bluuebunny/crossref_metadata_2025 huggingface dataset:
Organizational Analysis of Sustainable Building Certifications in Mexico City
Authors: Velasco-Baca Sara , Cruz-Muñoz Fermín
Published: February 2021

In 2008, the Sustainable Building Certificate Program was implemented in order to identify and to foster sustainable buildings. The aim of the work is to analyze, since an organizational perspective, the contribution of the users’ “day a day” actions to archive sustainability. The principal variable is the building property actions to obtain the certification and the criteria defined at the Certification Program. The central significance of this work is to define how important is the implementation of strategies to introduce sustainable patterns to the building users in contrast with the facility features. The most interesting finding shows that certification design and punctuation assignation to each criteria influence in sustainable actions. The incorporation of technology devices primes over the sustainable actions by the users of the buildings. This condition represents a practical implication because the sustainable actions pattern presents a challenge to the sustainable vision. People do not assume the sustainability as a change in human actions, but a technological question. So, the central value of this research is to demonstrate the very low importance in the Mexico City certification program and stakeholders in sustainable user’s patterns. The principal limitation the research is many sustainable buildings, certificated by international programs were not includes. This consideration implies future studies, to identify a general tendency of sustainable actions related with the users’ activity.
Pediatric Skull Base Tumors
Authors: A. Khan Usman , H. Plonsker Jillian , C. Rennert Robert , L. Levy Michael
Published: February 2021

Management of pediatric skull base tumors requires a multi-disciplinary team that integrates advances in neuro-imaging, radiation, medical and surgical treatments, and allied therapies. Tumors of the skull base harbor complex genetic and molecular signatures that have major implications on prognosis and quality of life. Individualized management requires a strong inter-disciplinary alliance amongst practitioners, as well as a strong therapeutic alliance with the patient and family to navigate the complex decision-making process of treatments. In this chapter, we present our experience managing surgical lesions of the pediatric skull base. General considerations to tumor pathology genetics and radiobiology, diagnostic imaging, rehabilitation of cranial neuropathies and cognitive function, surgical anatomy and reconstructive options, and quality of life should be applied to each case. We also present location- and tumor-specific considerations in the anterior, middle, and posterior fossa skull base with a focus on surgical approaches and complication avoidance. Special consideration is given to syndromic tumors, particularly those from neurofibromatosis type 2 (NF-2). Tumors can exist in multiple cranial compartments and as such some redundancy in concepts is unavoidable. Nevertheless, each patient presents with a unique clinical picture and tumor behavior. Knowledge and proficiency in skull base approaches is a necessary tool in every pediatric neurosurgeon’s armamentarium.
Rehabilitation for Spinocerebellar Ataxia
Authors: Matsugi Akiyoshi , Bando Kyota , Kikuchi Yutaka , Kondo Yuki , Nakano Hideki
Published: February 2021

Rehabilitation is an important treatment for spinocerebellar ataxia (SCA). The lack of improvement in ataxia, deficit of motor learning, and unstable balance causes disability for activities of daily living and restricts participation in social activities, further resulting in a disturbance of the restoration of quality of life. This narrative review describes physical rehabilitation, including measurement of movement disorder, associated with ataxia and possible interventions. Several lines of evidence suggest that high-intensity individualized physical rehabilitation programs, especially for gait and balance training, improve motor function. Continuous exercise at home contributes to the maintenance of the gait and balance function. Moreover, videography and mechanical technology contribute to the evaluation of ataxia and motor learning ability, and assistive robotic systems may improve gait stability. Neuromodulation montages, such as repetitive transcranial magnetic stimulation and transcranial electrical stimulation, can enhance the effect of physical rehabilitation. Further research aimed at developing a more-effective physical rehabilitation for these patients is expected.
Shale Oil and Gas Produced Water Treatment: Opportunities and Barriers for Forward Osmosis
Authors: Ogletree Layla , Du Hongbo , Kommalapati Raghava
Published: February 2021

The treatment of shale oil & gas produced water is a complicated process since it contains various organic compounds and inorganic impurities. Traditional membrane processes such as reverse osmosis and nanofiltration are challenged when produced water has high salinity. Forward osmosis (FO) and membrane distillation as two emerging membrane technologies are promising for produced water treatment. This chapter will focus on reviewing FO membranes, draw solute, and hybrid processes with other membrane filtration applied to produced water treatment. The barriers to the FO processes caused by membrane fouling and reverse draw solute flux are discussed fully by comparing some FO fabrication technologies, membrane performances, and draw solute selections. The future of the FO processes for produced water treatment is by summarizing life cycle assessment and economic analyses for produced water treatment in the last decade.
The Rate of Manual Microscopic Examination of Urine Sediment: A College of American Pathologists Q-Probes Study of 11 243 Urinalysis Tests From 88 Institutions
Authors: Tworek Joseph A. , Wilkinson David S. , Walsh Molly K.
Published: February 2021

Context.—The manual microscopic examination (MME) of the urine sediment is an imprecise and labor-intensive procedure. Many laboratories have developed rules from clinical parameters or urinalysis results to limit the number of these examinations.

Objective.—To determine the rate of urinalysis specimens on which an MME of the urine sediment was performed, document how various rules influence this rate, and determine whether any new information was learned from the MME.

Design.—Participants selected 10 random urinalysis tests received during each traditional shift and determined if an MME was performed until a total of 50 urinalysis tests with an MME were reviewed. Participants recorded the rules that elicited an MME and any new information learned from such an examination.

Results.—The MME rate for the median institution was 62.5%. An MME of urine was most frequently done for an abnormal urinalysis result and often resulted in new information being learned, irrespective of the rule that elicited the MME. The median institution learned new information as a result of the manual examination 66% of the time. The use of an automated microscopic analyzer was associated with fewer manual examinations (P = .005), whereas the ability of a clinician to order a manual examination was associated with more manual examinations (P = .004).

Conclusions.—The use of an automated microscopic analyzer may decrease the number of MMEs. An MME when triggered by an abnormal macroscopic appearance of urine, a physician request, or virtually any positive urinalysis result often resulted in new information.
Nonneoplastic Alterations of the Mammary Epithelium Can Mimic Atypia
Authors: Murray Melissa
Published: February 2021

Context.—The pathologist evaluating breast biopsy specimens sometimes encounters nonneoplastic alterations of the mammary epithelium that raise the differential diagnosis of atypia. Because the identification of atypical ductal hyperplasia of the breast has significant clinical implications, it is important to correctly recognize its nonneoplastic morphologic mimics.

Objective.—To highlight a spectrum of physiologic and treatment-related changes that can occur in the mammary epithelium and to discuss the differential diagnosis with true atypia.

Data Sources.—A comprehensive review of the published English literature on physiologic and treatment-related changes of the breast epithelium was performed.

Conclusions.—Among physiologic alterations of the ductal epithelium, luteal-phase changes and secretory changes can sometimes be overinterpreted as atypical. Treatment-related changes, secondary to chemotherapy and radiation, can pose a major diagnostic challenge and their misinterpretation as neoplastic carries major clinical consequences. Familiarity with the morphology of both physiologic and treatment-related alterations of the mammary epithelium is essential to avoid misdiagnosis.
Detection, Distribution, and Pathologic Significance of BK Virus Strains Isolated From Patients With Kidney Transplants, With and Without Polyomavirus-Associated Nephropathy
Authors: Boldorini Renzo , Allegrini Sara , Miglio Umberto , Paganotti Alessia , Veggiani Claudia
Published: February 2021

Context.—BK virus strains or regulatory region sequence variations may play a role in the pathogenesis of polyomavirus-associated nephropathy (PVAN), although no definite relationship has yet been demonstrated.

Objective.—To investigate the pathologic significance of BK virus strains and regulatory region sequence variations.

Design.—Eight (3.5%) of 226 patients with renal transplants developed PVAN; the remaining 218 cases were used as controls. From the patients who developed PVAN, 70 urine samples, 63 blood samples, and 17 renal biopsy samples were taken, and 682 urine samples, 677 blood samples, and 101 renal biopsy samples were taken from the control cases. Amplification and sequence analyses of regulatory region were obtained, and the sequences were analyzed using the Basic Local Alignment Search Tool program.

Results.—The WWT strain was more frequently detected in PVAN cases than in the control cases (urine: 88.5% vs 22.1%; blood: 85.2% vs 40%; renal biopsies: 77.8% vs 0%), and the AS and WW strains were only isolated from controls. Strain 128-1 was frequently associated with JC virus coinfection in both groups (PVAN: 78.3%; controls: 98%). Major WWT rearrangements were detected in 29.6% of the urine samples, 30.4% of the blood samples, and one renal biopsy from the PVAN cases, but in only one urine sample from the controls. Insertion of 8 base pairs (P block) was found in all 128-1 strains; WW and AS were archetypal in 78.9% and 57.7% of the samples, respectively.

Conclusions.—Although the study included only 8 PVAN cases, regulatory region sequence variations seem to be frequent and independent of the development of the disease, and the WWT strain seems more frequently related to the development of nephropathy than other strains.
Teaching Pediatric Laboratory Medicine to Pathology Residents
Authors: Pysher Theodore J. , Bach Philip R. , Geaghan Sharon M. , Hamilton Marilyn S. , Laposata Michael , Lockitch Gillian , Brugnara Carlo , Coffin Cheryl M. , Pasquali Marzia , Rinaldo Piero , Roberts William L. , Rutledge Joe C. , Ashwood Edward R. , Blaylock Robert C. , Campos Joseph M. , Goldsmith Barbara , Jones Patricia M. , Lim Megan , Meikle A. Wayne , Perkins Sherrie L. , Perry Deborah A. , Petti Cathy A. , Rogers Beverly B. , Steele Paul E. , Weiss Ronald L. , Woods Gail
Published: February 2021

Context.—Laboratory data are essential to the medical care of fetuses, infants, children, and adolescents. However, the performance and interpretation of laboratory tests on specimens from these patients, which may constitute a significant component of the workload in general hospitals and integrated health care systems as well as specialized perinatal or pediatric centers, present unique challenges to the clinical pathologist and the laboratory. Therefore, pathology residents should receive training in pediatric laboratory medicine.

Objective.—Children's Health Improvement through Laboratory Diagnostics, a group of pathologists and laboratory scientists with interest and expertise in pediatric laboratory medicine, convened a task force to develop a list of curriculum topics, key resources, and training experiences in pediatric laboratory medicine for trainees in anatomic and clinical pathology or straight clinical pathology residency programs and in pediatric pathology fellowship programs.

Data Sources.—Based on the experiences of 11 training programs, we have compiled a comprehensive list of pediatric topics in the areas of clinical chemistry, endocrinology, hematology, urinalysis, coagulation medicine, transfusion medicine, immunology, microbiology and virology, biochemical genetics, cytogenetics and molecular diagnostics, point of care testing, and laboratory management. This report also includes recommendations for training experiences and a list of key texts and other resources in pediatric laboratory medicine.

Conclusions.—Clinical pathologists should be trained to meet the laboratory medicine needs of pediatric patients and to assist the clinicians caring for these patients with the selection and interpretation of laboratory studies. This review helps program directors tailor their curricula to more effectively provide this training.
Current Techniques Used for the Radiologic Assessment of Intracranial Neoplasms
Authors: Debnam J. Matthew , Ketonen Leena , Hamberg Leena M. , Hunter George J.
Published: February 2021

Context.—Radiologic studies are obtained for diagnostic and treatment planning purposes in the evaluation of patients with intracranial neoplasms. These studies are discussed at radiology/pathology working conferences and are often beneficial in the analysis of pathologic specimens for tissue diagnosis. Therefore, clinical pathologists should be aware of the current and evolving imaging techniques that are used in the radiologic assessment of intracranial neoplasms.

Objective.—To describe the imaging techniques used in the assessment of intracranial neoplasms and provide current references.

Data Sources.—We searched PubMed for articles published between 1995 and 2006 and also reviewed several textbooks on intracranial neoplasms, to prepare a discussion of basic modalities such as computed tomography (CT) and magnetic resonance (MR) imaging as well as advanced imaging techniques such as CT and MR angiography and venography, CT and MR perfusion, MR spectroscopy, functional MR imaging, and positron emission tomography.

Conclusions.—Knowledge of currently used imaging techniques for the assessment of intracranial neoplasms will assist the clinical pathologist in communications with neuroradiologists, surgeons, and referring clinicians. This review will also aid the pathologist in understanding the new and rapidly evolving imaging techniques that will likely become the standard of care in the future.
Safe Handling and Administration of Blood Components: Review of Practical Concepts
Authors: Osby Melanie A. , Saxena Sunita , Nelson Janice , Shulman Ira
Published: February 2021

Context.—The more advanced we become, the more evident are the infectious and noninfectious risks of the blood supply. Infectious risks are somewhat straightforward and are addressed by implementing stricter donor criteria and testing. The noninfectious risks, however, are more complicated. Each step in the transfusion process, beginning with the physician who orders a transfusion to the actual transfusion of the component, is subject to adverse outcomes and increases the noninfectious risks of transfusion. The challenges to provide the safest blood possible with zero risk have resulted in the implementation of stringent standards from both the American Association of Blood Banks and the Joint Commission on Accreditation of Healthcare Organizations.

Objective.—A series of case scenarios serve as the basis for discussion of the risks, which affect the safety and administration of blood components, inherent in the transfusion process.

Data Sources.—Journals, textbooks, Internet.

Conclusions.—The transfusion process is a complex multistep process with inherent risks. Infectious risks of transfusion are being adequately addressed such that the noninfectious risks of transfusion are becoming much more evident. Patient safety can be compromised if each step of the transfusion process is not completed according to established policies and procedures at each individual institution.
Pathology Services in Developing Countries—The West African Experience
Authors: Adeyi Oyedele A.
Published: February 2021

Context.—Histopathology, like other branches of medicine in West Africa, has suffered largely from economic, political, social, and infrastructural problems, becoming a shadow of the top quality that had been obtained in the past. To address the prevailing problems, one needs to attempt defining them.

Objective.—The existing structure of training and practice are discussed, highlighting the author's perception of the problems and suggesting practical ways to address these while identifying potential roles for North American pathology organizations.

Design.—The author's past and ongoing association with pathology practice in Nigeria forms the basis for this review.

Results.—Pathology practice is largely restricted to academic medical centers. The largest of academic centers each accession around 4000 or fewer surgical specimens per year to train 9 to 12 residents. Histopathology largely uses hematoxylin-eosin routine stains, sometimes with histochemistry but rarely immunohistochemistry. Pathologists depend largely on their skills in morphology (with its limitations) to classify and subclassify tumors on routine stains, including soft tissue and hematolymphoid malignancies. Immunofluorescence, intraoperative frozen section diagnosis, electronic laboratory system, and gross and microscopic imaging facilities are generally not available for clinical use.

Conclusion.—The existing facilities and infrastructure can be augmented with provision of material and professional assistance from other pathology associations in more developed countries and should, among other things, focus on supplementing residency education. Virtual residency programs, short-visit observerships, development of simple but practical laboratory information systems, and closer ties with pathologists in these countries are some of the suggested steps in achieving this goal.
Pulmonary Preneoplasia
Authors: Dacic Sanja
Published: February 2021

Context.—Improved screening techniques for lung cancer have resulted in detection of lesions that are considered to represent precursors of invasive lung carcinomas. These lesions may cause a diagnostic dilemma particularly on small biopsy or cytology specimens. Ancillary studies are usually not helpful, and diagnosis is based on morphology alone. Recognition of these lesions is very important to prevent potential diagnostic mistakes that may result in inadequate patient management. Future molecular studies may provide clinically useful diagnostic and prognostic gene markers.

Objective.—To review currently proposed morphologic criteria for precursor lesions of non–small cell lung carcinomas including squamous dysplasias, atypical adenomatous hyperplasia, and diffuse idiopathic neuroendocrine cell hyperplasia. Major molecular abnormalities are briefly discussed.

Data Sources.—Published literature and recent World Health Organization classification of lung tumors.

Conclusions.—Practicing surgical pathologists must be familiar with morphology of recognized pulmonary preneoplastic lesions that are more frequently detected radiographically and subjected to diagnostic procedures. Future understanding of underlying molecular abnormalities associated with progression of these lesions into invasive lung carcinoma may result in a development of molecular assays with potential diagnostic and prognostic importance.
Pulmonary Langerhans Cell Histiocytosis and Other Pulmonary Histiocytic Diseases: A Review
Authors: Allen Timothy Craig
Published: February 2021

Context.—Pulmonary Langerhans cell histiocytosis is the most common and best known pulmonary histocytic lesion; however, the realm of pulmonary histiocytic lesions also includes an assortment of uncommon diseases that may exhibit pulmonary involvement.

Objective.—To review pulmonary Langerhans cell histiocytosis and other pulmonary histiocytoses to better ensure correct diagnosis and optimal assessment of prognosis and treatment.

Data Sources.—Literature review and primary material from the author's institution.

Conclusions.—This review discusses the most common pulmonary histocytosis, pulmonary Langerhans cell histiocytosis, and also reviews the uncommon pulmonary histiocytic lesions, which are distinct from pulmonary Langerhans cell histiocytosis.
Update on the Diagnosis and Treatment of Barrett Esophagus and Related Neoplastic Precursor Lesions
Authors: Odze Robert D.
Published: February 2021

Context.—At present, Barrett esophagus is the most common cause of esophageal adenocarcinoma. In the past 20 years, the incidence of esophageal adenocarcinoma in white males has exceeded that of tumors of the colorectum, lung, prostate, and skin.

Objectives.—To (1) provide an evidence-based review of the diagnosis, classification, and histologic differentiation of Barrett esophagus from gastric carditis, (2) provide a summary of the key pathologic features of precursor lesions, such as dysplasia, and (3) evaluate adjunctive markers of dysplasia and predictive markers for the development of cancer. The natural history and risk of cancer in patients with Barrett esophagus is also reviewed.

Data Sources.—For this review, selected published peer reviewed articles were chosen from a search through PubMed between the years 1970 and 2007.

Conclusions.—The current definition of Barrett esophagus is partially flawed because not all cases are endoscopically recognizable, nongoblet epithelium is biologically intestinalized, and determination of the presence or absence of goblet cells is susceptible to sampling error. Differentiation of ultrashort segment Barrett esophagus from chronic gastric carditis can be accomplished, in a minority of cases, by evaluating for the presence or absence of histologic features that are known to be associated with Barrett esophagus. Dysplasia in Barrett esophagus begins in the crypt bases and then extends more superficially to include the upper portions of the crypts and surface epithelium. Low- and high-grade dysplasia are distinguished by the presence of marked cytologic and/or architectural abnormalities in the latter compared with the former. There are few, if any, reliable adjunctive diagnostic techniques that can help differentiate nondysplastic from dysplastic epithelium. However, α-methylacyl coenzyme A racemase staining has been shown to be useful in 2 separate studies. Both low- and high-grade dysplasia are progressive lesions, and in general, the extent of dysplasia, particularly low grade, is a strong risk factor for progression to carcinoma. Of all the biologic and genetic biomarkers studied to date, evaluation of DNA content is the most reliable and specific. The management of patients with dysplasia is variable among institutions and ranges from aggressive surveillance, endoscopic mucosal resection, mucosal ablation, or total esophagectomy.
Cytologic Malignancy Versus Benignancy: How Useful Are the “Newer” Markers in Body Fluid Cytology?
Authors: Lyons-Boudreaux Virganeyce , Mody Dina R. , Zhai Jim , Coffey Donna
Published: February 2021

Context.—Differentiating reactive effusion, malignant mesothelioma, and metastatic adenocarcinoma in body cavity fluids can be challenging. Interpreting immunohistochemical markers in cell block preparations can be difficult because of nonspecific staining, focal staining, or poor staining quality. We selected a panel of conventional and newer markers to assess their utility in evaluating effusions.

Objective.—To evaluate the efficacy of 5 immunohistochemical markers in the differential diagnosis of reactive mesothelial proliferation, malignant mesothelioma, and metastatic adenocarcinoma in body cavity fluids.

Design.—A total of 72 formalin-fixed, paraffin-embedded cell block specimens from pleural and peritoneal effusions, including 5 mesotheliomas, 48 adenocarcinomas, and 19 benign effusions were stained with antibodies against calretinin, D2-40, XIAP, MOC-31, and WT1.

Results.—All benign effusions and mesotheliomas demonstrated diffuse membranous staining with D2-40. All mesotheliomas displayed calretinin positivity, whereas only 58% of benign effusions stained focally with calretinin. MOC-31 was positive in all cases of adenocarcinoma, whereas all benign effusions and mesotheliomas were negative. All cases of the metastatic adenocarcinoma were negative for calretinin and D2-40. However, background reactive mesothelial cells were positive for calretinin and D2-40. Overall, D2-40 highlighted more mesothelial cells than calretinin. WT1 was positive in 50% of benign effusions, 60% of mesotheliomas, and 27% of adenocarcinomas. XIAP stained most mesotheliomas (80%), some adenocarcinomas (51%), and rare benign effusions (11%).

Conclusions.—MOC-31 and D2-40 were very sensitive and specific markers of epithelial and mesothelial cells, respectively. Compared with calretinin, D2-40 was a more sensitive marker of mesothelial cells. WT1 proved to be nonspecific. XIAP was not a sensitive marker for malignancy and had a limited value in cytology. We recommend using a panel to include MOC-31 and D2-40 to improve diagnostic accuracy in body cavity effusions.
Analysis of Expression Patterns of Breast Cancer–Specific Markers (Mammaglobin and Gross Cystic Disease Fluid Protein 15) in Lung and Pleural Tumors
Authors: Takeda Yuji , Tsuta Koji , Shibuki Yasuo , Hoshino Tatsuhiro , Tochigi Naobumi , Maeshima Akiko Miyagi , Asamura Hisao , Sasajima Yuko , Ito Tsuyoshi , Matsuno Yoshihiro
Published: February 2021

Context.—The lung is the most common site of metastasis during the natural history of malignant tumors. Breast carcinoma has a propensity for distant metastasis, and the lung and pleura are among the most common metastatic sites. Although it is often difficult to make a clear-cut differential diagnosis between the two, distinguishing primary lung carcinoma from breast carcinoma metastatic to the lung is important because the treatment modalities are different.

Objective.—To elucidate the utility of mammaglobin and gross cystic disease fluid protein 15 (GCDFP-15), which are known to be breast-specific antigens, in distinguishing various primary lung and pleural tumors from breast carcinoma metastasizing to the lung.

Design.—A total of 20 cases of breast carcinoma metastatic to the lung and 263 tumors of nonbreast origin located in the lung and pleura were analyzed.

Results.—Of the 20 cases of breast carcinoma metastatic to the lung, 10 (50.0%) were immunoreactive for mammaglobin and 9 (45.0%) for GCDFP-15, the frequency of positivity being slightly higher for the former than for the latter. The area immunopositive for mammaglobin showed more diffuse staining than the area immunopositive for GCDFP-15. Furthermore, the specificity of mammaglobin for breast carcinoma metastatic to the lung was superior (98.9%) to that of GCDFP-15 (91.8%).

Conclusion.—The sensitivity of mammaglobin is equal or superior to that of GCDFP-15 for investigation of breast carcinoma. Immunopositivity for mammaglobin is more diffuse than that for GCDFP-15. In terms of practical diagnosis, mammaglobin immunohistochemistry can serve as a differential marker of breast carcinoma and should be added to the immunohistochemical panel.
Application of Immunohistochemistry to Breast Lesions
Authors: Yeh I-Tien , Mies Carolyn
Published: February 2021

Context.—Immunohistochemistry has an expanding role in mammary pathology that has been facilitated by a growing list of available antibodies and a better understanding of biology.

Objective.—To explore the key role of immunohistochemistry in guiding adjuvant therapy decisions and sentinel node staging in breast cancer, as well as the role of immunohistochemistry as an aid to distinguishing usual ductal hyperplasia from atypical ductal hyperplasia/low-grade carcinoma in situ; subtyping a carcinoma as ductal or lobular, basal or luminal; ruling out microinvasion in extensive intraductal carcinoma; distinguishing invasive carcinoma from mimics; and establishing that a metastatic carcinoma of unknown primary site has originated in the breast.

Data Sources.—Current literature is reviewed, including clinical and pathologic journals.

Conclusions.—As new, targeted treatments for breast cancer are developed, pathologists can expect additional immunohistochemistry applications in the future.
Smooth Muscle Tumors of the Uterus: A Practical Approach
Authors: Toledo Gemma , Oliva Esther
Published: February 2021

Smooth muscle tumors (SMTs) are the most frequent mesenchymal tumors of the uterus. The majority of the uterine SMTs are readily classificable as benign or malignant based on their gross and microscopic appearances. However, when unusual features are seen in some leiomyoma variants, the differential diagnosis with a leiomyosarcoma may become challenging. Moreover, diagnostic criteria for the different subtypes of leiomyosarcoma are not uniform. Finally, non–smooth muscle tumors that originate in the uterus may show overlapping histologic and even immunohistochemical features with uterine SMTs, more commonly with the spindle and epithelioid variants, complicating their correct classification. The diagnosis of malignant uterine SMTs has important prognostic and therapeutic implications. This review provides a practical approach to the diagnosis of uterine leiomyosarcoma based on a systematic assessment of histologic parameters as well as a systematic approach to its differential diagnosis based on histologic and immunohistochemical features.
Gastric Polyps: Classification and Management
Authors: Park Do Youn , Lauwers Gregory Y.
Published: February 2021

Gastric polyps can be broadly defined as luminal lesions projecting above the plane of the mucosal surface. They are relatively frequent in routine pathology practice, where the main goal is to rule out the possibility of malignancy. Various subtypes of gastric polyps are recognized and generally divided into nonneoplastic and neoplastic. We will review herein only a limited subset of gastric polyps representing the most common or, sometimes, challenging.
Summary of the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program
Authors: Bentz Joel S. , Hughes Jonathan H. , Fatheree Lisa A. , Schwartz Mary R. , Soures Rhona J. , Wilbur David C.
Published: February 2021

Context.—Creating a tool that assesses professional proficiency in gynecologic cytology is challenging. A valid proficiency test (PT) must reflect practice conditions, evaluate locator and interpretive skills, and discriminate between those practitioners who are competent and those who need more education. The College of American Pathologists Gynecologic Cytology Proficiency Testing Program (PAPPT) was approved to enroll participants in a nationwide PT program in 2006.

Objective.—Report results from the 2006 PAPPT program.

Design.—Summarize PT results by pass/fail rate, participant type, and slide-set modules.

Results.—Nine thousand sixty-nine participants showed initial PT failure rates of 5%, 16%, and 6% for cytotechnologists, primary screening pathologists, and secondary screening pathologist, respectively. The overall initial test failure rate was 6%. After 3 retests, 9029 (99.6%) of the participants were able to achieve compliance with the PT requirement. No participant “tested out”; however, 40 individuals “dropped out” of the testing sequence (8 cytotechnologists, 9 primary screening pathologists, 23 secondary screening pathologists). Initial failure rates by slide-set modules were 6% conventional, 6% ThinPrep, 6% SurePath, and 5% mixture of all 3 slide types.

Conclusions.—A total of 99.6% of individuals enrolled in the 2006 PAPPT program achieved satisfactory results. The data confirm that cytotechnologists have higher initial pass rates than pathologists and pathologists who are secondary screeners perform better than those who are primary screeners. There was no difference identified in overall pass rates between the slide-set modules. Further analysis of data should help define the results and ongoing challenges of providing a nationwide federally mandated proficiency testing program in gynecologic cytology.
Attributes of Antiangiogenic Factor Plasminogen Kringle 5 in Glomerulonephritis
Authors: Chen Jin-Shuen , Hwang Jyh-Chang , Chang Li-Chien , Wu Chia-Chao , Lin Yuh-Feng
Published: February 2021

Context—Plasminogen kringle domain (K) 5 is known to inhibit endothelial cell growth, but limited data are available investigating the relationship between K5 and glomerulonephritis (GN).

Objective—To understand the relationships among K5, GN, and glomerular endothelial cells in GN mice models and human subjects.

Design—Two mice models of GN and 2 categories of human GN biopsy samples were collected to gain insight into the disease mechanism from the laboratory to bedside. In the mechanistic animal study, membranous nephropathy (MN) and focal segmental glomerulosclerosis mice models were used. Kringle domain 5 in the diseased kidney was located by immunofluorescence and quantified by Western blotting. In the kinetic animal study, different MN time points were stained with K5, immunoglobulin G, and C3 by immunofluorescence. CD31 and proliferating cell nuclear antigen were evaluated by immunohistochemical double staining for alterations in the glomerular endothelial cells. Biopsy samples from patients diagnosed with antibody (Ab)-mediated and non-Ab–mediated GN were collected for K5 analysis.

Results—The expression level of K5 was found to be significant in MN, but not in focal segmental glomerulosclerosis, and was markedly elevated in the diseased glomeruli along the capillary walls. Kringle domain 5 levels increased steadily with the evolution of MN, appearing after the deposition of Abs. In altered glomerular endothelial cells, CD31 decreased with the evolution of MN. In human subjects, K5 occurred only in patients with Ab GN.

Conclusions—Kringle domain 5 might be involved in the progression of Ab-mediated GN and associated with the alteration of MN glomerular endothelial cell growth.
Antihuman Leukocyte Antigen–Specific Antibody Strength Determined by Complement-Dependent or Solid-Phase Assays Can Predict Positive Donor-Specific Crossmatches
Authors: Batal Ibrahim , Zeevi Adriana , Lunz John G. , Aggarwal Nidhi , Shapiro Ron , Randhawa Parmjeet , Girnita Alin
Published: February 2021

Context.—The association of circulating donor-specific antibody (DSA) strength with crossmatch results is of potential interest to predict allograft outcome.

Objectives.—To systematically investigate the aforementioned association and to attempt to define a cutoff value for DSA strength that can predict a positive crossmatch result.

Design.—We analyzed DSA strength and crossmatch results from the 2006 to 2008 proficiency testing samples of the American Society of Histocompatibility and Immunogenetics (n  =  50). We further validated our findings in candidates for potential kidney transplant (n  =  19).

Results.—Proficiency test samples with positive antihuman globulin T-cell crossmatch results had significantly higher DSA strength, as assessed by Luminex (Austin, Texas) mean fluorescent intensity (MFI; MFI [SD], 7860 [4770]), compared with samples with negative crossmatch results (MFI [SD], 2900 [1820]; P  =  .001). Similarly, higher Luminex values were observed in samples from candidates for transplant with positive antihuman globulin T-cell crossmatch results (MFI [SD], 7910 [2370] versus 2840 [1960]; P < .001). The MFI value of 6540 had 61% and 75% sensitivity and 92% and 94% specificity for predicting positive antihuman globulin T-cell crossmatches in proficiency test samples and in candidates for transplant, respectively.

Conclusions.—The DSA strength correlates well with crossmatch results. An MFI of 6540 predicted a positive antihuman globulin T-cell crossmatch.
The Multiple Faces of Carcinoid Tumor: Performance Characteristics of Low-Grade Neuroendocrine Carcinoma Metastatic to the Liver in an Educational Interlaboratory Slide Comparison Program
Authors: Clayton Amy C , Wasserman Patricia G , Souers Rhona J , Chmara Beth Anne , Renshaw Andrew , Wilbur David C , Moriarty Ann T ,   for the College of American Pathologists Cytopathology Resource Committee
Published: February 2021

Context.—Cytologic features of low-grade neuroendocrine carcinoma are well described in primary sites. There are fewer reports of the cytologic features specific to metastatic liver lesions or the frequency of misdiagnosis.

Objective.—To identify discriminating cytologic features and characterize the rate of misdiagnosis of low-grade neuroendocrine tumors metastatic to the liver in an educational interlaboratory slide comparison program.

Design.—Glass slides with the specific reference diagnosis of metastatic low-grade neuroendocrine tumor involving liver were circulated to 175 laboratories, with 575 participant responses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Eight specific cytologic features were assessed to identify predictors of poor performance (>10% misdiagnosis).

Results.—There was an exact match diagnosis in 496 of 575 responses (86%); 555 of 575 responses (96.5%) were correctly identified as malignant. Incorrect responses included adenocarcinoma (27), hepatocellular neoplasm (21), small cell carcinoma (11), benign neoplasm not otherwise specified (6), benign liver (3) and inflammation (3). Three features were significantly associated with the misdiagnosis of adenocarcinoma: presence of large clusters (P  =  .02), lack of single-cell pattern (P  =  .02), and lack of stripped nuclei (P  =  .01).

Conclusion.—Participants often recognize metastatic low-grade neuroendocrine carcinoma in an educational glass-slide program. Adenocarcinoma was the most common incorrect diagnosis, especially in the presence of large cellular clusters or absence of a single-cell pattern or stripped nuclei.
Aberrant Protein Expression and Promoter Methylation of p16 Gene Are Correlated With Malignant Transformation of Salivary Pleomorphic Adenoma
Authors: Hu Yu-Hua , Zhang Chun-Ye , Tian Zhen , Wang Li-Zhen , Li Jiang
Published: February 2021

Context.—The significance of promoter methylation of the p16 gene and intracellular localization of p16 protein in the carcinogenesis of salivary carcinoma ex pleomorphic adenoma (Ca-ex-PA) is not clear. The correlation of the promoter methylation of the p16 gene and the expression and localization of p16 protein in Ca-ex-PA need to be further clarified.

Objective.—To investigate the p16 protein expression and promoter methylation of p16 gene in Ca-ex-PA and their roles in the malignant transformation of pleomorphic adenoma to Ca-ex-PA.

Design.—The p16 protein expression and promoter methylation of the p16 gene were determined in both benign and malignant components of 50 primary salivary Ca-ex-PA tissues by immunohistochemistry and methylation-specific polymerase chain reaction. Expression of p16 protein and promoter methylation of the p16 gene between the benign and the malignant components was compared statistically.

Results.—The tumor cells in the malignant components showed significantly higher p16 protein expression in the cytoplasm and lower expression in the nuclei than those in the benign components. Promoter methylation frequency of the p16 gene in the malignant components (36%) was significantly higher than that in the benign components (16%). There were no correlations between p16 protein expression and promoter methylation of the p16 gene in either benign or malignant components.

Conclusions.—Overexpression of p16 protein in the cytoplasm and decreased expression of p16 protein in the nucleus may play important roles in the evolution of pleomorphic adenoma to Ca-ex-PA. Promoter methylation of the p16 gene may be correlated with the malignant transformation of pleomorphic adenoma.
The College of American Pathologists and National Society for Histotechnology Workload Study
Authors: Kohl Shane K. , Lewis Sue E. , Tunnicliffe Janet , Lott Robert L. , Spencer Lena T. , Carson Freida L. , Souers Rhona J. , Knapp Robert H. , Movahedi-Lankarani Saeid , Haas Thomas S. , Brown Richard W.
Published: February 2021

Limited data exist in regard to productivity and staffing in the anatomic pathology laboratory. In 2004, the National Society for Histotechnology (NSH) conducted a pilot study to examine productivity and staffing in the histology laboratory. After review of the data, The College of American Pathologists (CAP)/NSH Histotechnology Committee concluded that a larger survey was required to further address and expand on the pilot study findings. In 2007, a total of 2674 surveys were sent out to North American laboratories. From the responses, comparisons of laboratory demographics and productivity were examined by institution type and workload volume. Productivity was measured as the number of paraffin-embedded tissue blocks processed per full-time equivalent per year. This manuscript presents and discusses the data collected from the CAP/NSH Workload Study.
Effects of Low Dose Dexmedetomidine Infusion on Intraoperative Haemodynamic Stress Response in Patients Undergoing Oral Oncological Surgeries: A Randomised Control Study
Authors: Philip Gifty Susan , Shashidhar GS , Ranganath Namrata
Published: February 2021

Introduction: Maintaining stable haemodynamics throughout oral and maxillofacial surgeries helps to decrease intraoperative bleeding and thus improves the surgical field avoiding unnecessary damage to vital structures and tissues. Dexmedetomidine improves haemodynamic stability when used as an adjuvant during general anaesthesia. Limited studies have been done using low dose of dexmedetomidine for the attenuation of haemodynamic stability perioperatively in oral oncological surgeries. Aim: To study the effect of two doses of dexmedetomidine, 0.4 mcg/kg/hr, 0.2 mcg/kg/hr and normal saline (0.9%) on haemodynamic stress response in patients undergoing elective oral oncological surgeries. Materials and Methods: The present study was a randomised control study. After institutional Ethical Committee clearance, one twenty patients of American Society of Anaesthesiologists (ASA) physical grades I and II aged between 18-65 years, undergoing elective oral oncological surgeries under general anaesthesia were enrolled. Patients were randomly assigned to 3 groups with 40 patients in each group. Group A received dexmedetomidine 0.4 mcg/kg/hr, Group B received dexmedetomidine 0.2 mcg/kg/hr and Group C received normal saline. The infusion was initiated 15 minutes prior to pre-oxygenation and continued intraoperatively till the beginning of skin closure. Parameters noted were Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressures (MAP). Any adverse effects during the observation period were also noted. Statistical tests done were analysis of variance (ANOVA), Post-Hoc Tukey’s test, Chi-square, Nonparametric setting for Qualitative data analysis. Results: Intravenous (lV) dexmedetomidine 0.4 mcg/kg/hr effectively attenuated haemodynamic stress response to intubation and surgical stimuli throughout the observation period compared to 0.2 mcg/kg/hr and saline, being statistically significant (p<0.05). No significant side effects were noted. Conclusion: Inj. dexmedetomidine 0.4 mcg/kg/hr IV is the minimum effective dose required to attenuate the haemodynamic stress response to both intubation and surgical stimulus intraoperatively in patients undergoing oral oncological surgeries.
Role of Dynamic Contrast Enhanced MRI in the Evaluation and Characterisation of Breast Lesions with Pathological Correlation
Authors: Kumari Kanta , Tapasvi Chaitanya , Tapasvi Isha , Sandhu Vaneet Kaur , Singh Sarbjeet , Kaur Rashmeet
Published: February 2021

Introduction: Magnetic Resonance Imaging (MRI) has an excellent soft tissue resolution and can detect and accurately characterise lesions which are not seen on other imaging modalities like mammography or ultrasonography. Dynamic Contrast Enhanced (DCE) MRI is better for characterisation of fibroglandular tissue and breast lesions as it further improves specificity of MRI. Kinetic Curves (KC) derived from DCE MRI according to the wash in and wash out patterns of intravenous contrast are analysed and correlated with morphology of a lesion. Aim: To evaluate the efficacy of DCE MRI in detection and characterisation of breast lesions according to KC analysis and to correlate MRI findings with pathological findings. Materials and Methods: A prospective observational study was conducted at Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. DCE MRI was performed after informed consent in 50 females (Age ranging from 17 years to 80 years). MRI was conducted on Siemens “MAGNETOM Avanto” 1.5 Tesla machine using standard dedicated breast matrix coils. The standard MRI protocol included the T1 and T2 weighted fat-sat sequences along with DCE MRI after intravenous administration of Meglumine-Gadoterate (0.1 mmol/kg body weight) followed by a 20-mL saline flush. Post processing manipulation included standard subtraction, reverse subtraction, Maximum-Intensity Projection (MIP) images and KC analysis. Findings of DCE MRI were graded according to Breast Imaging-Reporting and Data System (BI-RADS) category after morphological and KC analysis and were correlated with pathological findings. Results: MRI is a highly sensitive modality to detect breast lesions especially bilateral and multifocal/multicentric lesions with sensitivity of 98.18%. However, specificity was relatively low (55.56%). The Positive and Negative Predictive Values (PPV, NPV) of MRI in characterisation of breast lesions in present study were 93.10% and 83.33%, respectively. Conclusion: Although MRI is extremely sensitive for detecting breast lesions it has a relatively low specificity. Both morphological characteristics and KC analysis should be used in combination for interpretation as it improves the specificity of MRI.
Framework for Prioritizing Contact Tracing and Mass Testing of COVID-19 Using Graph Theory
Authors: Appiah Obed , Otoo Dominic , Ninfaakang Christopher Bombie
Published: February 2021

Contact tracing has become one of the most useful tools for fighting the novel Corona Virus (COVID-19) pandemic worldwide. The underlining philosophy of contact tracing is determining people who have been in contact with infected persons and thus isolate them from becoming agents of onward transmission of the virus.  Slow tracing of contacts and inconsistent or inaccurate information provided by patients usually leads to the spread of the virus along a trajectory at the healthcare systems' blindside. This has led to the proposal of app-based contact tracing solutions.  This paper proposes an SQL-based framework that transforms simple interaction data entries into interaction graphs and applies graph theory to prioritize the contact tracing process. The framework returns nodes or individual IDs together with values called Risk_Points to enable individuals' selection for isolation and treatment. Results on simulated data show that the proposed framework can help slow the virus's rate of transmission.