bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental investigation on reservoir damage caused by clay minerals after water injection in low permeability sandstone reservoirs
Authors: Zhou Yazhou , Yang Wenbin , Yin Daiyin
Published: October 2021

Water injection is an effective method for developing low permeability sandstone reservoirs. In the process of water flooding, reservoir damage can occur due to clay mineral content changes and it will significantly affect oil production. There are few investigations on the changes in clay mineral content and the degree of reservoir damage after injecting the water into low permeability sandstone reservoirs with different permeabilities and lithologies. In this study, low permeability natural cores from different lithological strata were collected from 4 wells in the Daqing sandstone reservoir, and clay mineral components and contents were measured through X-ray diffraction. Changes in the clay mineral content were determined after water injection. The reservoir damage mechanism by clay mineral migration was determined by analyzing scanning electron microscopy (SEM) images after water injection. Meanwhile, the porosity and permeability of the cores were tested after water injection, and the degree of reservoir damage in different lithological strata was determined. The clay mineral content ranges from 6.78 to 14.14% in low permeability sandstone cores and declines by 49.73% after water flooding. Illite, chlorite and illite/smectite mostly decrease, and kaolinite decreases the least. Due to the large particle size of kaolinite, kaolinite migration will block the pore-throats and cause formation damage after water flooding. In argillaceous siltstone and siltstone, kaolinite particles blocking pore-throats are very serious, and the permeability decreases greatly by 21.87–36.89% after water injection. With increasing permeability, the permeability decreases greatly after water injection. The findings of this study can help to better understand the mechanisms of formation damage after injecting water into low permeability sandstone reservoirs.
Comprehensive effect of tuning Cu/SAPO-34 crystals using PEG on the enhanced hydrothermal stability for NH3-SCR
Authors: Lin Qingjin , Liu Shuang , Xu Shuhao , Xu Shi , Pei Mingming , Yao Pan , Xu Haidi , Dan Yi , Chen Yaoqiang
Published: October 2021

PEG fabricates advantageous hierarchical zeolite crystals, enhancing the high-temperature and low-temperature hydrothermal stability of Cu/SAPO-34.
User-friendly lab-on-paper optical sensor for the rapid detection of bacterial spoilage in packaged meat products
Authors: Abo Dena Ahmed S. , Khalid Shaimaa A. , Ghanem Ahmed F. , Shehata Ahmed Ibrahim , El-Sherbiny Ibrahim M.
Published: October 2021

A lab-on-paper colorimetric sensor for detection and quantification of bacterial meat spoilage is reported.
Secure transmission for cooperative NOMA systems with source‐relay selection
Authors: Xu Shu , Liu Chen , Qian Mujun , Wang Hong , Sun Wenfeng
Published: October 2021

Both cooperative non‐orthogonal multiple access (NOMA) and physical layer security (PLS) are promising techniques for future communication systems. This paper investigates the PLS performance of a cooperative NOMA system where multiple sources transmit a superposed message to two users by utilizing either amplify‐and‐forward (AF) or decode‐and‐forward (DF) relays in both non‐colluding and colluding eavesdropper scenarios. A source‐relay selection scheme is proposed for this system aiming at improving the secrecy performance. Additionally, the closed‐form expression of the secrecy outage probability (SOP) is derived for the proposed source‐relay selection schemes. It is demonstrated that in the proposed schemes, the theoretical results match well with the simulation results. In addition, the proposed schemes outperform the conventional OMA system in terms of SOP.
A new methodology for the analysis and optimal setting of directional polarisation methods for overcurrent elements in line protection applications
Authors: Vaca Sebastián , Fonseca Antonio , Chapi Fernando , Pérez‐Yauli Fabián
Published: October 2021

Directional protection of transmission lines is an important feature in situations where short‐circuit direction must be correctly detected. The proper operation of this protection is highly dependent on phasor comparison techniques called polarisation methods. In practice, there are not clearly defined procedures to analyse and set polarisation methods. Hence, these methods are not normally studied in detail, so their effectiveness is often uncertain. For this reason, this work proposes a novel methodology for analysing the performance of polarisation methods, which includes criteria for the selection of the most appropriate methods and their settings according to each application. Particular phasor diagrams and angular statistics are used for the analysis, while a mathematical optimization problem is defined to determine the best settings of these methods. Based on the benefits that can be obtained, the methodology is intended to be considered as an effective strategy to ensure proper use of polarization methods. The methodology is applied in a portion of the Ecuadorian Transmission System which shows the possibility of studying the performance of polarisation methods. The selection and optimal setting criteria of these methods are also analysed providing opportunities to improve the initial performance of the protection system.
Machine Learning-Based Automated Selection of Regions for Analysis on Bone Marrow Aspirate Smears
Authors: Lewis Joshua , Zhang Xuebao , Shanmugam Nithya , Drumheller Bradley , Shebelut Conrad , Smith Geoffrey , Cooper Lee , Jaye David
Published: October 2021

Manual microscopic examination of bone marrow aspirate (BMA) smears and counting of cell populations remains the standard of practice for accurate assessment of benign and neoplastic bone marrow disorders. While automated cell classification software using machine learning models has been developed and applied to BMAs, current systems nonetheless require manual identification of optimal regions within the slide that are rich in marrow hematopoietic cells. To address this issue, we have developed a machine learning-based platform for automated identification of optimal regions in whole-slide images of BMA smears. A training dataset was developed by manual annotation of 53 BMA slides across biopsy diagnoses including unremarkable trilineal hematopoiesis, acute leukemia, and plasma cell neoplasms, as well as across differences in total cellularity represented by a spectrum of marrow nucleated cell content and white blood cell counts. 10,537 regions among these 53 slides were manually annotated as either “optimal” (regions near aspirate particles with high proportions of marrow nucleated cells), “particle” (aspirate particles), or “hemodilute” (blood-rich regions with high proportions of red blood cells). Training of a neural network-based classifier on 10x magnification slides with region cropping and image augmentation resulted in a classifier with substantial accuracy on new testing-set BMA slides (one-vs-rest AUROC > 0.999 across 10 training/testing splits for all 3 region classes), with very few particle and hemodilute regions being classified as optimal (particle: 0.83%, hemodilute: 0.39%). Additionally, this classifier accurately classifies BMA regions on slides from hematological disorders not represented in the training data, including Burkitt lymphoma (AUROC > 0.999 across region classes), chronic myeloid leukemia (AUROC > 0.999 across region classes), and diffuse large B-cell lymphoma (AUROC = 1 across region classes), demonstrating the broad applicability of our approach. To assess the performance of our classifier on whole-slide images, tiles from 10x magnification slides were manually annotated by three participants with notable concordance (Krippendorff’s alpha = 0.424); substantial agreement was found between manual annotations and model predictions within whole-slide images (optimal AUROC = 0.958, particle AUROC = 1.0, hemodilute AUROC = 0.947). Based on these promising results, this machine learning-based region classification model is being connected to a previously-developed bone marrow cell classifier to fully automate differential cell counting in whole-slide images. The development of this novel automated pipeline has potential to streamline the diagnostic process for hematological disorders while enhancing accuracy and replicability, as well as decreasing diagnostic turnaround time for improving patient care.
Development of B-lymphoblastic leukemia in patients treated for multiple myeloma – A case series of 14 patients
Authors: Abro Brooj , Wang Tianjiao , Hassan Anjum , Ruzinova Marianna , Lee Yi-Shan , Frater John , Parikh Bijal , Wartman Lukas , Kreisel Friederike
Published: October 2021

Development of B-lymphoblastic leukemia/lymphoma (BALL) is uncommon in patients with plasma cell neoplasm (PCN). Currently, little is known about risk factors for and characteristics of BALL arising in patients who have undergone treatment for PCN. We reviewed the clinicopathologic features of 14 patients with PCN who developed subsequent BALL and assessed the clonal relationship between these two neoplasms in 5 of the 14 patients. Clinical and laboratory data were extracted from the electronic medical record in accordance with an institutional review board-approved protocol. For the IgH clonality studies DNA was extracted from formalin fixed paraffin embedded tissue and analyzed utilizing the LymphoTrack® IGH FR2/3 Assay -- S5/PGM™ reagents from Invivoscribe Technologies. Next-generation sequencing of libraries was performed on a ThermoFisher Scientific Ion Torrent S5™ sequencer. The LymphoTrack® Software - S5/PGM™ Version 2.4.5 was used to analyze the IGH rearrangement sequences and relative proportion of the sequences was determined as a percentage of total sequencing reads. All PCN patients in our cohort received an autologous stem cell transplant (auto-SCT) with subsequent lenalidomide maintenance therapy. The mean time from the start of lenalidomide treatment after auto-SCT to BALL development was 62 months. None of the BALL cases were Philadelphia chromosome-positive. There was increased incidence of TP53 mutations and deletions (36%). IgH clones were identified in all but one sample. Comparison of the IgH clones from the original PCN and subsequent BALL revealed distinct clones in all 5 patients tested. In 2 of the 5 patients, the original PCN clone was also identified along with the distinct BALL clone. Our study reveals that BALL cases arising in patients with treated PCN are not clonally related to the original disease, and may represent therapy-related malignancy associated to prior treatment including lenalidomide maintenance therapy. More studies are needed to establish the incidence and understand the pathogenesis of this possible therapy-related complication.
Aspiration pneumonia complicated by disseminated fungal sepsis in the setting of incidental esophagitis cystica: A rare autopsy case report with review of the literature
Authors: Albayrak N
Published: October 2021

Introduction/Objective

Esophageal retention cysts are presumed to arise from obstruction of the excretory ducts of the submucosal glands of the esophagus. Since the first description by Kuhne in 1899, different terminologies have been used to denote these lesions including retention cysts, mucocele, esophagitis cystica, and cyst of esophageal submucosal gland duct. Esophageal retention cysts are generally benign, asymptomatic and discovered incidentally. However, a few studies have reported symptomatic dysphagia and to date, only one autopsy case report described esophageal retention cysts contributing to aspiration pneumonia and cause of death.

Methods/Case Report

We present a case of aspiration pneumonia, associated with both reduced oropharyngeal tone secondary to alcohol consumption and esophageal dysphagia due to esophagitis cystica in a 69 year old female with alcohol use disorder complicated by alcoholic liver disease. The patient was found unresponsive at home with bloody oral secretions and evidence of head trauma. On autopsy all lung lobes demonstrated that large and small airways and alveoli were filled with vegetable matter, associated with prominent bacterial and fungal forms. EVG stain demonstrated vascular disruption with red blood cell extravasation, next to a focus of aspiration pneumonia. This explained the patient’s “bloody oral secretions”, originating from the respiratory tract. Demonstration of fungal hyphae in sections from lungs as well as necrotic colon was consistent with disseminated fungal sepsis. While sections from esophagus showed no varices which could explain the patient’s “bloody oral secretions” in the setting of alcoholic liver disease, there were numerous dilated esophageal submucosal cysts. Cysts were lined by a single to double layer of cuboidal epithelium with eosinophilic cytoplasm and basally-located, bland-appearing nuclei.

Conclusion

In summary, we present a rare case of esophageal retention cyst associated aspiration pneumonia complicated by pulmonary hemorrhage, adding to the growing body of knowledge regarding fatal complications of these usually incidental lesions.
Histopathologic spectrum of glomangioma: A clinico-pathologic review
Authors: Kilapandal Venkatraman S , Braun A , Miller I , Reddy V , Gattuso P
Published: October 2021

Introduction/Objective

Glomus tumors are mesenchymal neoplasms with glomus body type modified smooth muscle cell differentiation. Most glomus tumors have a benign clinical course. However, rarely, they display malignant histologic features.

Methods/Case Report

We undertook a retrospective study using a natural language search in CoPath to find surgical pathology cases from 1993-2020 containing “glomus” in the pathology diagnosis. All relevant cases were included, and clinicopathologic data were reviewed in detail.

Results (if a Case Study enter NA)

A total of 66 tumors were identified, of which 42 were in female (63.6%) and 24 in male (36.4%) patients. The age at surgery ranged from 22 to 79 years with a median of 47.5. Females were significantly younger than males at presentation (p=0.025) by 8.8±3.8 years. Forty cases (60.6%) were located on the digits, 24 in nonvisceral soft tissue of extremities, trunk, and lip (36.4%), and one each in stomach and breast parenchyma. Sixty-three (95.5%) were benign (of which one recurred locally), 2 (3%) were malignant, and 1 (1.5%) was atypical. Four (6%) were multicentric. One case showed mixed histology (oncocytic and classic features) and one was classified as glomangiomatosis. The malignant cases each presented with a single tumor in lower extremity soft tissue in female patients (aged 33 and 49 years). The tumors measured 0.5 and 1.8 cm respectively and showed marked cytologic atypia in both and increased mitotic activity in the first. They were both completely excised.

Conclusion

The majority of glomus tumors are benign, however 3% are malignant. The most common location is the digits, followed by soft tissue. This tumor is more commonly seen in female patients. Unusual histologic variants such as glomangiomatosis and oncocytic component at times may create some difficulty to reach the diagnosis, especially on small biopsies. Unusual locations such as stomach can lead to a wrong diagnosis such as carcinoid, especially in a small biopsy material.
Sex Differences in Proximal Thoracic Aortic Disease Pathology: A Call to Action
Authors: Sadaf H , Zhao B , Lelenwa L , Buja L , Segura A , Cecchi A , Milewicz D M , Safi H , Estrera A
Published: October 2021

Introduction/Objective

Sex disparity is reported across all forms of cardiovascular diseases. Only few studies have focused on sex differences in thoracic aortic disease pathology. We aim to identify and understand sex differences in this patient group to bridge the knowledge gap and improve clinicopathologic outcomes.

Methods/Case Report

This is a retrospective analysis of 83 proximal thoracic aortic aneurysm and dissection (TAAD) cases treated at a single quaternary care center in 2019. Chart review was done for demographics. Consensus criteria (Stone JR et al. Cardiovasc Pathol 2015; 24:267-78; Halushka MK et al. Cardiovasc Pathol 2016; 25:247-57) and a scoring system (Waters KM et al. Cardiovasc Pathol 2017; 30:6-11) were used for pathology reporting. Clinical correlation was also made. Pearson’s chi-square test was used for statistical analysis.

Results (if a Case Study enter NA)

83 patients (61 male and 22 female) were retrieved. Overall thoracic aortopathy was higher among males, accounting for 73.4% of individuals with TAAD. In a subgroup analysis, there was no sex difference in dissection, aortic root involvement, and bicuspid aortic valve (p>0.05). Genetic aortopathy was more prevalent in females than males (27.2% vs 9.8%, p=0.04) alongside early age at first aortic event (median age: 31y vs 52y). Histopathologically, females had frequent translamellar mucoid extracellular matrix accumulation (45.4% vs 22.9%, p=0.04), extensive (54.5% vs 27.8%, p=0.02) and severe (59% vs 34.4%, p=0.04) elastic fiber fragmentation, higher band like (9% vs 6.5%, p>0.05) plus extensive (13.6% vs 4.9%, p>0.05) smooth muscle nuclei loss, and extensive (13.6% vs 1.6%, p=0.01) plus dense (4.5% vs 1.6%, p>0.05) laminar medial collapse than males.

Conclusion

In our patient population, females have a lower prevalence of thoracic aortic disease treated with open repair. However, those who develop TAAD harbor a greater burden of wall pathology and probable worse outcomes. We recommend sex-based analysis of all research on thoracic aortic diseases.
Proficiency Testing Performance for Point of Care Glucose Users in a Tertiary Hospital in Kenya
Authors: Mukunya F M , Amayo A A , Ongeso A , Gitau A
Published: October 2021

Introduction/Objective

Introduction: Point of Care (POC) blood glucose measurements are widely used for monitoring diabetes in hospitals. Ensuring quality of POC glucose is important for patient safety. Proficiency testing (PT) where POC users are provided with samples to analyze in the same way as they would patient samples, and the test results are compared with those of peers, is especially important for hospitals with multiple glucose meters where multiple operators with varying levels of education and experience are performing POC glucose analysis.

Objective

To evaluate the performance of POC glucose users at a tertiary hospital in Nairobi, Kenya.

Methods/Case Report

Methodology: The study was conducted at the Kenyatta National Hospital (KNH), an 1800 bed public teaching and referral hospital located in Nairobi, Kenya.Nurses in 46 wards and clinics who use blood glucose machines (BGM) were given low and high glucose quality control (QC) materials to analyze using BGMs like patient samples. The results of each ward were analyzed. Comparison of each participant was made with the group (consensus values) and the central laboratory (assigned values), and graded as acceptable or unacceptable.

Results (if a Case Study enter NA)

Results:Most participants obtained acceptable glucose results but 7.6% and 13% results were unacceptable when consensus values and assigned values were used respectively. Two participants (4.3%) obtained unacceptable with both low and high glucose controls.

Conclusion

The unacceptable results indicate need for improvement, and two BGM users who should be trained and their competency assessed to ensure quality of glucose tests.
Validation of High sensitivity cardiac troponin (HsTnI) – a breakthrough in diagnostic accuracy of acute coronary syndromes
Authors: Dalal S , Petersen J M , Jhala D
Published: October 2021

Introduction/Objective

Cardiac troponin (cTn) testing is an essential component of the diagnostic workup and management of acute coronary syndromes (ACS). Rapid advances in immunoassay technologies has led to the development of high sensitivity troponin (HsTnl) assays with unprecedented analytic sensitivity and precision. These assays are FDA approved and the use of HsTnl assays is recommended by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), the Joint European Society of Cardiology (ESC), the American College of Cardiology (ACC), and the American Heart Association (AHA) in the Fourth Universal Definition of Myocardial Infarction (2018). The incidence of ACS and its mimics in emergency room visits are much more prevalent in veterans due to increased medical comorbidities. We report here our experience with its validation on two Unicel DXI 800 Access Immunoassays as it has not been well published, particularly in a Veterans Healthcare Clinical Laboratory setting.

Methods/Case Report

The quality assurance goal of the validation is to demonstrate that the Unicel DXI 800 Access Immunoassay HsTnl assay performs as expected on two analyzers and can be put into clinical use. Method to method correlation with a validated conventional Troponin I, within run precision, day to day precision, and a linearity study were performed as part of this validation.

Results (if a Case Study enter NA)

For the total of 60 specimens run for the method comparison, Data was plotted and evaluated against EP evaluator, both hsTnI and Troponin I were within the 95% confidence intervals of the method. The linearity study demonstrated results are linear with results as expected. Two levels of cardiac control were tested in a run of 60 replicates each in one day for within run precision, with all results as expected. The day to day precision with three levels of control run daily over 10 days also yielded results as expected.

Conclusion

The HsTnI is a highly accurate, faster test for the detection of ACS allowing earlier detection of smaller infarcts with much better precision, and there by reducing the morbidity and mortality. It allows rapid discharge of the patients with reducing the cost of hospital stay. This is an example of excellence in laboratory practice by extending the best quality laboratory care with proper validation of instrument methods conducive to laboratory workflow.
An aggressive case of Warthin-like variant of papillary thyroid carcinoma (PTC)
Authors: Ali M , Thomas S
Published: October 2021

Introduction/Objective

Warthin-like variant of PTC is a rare subtype of PTC, characterized by papillary growth lined with oncocytic neoplastic cells and lymphocytic rich stroma in the stalks of the papillae. It is frequently associated with Hashimoto thyroiditis and has good prognosis due to lower risk of metastasis. An association with BRAF V600E mutation has been reported. Here we report an aggressive case of Warthin-like variant of PTC.

Methods/Case Report

A 33-year-old Hispanic female presented with a progressively expanding neck mass, difficulty swallowing, voice hoarseness, and neck pain. Ultrasound showed a 3.8 cm left thyroid nodule which on biopsy was positive for PTC. Laboratory tests were positive for anti-peroxidase and anti-thyroglobulin antibodies. A total thyroidectomy was performed. Grossly, the left thyroid lobe nodule was well-circumscribed, unencapsulated, and firm with solid homogenous gray-tan cut surface. Microscopically, the nodule consisted of large eosinophilic cells demonstrating characteristic PTC nuclear features, arranged in papillary structures with the cores packed with prominent lymphoplasmacytic infiltrate consistent with Warthin-like variant of PTC (figure). Separate sub-centimeter foci of PTC with similar features were identified in a background of chronic lymphocytic thyroiditis. Central and left neck dissection showed extensive lymph node metastasis which had features similar to the primary tumor but with less pronounced lymphoplasmacytic cores. The patient is currently 6-month post operation and is receiving iodine ablative therapy.

Results (if a Case Study enter NA)

NA

Conclusion

Molecular analysis of the tumor may aid in identifying molecular aberrations responsible for the aggressive nature in this case and potentially guide treatment.
Incidental Colonic Masses and Cytomegalovirus (CMV) Infection in a Treatment- Naïve Chronic Lymphocytic Leukemia Patient without GI symptoms
Authors: Elzamly S , Taha H , Shitawi M , Ghosh A , Everett J
Published: October 2021

Introduction/Objective

Gastrointestinal (GI) involvement by leukemia ranges from 5.7 to 13 % with very few published reports describing infiltration of the GI tract by chronic lymphocytic leukemia (CLL). GI bleeding, abdominal pain, and obstruction have been described as presenting symptoms of GI involvement. Yet, discrete lesions are rare. Infection is a common complication in patients with CLL. In untreated patients, these infections are typically by encapsulated bacteria involving the respiratory tract and associated with hypogammaglobulinemia. Viral infections often happen after therapy. This report presents a patient with a history of treatment- naïve CLL and HSV who presented for colostomy reversal and was incidentally found to have two partially obstructing colonic masses, as well as cytomegalovirus (CMV) infection.

Methods/Case Report

This is a 78-years-old female with treatment-naïve CLL and past medical history of hypertension, atrial fibrillation, diverting colostomy secondary to chronic perineal HSV-2 ulcer and recent perirectal abscess. She presented for colostomy reversal in the absence of any reported GI symptoms at that time. Labs showed leukocytosis; WBCs count of 25 K/MM3, anemia and neutropenia. Endoscopic studies incidentally discovered two partially obstructing masses in the ascending and transverse colon that were biopsied. A right hemicolectomy and colostomy closure were followed, and the patient was discharged on valganciclovir.

Results (if a Case Study enter NA)

Histopathological examination demonstrated mucosal ulceration with viral cytopathic changes and positive CMV IHC stain. In addition, a dense atypical, small sized lymphoid cell infiltrate with no sheets of large cells or confluent necrosis were identified. Flowcytometry and IHC stains showed aberrant CD5+ B cells with CD23 co-expression consistent with the patient’s history of CLL.

Conclusion

The case describes the unique presentation of a patient with treatment- naïve CLL without any GI symptoms, yet was incidentally found to have colonic involvement by CLL forming discrete colonic masses as well as CMV and HSV infections. Since she is untreated, her infections (HSV and CMV) are likely secondary to being immunocompromised by CLL and neutropenia. In conclusion, although rare, GI involvement by CLL should be considered in treatment naïve CLL patient’s and concomitant infections should be evaluated.
Differential Diagnosis of Periportal Adenopathy Based on Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA)
Authors: Esebua M
Published: October 2021

Introduction/Objective

Endoscopic ultrasound guided fine-needle aspiration is a safe and accurate diagnostic procedure for abdominal lymphadenopathy. Goal of this study is to evaluate the utility of EUS-FNA in two groups of patients with periportal lymphadenopathy: group 1 with diagnosis of malignancy and group 2 with no known malignant diagnosis.

Methods/Case Report

This is a retrospective study of 74 patients in our database with enlarged periportal lymph nodes detected on cross sectional imaging of the abdomen. All patients underwent EUS-FNA with 22-gauge needle. Three passes were performed for each lymph node detected. Median size of periportal lymph nodes was 19.8 mm (ranging from 5 to 59 mm). 2 groups were compared: group 1 with known malignancy and group 2 with no known malignancy. All patients were clinically followed 6-12month from the procedure.

Results (if a Case Study enter NA)

25 of the 74 (34%) patients had malignant diagnosis. The types of neoplasia detected were lymphoma (3), metastatic adenocarcinoma (16), metastatic acinar cell carcinoma (1) and metastatic neuroendocrine tumor (5). 42 of 74 patients (57%) had negative fine-needle aspiration diagnosis: 40 patients had reactive lymph node diagnosis, 2 patients had granulomatous inflammation diagnosis. 2(1%) of 74 cases had atypical diagnosis, 5(7%) cases were unsatisfactory due to inadequate material obtained during procedure. Sensitivity of the procedure is 45.8% and, specificity is 100%. Positive predictive value (PPV) is 100% and negative predictive value (NPV) is 78.7%. EUS-FNA can detect positive lymph nodes as small as 1 cm, however, this method can also miss positive lymph nodes up to size of 3.5 cm which probably due to the uneven involving of the nodes by tumor cells. Lymph nodes 3.5cm and larger are more likely to be malignant, however in differential diagnosis of small lymph nodes (1 cm in length) they were noT statistically significant difference between the pathologic and benign lymph nodes.

Conclusion

EUS-FNA is effective method for investigating periportal lymphadenopathy with known or unknown malignancy.
Epstein-Barr Virus associated gastric carcinoma in a patient with germline STAT3 gain-of-function mutation
Authors: Mahadik J , Patel K , Cortes-Santiago N
Published: October 2021

Introduction/Objective

Signal transducer and activator of transcription 3 (STAT3) is a transcription factor involved in inflammation, proliferation, differentiation and survival. STAT3 gain-of-function (GoF) disorders are characterized by immune dysregulation and present with polyendocrinopathy, enteropathy, X-linked syndrome (IPEX)- or autoimmune lymphoproliferative syndrome (ALPS)-like features. While patients with STAT-3 GoF are known to have an increased risk for hematologic malignancies, neither solid tumors nor an increased risk for EBV-associated disorders have been described. We report the first case of an EBV-associated solid organ tumor in a patient with STAT-3 GoF.

Methods/Case Report

A 21-year-old male with germline mutation in STAT3 (variant p. M329K) presented with early satiety, abdominal pain and worsening of chronic anemia. Serology showed high EBV DNA PCR levels. Endoscopy showed multiple nodular lesions in the stomach, which were biopsied to reveal EBV-associated high-grade dysplasia and intramucosal adenocarcinoma. Initiation of chemotherapy with a poor response led to a total gastrectomy. Gross examination of the specimen showed a 7.9 x 6.5 x 1.8 cm tan-brown, exophytic mass in the posterior wall of the body and antrum, involving the greater curvature. Histology revealed an adenocarcinoma with tubulovillous morphology extending into the lamina propria, without invasion into the muscularis mucosa or submucosa. EBER in-situ hybridization was diffusely positive in the tumor cells. The background mucosa showed severe chronic active and atrophic gastritis with intestinal metaplasia and low-grade dysplasia. All the seventy examined lymph nodes were negative for metastasis. Helicobacter-like organisms were not seen.

Results (if a Case Study enter NA)

NA

Conclusion

This is the first report of a solid tumor in a patient with STAT3 GoF mutation. The role of the patient’s underlying immune dysregulation disorder in the development of EBV-associated gastric adenocarcinoma is unclear and warrants further investigation. The case also highlights the importance of a close clinical follow-up in this patient population, as unexpected malignancies can develop at younger ages.
Placental Mesenchymal Dysplasia, An Exceedingly Rare Entity and Challenging Diagnosis
Authors: Hussain F , Kumar V , Prakash V , Shenoy V , Al Hmada Y
Published: October 2021

Introduction/Objective

Placental mesenchymal dysplasia (PMD) is an extremely rare entity with an incidence of only 0.02/1000 deliveries.

Methods/Case Report

We present a case of a 26 year-old female Gravida 3, Para 1 with intrauterine pregnancy at 37 weeks of gestation. Fetal ultrasound showed mildly cystic upper portion of the placenta. The noninvasive prenatal testing was negative for triploidy. A viable healthy female infant was delivered with no maternal complications.

On gross examination, placenta was heavy with approximately 25% incomplete cotyledons. Placental maternal surface showed, spongiform cut surfaces admixed with multiple cystic structures ranging in size from 0.5 to 1.5 cm and markedly dilated blood vessels.

Histopathologic examination revealed markedly enlarged villi, mesenchymal hyperplasia, and hyper vascularity of small vessels. No trophoblast proliferation was identified. Subsequently, the diagnosis of PMD was made.

Results (if a Case Study enter NA)

NA

Conclusion

PMD is a rare anomaly which is characterized by placentomegaly and grape like vesicles resembling molar pregnancy. Etiologies include imbalance of paternal and maternal alleles, androgenetic and bi-parental mosaicism, and Beckwith Weidman Syndrome (BWS). Differential diagnosis includes partial molar pregnancy, complete mole with co-existing normal fetus, hemangioma, subchorionic hematoma, confined placental mosaicism and hydropic complications. Histologic features, ancillary studies including immunohistochemistry and genetic testing are helpful in differentiating PMD. PMD is an underdiagnosed entity with increased risk of premature delivery and intrauterine fetal death. It is pertinent for the clinicians to be aware of this entity for optimal patient management.
Molecular findings in bone marrow samples of myeloid sarcoma
Authors: Khan J , Nassiri M
Published: October 2021

Introduction/Objective

Myeloid sarcoma is a rare extramedullary manifestation of acute myeloid leukemia. There are very few studies regarding molecular findings in myeloid sarcoma or their associated myeloid leukemia

Methods/Case Report

We evaluated cases of myeloid sarcoma with concurrent or prior bone marrow studies diagnosed as acute myeloid leukemia, from 2014 to 2021. We searched our Anatomic pathology information system for the terms ‘myeloid sarcoma’ or ‘leukemia cutis’. Out of 58 cases of myeloid sarcoma, ten had next generation sequencing studies (FoundationOne Heme) performed on bone marrow aspirate. Results-There were 7 male and 3 female patients. Age range was from 1-79 yrs. Myeloid sarcoma involved the skin (n=7) or soft tissue (n=3). Most common mutated genes were KMT2A/MLL (n=4, all translocations/fusions) followed by AXL1 (n=3), TP53 (n=3), NRAS (n=2), TET2 (n=2) and CEPBA (n=2). KMT2A fusion partners were MLLT1/ENL (n=1), MLLT3 (n=1), and MLLT10/AF10 (n=2). In all except for one case that harbored KMT2A/MLL fusions, karyotype also showed translocation of KMT2A. Only one case had both an AXL stop codon and a KMT2A translocation, otherwise AXL1/CEBPA mutated cases and KMT2A/MLL mutated cases were mutually exclusive. Other mutated genes were PHF6, BRCA2, DNMT3A, NPM1, RAD21, CBL, KMD6A, and NF1; each found in one case.

Results (if a Case Study enter NA)

Our result support the notion of higher risk of myeloid sarcoma in KMT2A and TP53 mutated AMLs. Except for absence of spliceosomes mutation, the incidence of mutated genes and functional categories in our series is concordance with two previously published studies.

Conclusion

Our result support the notion of higher risk of myeloid sarcoma in KMT2A and TP53 mutated AMLs. Except for absence of spliceosomes mutation, the incidence of mutated genes and functional categories in our series is concordance with two previously published studies.
A Case Of Disseminated Histoplasmosis In A Patient With Sarcoidosis
Authors: Prisneac I , Vos J , LaSala R , Randall C
Published: October 2021

Introduction/Objective

Sarcoidosis is a syndrome of unknown cause that may manifest with clinical, radiographic and pathological findings similar to those seen with histoplasmosis. We present a case of disseminated histoplasmosis in an immunocompetent patient previously diagnosed with sarcoidosis.

Methods/Case Report

A 69-year-old obese male with a history of hypertension, diabetes mellitus and long-standing sarcoidosis was admitted to the hospital for several months of intermittent fevers and pancytopenia. His sarcoidosis was diagnosed 21 years prior, initially involving the lungs and eventually showing cardiac involvement, requiring a pacemaker. He had been treated with methotrexate and prednisone. His recent medical history was also significant for COVID-19 infection, diagnosed 3 months before admission. His fevers were initially attributed to sarcoidosis and his pancytopenia to methotrexate. However, his symptoms continued despite discontinuation of his medications, and further workup was initiated.

Computed tomography showed hepatomegaly, splenomegaly, and lymphadenopathy, concerning for a lymphoproliferative disorder. The patient underwent a bone marrow biopsy that showed noncaseating granulomas and microorganisms consistent with histoplasmosis on fungal stain. Bone marrow cultures were not possible as the marrow was inaspirable. The patient subsequently underwent a lymph node biopsy with both morphology and culture identifying histoplasmosis. Urine and serum histoplasma antigen also returned positive. The patient’s overall clinical picture was consistent with disseminated histoplasmosis and he was administered intravenous Amphotericin B for 3 weeks followed by oral itraconazole for 1 year. One month follow-up after discharge showed significant improvement in the patient’s condition.

Results (if a Case Study enter NA)

N/A

Conclusion

Sarcoidosis reduces T-cell activity, and treatment with steroids causes further immunosuppression and vulnerability for development of a disseminated infection. COVID-19 also presumably increases the predisposition to acquire bacterial or fungal co-infections. Clinicians and pathologists should be aware of the overlap in clinical, radiologic and pathological presentations of sarcoidosis and histoplasmosis to make the correct diagnosis and administer the appropriate treatment.
A Novel Automated Hematopathologist-Styled Commenter for Complete Blood Count and Smear Review
Authors: Elsafty A , Ahmed Y , Soliman A , Morsy A A
Published: October 2021

Introduction/Objective

Prevention of errors and increasing productivity are essential for managing the workflow in hematopathology labs, particularly under stress and fatigue conditions. The proposed automated commenter system is designed to directly address these critical issues. Care was also taken to ensure ease of use and minimum training time.

Methods/Case Report

Using 20 quantitative and qualitative parameters in 3 groups (RBCs, WBCs and platelets), our novel automated commenter is able to generate a hematopathologist’s report/interpretation for CBC and smear review. Built-in reference ranges can be adjusted to accommodate variability in cutoffs. There are alarms for entry of seemingly odd values, differential counts not adding up to 100% or suspected cold agglutination, lipemia and hemolysis in the specimen. Our automated commenter was developed and tested against more than 1,000 hematopathology reports. These reports included clinicopathologic correlations for different type hematopathology neoplasms and benign disorders. At least 100 reports were selected for each disease category covering all subclasses and grades. Ample user acceptance testing was conducted using feedback surveys from hematopathologists, hemato-oncologists and clinicians.

Results (if a Case Study enter NA)

Generated comments are narrative, concise, comprehensive and accurate. The abnormal findings are arranged by their grade and significance. For example, the following comment was generated using the system: “CBC and smear review reveals mild macrocytic pancytopenia with anisocytosis, increased peripheral circulating blasts above the cutoff of Acute Leukemia and critically severe neutropenia (Hgb 11.0 g/dL, MCV 103.5 fL, RDW 14.9%, WBC 3.2 K/µL, blasts 29%, promyelocytes 2%, myelocytes 5%, metamyelocytes 1%, nRBCs 5/100 WBCs, ANC 0.3 K/µL & Plt 125 K/µL) with mild dysgranulopoiesis and dacrocytosis (teardrops).”

Conclusion

Absence of clerical and scientific errors, reportedly positive user experience and saving 50-80% of pathologists’ working time are all advantages that indicate feasibility of large-scale adoption of our system by hematopathology labs. Workflow fitness, standardization, minimizing the manual variations and using the system as a professional training tool also strongly support this conjecture. The system could be used to fully automate clinicopathologic correlation with phenotypic and genetic tests and to develop an automated test selector (Triage Advisor).
Laboratory Analysis of Antiphospholipid Antibodies with Clinical Correlation: A Hospital-Based 10 Year Study
Authors: Myrzykowski M , Xie C , Sweet R , Xie M
Published: October 2021

Introduction/Objective

Antiphospholipid syndrome (APS) is an autoimmune disorder and its diagnosis requires both laboratory evaluation of antiphospholipid antibodies (APAs) and clinical correlation. This study focused on the laboratory analysis of APS with clinical correlation in a hospital-based patient population.

Methods/Case Report

From 2010-2020, immunological studies for APAs were performed at Department of Pathology, William Beaumont Hospital – Troy, Michigan and patients with positive results were selected for further analysis. Four APAs were included: IgG and IgM beta-2 glycoprotein I antibodies (IgG B2GA and IgM B2GA), and IgG and IgM anticardiolipin antibodies (IgG ACA and IgM ACA). Clinical information was collected from hospital electronic medical chart with focus on thromboembolism and abortion history, autoimmune disorders, antithrombotic therapies and other studies.

Results (if a Case Study enter NA)

There were 167 patients, 136 females and 31 males (F/M=4.4). The median age for females was 50 and for males, 57. Overall, B2GA was present more than ACA (102/81) in females, and ACA was present slightly more than B2GA (20/17) in males. IgM APAs were much more common than IgG APAs; IgM B2GA/IgG B2GA: 87/32 (p<0.01) and IgM ACA/IgG ACA: 81/20 (p<0.01). Most APAs were at the low-intermediate titer range and increased APAs titer correlated with decreased positive rate: APAs titer at 20-40, 41-80 and >80 with positive results at 115, 61 and 44 respectively. In addition to documented autoimmune disorders, pregnancy miscarriage was a common clinical condition (24/66) in females at age <45. But for females at age >45, vascular thrombosis became more common (18/70). Vascular thrombosis was a common clinical disease in males (16/31) followed by autoimmune disorders (10/31). Most patients with vascular thrombosis received antithrombotic therapies.

Conclusion

Female patients positive for APAs was significantly more and younger than males in this study. IgM B2GA was the most common type of APAs followed by IgM ACA. IgG B2GA and IgG ACA were much less common. In younger female patients autoimmune disorders and abortion were the most common clinical conditions. In older female and male patients, autoimmune disorders and vascular thrombosis were the most common clinical conditions. The titer of APAs detected was at low-intermediate range in most patients. The relationship between the titer of APAs and clinical conditions needs further study.
Hyperhemolysis Syndrome Following Pre-Operative Red Blood Cell Exchange
Authors: Allison D , Karimi S S , Campbell-Lee S
Published: October 2021

Introduction/Objective

Pre-operative red blood cell exchange (RBCX) for patients with Sickle Cell Disease (SCD) is a category III indication. In our institution, RBCX is routinely performed pre-operatively when general anesthesia is necessary with the goal of HbS%<30 and reduction in adverse events related to general anesthesia. In the context of elective surgery, the risks and benefits of both the operation and any pre-operative transfusion must be discussed with the patient. Herein, we present an extreme case of Hyperhemolysis Syndrome resulting from a pre-operative RBCX.

Methods/Case Report

A 23-year-old transgender female with SCD (Hb S Lepore) treated with Hydroxyurea presented for elective breast augmentation for gender-affirmation. Her pre-operative plan included a RBCX. Her pre-exchange hemoglobin (Hb) and hematocrit (Hct) were 10.3 g/dL and 29.3%, respectively. Hb electrophoresis revealed HbS 52%, HbF 41.4%, HbA2 7.4%, and HbA was not detected. Type and Screen (T&S) demonstrated O + blood group, with a negative antibody screen, and with no known historical alloantibodies.

RBCX was performed using the Spectra Optia (TerumoBCT, Lakewood, CO, USA) with exchange volume of 1.9 L of group O+ RBCs, phenotypically matched for C, E, and K, an end Hct of 30% and an FCR of 30%. Her post-exchange Hb and Hct were 10.2g/dL and 29.5%, respectively. Hemoglobin fractionation revealed HbS 12% and HbA 73%.

She underwent surgery without intraoperative complications. Two weeks post RBCX, her Hb had decreased to 5.3 g/dl, and her LDH and Total Bilirubin had increased to 253 ul and 1.8 mg/dl, respectively. A repeat T&S drawn 8 days after RBCX revealed a positive antibody screen and direct antiglobulin test (DAT). Three new alloantibodies were identified: anti-Fya (present in plasma and eluate); anti-Jkb (present in plasma); anti-S (eluate). She was treated with IVIG, 0.4 g/Kg/day for 5 consecutive days and 2 doses of subcutaneous darbepoetin 100 mcg and subsequently discharged with close outpatient follow up. Her Hb returned to baseline at 11 g/dL, 48 days post RBCX.

Results (if a Case Study enter NA)

N/A

Conclusion

Pre-operative RBCX decreases morbidity in sickle cell patients undergoing general anesthesia. In the setting of elective surgery, patients must be counseled on the benefits and risks of surgery as well as the requisite RBCX. In our case, the patient developed multiple alloantibodies, with lifelong implications should she ever need future blood transfusions.
Rat-Bite Fever: Developing and testing a modified time-kill protocol based on Edberg and Edberg 1983 experiemnt in order to test S. moniliformis growth in 0.05% SPS and proposed growth curve
Authors: Szewc A M , Bell M , Kelly A , Humrighouse B , McQuiston J
Published: October 2021

Introduction/Objective

Streptobacillus moniliformis is the primary causative agent of rat-bite fever (RBF) and Haverhill fever (HF). Rat-bite fever and Haverhill fever are difficult to diagnose in a clinical setting and are likely severely under-represented and under-reported worldwide. Clinical presentation often includes fever, chills, myalgia, headache, and vomiting. Patients may also develop a maculopapular rash covering their extremities approximately 2-4 days after onset of fever followed by polyarthritis in roughly 50% of patients with a mortality rate of 10-13% if left untreated. This is further complicated by the fact that submission and processing guidelines of clinical samples for the recovery of the organism are based on ‘outdated’ techniques and clinical laboratory methods that are over 50 years removed from current procedures, instrumentation and guidance.

Methods/Case Report

DNA from collected frozen time-point samples, were collected (n=84) and extracted using an in-house custom protocol utilizing 180 µl of bacterial lysis buffer with 20 µl of PCR grade proteinase K, for a total of 200 µl. The blood culture time-point samples were then thawed on ice, and 200 µl of blood culture sample was then added to the lysis mix, vortexed and incubated at 65°C for 10 minutes (an additional 95°C inactivation step was omitted to avoid whole blood clotting). After incubation, each sample was vortexed briefly again and extracted using the Roche automated MagNA Pure Compact instrument with an initial input volume of 400 µl and stored in a final elution buffer volume of 100 µl. All quantatitive time kill data was colleced via a CDC in-house designed PCR assay developed for S. moniliformis.

Results (if a Case Study enter NA)

Experimenting with varying amounts of blood inoculum, 10 ml of blood was determined to provide the best results for detection and growth/viability as well as propose a theoretical growth curve for the organism.

Conclusion

We found that in 100% of the isolates tested (and all the variations of testing within), SPS (up to a concentration of 0.05 % w/v) in commercially available blood culture bottles appeared to be inactivated, allowing for the growth detection and culturing of S. moniliformis using an automated continuous blood culture system when 10 ml of blood was inoculated.