paired-samples t test.

Results.—The maximum meconium macrophage count was 13.2/10 HPF in the unexposed sections versus 6.1/10 HPF in the exposed sections (P < .001). Unexposed sections varied from 1+ to 2+ intensity, while exposed sections were all 1+ or negative (P < .001).

Conclusion.—Exposure to fluorescent laboratory lights for 8 hours resulted in a significant loss in the intensity and number of identifiable meconium macrophages in histologic sections. These findings have important implications in the handling of placental specimens, and we recommend that care be taken to minimize exposure to laboratory lights during processing.
Comparison of Direct Selective Versus Nonselective Agar Media Plus LIM Broth Enrichment for Determination of Group B Streptococcus Colonization Status in Pregnant Women
Authors: Elsayed Sameer , Gregson Daniel B. , Church Deirdre L.
Published: January 2021

Context.—Group B streptococcus (GBS) is the most common cause of early-onset neonatal sepsis in developed countries, and determination of the GBS colonization status in pregnant patients near term is essential for the provision of prophylactic measures to prevent early-onset disease.

Objectives.—To determine if GBS recovery rates and/or result turnaround times for vaginal or combined vaginal/rectal swab specimens from pregnant patients near term are enhanced if swabs are inoculated initially onto selective versus nonselective agar media, in addition to the standard Centers for Disease Control and Prevention method.

Design.—Prospective laboratory analysis.

Setting.—Urban health region/centralized diagnostic microbiology laboratory.

Patients.—Pregnant women presenting for routine obstetrical care and collection of vaginal or combined vaginal/rectal swab specimens for GBS testing at 35 to 37 weeks' gestation.

Intervention.—Culture of specimens directly onto selective (5% sheep blood with colistin and nalidixic acid) or nonselective (5% sheep blood) agar media, in addition to LIM broth enrichment and terminal subculture.

Main Outcome Measures.—Group B streptococcus recovery rate and culture result turnaround time.

Results.—A total of 639 specimens were tested, with 128 (20%) positive for GBS. Sixty-three isolates were recovered on direct agar media at 24 hours, of which 16 (12.5%) were isolated on selective plates only. An additional 38 isolates were recovered at 48 hours from direct plates. Twenty-seven (21.1%) isolates that failed to grow on direct plates were recovered from the LIM broth subculture only. Three (2.3%) isolates not recovered from LIM broths were detected at 48 hours on the direct selective (2 isolates) and nonselective (1 isolate) agar plates. A 24-hour result turnaround time was achieved for 63 (49.2%) and 47 (36.7%) of the 128 culture-positive specimens for direct selective and nonselective plates, respectively (χ2 = 76.63, P < .001).

Conclusions.—Use of direct selective agar media, in addition to LIM broth enrichment, for the determination of the GBS colonization status in pregnant patients near term results in decreased turnaround time for reporting positive results.
Pancreatic Acinar Cell Metaplasia in Autoimmune Gastritis
Authors: Jhala Nirag C. , Montemor Mario , Jhala Darshana , Lu Lin , Talley Lynya , Haber Marian M. , Lechago Juan
Published: January 2021

Objective.—To determine the frequency and significance of pancreatic acinar cells in the gastric oxyntic mucosa.

Design.—One hundred gastric oxyntic mucosal biopsy specimens from patients with chronic active gastritis (n = 30), multifocal atrophic gastritis (n = 15), autoimmune gastritis (n = 18), and normal gastric oxyntic mucosa (n = 37) were evaluated for the presence of pancreatic acinar cells. Formalin-fixed, paraffin-embedded tissues were stained with hematoxylin-eosin, and those positive for pancreatic acinar cells were immunostained with antibodies against trypsin and pancreatic amylase.

Results.—Eleven (11%) of 100 oxyntic mucosal tissue samples contained pancreatic acinar cells. These samples came from 9 of the 18 (50%) specimens of autoimmune gastritis, 1 of the 15 (6.6%) specimens of multifocal atrophic gastritis, and 1 of the 37 (2.7%) specimens of normal oxyntic mucosa. None of the samples with chronic active gastritis contained pancreatic acinar cells.

Conclusions.—Pancreatic acinar cells were found in the oxyntic mucosa of patients with autoimmune gastritis significantly more frequently (P < .001) than in individuals with multifocal atrophic gastritis, normal oxyntic mucosa, or chronic active gastritis. Our study supports a metaplastic origin for pancreatic acinar cells in the oxyntic mucosa. Furthermore, detection of pancreatic acinar cells in the oxyntic mucosa of patients with gastritis strongly suggests an autoimmune pathogenesis.
Localized Retroperitoneal Lymphangioleiomyomatosis Mimicking Malignancy
Authors: Jaiswal Vilkesh R. , Baird Julie , Fleming Jason , Miller David Scott , Sharma Suash , Molberg Kyle
Published: January 2021

Lymphangioleiomyomatosis (lymphangiomyomatosis [LAM]), a rare disease of unknown etiology that is seen only in women usually in the reproductive period, generally presents with features of pulmonary involvement. Extrapulmonary involvement, such as angiomyolipomas and retroperitoneal adenopathy, can occur in up to 75% of cases. It is very rare, however, for patients to present with features of extrapulmonary LAM. We present an unusual, localized case of LAM presenting with neurologic symptoms related to a retroperitoneal mass in a 51-year-old woman. Magnetic resonance imaging showed that the mass involved retroperitoneal lymph nodes, and a clinical diagnosis of atypical sarcoma (possibly from a uterine primary) was made. The mass was resected, and a total abdominal hysterectomy was performed. On pathologic examination, the mass showed classic histologic features of LAM with spread along lymphatic channels in the lymph nodes. Intralymphatic projections simulated lymphatic metastasis; however, the cytologic features were benign. Immunostains revealed the tumor to be positive for smooth muscle actin and desmin, but negative for HMB-45. The uterus was unremarkable, except for a subserosal leiomyoma. Although intratumoral variability for HMB-45 has recently been described, to the best of our knowledge, this is the first documented case of HMB-45–negative, histologically classic LAM. Because of the presence of several atypical features in this case, such as age, location, compressive neurologic presentation, radiologic impression of atypical sarcoma, and HMB-45 negativity, we feel that this case may represent a distinct, as yet uncharacterized variant of LAM.
Primary Primitive Peripheral Neuroectodermal Tumor of the Prostate
Authors: Colecchia Maurizio , Dagrada Gian Paolo , Poliani Pietro Luigi , Messina Antonella , Pilotti Silvana
Published: January 2021

A case of primitive peripheral neuroectodermal tumor arising in the prostate gland of a 31-year-old man and first diagnosed through a biopsy is reported. Microscopically, the tumor was made up of solid nests and sheets of small round cells, and it was difficult to distinguish the neoplasm from other small round cell tumors, such as small cell carcinoma, rhabdomyosarcoma, or malignant lymphoma. Immunohistochemically, the tumor cells showed immunoreactivity for CD99, vimentin, neuron-specific enolase, and synaptophysin. The neoplasm was excised by a radical surgical procedure preceded by chemotherapy and radiation therapy. The morphologic diagnosis of the prostatectomy specimen was complemented by molecular analysis performed on viable microdissected tissue obtained from formalin-fixed, paraffin-embedded tumor sections. Polymerase chain reaction and sequencing assessment showed the presence of EWS/FLI1 type 2 chimeric transcript, confirming the diagnosis of peripheral primitive neuroectodermal tumor. To our knowledge, this is the first description of a primary peripheral primitive neuroectodermal tumor in the prostate gland.
Hairy Cell Leukemia Variant Developing in a Background of Polycythemia Vera
Authors: Kelly Nadine P. , Alkan Serhan , Nand Sucha
Published: January 2021

We report a case of hairy cell leukemia variant developing in a background of polycythemia vera in a 77-year-old man who presented with lymphocytosis and splenomegaly. Classic hairy cell leukemia in a patient with polycythemia vera has been reported previously, but hairy cell leukemia variant arising in a patient with polycythemia vera has never been described to the best of our knowledge. Initial testing of the peripheral blood showed circulating medium to large leukemic cells with large, centrally placed nuclei, each containing a prominent nucleolus, and some cells showed cytoplasmic projections. A bone marrow biopsy had marked myeloid and erythroid hyperplasia and interstitially distributed cells with a fried-egg appearance. We verified a monoclonal B-cell population by flow cytometric analysis, which revealed expression of bright CD11c, CD22, and CD103 expression, and a lack of CD25 expression. The patient received a 5-day course of cladribine and subsequently had a complete remission. Approximately 2 months later, he had a relapse and was treated with pentostatin; however, he had no clinical response and died.
Splenic Lymphoma Arising in a Patient With Gaucher Disease
Authors: Bertram Heidi C. , Eldibany Mohamed , Padgett James , Dragon Leon H.
Published: January 2021

Patients with Gaucher disease have an increased risk of malignancies, especially the lymphoreticular type. To our knowledge, this is the first reported case of Gaucher disease diagnosed during the workup and diagnosis of a splenic marginal-zone lymphoma with progression to diffuse large B-cell lymphoma. There are several theories as to how Gaucher disease leads to malignancies. The accumulated glucocerebroside in the reticuloendothelial organs, histologically visible as Gaucher cells, is thought to provide chronic antigenic stimulus to the immune system. Polyclonal hypergammaglobulinemia develops, and monoclonal populations of lymphocytes and plasma cells may arise from this premalignant proliferative state. How Gaucher disease is related to nonlymphoid malignancies remains unclear.
Pleomorphic Leiomyosarcoma of the Adrenal Gland
Authors: Lujan Mario G. , Hoang Mai P.
Published: January 2021

Primary leiomyosarcomas arising in the adrenal gland are exceedingly rare, with only 3 cases reported in the literature. We present the clinical, morphologic, and immunohistochemical features of a pleomorphic leiomyosarcoma, a variant of leiomyosarcoma that has not been described in the adrenal gland. A 63-year-old man presented with a 1-year history of enlarging right upper quadrant mass and pulmonary nodule. A diagnosis of metastatic pulmonary carcinoma to the adrenal gland was rendered on a needle biopsy specimen. Preoperative chemotherapy reduced only the pulmonary mass but not the adrenal mass, which continued to enlarge. Documented by computed tomography and confirmed at surgery, the tumor had completely replaced the right adrenal gland, invading into both the posterior aspect of the right liver and the superior pole of the right kidney. Histologic sections showed a diffuse proliferation of pleomorphic, large, and polygonal neoplastic cells with prominent nucleoli. Many bizarre mitotic figures were present. The neoplastic cells were strongly positive for desmin, calponin, and vimentin. Approximately 80% of the neoplastic cells were positive for the proliferation marker Ki-67. They were negative for smooth muscle actin, muscle-specific actin, myoglobin, myogenin, CD117, cytokeratins, carcinoembryonic antigen, epithelial membrane antigen, chromogranin, CD34, CD31, S100 protein, and HMB-45.
Automated Analysis of Differentiation-Induced Leukemic Cells During All-Trans Retinoic Acid Therapy of Acute Promyelocytic Leukemia
Authors: Tohyama Kaoru , Shiga Shuichi , Fujimoto Hiroyuki , Hamaguchi Yukio , Ichiyama Satoshi
Published: January 2021

During differentiation-induction therapy of acute promyelocytic leukemia (APL) patients with all-trans retinoic acid (ATRA), a variety of APL-derived bizarre granulocytic cells appear in the peripheral blood. To evaluate the differentiation induction of leukemic cells, we have developed a new scattergram analyzing program with an automated hematology analyzer and compared the data with the flow cytometry measuring the expression of differentiation-associated cell surface antigens, CD11b and CD16. We used the fluorescence intensity and side scatter as parameters of granulocytic maturation in the analysis with the automated hematology analyzer. The analysis of 2 ATRA-treated APL patients and in vitro study using HL-60 cells demonstrated that the levels of fluorescence intensity and side scatter decreased as accompanied with granulocytic maturation, and these changes were parallel with the results of flow cytometry. Our automated scattergram analysis of cell differentiation will contribute to general, objective, and real-time evaluation of differentiation-induction therapy of APL with ATRA.
Hereditary Nonpolyposis Colorectal Cancer Syndrome in a Patient With Urothelial Carcinoma of the Upper Urothelial Tract
Authors: Hartmann Arndt , Cheville John C. , Dietmaier Wolfgang , Hofstädter Ferdinand , Burgart Lawrence J. , Blaszyk Hagen
Published: January 2021

Urothelial carcinoma of the upper urinary tract is relatively uncommon but may develop as a manifestation of the hereditary nonpolyposis colorectal cancer syndrome (HNPCC), which is characterized by mutations in a number of DNA mismatch repair genes and detectable as microsatellite instability or loss of the respective protein by immunostaining. No well-established screening test is available for urothelial carcinomas of the upper urinary tract, and little is known of the clinical impact of screening for HNPCC in patients with upper urinary tract cancer. We describe herein a patient with a urothelial carcinoma of the ureter and a strongly positive history of cancer, who was subsequently found to have HNPCC. Our findings reinforce the importance of obtaining a comprehensive history of cancer in patients with urothelial carcinoma of the renal pelvis and ureter. Subsequent identification of individuals with HNPCC enables the patient and at-risk relatives to benefit from targeted surveillance and management programs.
Pulmonary Embolization of Bovine Collagen
Authors: McCarthy Denis M. , Haas Mark , Thuluvath Paul J. , Geschwind Jeff F. , Hutchins Grover M. , Westra William H.
Published: January 2021

A bovine collagen matrix is sometimes used as a delivery medium during direct intratumoral injection of a chemotherapeutic agent. The bovine collagen enhances the dose and duration of local drug delivery and limits systemic toxicity. Although this strategy is advocated as a means of easy and effective delivery of chemotherapeutic drugs, the associated risks are not well defined. We report the case of a 71-year-old man with hepatocellular carcinoma who underwent weekly intratumoral injections of cisplatin in a bovine collagen matrix. During the third injection, he suddenly and unexpectedly underwent cardiac arrest and died. An autopsy disclosed diffuse occlusion of the pulmonary microcirculation by bovine collagen. The collagen emboli were associated with an inflammatory infiltrate typical of bovine collagen–induced hypersensitivity. This case identifies a fatal complication of intratumoral chemotherapy injections using a bovine collagen matrix, which does not appear to have been previously reported. This case underscores the valuable role of the traditional autopsy examination as a means of identifying possible complications of novel oncologic strategies, which are being rapidly developed and implemented.
Glomerular Calcification in Hypercalcemic Nephropathy
Authors: Henegar Jeffrey R. , Coleman John P. , Cespedes Julio , Hughson Michael D.
Published: January 2021

Hypercalcemic nephropathy has been classified as a tubulointerstitial renal disease. The presence of glomerular pathologic findings attributable to hypercalcemia has been observed in only a few patients and therefore has been considered an unusual finding. In the current study, calcium deposition within glomeruli was investigated in 2 patients with extreme elevations in serum calcium levels and hypercalcemic nephropathy. The study material consisted of a renal biopsy specimen from a 31-year-old woman (patient 1) who had T-cell lymphoma/leukemia and a serum calcium level of 20.2 mg/dL (5.0 mmol/L) and autopsy kidney specimens from a 19-year-old woman (patient 2) who was being evaluated for primary hyperparathyroidism and a calcium level of 18.4 mg/dL (4.6 mmol/L). The renal biopsy specimen for patient 1 exhibited calcium deposits present in the glomerular capillary basement membranes, where they were associated with segmental sclerosing lesions (21% of glomeruli). Nine percent of the cortical tubules contained calcifications. In patient 2, calcium was found in the mesangial areas in 95% of glomeruli, filling the Bowman space in 7% of glomeruli, or associated with capillary basement membranes and segmental sclerosing lesions (12% of glomeruli). Fifteen percent of cortical tubules, 4% of outer medullary tubules, and 40% of inner medullary tubules were calcified. In neither case was there immunofluorescence or electron microscopic evidence of primary glomerular disease. Thus, glomerular calcification may exceed that occurring in the cortical and outer medullary tubules and may play a significant role in the loss of renal function in hypercalcemic nephropathy. Glomerular calcinosis may also be recognized as an additional cause of segmental glomerulosclerosis and nephrotic range proteinuria in patients with extremely high levels of serum calcium.
INFOCOVID: a socialização de saberes e informações científicas sobre covid-19 na rede social
Authors: Cruz Gênesis Vivianne , Modesto Closeny Maria Soares , Sacal Yasmin Aynohan , Silva Stefany Pelegrini da , Luz Yara Rocha
Published: January 2021

O objetivo do projeto de extensão “INFOCOVID” foi informar a população e profissionais de saúde através de dados científicos, utilizando uma linguagem acessível em diversas estratégias de alcance. Trata-se de um relato de experiência de ações de extensão mediadas por recursos virtuais e equipamentos eletrônicos, mantendo as recomendações de distanciamento social. O projeto foi divulgado no Instagram efetuando “posts, stories e lives” com diferentes conteúdos relacionados ao COVID-19. Considera-se que o projeto tem promovido a responsabilidade social de acadêmicos com a comunidade através da educação em saúde, reinventando meios de alcance e comunicação, com o propósito de promover o bem-estar e a saúde.
Authentic Engagement through Workplace Pedagogy
Authors: Nealy Chynette
Published: January 2021

Readiness: Are business majors equipped with industry-expected skills? This question remains the central theme of discussions between employers and business academicians in terms of bridging the gap between theory and practice. These discussions are useful in identifying reasons that might impede “readiness.” This article provides an overview of pedagogical and practical considerations by offering a process and evaluation framework to help business communication faculty integrate workable pedagogy to ever-evolving business practices. Suggestions are provided for authentically engaging business majors in developing industry-expected skills, such as teamwork, social collaboration, and technology. Although these suggestions will not pertain equally to all business communication settings (i.e. regional or local practices), they do allow for the examination, reflection, and application of best practices to bridge the gaps between theory and practice in terms of providing meaning and value for undergraduate business majors to develop applicable workplace and employability skills. These uncertain times underscore the importance of reflecting on and applying best practices from academic and workplace settings that can authentically engage and develop students.
Medienarrativer og forståelser af religion i den syriske diaspora
Authors: Yonus Zenia
Published: January 2021

Denne artikel undersøger, hvordan forståelsen og italesættelsen af spørgsmålet omkring religiøse tilhørsforhold kommer til udtryk i kontekst af konflikten i Syrien. Konflikten i Syrien har øget sekteriske skel og ekspliciteret sekteriske kløfter, og artiklen belyser, hvordan nogle diasporiske syreres syn på deres religiøse identitet har udviklet sig over tid og sted, både i forhold til konfliktens udvikling og efter fysisk at være flyttet til Europa. Artiklen tager udgangspunkt i interviews og deltagerobservation med revolutionære syrere i Danmark, Sverige og Tyskland, som er indsamlet over de seneste to år. Formålet er at belyse religion fra syrernes eget perspektiv, hvilket tydeligvis påvirkes af interaktioner med medieindhold. Medier er vigtige aktører i konflikten, der både formidler og former forståelsen af udviklingen og fungerer som en sfære, hvor debat finder sted. Informanterne påpeger, hvordan politik og religion blandes sammen, og hvordan religion instrumentaliseres i kampen om narrativerne. I mindre grad belyses også den syriske stats narrativ i medierne, da det er en vigtig komponent i kampen om narrativerne. Informanterne i studiet refererer til de statslige medier som stiftere af de tiltagende dybe kløfter på tværs af sekter og ser sig selv som sekulære fortalere for antisekterisme. Artiklen viser, hvordan de diasporiske syrere taler om og oplever deres religiøse identitet i deres nye hverdagsliv, i deres nye stedlige kontekst og ikke mindst, hvordan de forholder sig til debatten om konflikten og de konkurrerende narrativer i medierne.
Christian Høgel og Saer El-Jaichi: Arabisk filosofi. København: Systime, 2020.
Authors: Christensen Tina Dransfeldt
Published: January 2021

Med Arabisk filosofi af Christian Høgel og Saer El-Jaichi har vi for første gang på dansk fået et udvalg af arabiske, filosofiske tekster målrettet gymnasieundervisningen i filosofi og religion. Som undervisningsbog til ungdomsuddannelserne udgør den en lettilgængelig introduktion til den klassiske, arabisk-islamiske religionsfilosofi og religionskritik.
Francia: ¿instrumentalización de la COVID-19 contra la igualdad escolar?
Authors: Bonnéry Stéphane
Published: January 2021

La pandemia de COVID-19 ha puesto a prueba los sistemas educativos. Este artículo trata del caso francés, en el que tuvo lugar un confinamiento de dos meses, seguido de una reanudación muy parcial y selectiva del curso antes del verano, que no llegó a funcionar de nuevo realmente hasta septiembre, en condiciones sin precedentes. Muestra que lejos de ser un paréntesis excepcional, la crisis sanitaria fue utilizada por el gobierno para tratar de imponer cambios estructurales. Estas conclusiones se derivan de un análisis de las lógicas que estaban previamente en marcha en los proyectos de reforma de la enseñanza francesa, lo que permite distinguir entre las respuestas puntuales a una situación excepcional de los intentos de instrumentalizar la pandemia. De este modo, las tentativas del Gobierno suponen una renuncia a la igualdad y a la democratización escolar, pues reducen los contenidos que se enseñan a todo el alumnado y derivan a las familias la responsabilidad y la financiación de disciplinas enteras y de contenidos de otras asignaturas, mediante el desarrollo de la educación a distancia y la transferencia al sector privado y a las autoridades locales de contenidos que finalmente no se incluirían en los planes de estudios nacionales. Estas políticas de repliegue público y de competencia entre el alumnado se derivan de lógicas que ya están en funcionamiento, dado que el sistema educativo francés ha sido objeto hasta ahora de un compromiso inestable entre lógicas de selección social y lógicas de democratización de los estudios.
Educación y brecha digital en tiempos del COVID-19. Perfiles y problemáticas experimentadas por el alumnado juvenil para continuar sus estudios durante el confinamiento
Authors: Kuric Kardelis Stribor , Calderón Gómez Daniel , Sannmartín Ortí Anna
Published: January 2021

En este artículo analizamos las principales perfiles y problemáticas experimentadas por el alumnado de secundaria y estudios universitarios para continuar el curso académico durante el confinamiento debido a la pandemia del COVID-19. A partir de un análisis cuantitativo bivariado y multivariable, mostramos cómo los grupos sociales más vulnerables (clase baja, nacionalidad extranjera) han tenido más dificultades para continuar con la educación online. Además, elaboramos una tipología de dificultades experimentadas por el alumnado (Q1-sin problemas importantes, Q2-problemas técnicos, Q3-problemas psico-sociales, Q4-problemas de competencias) que nos permiten dimensionar los diferentes tipos de dificultades según las características sociodemográficas de los sujetos. La falta de competencias es la problemática más extendida para continuar con los estudios, si bien las condiciones estructurales (falta de tiempo y espacio, acceso a las TIC, estado anímico, etc.) son especialmente relevantes entre los grupos sociales más vulnerables (clase social baja, áreas rurales, mujeres).
COVID-19 y escuela a distancia: viejas y nuevas desigualdades
Authors: Jacovkis Judith , Tarabini Aina
Published: January 2021

El cierre de las escuelas como medida de emergencia a la situación generada por el COVID-19 ha generado retos sin precedentes para los sistemas educativos. En el caso español este cierre  se desarrolla en un sistema profundamente desigual, lo que,  entre otros aspectos, se expresa por unos índices de segregación escolar que se sitúan entre los más altos de Europa. El objetivo del artículo es analizar el impacto del confinamiento sobre las desigualdades educativas, poniendo un foco especifico en la expresión escolar de dichas desigualdades. Específicamente, se pretende explorar la diversidad de estrategias adoptadas por los centros educativos durante el primer período de confinamiento, analizando sus efectos sobre las oportunidades de aprendizaje de niños, niñas y jóvenes. El análisis se basa en un cuestionario respondido por 2.777 docentes de Cataluña que realizan su labor desde P3 hasta educación secundaria postobligatoria y se estructura en cuatro grandes ejes: 1) las prioridades educativas de los centros durante el tiempo de confinamiento; 2) las formas de comunicación con su alumnado; 3) las actividades pedagógicas llevadas a cabo durante este tiempo; y 4) las dificultades que los y las docentes consideran que enfrenta su alumnado para seguir el curso de forma remota. Los resultados del análisis ponen de manifiesto el impacto del COVID-19 en el agravamiento de las desigualdades educativas, expresadas por una elevada desigualdad de condiciones entre los centros educativos para articular sus procesos de enseñanza y garantizar el aprendizaje de todos los estudiantes.