bluuebunny/crossref_metadata_2025 huggingface dataset:
Single Motherhood by Choice: Difficulties and Advantages
Authors: Dor Asnat
Published: February 2021

This qualitative phenomenological study focuses on the advantages and difficulties encountered by 20 single mothers by choice (SMC). Research has addressed the difficulties that single mothers face, and the present study will discuss these, as well as the advantages that SMC see in this family structure. The research tool was semi-structured in-depth, non-directive interviews. Findings revealed that the difficulties SMCs face are similar to those faced by women who are single mothers due to life circumstances. The fact that they are solely responsible for their child/ren is a source of emotional stress, and they must deal with society’s ambivalent attitudes. At the same time, SMCs emphasized their freedom to decide exclusively, and their success in maintaining a calm atmosphere at home, devoid of possible tension with a partner. This study suggests that although the women had chosen to become single mothers, the choice does not ease their difficulties. However, it allows SMCs to acknowledge the advantages of this family structure.
Assessment of Safety Performance in Banana Alcoholic Beverage Processing Factories in Rwanda
Authors: Irakiza Grace , Ugirinshuti Viateur , Kamana Olivier , Ongol Martin P.
Published: February 2021

Although the Rwandan competent authorities are putting effort to improve the safety of traditional banana alcoholic beverages, safety problems still exist. This study aimed to apply customized diagnostic tool to gain an insight into the performance of food safety in traditional banana alcoholic beverage factories as an evidence based to support the selection of suitable interventions for improvement to assure sustainability and meet growing market of traditional banana alcoholic beverages. Literature search was used to identify context factors, quality assurance and control activities that can influence safety of banana alcoholic beverage products and validated by processors through interview and participant observation. The data were collected in eleven factories located in Kigali city and four provinces of Rwanda using an assessment tool. Data analysis was performed using Microsoft Office Excel. All factories have shown to operate in relatively high risk context (score 2-3), most of control activities were at basic level (score 1), whereas assurance activities were at relatively average level (score 1-2) which resulted into poor food safety performance (score 1). This shows that, the modern food safety practices can’t be applied in traditional food processing factories due to traditional methods and equipment, low level of science-based knowledge related to processing technology, food safety and hygiene. Therefore, there is a need to design modern equipment that are easy to clean and disinfect to replace traditional ones, to train technical staff on processing technology, safety and hygiene, and to change behaviors towards making decisions based on scientific knowledge.
Adjustment of enterprises to the requirements of the fourth industrial revolution – regional approach
Authors: Sokołowski Andrzej , Markowska Małgorzata
Published: February 2021

The aim of the paper is to propose a composite indicator characterising the level of development of Polish NUTS 2 regions with respect to the implementation and results of the changes the fourth industrial revolution (Industry 4.0) entails, and to present a ranking of regions illustrating the degree to which enterprises have adjusted to the requirements of Industry 4.0. Data used for the calculations have been based on the results of an experimental research conducted by Statistics Poland (GUS) in 2019. Two methods for constructing the composite indicators have been used – classical and iterative which is to assess the indicator’s resilience to the influence of any potential outliers. 10 sub-criteria, covered by 21 variables have been taken into account. Opolskie region appeared to be the best NUTS 2 region in Poland in terms of the implementation of the requirements outlined by Industry 4.0. The evaluation of the proposed composite indicator will be possible when comparing it with the results of similar surveys carried out by GUS in the future.
ANÁLISE DA VIABILIDADE DE UTILIZAÇÃO DO LODO DE INDÚSTRIA FRIGORÍFICA EM SUBSTITUIÇÃO PARCIAL DO AGREGADO DE CONCRETO NÃO ESTRUTURAL
Authors: Teixeira  De  Souza Alexandre , Mello  da  Silva Ruth , Camargo Miranda Stefany
Published: February 2021

Much of thesludge present in the effluent treatment stations is destined for disposal in an inappropriate place or without the correct treatment, which can significantly affect the environment. Therefore, the current research aims to analyze the dry sludge of a refrigeration industry as a partial substitution of fine aggregate for non-structural concrete, making it necessary to choose features with a lower proportion of this in order not to extrapolate consumption costs. The specimens subsidized by NBR 5738 weremolded with partial addition of dry refrigerator sludge to replace fine aggregate, being 2%, 5% and 8%, respectively, and tested for axial compression in the Civil Engineering laboratory of UNOESTE. Through the results obtained, there was an increase in resistance compared to the standard trace in the specimens with less addition of sludge, however the solid residue retains a large amount of water, making it necessary to choose a trace with a lower proportion.
Classroom Response Systems in der juristischen Lehre – (auch oder gerade) in Zeiten von Corona
Authors: Czerny Olivia
Published: February 2021

Der vorliegende Beitrag möchte zur Nutzung von Classroom Response Systems (CRS) in der juristischen digitalen und analogen Lehre ermutigen. Nach einer kurzen Beschreibung, was CRS sind, werden Vorteile und Hoffnungen der Nutzung aufgezählt. Schließlich werden mögliche Einsatzfelder in der juristischen Lehre skizziert und anhand von Beispielen aus dem Zivilrecht illustriert. Anforderungen und mögliche Probleme werden beschrieben und Hilfestellungen zur bestmöglichen Nutzung gegeben. Abschließend wird ein Blick auf Evaluationen in anderen Disziplinen sowie in der juristischen Lehre geworfen.
Ovarian Cancer: Molecular Classification and Targeted Therapy
Authors: Ravindran Febina , Choudhary Bibha
Published: February 2021

Ovarian cancer is the deadliest gynecological cancer among women with an overall 5-year survival rate below 50% due to its asymptomatic nature, diagnosis at advanced stages, and a high recurrence rate after standard therapy in 70% of cases. Ovarian cancers are heterogenous cancers where each subtype possesses a varied morphology and biologic behavior. Accumulating evidence has identified each of these subtypes characterized with specific pathways activated in each along with specific gene alterations. For example, high-grade serous ovarian cancer is characterized by universal TP53 mutation, mucinous ovarian cancer with KRAS mutation and clear cell or endometrioid ovarian cancers with ARID1A mutations. With the current focus of molecular-targeted therapies for cancer, such druggable markers serve as excellent targets for precision therapy and combination therapy. This chapter, provides an overview of the critical molecular pathways activated in the ovarian cancer subtypes with its druggable targets studied in ovarian cancer. We also highlight the implications of miRNAs in chemoresistance and sensitivity in the regulation of ovarian cancer.
Canine Hepatic Carcinoma: Diagnoses and Treatments Via Global State-of-the-Art Approach and Traditional Chinese Veterinary Medicine
Authors: Chen Chih-Feng , Chiu Shao-Wen , Pan Lung-Kwang , Chuang Chao-Hsun
Published: February 2021

This chapter discusses effective diagnostics and treatment of canine hepatic carcinoma (CHC), where state-of-the-art global technologies are complemented by traditional Chinese veterinary medicine (TCVM). The biokinetic Ga-67 model of CHC is proposed to clarify the Ga-67 metabolic mechanism among various organs. It is aimed at identifying the best routine for detecting the metastatic or primary CHC and substantiating the optimal further treatment. The routine examination of CHC can be performed via Ga-67 nuclear examination or MRI, biological index, X-ray, and abdominal ultrasound. The available methods of animal cancer treatment imply separate or combined application of surgery, radiation therapy, and chemotherapy targeted at the particular cancer cells. However, there is also a general concern on the quality of life of pets/canine patients. This leaves enough space to the TCVM (including acupuncture and famous herbal drugs) with a long application history in Asia and growing usage as alternative treatment in other regions. However, its current applications to domestic animals/pets suffering from carcinomas are based on individual expert opinions, while there are no outlined veterinary treatment strategies and guidelines for clinical practice in this field. A comprehensive combination of state-of-the-art global technologies and TCVM is considered instrumental in curing canine hepatic carcinoma.
Laboratory Performance in Neonatal Bilirubin Testing Using Commutable Specimens: A Progress Report on a College of American Pathologists Study
Authors: Lo Stanley F. , Jendrzejczak Bernadine , Doumas Basil T.
Published: February 2021

Context.—In 2003 the Chemistry Resource Committee of the College of American Pathologists introduced a commutable specimen in the Neonatal Bilirubin Surveys. This specimen was intended to help evaluate all bilirubin methods.

Objective.—To evaluate the effect of commutable specimens on the performance of selected clinical analyzers in measuring neonatal bilirubin from 2003 through 2006.

Design.—A human serum–based specimen enriched with unconjugated bilirubin in human serum has been included since 2003 in the Neonatal Bilirubin Surveys. The bilirubin values of these specimens were determined by the reference method and used to evaluate results reported by various chemistry analyzers.

Results.—Coefficients of variation for College of American Pathologists All Data ranged from 4.9% to 6.2% for the Neonatal Bilirubin Survey. However, coefficients of variation for the 4 major instrument groups (Dimension, Olympus, Synchron, and Vitros), which report 65% of all results, varied from 2% to 3%. College of American Pathologists All Data mean bilirubin values were within 0.46 mg/dL (7.8 μmol/L) of the reference method mean in 2003; in subsequent years these differences became larger, peaking at 1.87 mg/dL (32 μmol/L) in 2005.

Conclusions.—The large systematic error of bilirubin measurements is due primarily to failure of instrument manufacturers to produce reliable bilirubin calibrators. Primary calibrators should consist of human serum enriched with unconjugated bilirubin. Bilirubin values must be assigned by the reference method, the performance and robustness of which are reported in this article. Secondary calibrators distributed to users must be traceable to primary calibrators.
Ultrastructural Abnormalities of Respiratory Cilia: A 25-Year Experience
Authors: Plesec Thomas P. , Ruiz Angela , McMahon James T. , Prayson Richard A.
Published: February 2021

Context.—Ciliary dyskinesia is a rare, but significant, cause of chronic respiratory infections, and transmission electron microscopy is a critical adjunct to making the diagnosis.

Objective.—To investigate a single institution's experience with patients demonstrating abnormal ciliary ultrastructure.

Design.—Retrospective clinicopathologic review of 278 bronchial or nasal turbinate brushings or biopsies from 1983 through 2007.

Results.—There were 12 women and 9 men (mean age, 19.6 years; range, 1–54 years) with abnormal ciliary ultrastructure. Clinical history was unavailable in 3 patients, 15 (83%) of 18 patients presented with chronic or recurrent upper respiratory infections, and 3 (17%) presented with infertility. Seven (39%) of 18 patients had findings of Kartagener syndrome with situs inversus, dextrocardia, and bronchiectasis. Truncation or absence of inner or outer dynein arms occurred in 15 (71%) of 21 cases, and 5 (24%) revealed transposition defects with displacement of the central microtubules and peripheral doublets in 9 + 0 and 8 + 1 patterns. Radial spoke defects with microtubular disarray occurred in 4 (19%) of 21 cases. Compound cilia with multiple axonemes within a single outer sheath and supernumerary microtubules each occurred in 2 (10%) of the cases. Random ciliary orientation was also found in 2 (10%) of the cases, and dense granular basal body inclusions occurred in 1 case (5%). Multiple abnormalities occurred in 6 (29%) of the 21 cases.

Conclusions.—Most patients presented with chronic respiratory tract infections or infertility. Dynein arm defects, transposition defects, and radial spoke defects were the most commonly encountered abnormal findings. Less-frequent abnormal findings included compound cilia, supernumerary microtubules, and dense granular basal body inclusions.
Expression of the Serine Protease Kallikrein 7 and Its Inhibitor Antileukoprotease Is Decreased in Prostate Cancer
Authors: Xuan Qiang , Yang Xiaoli , Mo Linjian , Huang Fengyu , Pang Youhong , Qin Min , Chen Zhiqiang , He Min , Wang Qi , Mo Zeng-Nan
Published: February 2021

Context.—Kallikreins are a subgroup of serine proteases with diverse physiologic functions. It has been confirmed that kallikrein 7 (KLK7) is differentially expressed in ovarian and breast cancer. Antileukoprotease (ALP) has been shown to be a specific inhibitor of human kallikrein 7 (hK7). Antileukoprotease overexpression is commonly associated with aggressive, high-risk, or metastatic cancer originating from various organs.

Objective.—To investigate the expression and potential role of hK7 and its inhibitor ALP in prostate cancer.

Design.—The mRNA expression of KLK7 and ALP transcript in benign prostate epithelial cells and prostate cancers was evaluated by semiquantitative reverse transcription–polymerase chain reaction. We examined hK7 and ALP protein expression by immunohistochemistry in 20 normal prostate tissues, 50 benign prostatic hyperplasia tissues, and 103 prostate cancers. Western blot examination showed protein expression of hK7 and ALP in benign prostate epithelial cells and prostate cancer cell lines.

Results.—Semiquantitative polymerase chain reaction examination revealed that the mRNA level of KLK7 and ALP was significantly decreased in prostate cancers compared with that in benign prostate epithelial cells (P < .001). Immunohistochemical expression of hK7 was observed in prostate epithelial cells, whereas little or no staining was observed in prostate cancer. Western blot analysis revealed that hK7 and ALP were decreased in malignant prostate epithelium.

Conclusions.—Like hK7, ALP is down-regulated in prostate cancers, which begs the question of whether it remains an effective inhibitor of hK7 or whether it is discordant in time or space and is ineffective as an inhibitor of hK7. The function of KLK7 and ALP in prostate cancer should be further studied.
Notification of Critical Results: A College of American Pathologists Q-Probes Study of 121 Institutions
Authors: Valenstein Paul N. , Wagar Elizabeth A. , Stankovic Ana K. , Walsh Molly K. , Schneider Frank
Published: February 2021

Context.—Hospital accreditors are placing increased emphasis on the timeliness with which critical laboratory results are reported to caregivers.

Objective.—To measure the speed of critical result notification at a group of laboratories, identify factors associated with faster reporting, and place findings in the context of the time required to transport and test specimens and to correct critical abnormalities.

Design.—Contemporaneous review of 3545 inpatient and emergency department critical result notifications in 121 laboratories enrolled in the College of American Pathologists Q-Probes program.

Results.—The median laboratory required a median of 5 minutes for staff to notify someone about a critical result once testing was complete. Laboratories affiliated with smaller institutions (P = .01), rural laboratories (P = .001), and sites that called results before releasing them from the laboratory computer (P = .02) were able to notify caregivers more quickly. There was variation among institutions in the time it took to notify caregivers (interquartile range, 1.5–8 minutes). At the median facility, notification took place 56.5 minutes after the specimen had been collected.

Conclusions.—The time required to notify caregivers of a critical laboratory result is a small proportion of the time taken to collect and test specimens or the time that has been reported for caregivers to correct abnormalities. Although failure to notify caregivers of critical results may represent an important patient safety vulnerability, the timeliness of laboratory notification is a minor contributor to total test turnaround time at most institutions.
Adjunctive Human Papillomavirus DNA Testing Is a Useful Option in Some Clinical Settings for Disease Risk Assessment and Triage of Females With ASC-H Papanicolaou Test Results
Authors: Bandyopadhyay Sudeshna , Austin R. Marshall , Dabbs David , Zhao Chengquan
Published: February 2021

Context.—Recent guidelines recommend colposcopy for women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H).

Objective.—To determine whether adjunctive high-risk human papillomavirus (hrHPV) testing is useful for disease risk assessment in females with ASC-H Papanicolaou (Pap) test results.

Design.—High-risk HPV prevalence and histopathologic follow-up data on 1187 females with ASC-H ThinPrep Pap test (TPPT) and hrHPV test results were analyzed.

Results.—ASC-H was reported in 1646 (0.006%) of 277 400 (270 338 TPPT and 7062 conventional) Pap test results. The difference in ASC-H detection rates between TPPTs and conventional Pap smears was statistically significant (0.60% vs 0.38%; P = .02). High-risk HPV was detected in 589 (49.6%) of 1187 females with ASC-H TPPT and hrHPV testing. The hrHPV DNA–positive rate in females younger than 40 years was 54.7%, significantly higher than the 36.5% in women 40 years and older. Among 505 females with histopathologic follow-up, cervical intraepithelial neoplasia 2/3 was identified in 32.7% of hrHPV-positive females compared with 1.2% in hrHPV-negative females. The sensitivity, specificity, positive predictive value, and negative predictive value of ASC-H cytology in conjunction with hrHPV DNA testing results for detection of cervical intraepithelial neoplasia 2/3 were 96.1% versus 100.0%, 54.0% versus 68.4%, 35.8% versus 20.8%, and 98.1% versus 100.0% in females younger than 40 years and women 40 years and older, respectively.

Conclusions.—Our data suggest that reflex hrHPV testing is a highly useful option for women with ASC-H Pap tests. Females with ASC-H and negative hrHPV testing may be more efficiently managed by follow-up with regular Pap and hrHPV testing rather than universal colposcopy, especially for women 40 years and older.
Lymphatic Vessel Density Is Not Associated With Lymph Node Metastasis in Non–Small Cell Lung Carcinoma
Authors: Faoro Leonardo , Hutto Joann Y. , Salgia Ravi , El-Zayaty Shady A. , Ferguson Mark K. , Cheney Richard T. , Reid Mary E. , Armato III Samuel G. , Krausz Thomas , Husain Aliya N.
Published: February 2021

Context.—Angiogenesis is essential for tumors to grow and metastasize. Lymphatic metastasis is also an important means of tumor spread. In non–small cell lung carcinoma, the relationship of lymphangiogenesis with lymph node metastasis and, ultimately, patient prognosis is unknown.

Objective.—To evaluate whether lymphangiogenesis is related to lymph node metastasis and/or overall survival.

Design.—Seventy-eight cases of non–small cell lung carcinoma diagnosed from 1987 to 2004 were retrospectively analyzed for intratumoral, peritumoral, and uninvolved adjacent lung tissue lymphatic vessel density (LVD) by D2-40 immunostaining. Lymphatics in 6 cases of squamous dysplasia/carcinoma in situ were similarly evaluated. Appropriate statistical methods were used.

Results.—Intratumoral and peritumoral LVD was significantly higher than in the uninvolved adjacent lung but showed no significant association with lymph node stage at the time of tumor resection. Survival in patients with above average D2-40 values was not significantly different when compared with those who had below average values (median survival, 895 vs 1131 days; P = .97). Furthermore, patients with affected lymph nodes had significantly shorter survival (median survival, 467 vs 1425 days; P = .002). Overall, regardless of lymph node status, there was a significantly higher intratumoral (P < .001) and peritumoral (P < .001) LVD when compared with the adjacent uninvolved lung LVD. There was a trend toward increasing LVD with higher grade of squamous dysplasia.

Conclusions.—The results suggest that although lymphangiogenesis occurs in association with non–small cell lung carcinoma, it may not be an important factor in lymph node metastasis. In fact, there is a suggestion that the number of lymphatics that a person inherently has appears to be more important than lymphangiogenesis when it comes to the development of lymph node metastasis.
Tissue Handling and Specimen Preparation in Surgical Pathology: Issues Concerning the Recovery of Nucleic Acids From Formalin-Fixed, Paraffin-Embedded Tissue
Authors: Hewitt Stephen M. , Lewis Fraser A. , Cao Yanxiang , Conrad Richard C. , Cronin Maureen , Danenberg Kathleen D. , Goralski Thomas J. , Langmore John P. , Raja Rajiv G. , Williams P. Mickey , Palma John F. , Warrington Janet A.
Published: February 2021

Context.—Expression profiling by microarrays and real-time polymerase chain reaction–based assays is a powerful tool for classification and prognostication of disease; however, it remains a research tool, largely reliant on frozen tissue. Limiting the utility of expression profiling is the isolation of quality nucleic acids from formalin-fixed, paraffin-embedded tissue. The collection, handling, and processing of tissue directly impacts the biomolecules that can be recovered from it. High-quality nucleic acids can be obtained from formalin-fixed, paraffin-embedded tissue, but greater attention to all steps in the process of tissue handling and preparation is required.

Objective.—To summarize the current state-of-the-art of preanalytic factors in tissue handling and processing as they impact the quality of RNA obtainable from formalin-fixed, paraffin-embedded tissue. The goals are to provide recommendations that will improve RNA quality for expression profiling from formalin-fixed, paraffin-embedded tissue and highlight areas for additional research. Tissue is an analyte and it must be handled in a standardized fashion to provide consistent results.

Data Sources.—The literature was reviewed. Consultation with industry and academic leaders in the use of RNA for expression profiling was obtained to identify areas for additional research.

Conclusions.—Development of RNA-based assays from formalin-fixed, paraffin-embedded tissue is feasible. Greater attention to tissue handing and processing is essential to improve the quality of biospecimens for the development of robust RNA-based assays. Standardization of procedures and vigorous testing of alternative protocols are required to ensure that these assays function as designed.
Intraductal Carcinoma Arising in Intraductal Papilloma in an Axillary Lymph Node: Review of the Literature and Proposed Theories of Evolution
Authors: Jaffer Shabnam , Lin Robert , Bleiweiss Ira J. , Nagi Chandandeep
Published: February 2021

We report a case of an axillary lymph node containing benign glandular lesions, intraductal papilloma with florid and atypical duct hyperplasia, and ductal carcinoma in situ. We propose 2 theories for the development of the intraductal papilloma: from adjacent benign glandular inclusions, or from displaced epithelial cells from a previous intraductal papilloma in the ipsilateral breast. This case identifies yet another etiology for false-positive sentinel lymph nodes morphologically and by immunohistochemistry.
Comparative Analysis of Size Estimation by Mapping and Counting Number of Blocks With Ductal Carcinoma In Situ in Breast Excision Specimens
Authors: Dadmanesh Farnaz , Fan Xuemo , Dastane Aditi , Amin Mahul B. , Bose Shikha
Published: February 2021

Context.—The size of ductal carcinoma in situ (DCIS) is a significant predictor of local tumor recurrence and is used for selection of patients for conservative versus aggressive therapy. A standardized method for size assessment is lacking.

Objective.—To evaluate 2 commonly used methods for measurement of DCIS extent: one based on the distribution of the lesion in sequential series of sections (mapping method) and the other on the number of sections with DCIS (block method).

Design.—Ninety-eight consecutive cases of DCIS, measuring at least 1.0 cm, were retrieved from our files. All specimens were serially sectioned along the long axis. The size of DCIS was calculated for each case by 2 different methods: (1) mapping method (average thickness of each slice × number of consecutive slices with DCIS) and (2) block method (number of blocks with DCIS × 0.3 cm). Additional calculations were performed by using 0.35, 0.4, and 0.5 cm as multiplication factors for the block method in order to improve concordance.

Results.—The block method underestimated the size in 71 cases (72%) by 4.5% to 81.3% (mean, 33%). Using 0.4 cm as the multiplication factor improved concordance, while multiplying by 0.5 cm led to an overestimation of size.

Conclusions.—Assessment of DCIS size by the block method is inaccurate and underestimates size in most cases (72%), with an average reduction of 33%. Using 0.4 cm as the multiplication factor improves concordance. A standardized method for size estimation is necessary for effective patient management.
The Autopsy: Knowledge, Attitude, and Perceptions of Doctors and Relatives of the Deceased
Authors: Oluwasola Olayiwola Abideen , Fawole Olufunmilayo I. , Otegbayo Abiodun Jesse , Ogun Gabriel Olabiyi , Adebamowo Clement A. , Bamigboye Afolabi Elijah
Published: February 2021

Context.—Despite the crucial role that autopsy plays in the development of the science and practice of medicine, autopsy rates have been declining throughout the world in recent decades.

Objective.—To identify factors influencing the acceptance of autopsies in Nigeria.

Design.—Cross-sectional survey of the knowledge, attitude, and perceptions of doctors and relatives of deceased patients on factors influencing acceptance of autopsy at the University College Hospital, Ibadan, Nigeria.

Results.—Only 38% of relatives had satisfactory knowledge about autopsy and about 50% of doctors knew that physicians' desire for autopsy should not override patients' consent. Doctors identified difficulty in obtaining consent from relatives of deceased patients, administrative problems in requesting autopsy, and delay in obtaining autopsy report as major reasons responsible for the decline in autopsy requests, whereas relatives of the deceased cited fear of mutilation, concerns about delaying the funeral, and objection by the patient before death as reasons for refusal to grant permission for an autopsy. Sociodemographic factors such as age, occupation, religion, ethnicity, and level of education significantly influenced willingness to give consent for autopsy.

Conclusions.—There is need for concerted effort on the part of clinicians, pathologists, the public, and the government to resuscitate and sustain the practice of autopsy in Nigeria.
Standards to Support Information Systems Integration in Anatomic Pathology
Authors: Daniel Christel , García Rojo Marcial , Bourquard Karima , Henin Dominique , Schrader Thomas , Mea Vincenzo Della , Gilbertson John , Beckwith Bruce A.
Published: February 2021

Context.—Integrating anatomic pathology information— text and images—into electronic health care records is a key challenge for enhancing clinical information exchange between anatomic pathologists and clinicians. The aim of the Integrating the Healthcare Enterprise (IHE) international initiative is precisely to ensure interoperability of clinical information systems by using existing widespread industry standards such as Digital Imaging and Communication in Medicine (DICOM) and Health Level Seven (HL7).

Objective.—To define standard-based informatics transactions to integrate anatomic pathology information to the Healthcare Enterprise.

Design.—We used the methodology of the IHE initiative. Working groups from IHE, HL7, and DICOM, with special interest in anatomic pathology, defined consensual technical solutions to provide end-users with improved access to consistent information across multiple information systems.

Results.—The IHE anatomic pathology technical framework describes a first integration profile, “Anatomic Pathology Workflow,” dedicated to the diagnostic process including basic image acquisition and reporting solutions. This integration profile relies on 10 transactions based on HL7 or DICOM standards. A common specimen model was defined to consistently identify and describe specimens in both HL7 and DICOM transactions.

Conclusion.—The IHE anatomic pathology working group has defined standard-based informatics transactions to support the basic diagnostic workflow in anatomic pathology laboratories. In further stages, the technical framework will be completed to manage whole-slide images and semantically rich structured reports in the diagnostic workflow and to integrate systems used for patient care and those used for research activities (such as tissue bank databases or tissue microarrayers).
Primary Bone Lymphoma
Authors: Bhagavathi Sharathkumar , Fu Kai
Published: February 2021

Primary bone lymphomas are rare, even though secondary involvement of the bone marrow is a common event in systemic lymphomas. Most primary bone lymphomas are primary bone diffuse large B-cell lymphomas (PBDLBCLs) with a rare occurrence of follicular, marginal zone, anaplastic large cell, Hodgkin, and T-cell lymphomas. The PBDLBCL affects the middle-aged to elderly population, with a slight predominance in men. The patients present with bone pain, palpable mass, fractures, or neurologic symptoms. The metaphysis of bones is a common location of PBDLBCL. Morphologically, the lymphoma consists of a polymorphous mixture of small to large cells with multilobated nuclei, fine chromatin, and inconspicuous to prominent nucleoli. Differential diagnoses for PBDLBCL include chronic osteomyelitis, primary bone sarcoma, leukemic infiltrate, Ewing sarcoma, metastatic sarcomas, and carcinoma. Most PBDLBCLs are treated with combined radiotherapy and chemotherapy with good prognosis.
Unsatisfactory Reporting Rates: 2006 Practices of Participants in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology
Authors: Moriarty Ann T. , Clayton Amy C. , Zaleski Sue , Henry Michael R. , Schwartz Mary R. , Eversole Galen M. , Tench William D. , Fatheree Lisa A. , Souers Rhona J. , Wilbur David C.
Published: February 2021

Context.—Minimum cellular criteria for satisfactory Papanicolaou tests were established with the Bethesda System in 2001, and unsatisfactory rates are used as a quality-reporting measure.

Objective.—To evaluate practices and unsatisfactory rates from laboratories responding to the 2007 College of American Pathologists supplemental questionnaire survey.

Design.—In 2007, a supplemental questionnaire was mailed to 1621 laboratories enrolled in the 2006 College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology (PAP Education), requesting data from the 2006 calendar year. Unsatisfactory rates, reasons for unsatisfactory specimens, laboratory size, and specimen preparation type were analyzed.

Results.—A total of 42% of the laboratories responded to the survey. Most of those laboratories (637 of 674; 94.5%) used the Bethesda System minimum cellularity criteria. Of those laboratories responding, 79% (527 of 667) used the Bethesda System criteria for atrophic or postirradiation specimens. Unsatisfactory rates have increased since 1996. SurePath preparations were associated with the lowest unsatisfactory rate (50th percentile, 0.30; 95th percentile, 1.3), conventional Papanicolaou tests had the highest 95th percentile rates (50th percentile, 1.0; 95th percentile, 5.90), and ThinPrep specimens had the highest median percentile (50th percentile, 1.1; 95th percentile, 3.4). The most-common reason for unsatisfactory Papanicolaou tests was too few squamous cells. Air-drying artifact was the least-common reason for unsatisfactory reporting for liquid-based preparations.

Conclusions.—Use of the Bethesda System criteria for unsatisfactory specimens is widespread. Unsatisfactory rates have increased since 1996; however, the median rates are 1.1% or less for all preparations. Results from the College of American Pathologists PAP Education supplemental questionnaire continue to provide valuable benchmarking data for cytologic quality-improvement programs in laboratories.
Hepatocellular Carcinoma Metastases to the Epidural Space
Authors: Somerset Hilary , Witt J. Peter , Kleinschmidt-DeMasters Bette K.
Published: February 2021

Hepatocellular carcinoma (HCC) is relatively uncommon in the United States, although hepatitis C, one of the known risk factors for disease, is currently showing burgeoning growth in the country. Hence, it is possible that the incidence of HCC also will increase. Clinicians and pathologists in the United States are relatively unfamiliar with the patterns of metastatic spread for HCC. We report 2 US-native patients with cirrhosis and HCC who developed epidural space metastasis, a pattern of disease spread seen infrequently, even in endemic areas. Diagnostic testing was delayed in both patients because of the lowered suspicion for metastasis and the fact that neither patient had recognized metastatic spread to more common sites, such as lung or lymph nodes. New-onset neck or back pain—especially with symptoms of paresthesia, radiculopathy, or cord compression—in the setting of HCC warrants prompt investigation for metastases to the spine and epidural space.
Solid-Pseudopapillary Neoplasm: A Pancreatic Enigma
Authors: Chakhachiro Zaher I. , Zaatari Ghazi
Published: February 2021

Solid-pseudopapillary neoplasm of the pancreas is a relatively uncommon tumor. It typically affects young women, has nonspecific clinical and radiologic manifestations, and can be readily diagnosed by ultrasound-guided fine-needle aspiration and histopathologic evaluation. Histologic features characteristically show loosely cohesive, relatively uniform polygonal cells surrounding delicate capillary-sized blood vessels. Other features include cytoplasmic vacuolization, finely stippled chromatin, nuclear grooving, eosinophilic hyaline globules, and degenerative changes. Almost all solid-pseudopapillary neoplasms harbor mutations in the β-catenin gene. They stain with β-catenin, CD10, and focally with neuroendocrine markers. Although previously considered benign, this tumor is currently considered a low-grade malignant epithelial neoplasm with low metastatic rate and high overall survival. Most patients are cured by complete surgical excision. Despite the characterization of the morphologic and molecular features of this enigmatic neoplasm, more work is needed to uncover its cell of origin and true histogenesis.
Focal Glomerular Immune Complex Deposition: Possible Role of Periglomerular Fibrosis/Atubular Glomeruli
Authors: Satoskar Anjali A. , Calomeni Edward , Bott Cherri , Nadasdy Gyongyi M. , Nadasdy Tibor
Published: February 2021

Context.—Consensus exists among renal pathologists that, in biopsies with immune complex glomerulonephritis, even a single glomerulus with open capillary loops may be sufficient for immunofluorescence and/or electron microscopy evaluation because immune complex deposition is a diffuse phenomenon. However, we have encountered renal biopsies with focal absence of immune complexes in glomeruli on either immunofluorescence or electron microscopy examination despite presence of open glomerular capillary loops.

Objective.—To evaluate renal biopsies with focal immune complex deposition and look for any subtle or unusual morphologic changes in the glomeruli (and in the biopsy in general).

Design.—Native and transplant renal biopsies were reviewed. All biopsies had been triaged and processed according to our routine protocol for light microscopy, immunofluorescence, and electron microscopy examination.

Results.—Of 2018 renal biopsies from December 2005 to December 2007, we found 10 such biopsies; 5 native and 5 transplant kidney biopsies. We found that the glomeruli with absent immune complex deposits had periglomerular fibrosis with open, albeit, wrinkled appearing capillary loops but no glomerular sclerosis.

Conclusions.—We hypothesize that these histologic features are indicative of nonfunctional glomeruli and may be associated with disconnection between the Bowman capsule and proximal tubule (atubular glomeruli). These glomeruli may not have effective filtration, despite some degree of circulation through the open capillary loops, and therefore are unable to accumulate immune complex deposits. If biopsies are small and only such glomeruli are available for immunofluorescence or electron microscopy examination, the absence of immune complex deposition in them should be evaluated carefully.
An Algorithmic Approach to the Diagnosis of Pancreatic Neoplasms
Authors: Klimstra David S. , Pitman Martha B. , Hruban Ralph H.
Published: February 2021

Context.—The pancreas gives rise to an array of distinct neoplasms that can be solid, cystic, or intraductal and can recapitulate the various lines of differentiation present in the normal gland.

Objective.—To develop an algorithmic approach to the diagnosis of pancreatic neoplasms that simplifies their pathologic evaluation.

Data Sources.—We reviewed literature related to the classification of pancreatic neoplasms on the basis of their gross, histologic, and immunohistochemical features.

Conclusions.—By using a series of dichotomous decisions, the differential diagnosis of a pancreatic neoplasm can be narrowed, and in cases of the more common neoplasms, accurate classification can be achieved. Uncommon neoplasms not accounted for by this approach are also discussed, and the additional diagnostic information needed for complete pathologic reporting is presented.
Inaccurate Doses of Rh Immune Globulin After Rh-Incompatible Fetomaternal Hemorrhage: Survey of Laboratory Practice
Authors: Ramsey Glenn
Published: February 2021

Context.—Rh(D)-negative women with a large fetomaternal hemorrhage (FMH) from an Rh(D)-positive fetus are at risk for anti-D alloimmunization if they do not receive adequate Rh immune globulin (RhIG). Determination of the adequate RhIG dose for these women is a critical laboratory procedure for protecting their future Rh(D)-positive children.

Objective.—To determine how often laboratories recommended an inaccurate dose of RhIG for excess FMH.

Design.—Nearly 1600 laboratories using the College of American Pathologists' proficiency testing for fetal red blood cell detection were surveyed to determine (1) their calculation method and (2) the number of RhIG doses recommended for a survey specimen, based on their measured percentage of fetal red blood cells. We surveyed nearly 1450 laboratories for their accuracy in determining RhIG dose, using 2 common calculation methods we provided.

Results.—The AABB Technical Manual method was used by 67% of responding laboratories. However, 20.7% of laboratories using this method would have recommended an inaccurate dose of RhIG—11.5% too much and 9.2% too little—for the level of FMH reported in the survey specimen. If all laboratories had used the common recommendation of 300 μg/30 mL of fetal blood present, 2% would have recommended RhIG doses too low for the volume of FMH they measured. In 3 of the 4 calculation exercises we provided, 20% to 30% of laboratories underestimated the necessary dose of RhIG.

Conclusions.—Based on our surveys, some mothers with excess FMH may be receiving inaccurate doses of RhIG. Laboratories performing quantification of FMH should review their procedures and training for calculating RhIG dosage.
Implementation of American Society of Clinical Oncology/College of American Pathologists HER2 Guideline Recommendations in a Tertiary Care Facility Increases HER2 Immunohistochemistry and Fluorescence In Situ Hybridization Concordance and Decreases the Number of Inconclusive Cases
Authors: Middleton Lavinia P. , Price Kathy M. , Puig Pamela , Heydon Lori J. , Tarco Emily , Sneige Nour , Barr Kaye , Deavers Michael T.
Published: February 2021

Context.—The American Society of Clinical Oncology/ College of American Pathologists (ASCO/CAP) guideline recommendations from January 2007 identified many sources of immunohistochemistry (IHC) testing variation.

Objective.—In this current study, we implemented the guidelines and addressed our institution's preanalytic, analytic, and postanalytic variables relating to HER2 testing to improve clinical outcomes.

Design.—We evaluated core biopsies performed on breast lesions from 2006 through 2007. Prognostic/predictive markers obtained by IHC were correlated with HER2 fluorescence in situ hybridization (FISH). Preanalytic sources of biopsy testing variation were studied by collecting data on the number of biopsies that needed repeat testing because of inconclusive FISH results.

Results.—In the year preceding implementation of the guidelines, the HER2 IHC and FISH concordance was 98%. In an additional 10.8% of cases, the FISH results were inconclusive. When additional material became available to retest the inconclusive cases, the results were informative. Further evaluation of the inconclusive cases revealed that the core needle biopsies received, on average, 4 hours of formalin fixation. After implementation of a minimum 6 hours of fixation and the ASCO/CAP guideline recommendations, the HER2 IHC and FISH concordance was 98.5%. The number of FISH inconclusive cases decreased from 10.8% to 3.4% (a 64% reduction). Repeat estrogen-receptor IHC requests decreased by 40% from 38 in 2006 to 23 in 2007.

Conclusions.—We have shown that standardized fixation and adherence to the ASCO/CAP guidelines for HER2 testing has resulted in a greater HER2 IHC and HER2 FISH correlation, decreased numbers of inconclusive FISH cases, decreased repeat estrogen-receptor requests, and financial savings to the Department of Pathology.
Clinical Outcomes for “Suspicious” Category in Thyroid Fine-Needle Aspiration Biopsy: Patient's Sex and Nodule Size Are Possible Predictors of Malignancy
Authors: Raparia Kirtee , Min Soo Kee , Mody Dina R. , Anton Rose , Amrikachi Mojgan
Published: February 2021

Context.—Fine-needle aspiration (FNA) is recommended as an initial screening tool for the diagnosis of thyroid nodules. Approximately 10% of thyroid FNA diagnoses are “suspicious for neoplasm,” warranting surgical resection.

Objectives.—To examine the role of a patient's age, sex, size of nodule, and morphologic features as possible predictors of malignancy in patients with cytologic diagnosis of “suspicious for neoplasm.”

Design.—Cytopathology slides and reports of 402 consecutive thyroid FNAs from 2000–2005 interpreted as “suspicious” were reviewed. Of these, 180 cases that had subsequent surgical resection were selected.

Results.—Of the 108 cases suspicious for follicular neoplasm on cytologic evaluation, histologic follow-up showed malignancy in 26 (24%). Of the 37 cases suspicious for Hürthle cell neoplasm, 15 (41%) had malignancy. Of the 35 cases suspicious for malignancy, 29 had malignant histologic diagnoses. Among cases with cytologic diagnoses of “suspicious for follicular or Hürthle cell neoplasm,” the rate of malignancy in female patients was 22% as compared to 43% in male patients (P = .02). The rate of malignancy in nodules less than 2 cm was 19% compared to 47% in nodules measuring 2 cm or larger (P < .001). These differences were statistically significant. No statistically significant difference was noted between the age of the patient and the rate of benign versus malignant diagnosis.

Conclusions.—Malignant tumors were more frequent in male patients with a cytologic diagnosis of “suspicious for follicular or Hürthle cell neoplasm” than in female patients. Risk of malignancy was higher in nodules measuring 2 cm or larger. Age of the patient was not a predictor of malignancy.
Paratesticular Paraganglioma: A Rare Cause of an Intrascrotal Mass
Authors: Gupta Ruta , Howell R. Spencer , Amin Mahul B.
Published: February 2021

We describe a case of a paratesticular paraganglioma in a 33-year-old man who presented with a scrotal mass and underwent a right testicular exploration. Metastasis is the only definite criterion for diagnosis of a malignant paraganglioma; however, lymphovascular invasion was noted in this case, which warranted a close clinical surveillance. The patient is currently well with no evidence of disease 18 months after radical orchiectomy. Paratesticular paragangliomas are extremely rare tumors with 6 cases reported in English literature. The histogenesis of these tumors is unknown. Though the histology and immunohistochemistry resemble those of paragangliomas at any other location, these tumors raise a plethora of differential diagnoses especially with the more commonly occurring tumors. Herein the relevant histopathologic differential diagnoses are discussed along with a brief review of literature.
Challenges of the “Omics” Future and Pathology Informatics Systems: Are We—Pathologists, Clinicians, and Consumers—Ready?
Authors: Yee Kwang Chien
Published: February 2021

The health care system is extremely complex and it is currently undergoing a massive transformation with rapid advances in technology. Pathology services have been leading the technology adaptation process and will continue to evolve rapidly with the introduction of “omics” technology. Future pathology informatics systems (PIS) will need to meet the needs of pathologists, clinicians, organizations, community services as well as the expectations of patients, especially given the complexity of “omics” technology. Technology advances, however, often progress at a pace faster than socio-cultural adaptation. A major question therefore arises, “Are we ready?” This article explores the socio-cultural-technical issues and provides a conceptual framework for future discussion about socio-cultural integration in the use of technology to provide a seamless delivery of patient-centered care. It discusses system requirements of future PIS in the context of rapid evolution of medical care. Finally, this article proposes some strategies for the design and implementation of future PIS to achieve socio-cultural-technical harmony in the “omics” era.
Aortotracheal Fistula Secondary to Bacterial Aortitis
Authors: Allende Daniela S. , Rodriguez E. Rene , Tan Carmela D.
Published: February 2021

Fistulas between the aorta and tracheobronchial tree are rare fatal complications that occur in patients treated with external and endobronchial radiation for carcinomas of the upper and lower respiratory tract. The etiopathogenesis can be multifactorial. We report the case of a patient with irradiated tracheal carcinoma who died of massive hemoptysis 25 months after completing therapy. Autopsy revealed a fistula between the trachea and arch of the aorta. Multiple colonies of cocci and bacilli were demonstrated within the media at the site of rupture and were absent in other areas of the aorta. The development of an aortotracheal fistula in this patient was most probably related to infection in an area of tracheal and vascular wall previously damaged by exposure to high doses of radiation.