bluuebunny/crossref_metadata_2025 huggingface dataset:
Bridging the Gaps Between Theory and Practice of Inclusive Teacher Education
Authors: Sharma Umesh , Mullick Jahirul
Published: October 2020

Successful implementation of inclusive education reforms in any country depends on several factors. One critical factor is adequate preparation of pre-service teachers. We cannot expect our schools to be inclusive if teachers are not adequately prepared to teach in inclusive classrooms. There are some key challenges that most teacher education programs face, including lack of appropriate inclusive professional placement settings, lack of collaboration between universities and schools, lack of connection between curriculum content and placement activities, and lack of appropriate evaluation tools to measure teacher readiness to teach in inclusive classrooms. We need new ways to address the issues faced by teacher educators to ensure that the persistent gaps between theory and practice can be met. In this regard, a new framework entitled CHANGE (Collaboration, Hands-on activities, Assessment of readiness, Networking, Greater contact with learners with diversities, and Effective coaching) was developed to address the challenges and substantially fill in the gaps between the theory and practice of inclusion. The CHANGE framework guides teacher educators to focus on six different aspects of enhancing teacher readiness for inclusion. The application of the framework is not dependent on extensive resources, but it does require rethinking the way teacher education curriculum is developed and delivered. The framework can be applied in any country context and is likely to appeal to teacher educators who are looking for better ways to prepare confident and skilled inclusive educators.
Buddhist Ethics and Moral Education
Authors: Wang Chia-Ling
Published: October 2020

As a highly developed religion, Buddhism has very rich ideas related to ethics and morality. Buddhism itself is a way of education. It guides the method and action of cultivating one’s moral character. These practices can be applied in thinking about education, especially specific to education’s ethical and moral implications. In the early 21st century, Buddhist theory has multiple applications in the field such as applied psychology, counseling, and meditation. Though it is an ancient wisdom, its viewpoint can be used to solve contemporary social problems and human crises caused by the process of modernization. Mahāyāna Buddhism believes that this world is constituted by emptiness, which is the perspective on essence-absent ontology. Everything is in its becoming, which is dependent on everything else, following the law of cause and effect. When an important aspect of one’s daily behavior is to cultivate goodwill, the desirable consequences will be returned to them later. That is, one good turn deserves another. On the contrary, bad will receives ill effects back. This is the basis of the Buddhist moral concept. In this way, human beings are active agents who can decide their own conduct and the result of their life. Buddhism encourages an individual to perform practices of precepts, meditation, and wisdom all the time to rid oneself of craving, hatred, and delusion. The latter are origins of human suffering. Humans cannot reach the ultimate spiritual realm of Nirvāṇa until these three poisons are given up. As an approach to self-education, Buddhist ethical thoughts allow learners to search for their self-nature. Buddhist moral claims of compassion and equality can contribute to the thinking of modern educational issues, such as peace education, ecological education, and equality in education.
Transnational Childhood and Education
Authors: Tarc Aparna
Published: October 2020

The field of transnational childhood and education emerges under intensifying mobilities. These global conditions disrupt universalist educational treatments of childhood as a fixed developmental stage of human being. Transnationality shows childhood to be a psychosocially constructed experience that takes myriad form across diverse cultural, historical, educational, and political contexts. The lives of actual children are caught in colonial and national constructions of childhood and subject to its discourses, politics, and normative enactments through public schooling. The emerging field of transnational childhood and education represents a potentially critical intervention in colonial and national enactments of childhood worldwide.

Despite interdisciplinary efforts to reconceptualize childhood, Western educational institutions continue to hold to and reproduce hegemonic and colonial understandings of childhood as monocultural, heteronormative, familial, innocent, and protected. Mass global flows of people, culture, and ideas compel policy-makers and educational experts worldwide to consider transnational childhood as the dominant situation of children in and across multicultural nations. The fluidity of malleable childhood experience is poised to generate new educational arrangements and innovations. Transnational lives of children de-stable normative categorizations and fixed situations placed upon children in and through the mechanisms of early childhood education and national schooling.

Researchers of transnational childhood and education engage a range of educational experiences and arrangements of children moving within, across, and outside of formal and national schooling institutions. Increasingly children and families are caught in experiences produced by global, geo-political conditions including: war, forcible migration, detainment on borders, internal colonization, and environmental catastrophe. To respond to the times, families and communities seek out and/or are forced to provide opportunities and alternatives for children outside of school. Increasingly children use emergent digital and other forms of remote and inventive means of education. As research in this area is new, transdisciplinary, and ground-breaking, the study of transnational childhoods and education has the potential to radically innovate and deepen the meanings and possibilities of both childhood and education in a rapidly globalizing, uncertain, and changing world.
Women in Precolonial Africa
Authors: Saidi Christine
Published: October 2020

In precolonial Africa, relations between women and men were varied, changing, and culturally specific, yet there were some common themes. Most African societies attempted to attain forms of heterarchy, which meant they often created several centers of authority and aspired to establish communities where gender relations between women and men were equitable. Additionally, throughout history most Africans determined status by the amount of labor a group or individual could control, and in a historically underpopulated continent, this meant that motherhood and giving birth to children was very important. The result is that women, as both biological and social mothers and as grandmothers, were highly respected throughout the history of the continent. The earliest ancestors of modern humans originated in Africa, and so the history of women starts earlier in Africa than anywhere else, probably around 200,000 bce. Anthropologists of early humanity have proposed that the most successful human families in the earliest eras were based on family units that situated grandmothers at the center, a family structure found in many parts of Africa in the early 21st century. Around 5,500 years ago, a small group of Bantu-speaking people migrated from West Africa and over time populated large portions of Africa below the Sahara Desert. Heterarchy and gender equity were features of most Bantu-speaking societies. Their worldviews were manifested in the matrilineal social structure that most Bantu societies preferred until recent history. Even the earliest empires in Africa, Nubia and Egypt, were organized matrilineally. The West African Sahel empires from 700 ce were also matrilineal, and there is a long history of Muslim African female rulers. However, with the creation of empires and more centralized societies, hierarchy among some societies replaced heterarchy. This change motivated a shift in gender relations: Women from elite lineages maintained their status, while other women tended to lose their traditional positions of authority as mothers and elders within their clans. Overall, the Atlantic slave trade severely challenged heterarchical social relations and threatened women’s authority and status in West Africa. Another element of this period is the transference of African gender relations to the Americas. During the 19th century, as Europeans arrived in greater numbers, they imposed new gender ideologies as they began to structure how the rest of the world viewed Africans. From the so-called White Man’s Burden to Social Darwinism, new definitions of the Other placed African women at the bottom of this new social order. While women played key roles in the long term history of Africa, the Western analysis of African gender dynamics began to inform colonial policies, dominate world opinion, and shape academic research.
Mediation of Interstate Conflicts and Civil Wars
Authors: Svensson Isak
Published: October 2020

Mediation is a process of managing or resolving a conflict through the intervention of a third party, based on the consent of the combatants. It is one of the primary diplomatic tools available to third parties seeking to decrease violence, find joint agreements on conflictual issues, and transform bellicose relationships. There are different types of mediators. While mediators are always individuals, the mediating agency providing the basis for mediation in interstate conflicts and civil wars can be a single country, formal or informal groups of countries, regional or global intergovernmental organizations, civil society organizations inside or outside the country in conflict, or even, occasionally, individuals acting on their own. These different types of mediators all take actions bringing the parties together toward an agreement on the substance of the conflict or on the procedure for managing it, without relying on the use of direct force or a law-based authority. However, they differ in their motivations, styles, access to—as well as leverage over—the parties, degree of biasness and neutrality, and their ability for internal coordination. On the path from war to peace, mediation plays an important role. Mediators contribute with marginal but important tasks in the process, including the diagnosis of the problem, getting the parties to the table, finding a formula for a settlement, and helping to work out implementation guarantees as well as many other duties. In order to perform these tasks, mediators need to build trust, mount pressure, and sometimes do both. However, mediation is not the only factor and often not the primary one behind the peaceful settlement of armed conflicts. Whereas there are many structural similarities when mediating between governments (interstate conflicts) versus between governments and nonstate armed actors (civil wars), the primary difference is that civil war contexts are permeated more intensively by issues relating to international recognition, power asymmetry, fragmentation, and complexity.
Cultural Diversity and World Politics
Authors: Kalaycioglu Elif
Published: October 2020

The end of the Cold War, the emergence of nonWestern states as influential actors in global politics, and waves of Western nativism in the United States and Europe have placed questions of cultural diversity centrally in global politics. Although the mainstream paradigms of international relations (IR), namely, realism and liberalism, have remained focused on material power and mutual gains via institutions as the cruxes of global politics, starting with the mid-1990s, an increasing number of IR scholars have attended to the question of cultural diversity and world politics.

This scholarship has approached culture, alternatively, as a set of shared meanings stable over time, meanings that are institutionally stabilized, or a field of multiple and competing representations. Accordingly, some (the English school, conventional constructivism) posit culture as internally coherent and externally diverse, associating shared culture with accord and cultural diversity with discord. Others (critical constructivism, postcolonial IR) focus on the power-laden processes through which cultural diversity comes to be associated with Otherness and discord.

Most of the relevant scholarship, however, defies paradigmatic categorization. These works are better grouped as interventions into IR theory and as scholarship that focuses on the impact of cultural diversity on the conduct of world politics. The first set of interventions have identified the state of cultural diversity in IR theorizing as an absence, a deep suspicion and an active suppression, or an outdated conceptualization. The IR theoretical path forward has, accordingly, been identified as the inclusion of culture, as dispensing with key theoretical heuristics of the field, or as a new focus on how cultural diversity has been globally governed. The analyses of cultural diversity and the conduct of world politics, taken together, show the intricate connections between existing institutions and norms, and assertions of cultural diversity. While diversity challenges universalizing forms of governance, the demands for the equal recognition of diversity are shaped by existing institutions.

Despite key theoretical and analytical insights, the scholarship on cultural diversity can pay further attention to (a) the relation between theoretical notions of cultural diversity and cultural diversity as employed in global politics and (b) the relation between cultural diversity and other global political domains, such as geopolitics. On this, the literature can benefit from engagement with the IR scholarship on civilizations. At the same time, the latter scholarship is highly relevant to the question at hand because civilizations are key conduits of the global politics of cultural diversity.
Service Learning Study Abroad Trips in International Studies
Authors: Auchter Jessica
Published: October 2020

International service learning has become increasingly popular in higher education. Such trips focus on cultivating skills in students, including civic engagement and intercultural understanding, while also being key ways for students to achieve self-growth and learn to apply and contextualize the theories they learn in the classroom in the real world. The goals often outlined in the literature about international service learning tend to be student-centric. While pedagogical goals matter, faculty should also keep in mind the ethics of engaging community partners, especially given the often unequal power relationship at play in the practice of international service learning. Being more attentive to these ethical dilemmas may not eliminate them, but it will ensure that students are considering and learning from the gray areas involved in international service learning, including their own individual relationships to power and injustice. Additionally, faculty should consider how to avoid replicating neocolonial logics in their desire to expose students to the world beyond themselves. Specifically, faculty should be more mindful of the language they use to describe these trips and avoid reifying the notion that service learning is something to be done in the developing world while study trips tend to be conducted in the developed world. Engaging reciprocity with a community partner in both the design and practice of the trip, preparing for cultural complexity in advance by situating the students in larger sets of geopolitical and economic practices, being honest about the skill set students bring to the table, being aware of the cultural and gender dynamics at play, and building in time for reflection before, during, and after the trip are all ways to attend to the larger ethical considerations at play.
Normative Theory in the English School
Authors: Cochran Molly
Published: October 2020

Normative thinking permeates the work of the English School and has done so since its start as the British Committee for International Politics. Ethics, or, more precisely, the tension between ethics and power or interests, was one of the original concerns of the founding members of the Committee. It was an aim of the Committee to combine ethical reflection with the historical analysis of states systems. The approach in first-generation, or classical, English School scholarship to ethical questions primarily involved the identification of traditions of political and moral speculation about international relations (IR). Another significant feature of classical English School thought was moral skepticism, which seriously challenged what could be said about ethical choices within the forms of international interaction it charted. However, keen interest in what normative agendas can be supported within international or world society—basic subsistence rights, international criminal justice, and humanitarian intervention—does not necessarily amount to a normative theory. As such, order versus justice is a more productive starting point for normative theorizing within the English School. Meanwhile, there are two modes of normative thought in postclassical English School: practical and moral–philosophical arguments. The English School is grounded in the practical, in the real-world tussle of power and interests, while at the same time it works through what it is possible to say about the nature of obligation and moral responsibility among international actors. This is where ethics and practical interest meet, and it represents the unique contribution of the English School to contemporary normative IR theory.
Poverty and Resilience in Mexico
Authors: González de la Rocha Mercedes
Published: October 2020

Resilience has become the dominant conceptual framework through which the changing lives of the poor are understood. Across the disciplines, resilience is taken to be an analytic measure of the capacity to resist, adapt, and transform itself in the impact of a given disturbance or crisis. Critical engagement with the concept and associated literature, however, shows this framework to be neither original nor competent in providing the heuristic tools for a comprehensive and empirical understanding of poverty, vulnerability, and adaptability or responsiveness. Older, socio-anthropological approaches emerging out of Latin American research from the 1970s to the early 21st century mark an important if unacknowledged precedent of resilience scholarship, while demonstrating the potential weaknesses of a conceptual framework that privileges constant capacity and flexible stability at the expense of disadvantage, damage, and irreparable loss.
Squatter Housing
Authors: Smart Alan
Published: October 2020

Squatting is one of the most important forms of housing for the world’s poor, accommodating perhaps a billion people, with the numbers continuing to grow. Squatters occupy vacant land or buildings without the consent of the owner. Squatting in existing buildings is more common in the Global North, particularly in Europe, and tends to be more political, often explicitly anticapitalist, than squatting on vacant land, which accounts for the vast majority of squatters, particularly in the Global South. Urban squatter housing needs to be seen as valuable housing rather than just as a social problem. Housing generally has exchange value, a price on housing markets, as well as use value, the utility of it for those who live in it. Early research dealt primarily with use value because of the emphasis on self-building and collectively organized invasions of land. Demand for scarce stocks of affordable housing leads to market prices despite governmental denial of the possibility of ownership of illegal dwellings. Squatter housing often meets the needs of poor people more effectively than public housing, and policy initiatives around the world are attempting to enhance the utility of informally built and regulated housing while mitigating the environmental problems that they can cause. Formalizing informal housing is a key but controversial policy. Research has revealed that informal tenure security is considered adequate by residents, resulting in lower than expected demand for squatter titling. Formalization may also lead to gentrification and thus diminishes the abilities of informal housing to provide affordable accommodation.
Architecture in 20th-Century Brazil
Authors: Lara Fernando Luiz
Published: October 2020

Brazilian modern architecture was widely celebrated in the 1940s and 1950s as a tropical branch of Corbusian architecture. While there is truth and depth to the influence of Le Corbusier in Brazil, the architecture of this country is much more than simply an application of his principles to a warmer climate. Moreover, Brazilian 20th-century architecture cannot be defined only by a few decades in which their buildings coincided with and reinforce northern expectations. Many contemporary authors have explored the pervasive nature of such ethnocentrism in architectural history, which denies agency and initiative to anyone outside its intellectual borders. A more adequate analysis must give proper emphasis to Brazilian architects’ motivations and agency, exploring in their main buildings how they struggled to express themselves and their societal aspirations by skillfully manipulating a formal and spatial vocabulary of international modernity.

A contemporary study of Brazilian 20th-century architecture would not be worthy of its title if it did not address similar double standards that have been applied domestically. It is paramount to understand that the influence of modernism in the built environment reached way beyond the well-known centers of Rio de Janeiro and São Paulo, and its manifestations go way beyond the high modernism of the 1940s and 50s. The ethnocentrism of the global North Atlantic repeats itself in Brazil, with the architectures of Rio de Janeiro and São Paulo overshadowing all others. If Brazilian architecture in general is not well known, notwithstanding its extraordinary achievements, still less known are the buildings erected in Recife, Porto Alegre, Belo Horizonte, and Salvador, to mention only four other major urban centers, or the hundreds of buildings in medium-size cities with as much quality and intentionality as those of Rio and São Paulo.
Artistic Vanguards in Brazil, 1952 to 1990
Authors: Jackson Kenneth David
Published: October 2020

Vanguard movements in the arts and literature from mid-20th century Brazil are termed neo-vanguard to distinguish them from the historical vanguard movements of the century’s early decades, even though the neo-vanguards share common features with them. These include an open spirit of internationalism, experimentation with form and language, and the use of fragmentation, simultaneity, minimalism, and graphic display. When they first appeared in the 1950s and 1960s, the neo-vanguards were differentiated by a rationalist, materialist, and functional approach to language, letters and art, visible in geometrical abstraction and based on research.

The São Paulo poets Haroldo de Campos, Augusto de Campos, and Décio Pignatari formed the most prominent and influential literary group, known as “Poesia concreta” [Concrete Poetry]. Poesia concreta continues to shape and influence vanguard art, literature, and design in São Paulo. Their 1958 manifesto, “Plano-piloto para poesia concreta” [Pilot-Plan for Concrete Poetry], reshaped national poetics while adding an international aesthetic dimension. In Rio de Janeiro, the “Grupo Frente” led by artists Hélio Oiticica, Lygia Clark, and Lygia Pape supported the 1959 Neoconcrete movement and manifesto, defending the position that concrete poetry and art should be less mechanical and more expressive of human realities. Bossa nova introduced a syncopated, polished style that gained international fame through João Gilberto and Antônio Carlos Jobim, and it turned attention toward Brazilian arts. In the 1950s and 1960s, individual authors worked within their own neo-vanguard styles outside of any movement, the most important being João Guimarães Rosa, whose reworkings of language and orality produced the major novel of the century, Grande sertão: veredas (1956), and Clarice Lispector, creator of dense existential consciousness in prose, mainly involving women in crisis.

The 1964 military coup changed the disposition of vanguard art into one of resistance, reflected in Cinema Novo, Tropicália, theater, music, popular periodicals, mass culture, and marginal literature. Popular vanguard movements effectively ended, went underground, or adopted more unconventional formats in the 1970s because of political tension. The end of an effusive period of creativity in the 1950s and 1960s was marked by the publication of the collected works of the concrete poets, their inclusion in international anthologies, and a national atmosphere of increased political repression and violence.
In the Eye of the BBHolder: A Look into Recent Trends in Blood Bank Hold Order Utilization
Authors: Hensley Marie , Pagano Monica , Mathias Patrick
Published: October 2020

The transfusion service at a large academic institution provides transfusion support to the regional cancer center in inpatient and outpatient settings. This center has a large patient population many of whom require frequent blood count monitoring. To reduce the number of blood draws and port accesses, it is standard of care to collect a blood bank hold (BBHold) tube simultaneously with routine CBC samples. The BBHold tube is routed to the transfusion services lab and stored in case a type and crossmatch (TXM) is needed in preparation for transfusion; it is valid for 72 hours. While advantages to this system are eliminating the need for a secondary blood draw and ready access to a sample for transfusion testing, disadvantages include drawing an additional tube, increased cost and storage, and increased specimen mislabeling in the conversion of a BBHold to a TXM. Our objectives were to analyze trends in BBHold usage, make recommendations to reduce unnecessary utilization, and create an algorithm to predict which patients would need transfusion. We collected data from March 2016 to June 2019 including hemoglobin values, BBHold orders, and TXM orders, and used the statistical programming language R for data analysis. Approximately 1,000 BBHold samples were collected monthly, with 64.2% taking place in the outpatient setting. Our analysis focused on this outpatient population. A total of 31.1% of BBHold orders were unnecessary, as they were re-collected within the 72-hour window of sample viability. Of all the BBHold orders, including the previously mentioned unnecessary orders, only 32.7% were converted to a TXM, which was used as a surrogate marker for transfusion. Unexpectedly, 28.2% of the last hemoglobin values collected prior to a BBHold (either concurrently with the BBHold or up to 3 days prior) were ≥10 g/dL. Notably, only 44.6% of these hemoglobin orders occurred concurrently with a BBHold, indicating that over 55% of BBHold orders were placed after the hemoglobin order. Once a hemoglobin value is resulted, a BBHold has minimal use since the hemoglobin value would determine if a transfusion is indicated. If transfusion is indicated, a TXM order should be placed directly, rather than a BBHold. Next, the average hemoglobin values were compared between patients who did and did not receive a transfusion within 7 days, and these were 8.8 and 9.1 g/dL, respectively. In conclusion, the trends illustrated here indicate overutilization of BBHold orders and highlight potential areas for optimization. Hemoglobin values within 7 days of a BBHold may not be enough to design a robust algorithm to stratify patients based on need for transfusion. Recommendations moving forward may include improving the EHR interface to display the expiration date of the current BBHold sample or displaying the patient’s last hemoglobin if ≥10 g/dL.
P16 Immunostaining Can Eliminate Approximately 20% Inaccurate Diagnosis of Low-Grade Squamous Intraepithelial Lesions (SIL) in Cervical Biopsies
Authors: Afolayan-Oloye O I , Zhang P
Published: October 2020

Introduction/Objective

Differentiating low-grade SIL from reactive changes on light microscopy has remained controversial. P16 immunostaining is widely accepted in high-grade SIL unlike in low-grade SIL. We focused on the use of p16 immunostaining in eliminating inaccurate diagnosis of low-grade SIL on light microscopy.

Methods

A retrospective study on 60 cervical biopsies results over a 2 year-period was conducted using 35 suspicious cases for low-grade SIL (bi-nucleation and some nuclear atypia) and 25 low suspicion cases (enlarged nuclei but nuclear atypia cannot differentiate from reactive changes). All cases were stained for p16, significant nuclear expression of p16 was determined as low- grade SIL.

Results

After p16 immunostaining, 30/35 (85%) cervical biopsies from the suspicious group were found to be truly positive for low-grade SIL while 5/35 (15%) biopsies negative for p16 immunostaining were regarded as reactive changes. In the low suspicious group, 7/25 (28%) were found to be positive for low-grade SIL and 18/25 (72%) biopsies were negative, favoring reactive changes. The overall percentage of all 60 biopsies that showed a changed diagnosis based on p16 immunostaining was 20% (5 were truly negative in the suspicious group and 7 were truly positive in the low suspicious group). Using a 2 x 2 table with p16 as a gold standard for all biopsies, sensitivity and specificity of light microscopy for low-grade SIL were only 81% and 78% respectively.

Conclusion

Our study showed that p16 immunostaining can also be utilized to eliminate inaccurate diagnosis of low- grade SIL up to 20% in cervical biopsies.
Panniculitis at the Site of Injection: Infection or Foreign Body Reaction?
Authors: Williams G , Kwan E , Giraldo C N , Lincoln M , Lewin-Smith M
Published: October 2020

Introduction/Objective

A 63 year old diabetic female presented to the dermatology clinic with painful abdominal nodules. The nodules seemed to wax and wane every 1–2 weeks and appeared in different locations on the abdomen. The lesions were subcutaneous, tender, firm, and mobile with no discoloration. The patient had diabetes treated with injectable exenatide but no other significant medical or travel history.

Methods

The differential diagnoses included mycobacterial infection, mechanical insult from injectable diabetes medication, erythema nodosum, erythema induratum, and lupus panniculitis. Ultrasound was indicative of panniculitis. A biopsy of the active lesion was performed.

Results

The biopsy showed septal and lobular panniculitis with mixed inflammation and multinucleated giant cells. Small, circular, non-polarizable pink amphorous material was associated with the infiltrate. The amphorous material was strongly acid fast. The patient had a negative quantiferon-TB test. Scanning electron microscopy with energy dispersive x-ray analysis showed that the material contained more oxygen and less carbon than surrounding tissue, but no abnormal elements were identified. Infrared spectroscopy of the foreign material most closely matched poly(L- lactide-co-glycolide).

Conclusion

The diagnosis of exenatide induced granulomatous panniculitis was made. The patient had recently started using this injectable glucagon-like peptide-1 receptor agonist, which has been associated with panniculitis. The injectable formulation is loaded onto microspheres composed of poly (DL-lactic-co-glycolic acid), which is closely related to poly(L-lactide-co-glycolide). This material has been shown to stain strongly acid fast. This case of granulomatous panniculitis due to injectable diabetic medication highlights an important potential pitfall that pathologists should be aware of, especially in cases where mycobacterial infection is in the differential.
Large Solitary Luteinized Follicle Cyst of Pregnancy and Puerperium: a Rare Post-partum Clinical Presentation
Authors: Singh A , Yoxtheimer L , Bajestani S N , Harbert J L
Published: October 2020

Introduction/Objective

In literature, all large solitary luteinized follicular cysts of pregnancy and puerperium (LSLFCPP) recognized were removed before or during delivery. This would be the first case in literature describing the clinical behavior of the LSLFCPP in the post-partum period.

Methods

We herein report a rare case of 21-year-old G2P2 female who underwent a full-term uneventful spontaneous vaginal delivery (39w0d, APGARS 9,9) without removal of the undiagnosed LSLFCPP, which nearly doubled in size post-partum. Her past medical history was significant for treated syphilis and normal Pap Test of the cervix. Three months after delivery, the patient presented with LSLFCPP exhibiting mass effect (retroverted uterus, mild right-sided obstructive uropathy, compressed bladder and intermittent pain). The antepartum ultrasound showed 14 cm pelvic mass that had grown to 30 cm on CT scan, in largest dimension. Beta-hCG levels returned to pre- pregnancy levels. Treponema pallidum antibody, FTA-ABS and RPR were reactive. Alpha-fetoprotein, inhibin B, CA- 125, CEA, and CA 19-9 screen were unremarkable. The patient underwent exploratory laparotomy cyst removal with right salpingo-oophorectomy.

Results

Grossly, the tumor weighed 22 lbs with a diameter of 28 cm; excrescences were not noted. Intraoperative consultation revealed a unilocular benign cyst. Histologically, the cyst was not only lined by luteinized cells but nests of luteinized cells infiltrated the fibrous wall. These cells were positive for Inhibin A and calretinin. A rare mitotic figure was noted. A diagnosis of LSLFCPP was rendered.

Conclusion

High levels of gonadotropin in pregnancy are implicated in the pathogenesis of LSLFCPP; however, in our case, the cyst doubled in size three months after delivery with undetectable beta-hCG levels. This indicates that the pathogenesis of this cyst relies on more than beta-hCG stimulation. LSLFCPP is important to recognize because it can mimic a malignant proliferation on frozen section and can potentially compromise fetal viability with mass effect.
Thyroid and Parathyroid Neoplasms with Lipomatous Stroma: Report of Three Cases and Review of the Literature
Authors: Toprak M , Kashi M , Villanueva J , Wrzolek M , Tong G , Hamele-Bena D , Hoffman R , Hiltzik D
Published: October 2020

Introduction/Objective

Tumors with mixed adipose tissue and epithelial components are rare in thyroid and parathyroid glands. Most of them are benign and referred to as adenolipoma (or lipoadenoma). A handful of malignant tumors of thyroid follicular cell origin have been reported with abundant adipose tissue known as thyroid carcinoma with lipomatous stroma (TCLS). Adenolipomas of thyroid or TCLS are usually manifested as large thyroid nodules and evaluated by fine needle aspiration biopsy (FNAB) which frequently yield low-cellularity samples due to abundant adipose tissue. On FNAB, the adipose tissue usually interpreted as contamination of subcutaneous or perithyroid origin. Similarly, adenolipomas of the parathyroid are not frequently identified because of presence of adipose tissue which is a feature associated with normal parathyroid glands. Therefore, these tumors are not often correctly diagnosed preoperatively. For that reason, pathologist should report additional cases about this rare entity to increase our understanding and to decrease preoperative diagnostic error.

Methods

We report three cases of thyroid and parathyroid tumors with abundant adipose tissue with sonographic, cytologic and histologic features along with literature review.

Results

Among the reported cases in the literature and our cases; 10 out of 17 cases of thyroid carcinoma with lipomatous stroma are papillary thyroid carcinomas (58.8%), 3 out of 17 cases are papillary microcarcinomas (17.6%), 2 out of 17 cases are noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) (11.7%), and 2 out of 17 cases are minimally invasive follicular carcinomas (11.7%). No cases of poorly differentiated or anaplastic thyroid carcinomas have been reported.

Conclusion

Lipomatous stroma in thyroid carcinoma appears to be associated with differentiated carcinomas since no reported cases of poorly differentiated or anaplastic thyroid carcinomas are present to our knowledge. Although the presence of fatty tissue does not appear to alter the prognosis of these lesions, the question of the histogenesis of the adipose component is intriguing. Awareness of this unusual feature and increased utilization of multimodal approaches in the evaluation of this entity may increase preoperative detection and the understanding of the histogenesis and its possible significance.
Malignant Phyllodes Tumor with Lipomatous Differentiation: A Unique Presentation
Authors: Johal P , Sebastiano C
Published: October 2020

Casestudy

Phyllodes tumors (PT) are uncommon biphasic fibroepithelial neoplasms that account for <1% of all breast tumors. The distinction between benign and malignant PTs is made based on a number of histologic characteristics, including an infiltrative margin, stromal overgrowth, mitotic count, hypercellularity and atypia. 30% of cases show heterologous differentiation, which mostly occurs in stromal elements. This can result in a wide range of tumor histopathology including lipomatous areas.

Results

We present the case of a 46-year-old female with a 3.1 cm left breast palpated mass and no significant past medical history. Ultrasound guided needle biopsy revealed multiple foci of hypercellular spindle cells with marked atypia and mitoses (ki-67: 40–60%) surrounded by focal fat necrosis. Immunohistochemical staining was negative for CK 5/6, p63, CAM 5.2, SMA, desmin, AE1/3, CD163, nuclear beta-catenin and CD34. The patient subsequently underwent a wire localization excisional biopsy. Microscopic examination revealed a biphasic hypercellular lesion with both stromal and distorted glandular elements and extensive lipomatous differentiation. Although mostly well- circumscribed, some infiltration into the surrounding tissue was identified as well as nuclear atypia and an increased mitotic rate (10 mitoses/HPF). The diagnosis of malignant phyllodes tumor with lipomatous differentiation was made based on these findings. FISH was performed and was negative for MDM2, suggesting that the lipomatous component itself was not malignant (i.e. liposarcoma)

Conclusion

Malignant phyllodes tumors rarely show heterologous differentiation. A literature review revealed that most lipomatous differentiation was liposarcomatous with rare cases of pure lipomatous metaplasia. Although malignant phyllodes tumor have the highest rate of metastasis relative to their benign counterparts, complete excision has resulted in a mortality rate of approximately 12%. The clinical implications of lipomatous differentiation are currently unknown. However, in these cases ensuring the lack of malignant liposarcomatous tumor growth is imperative.
Multiple Pulmonary Pleomorphic Adenomas of Unknown Primary
Authors: Liu X , Miller W
Published: October 2020

Introduction/Objective

The most common site of pleomorphic adenomas (PAs) is salivary glands, which behave as benign tumors and rarely metastasize. Primary PAs in lungs are exceedingly rare. We report a case of multiple PAs in lungs with an inconclusive origin.

Methods

A 65-year-old woman had a two-year history of numerous scattered bilateral well-circumscribed pulmonary nodules measuring up to 2.1 cm. She had no prior history of smoking, asbestos exposure and salivary gland diseases, and denied any symptoms. The latest chest computed tomography (CT) scan showed the two largest lower lobe nodules had mildly increased in size compared to two years before. The patient then underwent wedge resections.

Results

Grossly, the wedge resection specimens showed multiple well-circumscribed, pale tan, firm nodules. Microscopically, the nodules comprised cytologically bland nests of polygonal to plasmacytoid cells with eosinophilic cytoplasm, variably set in a myxoid matrix. Immunohistochemical stains demonstrated that the cells were positive for AE-1/AE-3, S-100, bcl-2 and SOX-10, and negative for chromogranin, smooth muscle actin, p63, calponin, PAX-8, CD34, CD31, HMB-45, melan-A, HHF-35, GATA-3, GFAP and RCC marker; TTF-1 highlighted entrapped pulmonary epithelium but the tumor cells were negative. These findings might suggest metastatic low grade PA from salivary glands. However, the patient’s follow-up examination by an otolaryngologist was normal; the CT scan of her chest and abdomen did not show any remarkable findings other than her lung nodules.

Conclusion

To our knowledge, this is the first reported case of multiple pulmonary PAs without a preceding primary.

It has raised questions about the pathogenesis of multiple PAs in lungs. Could PA present as multiple primary nodules in lungs? Could one primary pulmonary PA generate multiple satellite nodules in lungs? Do multiple primary pulmonary PAs have a different IHC profile than that of a single primary pulmonary PA? More research is needed.
Mesonephric-Like Adenocarcinoma: Two Cases Of A Rare Entity And Review Of Literature
Authors: Liu Y , Karnezis A
Published: October 2020

Introduction/Objective

Mesonephric-like adenocarcinoma (MLA) is a rare gynecologic malignancy occurring in the uterus and ovary and is morphologic similar to cervical mesonephric adenocarcinoma. We present two cases of mesonephric-like adenocarcinoma of the ovary.

Methods

The first case is a 72-year-old female presented with abdominal pain with bloating. Abdominal CT scan showed a 7.4 x 6.3 x 6.1 cm heterogenous right adnexal mass. The second case is a 66-year-old female with history of heavy bleeding and endometriosis, status post total abdominal hysterectomy with bilateral salpingo-oophorectomy 20 years ago. Abdominal CT scan demonstrated a 5.3 cm right pelvic mass and 12.5 cm right pelvic sidewall lymph node.

Results

Both tumors have characteristic variety of features including ductal, tubular, retiform, papillary, solid and infiltrative morphological patterns. Cytologic atypia is mild to moderate. The histological features can raise a broad differential diagnosis including primary tubo-ovarian carcinomas, sex cord-stromal tumors, and metastatic carcinomas. Immunohistochemical stains demonstrate the ovarian tumor cells are positive for multiple pan-epithelial markers (AE1/AE3); negative for sex cord-stromal markers (inhibin and calretinin); positive for PAX8, GATA3, TTF1, and CD10; and negative for ER, PR, and WT1. In the first case, a small incidental endometrial carcinoma arising from an endometrial polyp was also identified. Morphologically, it is distinct from the ovarian mesonephric-like adenocarcinoma.

Conclusion

Morphological and immunohistochemical features of the two tumors are consistent with MLA, a very rare ovarian tumor that is thought to arise either from mesonephric remnants in the para-ovarian tissue or by trans- differentiation from a benign or neoplastic Mullerian precursor. These tumors are reported to have a very high frequency of KRAS mutations followed by PIK3CA mutations. Due to their rarity, the clinical behavior of these tumors is unknown.
Examination Of Nail Clippings For Onychomycosis: Histologic Observations With Microbiologic Correlations
Authors: Liaquat S , Bryson A , Mochel M
Published: October 2020

Introduction/Objective

Appropriate management of onychomycosis, the most common disease of the nail unit, depends on accurate and timely diagnosis. Histologic evaluation of nail clippings, paired with histochemical techniques such as Periodic acid-Schiff (PAS), is a rapid, sensitive method for diagnosis of onychomycosis. While studies have compared testing modalities for onychomycosis, few have systematically evaluated histologic changes of the nail plate and correlated findings with concomitant microbiologic culture.

Methods

A consecutive series of nail clipping specimens between July 2016 to July 2019 from our institution were evaluated. Clinical data were collected, H&E and PAS stains were examined for histologic nail plate alterations and fungal presence, morphology, location, and abundance. Concurrent culture results were also collected and correlated.

Results

Histologic slides, including PAS, of nail clippings were evaluated from 131 patients (median age 57, 65% female). 53 cases (40%) were positive for fungal organisms by PAS stain: 26 cases showed diffuse fungal involvement, while 27 cases showed focal fungal involvement, limited to one 200x field. Of the PAS-positive cases, 47 cases showed predominantly hyphae and 6 cases showing predominantly yeast-like morphology. Nail plate histologic changes associated with PAS positivity included parakeratosis (p= 0.0071) and neutrophilic aggregates (p=0.0017).

Of the total cases evaluated by histology, 67 cases had concomitant cultures performed, with 17 of these cases (25%) positive for fungal growth. Of the 23 PAS-positive cases with simultaneous culture sent, only 9 cases (39%) were positive for fungal growth. Conversely, of the 44 PAS-negative cases with simultaneous culture sent, 8 cases (18%) were positive for fungal growth. For cases positive by both PAS and fungal culture, significant correlations between fungal morphology on PAS and microbiologic speciation were not observed.

Conclusion

While PAS stains appear overall more sensitive for onychomycosis, both PAS and culture methods are falsely negative in a significant number of cases. In cases of high clinical suspicion for onychomycosis, consideration of employing more than one testing modality is recommended. Of note, histologic examination may reveal nail plate changes associated with fungal infestation, including nail plate parakeratosis and neutrophilic aggregates.
PD-L1 Expression in Sarcomas: An Immunohistochemical Study
Authors: Cunningham C , Schnabel J , Esebua M , Layfield L
Published: October 2020

Introduction/Objective

Immunotherapy is increasingly used for the treatment of metastatic melanoma and carcinomas. PD-I (programmed death 1) and its associated ligand (PD-L1) inhibits the activation of T lymphocytes. This inhibition can be impacted by a number of drugs. Response to these drugs is predicted by assessment of PD-L1 expression. PD-L1 expression varies between 19% and 92% in melanomas and carcinomas. PD-L1 expression is less well documented for sarcomas.

Methods

Fifty-one sarcomas of various histopathologic types were immunohistochemically stained (IHC) for PD-L1 using the antibody clone SP263 (Ventana, Tuscan, AZ). Membrane staining of tumor cells was quantitated as a percentage of total tumor cells. Sarcomas were judged as non-expressors (less than 1%) low-expressors (1 to 50%) and high expressors (greater than 50%). The percentage of each type of sarcoma judged as an expressor was determined.

Results

The percentage of each type of sarcoma expressing PD-L1 is reported and 20% of sarcomas expressed PD- L1. The percentage of sarcomas expressing PD-L1 varied significantly between types but the majority of sarcomas were non-expressors.

Conclusion

PD-L1 IHC expression is valuable in predicting response to immune-modulating drugs. Such therapies may be useful for treatment of metastatic sarcomas. Expression of PD-L1 in carcinomas and melanomas is variable ranging from 19% to 92%. In our study, a minority (20%) of sarcomas expressed PD-L1. Other studies have shown similar results with between 1.4 and 59% (average 24%) of sarcomas expressing PD-L1. Expression appears to be type specific. These finding suggest that PD-L1 based therapy may be less useful in sarcomas than in other malignancies.