bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunophenotypic Attributes of Benign Peripheral Blood γδ T Cells and Conditions Associated With Their Increase
Authors: Roden Anja C. , Morice William G. , Hanson Curtis A.
Published: February 2021

Context.—In comparison to αβ T cells, little is known about the immunophenotype of healthy peripheral blood γδ T cells or about conditions associated with expansion of this usually minor T-cell subset.

Objective.—To study the immunophenotype of increased nonneoplastic peripheral blood γδ T cells and to determine clinical conditions associated with this laboratory finding.

Design.—Flow cytometric T-cell phenotyping studies performed on 352 consecutive peripheral blood specimens were reviewed, and 62 cases (18%) in which γδ T cells comprised either more than 5% of the total lymphocytes or had an absolute count of more than 200 cells per μL or both, were studied further. Clinical data were available from 36 cases.

Results.—The γδ T cells often had an immunophenotype distinct from the αβ T cells, with differences in CD5 expression as the most common (n = 17), followed by differences in CD3 (n = 6) and CD7 (n = 3). CD16 coexpression by the γδ T cells was also frequent (n = 20). In 28 (78%) of 36 cases, there were one or more associated conditions: infection/inflammatory disease (n = 18), autoimmune disease (n = 9), lymphoproliferative disorder (n = 6), and splenectomy (n = 3).

Conclusions.—Circulating γδ T cells are immunophenotypically distinct from αβ T cells, and mild increases in these cells are not uncommon and may be associated with immune system activation and splenectomy. Recognition of this phenomenon is important because reactive γδ T cells can exhibit distinctive immunophenotypic features that are also encountered in neoplastic conditions, such as T-cell large granular lymphocytic leukemia.
Primary Intestinal Intraepithelial Natural Killer–like T-Cell Lymphoma: Case Report of a Distinct Clinicopathologic Entity
Authors: Muram-Zborovski Talia , Loeb Danielle , Sun Tsieh
Published: February 2021

Intestinal T-cell lymphoma is a heterogenous group. These tumors differ in their association with enteropathy, intraepithelial or nonintraepithelial origin, primary or secondary involvement, and T-cell or natural killer–like T-cell immunophenotype. There are also nonneoplastic conditions, such as celiac disease, refractory sprue, and reactive T-cell infiltration that mimic intestinal T-cell lymphoma. Therefore, the differential diagnosis requires extensive morphologic, immunophenotypic, and molecular genetic studies. A subset of primary intestinal intraepithelial T-cell lymphoma has emerged in recent years that is distinguished from enteropathy-type T-cell lymphoma in terms of clinical presentation (nonenteropathic), morphology (monomorphic small to medium-sized cells), immunophenotype (CD3−CD8+CD56+), and cytogenetics. We report such a case with a unique immunophenotype (CD3−, cytoplasmic CD3+, CD4−, CD8+, CD5−, CD7+, CD16−, CD56+, CD57−, CD103+, T-cell intracellular antigen 1+, and βF1+) that is comparable to that of a newly identified subset of intraepithelial T cells. The tumor progressed rapidly and the patient died within 6 months after the onset of the disease. We recommend a large monoclonal antibody panel for the differential diagnosis of this heterogeneous group of T-cell lymphoma.
Appeals in Gynecologic Cytology Proficiency Testing: Review and Analysis of Data From the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program
Authors: Crothers Barbara A. , Moriarty Ann T. , Fatheree Lisa A. , Booth Christine N. , Tench William D. , Wilbur David C.
Published: February 2021

Context.—In 2006, 9643 participants took the initial College of American Pathologists (CAP) Proficiency Test (PT). Failing participants may appeal results on specific test slides. Appeals are granted if 3 referee pathologists do not unanimously agree on the initial reference diagnosis in a masked review process.

Objectives.—To investigate causes of PT failures, subsequent appeals, and appeal successes in 2006.

Design.— Appeals were examined, including patient demographic information, Centers for Medicare and Medicaid Services category (A, B, C, or D), exact reference diagnosis, examinees per appeal, examinee's Centers for Medicare and Medicaid Services category, referee's Centers for Medicare and Medicaid Services category, slide preparation type, and slide field validation rate.

Results.—There was a 94% passing rate for 2006. One hundred fifty-five examinees (1.6%) appealed 86 slides of all preparation types. Forty-five appeals (29%) were granted on 21 slides; 110 appeals (72%) were denied on 65 slides. Reference category D and B slides were most often appealed. The highest percentage of granted appeals occurred in category D (35% slides; 42% of participants) and the lowest occurred in category B (9% slides; 8% of participants). The field validation rate of all appealed slides was greater than 90%.

Conclusions.—Despite rigorous field validation of slides, 6% of participants failed. Thirty percent of failing participants appealed; most appeals involved misinterpretation of category D as category B. Referees were never unanimous in their agreement with the participant. The participants and referees struggled with the reliability and reproducibility of finding rare cells, “overdiagnosis” of benign changes, and assigning the morphologically dynamic biologic changes of squamous intraepithelial lesions to static categories.
In Situ Detection of Inflammatory Cytokines and Apoptosis in Pemphigus Foliaceus Patients
Authors: Rodrigues Denise Bertulucci Rocha , Pereira Sanivia Aparecida Lima , dos Reis Marlene Antônia , Adad Sheila Jorge , Caixeta João Eduardo , Chiba Angélica Maeda , Sousa; RichardÁtila , Rodrigues, Jr Virmondes
Published: February 2021

Context.—Endemic pemphigus foliaceus, or fogo selvagem, is a chronic autoimmune disease characterized by the formation of intraepidermal blisters that reduce adhesion between keratinocytes. Endemic pemphigus foliaceus is associated with the presence of autoantibodies and high levels of cytokines involved in the inflammatory response.

Objectives.—To evaluate the expression of the proinflammatory cytokines interleukin 1, interferon γ, and tumor necrosis factor α; the proapoptotic inducers Fas and inducible nitric oxide synthase; and the apoptosis inhibitor Bcl-2; and to evaluate the presence of apoptosis.

Design.—Skin biopsies from 13 patients with endemic pemphigus foliaceus and controls were evaluated by immunohistochemistry and apoptosis was determined by terminal deoxynucleotidyl transferase–mediated dUTP nick-end labeling assay.

Results.—Proinflammatory cytokines were only detected in cells of the inflammatory exudate. Inducible nitric oxide synthase, Fas, and Bcl-2 were expressed by both epithelial and inflammatory cells. Epithelial apoptosis was observed in 12 cases (92.3%), and subepithelial apoptosis in 11 cases (85%).

Conclusions.—This study suggests that apoptosis as well as the local production of proinflammatory cytokines are associated with endemic pemphigus foliaceus lesions. These results may contribute to the development of new therapeutic approaches to endemic pemphigus foliaceus.
Correction Factors for Estimating Potassium Concentrations in Samples With In Vitro Hemolysis: A Detriment to Patient Safety
Authors: Mansour Mai M. H. , Azzazy Hassan M. E. , Kazmierczak Steven C.
Published: February 2021

Context.—Correction factors have been proposed for estimating true potassium concentrations in blood samples with evidence of in vitro hemolysis.

Objective.—We used 2 different models of true (ie, nonsimulated) in vitro hemolysis to evaluate the clinical utility of correction factors for estimating potassium concentrations in samples with evidence of in vitro hemolysis.

Design.—Potassium correction factors were derived using 2 different models. In model 1, potassium and plasma hemoglobin were measured with the Hitachi 747 analyzer in 132 paired blood samples, with each pair consisting of 1 sample with evidence of hemolysis and 1 without, collected during the same phlebotomy procedure. The change in measured potassium concentration was plotted versus the change in plasma hemoglobin concentration for each pair of samples. In model 2, the potassium levels of 142 784 blood samples and the corresponding hemolytic index values were measured with the Beckman LX20 analyzer. Potassium concentrations at the 10th, 25th, 50th, 75th, and 90th percentiles were calculated for each hemolysis index category.

Results.—From our 2 models, we derived correction factors expressing an increase in potassium concentration of 0.51 and 0.40 mEq/L for every increase in plasma hemoglobin concentration of 0.1 g/dL. These correction factors are much higher than those reported in studies that simulated in vitro hemolysis by freeze-thaw lysis or osmotic disruption of whole blood.

Conclusions.—Use of correction factors for estimating the true potassium concentration in samples with evidence of in vitro hemolysis is not recommended. Derivation of correction factors by using samples with nonsimulated in vitro hemolysis suggests that the actual increase in potassium in hemolyzed samples is much higher than that reported in previous studies that produced hemolysis with artificial means.
Comparability of Different Pathologic Protocols in Sentinel Lymph Node Evaluation: An Analysis of Two Step-Sectioning Methods for the Same Patients With Breast Cancer
Authors: Kanngurn Samornmas , Chewatanakornkul Siripong , Premprapha Teerapon , Thongsuksai Paramee
Published: February 2021

Context.—The pathologic protocol for sentinel lymph node evaluation has yet to be standardized. Results from previous studies are troublesome to compare because they have been conducted on different sets of subjects with cancer.

Objective.—To compare the detection of sentinel lymph node metastases by using step-sectioning methods at 20-μm and 150-μm intervals for the same patient with primary breast cancer.

Design.—A total of 186, initially tumor-negative sentinel lymph nodes from a group of 80 patients with breast cancer were included. For all nodes, each paraffin block was cut serially to produce a total of 10 levels: 5 consecutive levels of sections for each of the 20-μm and 150-μm intervals. The nodal findings obtained at these intervals on hematoxylin-eosin and cytokeratin slides were compared by using the McNemar test.

Results.—The overall detection rate for sentinel lymph node metastasis at intervals of 20 μm and 150 μm was 27.5% (22/80) and 20% (16/80), respectively. The overall agreement between the 20-μm and 150-μm sections was 82.5%. No macrometastasis was missed by either method. At the 20-μm interval, 2 cases of micrometastasis were missed, while 10 cases of isolated tumor cells were missed at the 150-μm interval. However, no statistical difference was observed for the final sentinel lymph node results with either method. (McNemar test, P = .18 for case-based results and P = .052 for nodal-based results).

Conclusions.—The 20-μm and 150-μm interval step-sectioning methods produce comparable results for detection of metastatic deposits in sentinel lymph nodes.
Pulmonary Pseudoneoplasms
Authors: Yi Eunhee , Aubry Marie-Christine
Published: February 2021

Context.—Not uncommonly, a surgical pathologist will be requested to review excised material, with a clinical diagnosis of cancer, in which no malignancy can be identified. Often, sampling may be the issue. However, different nonneoplastic processes may mimic cancer clinically and not be recognized histologically. These are commonly referred to as pseudoneoplasms and can involve the lung, pleura, and mediastinum.

Objective.—To review the most commonly encountered pseudoneoplasms of the thoracic cavity in surgical pathology and discuss the main differential diagnosis.

Data Sources.—Literature and personal review of cases with focus on inflammatory pseudotumors of the lung, organizing pneumonia, nodular lymphoid hyperplasia, apical cap, round atelectasis, and sclerosing mediastinitis with its pulmonary counterpart, hyalinizing granuloma.

Conclusions.—When reviewing specimens that appear nondiagnostic for malignancy, it is important to consider one of these pseudoneoplasms in the differential diagnosis as they may explain the clinical and radiologic information.
Pediatric Angiosarcoma of Soft Tissue: A Rare Clinicopathologic Entity
Authors: Ayadi Lobna , Khabir Abdelmajid
Published: February 2021

Angiosarcomas are rare tumors that predominantly affect adults and elderly patients. Although angiosarcomas are well described in a variety of clinical settings, they have been poorly studied in children and little is known about their biology, natural history, or optimal treatment. Childhood angiosarcomas are exceedingly rare. The head and neck region and mediastinum seem to be the preferred locations. Most tumors are high-grade tumors. Vasoformative architecture is not always obvious on light microscopy requiring the benefit of immunohistochemical study. The differential diagnosis includes Kaposi sarcoma, epithelioid hemangioendothelioma, hemangiopericytoma, and spindle cell hemangioendothelioma whose prognosis is different. Complete resection is required for patients with localized tumors. Malignant vascular tumors are rare in children in the first 2 decades of life and when they do occur they seem to be more aggressive than in adults. Pathologic diagnosis is difficult particularly in poorly differentiated angiosarcomas requiring immunohistochemical study to confirm vascular differentiation.
Papillary Cystadenoma of the Epididymis
Authors: Odrzywolski Karen J. , Mukhopadhyay Sanjay
Published: February 2021

Papillary cystadenoma is a rare benign neoplasm of the epididymis, occurring mainly in young adult males. More than one-third of the cases reported in the literature have occurred in patients with von Hippel-Lindau disease. Conversely, epididymal nodules presumed to be papillary cystadenomas are found in one-third of males with von Hippel-Lindau disease. The association is stronger for bilateral tumors. The pathogenesis involves loss of the von Hippel-Lindau gene resulting in overexpression of the angiogenic protein “hypoxia-inducible factor.” Papillary cystadenoma is of mesonephric derivation. It originates in the efferent ductules of the head of the epididymis in the form of tiny precursor lesions. Histologically, papillary cystadenoma is characterized by cystic spaces with intracystic papillary projections lined by clear cells, with a resultant resemblance to renal cell carcinoma. Immunohistochemical markers may facilitate the distinction between the 2 tumors. Treatment consists of surgical excision and the prognosis is excellent.
Hidradenocarcinomas: A Brief Review and Future Directions
Authors: Gauerke Steven , Driscoll James J.
Published: February 2021

Hidradenocarcinomas are rare, aggressive skin adnexal tumors of sweat gland origin that demonstrate a high potential for local recurrence, metastasis, and poor outcome. These neoplasms can derive from preexisting clear cell hidradenomas but more commonly appear de novo, with the molecular events responsible for the pathogenesis currently unknown. Historically, diagnosis has been difficult because of the few cases, inconsistent nomenclature, variable morphology of cells that compose the neoplasm, and confusion with other visceral metastatic tumors. Presentation is generally benign with an indolent clinical course that typically includes local and multiple recurrences. Despite wide-excision surgery, disease at regional lymph nodes and metastatic sites is common and linked to decreased survival. Currently, molecular markers of pathogenesis as well as effective forms of adjuvant chemotherapy are lacking. Future studies are required to identify the histopathologic and immunohistochemical features, which may facilitate diagnosis and foster development of molecularly targeted forms of adjuvant therapy.
Appendiceal Mucinous Neoplasms: Controversial Issues
Authors: Misdraji Joseph
Published: February 2021

Low grade appendiceal mucinous neoplasms can spread to the peritoneum as pseudomyxoma peritonei even though they are not obviously invasive in the appendix. During the past several decades, several problematic issues surrounding this enigmatic tumor have been debated in the literature, including appropriate nomenclature for the appendiceal tumors and their peritoneal metastases. In this article, the most contentious issues in the area of appendiceal mucinous tumors are examined. First, the classification systems that have been proposed for these tumors are compared in the context of whether the appendiceal mucinous tumors are ruptured adenomas or invasive carcinomas. The controversy about the nature of pseudomyxoma peritonei and its classification systems is discussed in the following section. A brief discussion follows that examines the issue of localized pseudomyxoma peritonei and its clinical significance. Next reviewed is the largely resolved controversy about whether ovarian mucinous tumors in this setting are separate primaries or are metastases from the appendiceal tumor. Finally, the controversy about the most effective treatment of patients with pseudomyxoma peritonei is discussed.
Field Histology: Point-of-Care Microscopic Technique
Authors: Calhoun Kaumakaokalani , Lin Alexander , Bryant-Greenwood Peter , Lum Christopher , Johnson Douglas , Namiki Thomas
Published: February 2021

Context.—Standard histology services in geographically remote areas are often not available or have long turn-around time, resulting in delayed diagnosis or inappropriate treatment due to incomplete diagnostic data. The use of rapid tissue processing and a portable microtome technique may offer timely, point-of-care histologic diagnosis to patients in a low resources setting, such as medical missions.

Objective.—To present an alternative to the conventional histologic processing that will permit point-of-care histopathology service.

Design.—A total of 21 tissue samples from a variety of sites were collected and subjected to a protocol of rapid manual tissue processing, lightweight portable field microtome sectioning, and hematoxylin-eosin staining. The histologic preparations were evaluated for diagnostic quality. The scoring of the preparations was based on completeness and uniformity of the sections, integrity of architectural features, cytologic detail, staining quality, and overall adequacy for diagnosis.

Results.—Diagnostic quality microscopic slides were obtained from each of the 21 samples that included lesions of the skin, uterus, colon, and breast. The average preparation time, including routine hematoxylin-eosin staining, was 1.5 hours.

Conclusions.—We validated a point-of-care field histology technique that will be useful in settings of low resources, such as medical missions. Actual field testing of the procedure with special staining for fungi and acid-fast bacilli is the next step in the validation of the methodology.
The Use of Real-Time Polymerase Chain Reaction for Rapid Diagnosis of Skeletal Tuberculosis
Authors: Kobayashi Naomi , Fraser Thomas G. , Bauer Thomas W. , Joyce Michael J. , Hall Gerri S. , Tuohy Marion J. , Procop Gary W.
Published: February 2021

We identified Mycobacterium tuberculosis DNA using real-time polymerase chain reaction on a specimen from an osteolytic lesion of a femoral condyle, in which the frozen section demonstrated granulomas. The process was much more rapid than is possible with culture. The rapid detection of M tuberculosis and the concomitant exclusion of granulomatous disease caused by nontuberculous mycobacteria or systemic fungi are necessary to appropriately treat skeletal tuberculosis. The detection and identification of M tuberculosis by culture may require several weeks using traditional methods. The real-time polymerase chain reaction method used has been shown to be rapid and reliable, and is able to detect and differentiate both tuberculous and nontuberculous mycobacteria. Real-time polymerase chain reaction may become a diagnostic standard for the evaluation of clinical specimens for the presence of mycobacteria; this case demonstrates the potential utility of this assay for the rapid diagnosis of skeletal tuberculosis.
Drug-Herb Interaction: Effect of St John's Wort on Bioavailability and Metabolism of Procainamide in Mice
Authors: Dasgupta Amitava , Hovanetz Melissa , Olsen Margaret , Wells Alice , Actor Jeffrey K.
Published: February 2021

Context.—St John's wort induces the activity of the cytochrome P450 enzyme system causing treatment failure because of increased metabolism of many drugs. Procainamide is metabolized by a different pathway to N-acetyl procainamide.

Objective.—To study St John's wort–procainamide interaction using a mouse (Swiss Webster) model.

Design.—One group of mice (group A, 4 mice in each group) was fed St John's wort each day for 2 weeks (last dose 1 day before administration of procainamide); another group (group B) received the same dose of St John's wort for 1 week. The third group (group C) received only a single dose 1 hour before administration of procainamide, and the control group (group D) received no St John's wort. All groups later received a single oral dose of procainamide. Blood was drawn 1, 4, and 24 hours after administration of procainamide and concentrations in serum of procainamide as well as N-acetyl procainamide were measured using immunoassays.

Results.—The procainamide concentrations 1 hour after administration was highest in group C (mean, 11.59 μg/mL) followed by group A (9.92 μg/mL), whereas group B (7.44 μg/mL) and control group D (7.36 μg/mL) showed comparable values. The concentration in group C was significantly greater than the control group D (P = .03, 2-tailed independent t test). N-Acetyl procainamide concentrations and estimated half-life of procainamide among groups were comparable. In a separate experiment when mice were fed purified hypericin, the active component of St John's wort, a significant increase in bioavailability (53%) of procainamide was observed compared with the control group.

Conclusions.—St John's wort has an acute effect to increase bioavailability of procainamide but has no effect on its metabolism.
Plexiform Fibrohistiocytic Tumor: A Brief Review
Authors: Taher Altaf , Pushpanathan Chitra
Published: February 2021

Plexiform fibrohistiocytic tumor is a rare mesenchymal neoplasm of intermediate malignancy, first reported by Enzinger and Zhang in 1988. It has a predilection for children and young adults but can occur at any age. The tumor usually involves the upper limbs as a slow-growing, painless mass. The tumor has a high local recurrence rate but metastasizes only rarely. Histologically, the tumor is characterized by poorly demarcated dermal or subcutaneous mass with multinodular plexiform growth and fibrohistiocytic cytomorphology. There are three distinct recognized growth patterns: fibrohistiocytic, fibroblastic, and mixed types. The tumor displays uniform immunoreactivity for vimentin and CD68. Ultrastructurally, the tumor cells have features of myofibroblasts and histiocyte-like cells. Complete surgical resection of the tumor, preferably with wider margins, is required to prevent local recurrence. Long-term follow-up is necessary to detect any nodal or pulmonary metastasis.
Recently Described and Emphasized Entities of Renal Neoplasms
Authors: Shen Steven S. , Truong Luan D. , Ayala Alberto G. , Ro Jae Y.
Published: February 2021

Context.—Recent advances of molecular biology and cytogenetics of renal cancer have resulted in the new classification of renal neoplasms and a number of subtypes are identified and emphasized. In addition, rare nonepithelial renal neoplasms are identified and characterized. Familiarity with these entities will help make the most accurate diagnosis and guide the treatment and follow-up of patients with renal neoplasm.

Objective.—To review the clinicopathologic entities of renal neoplasms that are recently defined or emphasized. Their clinical, gross, microscopic, and immunohistochemical features, as well as specific cytogenetic or molecular abnormalities, are discussed. Important differential diagnoses of each entity are also briefly discussed.

Data Sources.—Extensive review of published literature and our experience.

Conclusions.—A number of new entities of renal neoplasms or genetically defined renal cell carcinomas have been identified or emphasized because of their unique genetic or molecular changes. Recognition of these entities becomes important as some of them have different biologic behavior and treatment strategies may be different.
Para-arytenoid Cartilage Pseudodiverticulum Formation as a Sequela of Endotracheal Intubation
Authors: Gwin Che , Robinson Morton J.
Published: February 2021

Context.—Laryngotracheal injury secondary to endotracheal intubation results from ischemic necrosis, which develops within hours of intubation, with injury severity increasing with duration of intubation. Postextubation and postmortem observations demonstrate that laryngotracheal injury still occurs in a large number of intubated patients.

Objective.—To demonstrate laryngeal injury, specifically pseudodiverticulum formation, as a result of intubation.

Design.—A total of 41 autopsy cases from February 1970 to February 2006 were retrospectively reviewed. All patients had been intubated during their hospital course and had an endotracheal tube in place at the time of death. Continuous endotracheal intubation ranged from several hours to 33 days.

Results.—The earliest manifestations of laryngeal injury occurred within hours and included hyperemia, edema, and ovoid mucosal lesions over the arytenoid and inner posterolateral cricoid cartilages. Within 48 hours, superficial epithelial denudation progressed to mucosal ulceration, with inflammatory infiltrate into the submucosa. These ulcerations enlarged and deepened, and within 3 to 6 days they showed gross excavations and, in some cases, confluence with other ulcerations. Four cases had pseudodiverticulum formation in the area of the arytenoid cartilages, with deep, excavated lesions that extended to the underlying cartilage. Pseudodiverticulum formation occurred as early as 8 days of continuous intubation.

Conclusions.—Although endotracheal intubation is required for airway maintenance in many patients with respiratory dysfunction, the procedure carries risks. Laryngeal injury from intubation is very common, and the severity of injury is directly related to the duration of intubation. We add para-arytenoid pseudodiverticulum formation to the list of possible complications of endotracheal intubation.
Measuring the Clinical Impact of Pathologist Reviews of Blood and Body Fluid Smears
Authors: Sandhaus Linda M. , Wald David N. , Sauder Kenan J. , Steele Erica L. , Meyerson Howard J.
Published: February 2021

Context.—Despite the widespread practice of pathologist review of blood and body fluid smears, little is known about its impact on improving patient care.

Objective.—To assess the clinical usefulness of pathologist review of blood and body fluid smears.

Design.—Survey study. Pathology residents contacted the ordering physician after pathologist reviews were reported to assess their clinical impact.

Results.—Ninety-six pathologist reviews met criteria for study inclusion, and 64 ordering physicians were successfully contacted during the 2-month study period. Of the 64 cases, 19 reviews (30%) had been seen by the physician within 24 to 48 hours after the report was issued and 33 (51%) had not been seen; in 4 (6%) instances, physicians did not remember whether they had seen the review. Eight reviews (13%) were considered urgent enough to warrant immediate communication by the pathologist. Of the 27 reviews that were seen or directly communicated, 23 (85%) contributed to clinical diagnosis and/or patient management.

Conclusions.—This study demonstrates the contribution of pathologist reviews of blood and body fluids to clinical diagnosis and patient management. The results also highlight the problem of a lack of physician awareness of clinical pathology results.
The Impact of Amino-Terminal Pro-Brain Natriuretic Peptide Testing on Hospital Length of Stay and Morbidity in Patients With Acute Decompensated Heart Failure
Authors: Green Sandy M. , Redmond Patrick , Januzzi James L. , Aleryani Samir , Lee-Lewandrowski Elizabeth , Sluss Patrick , Lewandrowski Kent B.
Published: February 2021

Context.—In clinical trials, N-terminal pro-brain natriuretic peptide (NT-proBNP) testing has been shown to be valuable for diagnosis and triage of patients with acute decompensated heart failure. It is not yet clear what benefits might be expected from the initiation of NT-proBNP testing in an everyday clinical setting.

Objective.—To determine the effects of NT-proBNP testing on hospital length of stay as well as on 60-day morbidity and mortality in patients with acute decompensated heart failure before and after the test was implemented in the clinical laboratory.

Design.—We measured hospital length of stay and 60-day morbidity and mortality rates among patients with acute decompensated heart failure admitted before and after initiation of NT-proBNP testing in our hospital. Differences in demographics between preimplementation and postimplementation groups were compared with the χ2 test for categorical variables and the Wilcoxon rank sum test for continuous variables. Comparison between the hospital length of stay for each group was evaluated using the Mann-Whitney U test. Differences in rates of rehospitalization or death at 60 days following presentation were assessed using χ2 cross-tabulation.

Results.—Patients in the postimplementation group had similar clinical features as those in the preimplementation group. The hospital length of stay for patients in the postimplementation study group decreased both with respect to mean (1.86-day reduction) and median (1.3-day reduction) hospital stay (both, P = .03). Additionally, significantly lower rates of death (6.6% absolute risk reduction, P = .01), rehospitalization (12.1% absolute risk reduction, P = .005), and the composite of the 2 rates (18.7% absolute risk reduction, P = .008) were found following initiation of NT-proBNP testing.

Conclusions.—Implementation of NT-proBNP testing may result in significant reductions in hospital length of stay as well as improvements in rates of morbidity and mortality in patients with acute decompensated heart failure.
Alveolar Soft Part Sarcoma
Authors: Zarrin-Khameh Neda , Kaye Kim S.
Published: February 2021

This article provides an overview of the pathology of alveolar soft part sarcoma, focused on its morphology, special stains useful in diagnosis, and the clinical and radiographic features of the disease. Alveolar soft part sarcoma is a rare neoplasm of unknown histogenesis with poor prognosis. Although there are several immunohistochemical stains available to help reach the diagnosis, the morphology of the tumor should be considered the main diagnostic feature. The periodic acid–Schiff stain is the best single stain that supports the diagnosis.
Xp11.2 Translocation Renal Cell Carcinoma
Authors: Armah Henry B. , Parwani Anil V.
Published: February 2021

Xp11.2 translocation renal cell carcinomas (RCCs), a recently recognized distinct subtype, are rare tumors predominantly reported in young patients. They comprise at least one-third of pediatric RCCs, and only few adult cases have been reported. They are characterized by various translocations involving chromosome Xp11.2, all resulting in gene fusions involving the transcription factor E3 (TFE3) gene. In recent years, at least 6 different Xp11.2 translocation RCCs have been identified and characterized at the molecular level. These include a distinctive RCC that bears a translocation with the identical chromosomal breakpoints (Xp11.2, 17q25) and identical resulting ASPL-TFE3 gene fusion as alveolar soft part sarcoma. They typically have papillary or nested architecture and are composed of cells with voluminous, clear, or eosinophilic cytoplasm. Their most distinctive immunohistochemical feature is nuclear labeling for TFE3 protein. Although only limited data are available so far, they are believed to be rather indolent, but there have been increasing, recent reports of an aggressive clinical course in adult cases. The consistent immunohistochemical staining for TFE3 in all RCC with unusual histology, regardless of patient age, is likely to expand the spectrum of Xp11.2 translocation RCC with respect to age, clinical behavior, and molecular abnormalities.
Expression of Galectin-3 in Renal Neoplasms: A Diagnostic, Possible Prognostic Marker
Authors: Dancer Jane Y. , Truong Luan D. , Zhai Qihui , Shen Steven S.
Published: February 2021

Context.

Galectin-3, a member of the lectin family, was shown to be expressed in normal distal tubular cells and in renal cell carcinomas (RCC). However, its diagnostic and prognostic significance in RCC is as yet undefined.

Objectives.

To describe the expression of Galectin-3 among different histologic subtypes of renal neoplasms and to determine their diagnostic and prognostic significances.

Design.

The expression of Galectin-3 was evaluated in 217 renal neoplasms by tissue microarray and immunohistochemistry with semiquantitative analysis.

Results.

Strong expression of Galectin-3 was observed in 92 of 217 of renal neoplasms (42.4%). Although 22 of 23 oncocytomas (95.7%) and 19 of 21 chromophobe RCCs (90.5%) express Galectin-3, only 4 of 32 papillary RCCs (12.5%) and 47 of 137 clear cell RCCs (34.3%) express Galectin-3, suggesting that it may be used as a potential diagnostic marker. Galectin-3 expression was seen in 55% of high-grade (Fuhrman nuclear grades 3 and 4) versus 21% low-grade (grades 1 and 2) clear cell RCCs (P < .001).

Conclusions.

This study confirms that Galactin-3 is strongly overexpressed in renal cell neoplasms of distal tubular differentiation, that is, oncocytoma and chromophobe RCCs, suggesting it might be used as a possible differential diagnostic tool for renal cell neoplasm with oncocytic or granular cells. Furthermore, we observed a strong association of overexpression of Galectin-3 and high nuclear grade in clear cell RCC. These results also suggest a possible pivotal role for Galectin-3 in the differentiation and prognosis of clear cell RCC.
Esophageal Lichen Planus
Authors: Chandan Vishal S. , Murray Joseph A. , Abraham Susan C.
Published: February 2021

Esophageal lichen planus is an underrecognized condition, with fewer than 50 cases reported to date. Unlike cutaneous lichen planus, esophageal lichen planus occurs almost exclusively in middle-aged or older women who also have oral involvement. It commonly involves the proximal esophagus and manifests as progressive dysphagia and odynophagia. Endoscopic findings can include lacy white papules, pinpoint erosions, desquamation, pseudomembranes, and stenosis. Histologic features of esophageal lichen planus have only rarely been illustrated. They differ from those of cutaneous disease in several respects, including the presence of parakeratosis, epithelial atrophy, and lack of hypergranulosis. Correct diagnosis of esophageal lichen planus is difficult but bears important therapeutic implications. It is typically a chronic and relapsing condition that can require systemic or local immunosuppressive therapy and repeated endoscopic dilatations for esophageal strictures. Esophageal lichen planus may have malignant potential, as evidenced by 3 patients who developed squamous carcinoma of the esophagus after longstanding disease.
Cutaneous Malakoplakia
Authors: Kohl Shane K. , Hans Christine P.
Published: February 2021

Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is poorly understood, but it is thought to be secondary to an acquired bacteriocidal defect in macrophages occurring mostly in immunosuppressed patients or in the setting of autoimmune disease. Malakoplakia has been described in numerous anatomic locations, most commonly in the genitourinary tract. Microscopically, malakoplakia consists predominantly of sheets of macrophages known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. Cutaneous malakoplakia is a rare entity with less than 50 cases reported in the literature. In this article, we review cutaneous malakoplakia including the clinical, gross, and microscopic features as well as the treatment and prognosis of 40 cases of cutaneous malakoplakia identified in the literature.
Expression of Phosphatase of Regenerating Liver 1 and 3 mRNA in Esophageal Squamous Cell Carcinoma
Authors: Liu Yu-Qiong , Li Hui-Xiang , Lou Xi , Lei Jun-Yi
Published: February 2021

Context.—Phosphatase of regenerating liver (PRL) 3 messenger RNA (mRNA) was reported to express in human colorectal, gastric, ovarian, breast, and hepatic cancers.

Objective.—To examine the expression of PRL-1 and PRL-3 mRNAs in human esophageal squamous cell carcinoma (ESCC).

Design.—Expression of PRL-1 and PRL-3 mRNA was examined with reverse transcriptase–polymerase chain reaction in fresh tissue collected from 40 cases of ESCC with matched lymph node metastasis in 21 cases. The association of expression of PRL-1 and PRL-3 mRNAs with clinicopathologic parameters was analyzed.

Results.—The frequencies of PRL-1 and PRL-3 mRNA expression were significantly higher in ESCC than in normal esophageal tissue (P = .001; P = .01) and also significantly higher in ESCC with lymph node metastasis than in those without lymph node metastasis (P = .01; P = .03). The levels of PRL-1 and PRL-3 mRNA expression were significantly higher in ESCC with lymph node metastasis than in those without lymph node metastasis (P = .04; P = .04). The frequencies and levels of PRL-1 and PRL-3 mRNA expression were correlated with the later stages but not with tumor differentiation, tumor location in the esophagus, patient's sex, and age.

Conclusions.—PRL-1 and PRL-3 mRNAs may be involved in and used to predict the metastasis of ESCC. The possibility of using PRL-1 and PRL-3 as the therapeutical target is also discussed.
Analysis of Pathology Department Web Sites and Practical Recommendations
Authors: Nero Christopher , Dighe Anand S.
Published: February 2021

Context.—There are numerous customers for pathology departmental Web sites, including pathology department staff, clinical staff, residency applicants, job seekers, and other individuals outside the department seeking department information. Despite the increasing importance of departmental Web sites as a means of distributing information, no analysis has been done to date of the content and usage of pathology department Web sites.

Objective.—In this study, we analyzed pathology department Web sites to examine the elements present on each site and to evaluate the use of search technology on these sites. Further, we examined the usage patterns of our own departmental Internet and intranet Web sites to better understand the users of pathology Web sites.

Design.—We reviewed selected departmental pathology Web sites and analyzed their content and functionality. Our institution's departmental pathology Web sites were modified to enable detailed information to be stored regarding users and usage patterns, and that information was analyzed.

Results.—We demonstrate considerable heterogeneity in departmental Web sites with many sites lacking basic content and search features. In addition, we demonstrate that increasing the traffic of a department's informational Web sites may result in reduced phone inquiries to the laboratory. We propose recommendations for pathology department Web sites to maximize promotion of a department's mission.

Conclusions.—A departmental pathology Web site is an essential communication tool for all pathology departments, and attention to the users and content of the site can have operational impact.
Glomus Tumor
Authors: Gombos Zoltan , Zhang Paul J.
Published: February 2021

Glomus tumor is a benign mesenchymal neoplasm comprising less than 2% of soft tissue tumors. It is composed of cells resembling modified smooth muscle cells of the normal glomus body. The glomus body, a thermoregulator, is a specialized form of arteriovenous anastomosis localized in dermal and precoccygeal soft tissue. Although glomus tumors are rare neoplasms, clinical misdiagnosis of many of these lesions as hemangiomas or venous malformations makes an accurate assessment of their actual prevalence difficult. A malignant counterpart of this lesion exists but is extremely rare.
Squamous Differentiation in a Sarcomatoid Chromophobe Renal Cell Carcinoma: An Unusual Case Report With Review of the Literature
Authors: Viswanathan Seethalakshmi , Desai Sangeeta B. , Prabhu S. R. , Amin Mahul B.
Published: February 2021

We describe an extremely rare occurrence of a squamous differentiation in a sarcomatoid chromophobe renal cell carcinoma in a 45-year-old woman with nodal and lung metastasis at presentation. The tumor on histology showed all 3 components intimately admixed with each other, which to the best of our knowledge is the first such case to be reported in the literature. The renal pelvis was smooth walled and uninvolved. Kidney-specific cadherin was positive in the chromophobe renal cell carcinoma areas and negative in the sarcomatoid and squamous areas.
Composite Adenomatoid Tumor and Myelolipoma of Adrenal Gland: Report of 2 Cases
Authors: Timonera Elizabeth R. , Paiva Maria Emilia , Lopes Jose Manuel , Eloy Catarina , van der Kwast Theodore , Asa Sylvia L.
Published: February 2021

Adenomatoid tumor and myelolipoma are benign, hormonally inactive tumors that are often incidental findings in the adrenal glands. Myelolipoma is more common than adenomatoid tumor in this location but both are rare, and as yet, the pathogenesis of both remains unclear. We report 2 cases of composite adenomatoid tumor and myelolipoma, incidentally found in the adrenal gland on investigation for other diseases. To our knowledge, composite adenomatoid tumor and myelolipoma of adrenal gland has not been previously reported.
Acute Leukemia Immunohistochemistry: A Systematic Diagnostic Approach
Authors: Olsen Randall J. , Chang Chung-Che , Herrick Jennifer L. , Zu Youli , Ehsan Aamir
Published: February 2021

Context.—The diagnosis and classification of leukemia is becoming increasingly complex. Current classification schemes incorporate morphologic features, immunophenotype, molecular genetics, and clinical data to specifically categorize leukemias into various subtypes. Although sophisticated methodologies are frequently used to detect characteristic features conferring diagnostic, prognostic, or therapeutic implications, a thorough microscopic examination remains essential to the pathologic evaluation. Detailed blast immunophenotyping can be performed with lineage- and maturation-specific markers. Although no one marker is pathognomonic for one malignancy, a well-chosen panel of antibodies can efficiently aid the diagnosis and classification of acute leukemias.

Objective.—To review important developments from recent and historical literature. General immunohistochemical staining patterns of the most commonly encountered lymphoid and myeloid leukemias are emphasized. The goal is to discuss the immunostaining of acute leukemias when flow cytometry and genetic studies are not available.

Data Sources.—A comprehensive review was performed of the relevant literature indexed in PubMed (National Library of Medicine) and referenced medical texts. Additional references were identified in the reviewed manuscripts.

Conclusions.—Immunophenotyping of blasts using an immunohistochemical approach to lymphoid and myeloid malignancies is presented. Initial and subsequent additional antibody panels are suggested to confirm or exclude each possibility in the differential diagnosis and a general strategy for diagnostic evaluation is discussed. Although the use of immunohistochemistry alone is limited and evaluation by flow cytometry and genetic studies is highly recommended, unavoidable situations requiring analysis of formalin-fixed tissue specimens arise. When performed in an optimized laboratory and combined with a careful morphologic examination, the immunohistochemical approach represents a useful laboratory tool for classifying various leukemias.
State of the Art in Trueness and Interlaboratory Harmonization for 10 Analytes in General Clinical Chemistry
Authors: Miller W. Greg , Myers Gary L. , Ashwood Edward R. , Killeen Anthony A. , Wang Edward , Ehlers Glenn W. , Hassemer David , Lo Stanley F. , Seccombe David , Siekmann Lothar , Thienpont Linda M. , Toth Alan
Published: February 2021

Context.—Harmonization and standardization of results among different clinical laboratories is necessary for clinical practice guidelines to be established.

Objective.—To evaluate the state of the art in measuring 10 routine chemistry analytes.

Design.—A specimen prepared as off-the-clot pooled sera and 4 conventionally prepared specimens were sent to participants in the College of American Pathologists Chemistry Survey. Analyte concentrations were assigned by reference measurement procedures.

Participants.—Approximately 6000 clinical laboratories.

Results.—For glucose, iron, potassium, and uric acid, more than 87.5% of peer groups meet the desirable bias goals based on biologic variability criteria. The remaining 6 analytes had less than 52% of peer groups that met the desirable bias criteria.

Conclusions.—Routine measurement procedures for some analytes had acceptable traceability to reference systems. Conventionally prepared proficiency testing specimens were not adequately commutable with a fresh frozen specimen to be used to evaluate trueness of methods compared with a reference measurement procedure.
The Effect of the Number of Biopsy Cores on the Concordance Between Prostate Biopsy and Prostatectomy Gleason Score: A Prostate Volume–Controlled Study
Authors: Antunes Alberto A. , Leite Katia Ramos , Dall'Oglio Marcos F. , Cury Jose , Srougi Miguel
Published: February 2021

Context.—Studies analyzing the concordance of biopsy and radical prostatectomy (RP) Gleason scores have limitations. Some included 2 or more centers, used historical controls from the early prostate specific antigen era or lacked a clear definition of the biopsy schemes. Furthermore, most did not control the results for prostate volume.

Objective.—To confirm whether prediction of RP Gleason score can be optimized by taking more biopsy cores in a contemporary series of patients, with pathologic samples analyzed by the same pathologist, and controlling these results for prostate volume.

Design.—The study comprised a retrospective case-control analysis of 393 patients with prostate cancer treated with RP. Patients were divided into 3 groups: those in group 1 underwent a 6-core biopsy; group 2, an 8-core biopsy; and group 3, a 10 or more–core biopsy. Concordance rates between biopsy and RP Gleason scores, as well as the rates of undergrading and overgrading, were determined for each biopsy scheme.

Results.—Concordance rates were 60.9%, 58.3%, and 64.6% for patients from groups 1, 2, and 3, respectively (P = .18). When we analyzed patients with prostate volumes of less than 50 cm3, concordance rates were 58.3%, 58.3%, and 65.1% for each group, respectively (P = .03). Among patients with prostate volumes of 50 cm3 or more, concordance rates were 70%, 58.1%, and 63.6%, respectively (P = .66).

Conclusions.—Taking 10 or more cores can improve the prediction of RP Gleason score in patients with prostate volumes of less than 50 cm3. For patients with prostate volumes of 50 cm3 or more, increasing the biopsy cores to 10 or more did not improve prediction of RP Gleason score.