bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of loan-loss provision, non-performing loans and third-party fund on capital adequacy ratio
Authors: Nugroho Mulyanto , Arif Donny , Halik Abdul
Published: February 2021

This research was conducted in connection with the effective enactment of International Financial Accounting Standard IFRS 2020 to improve the concept of hedging accounting as well as basic measurement and classification of financial instruments. IFRS carries the concept of Expected loss backup which begins to acknowledge losses if there is a potential failure to pay even though it has not really happened, allowing the bank to form a larger loan-loss provision. The loan-loss provision is formed based on the number of failed pays in credits indicated by the ratio of Non-Performing Loans (NPLs). Fund distribution can be regulated by the Third-party Fund (TPF). The increasing number of loan-loss provisions and NPLs are feared to affect capital conditions for the bank. Therefore, the study aims to determine the partial and simultaneous influence of the loan-loss provision, Non-Performing Loans (NPLs), and third-party Fund (TPF) against the bank's capital adequacy ratio (CAR). The samples in this study are central government-owned banks, namely Bank Mandiri, Bank Negara Indonesia, Bank Rakyat Indonesia, and Bank Tabungan Negara period from 2011 to 2018. Data taken is a data time series of the quarterly financial statements published by the respective online website of the bank. The analysis used is a multiple linear regression analysis using SPSS Tools version 21 and Microsoft Excel. The results showed that a partial loan-loss provision had no significant effect on the bank's capital adequacy ratio, while the Non-Performing Loans (NPLs) and the Third-party Fund (TPF) were partially influential of the bank's capital adequacy ratio. Simultaneously the three independent variables have a significant effect on the dependent variable capital adequacy ratio (CAR).
The effect of financial policy and capital assets on firm performance: Evidence from service companies listed on the Amman Stock Exchange
Authors: Soda Mohammed Zakaria , Oroud Yazan , Makhlouf Mohammed Hassan
Published: February 2021

This study aimed to demonstrate the impact of the financial policy, represented in debt policy and dividend policy, and the capital assets on the financial performance measured by return on equity, total assets turnover and market value added of 53 service companies listed on the Amman stock exchange during the period 2014–2018, using the panel data models. According to the results of testing performed on return on equities (ROE) model, total assets turnover (TAT) model, and market value added (MVA) model, it can be concluded that debt policy has a negative significant effect on market value added and total assets turnover, on the other hand, it has a negative insignificant effect on return on equity. The financial performance of the Jordanian service companies is influenced negatively by the debt ratio as a measure of financial policy; which means service companies are using heavy debt to finance the operating activities, which increases financial cost and the risk of financial failure. The study recommended that service companies can increase the volume of investment in fixed assets to generate high financial performance indicators.
The effect of debt covenant, political cost and IFRS implementation towards the company value
Authors: Ahalik Ahalik , Suratman Adji , Hidayati Nuzulul
Published: February 2021

The research is aimed to analyze the influence of debt covenant, political cost and implementation of IFRS toward firm value. The population in this research are non public companies in the period 2016, 2017 and 2018. Non public companies are used as the population in this research to see the level of implementation of IFRS that have been applied by non public companies. The sample selection by using a random method and obtaining a sample of 46 companies or 138 observation data. The analysis used in this research is a Panel Data Regression by using Eviews 10.00. The partial result showed that political cost and implementation of IFRS affect firm value, while the debt covenant does not affect firm value. And the simultaneous result showed that debt covenant, political cost and implementation of IFRS affect firm value.
The effect of board characteristics on the audit committee meeting frequency
Authors: Aljaaidi Khaled Salmen , Sharma Raj Bahadur , Bagais Omar Ali
Published: February 2021

The focus of this study is to examine the impact of board of directors’ size and meetings on the audit committee meeting frequency among energy, materials and food and beverages sectors listed on Saudi Stock Exchange (Tadawul) for the period 2015-2017. The final sample of this study consists of 198 firm-year observations. Using the Pooled OLS regression, this study finds that board meeting is positively associated with audit committee meeting frequency. Furthermore, this study fails to report an association between board size and audit committee meeting frequency. This study provides insightful evidence to policy makers on the determinants influencing the audit committee meeting frequency among manufacturing companies.
An analysis of auditors’ perceptions towards artificial intelligence and its contribution to audit quality
Authors: Albawwat Ibrahim , Frijat Yaser Al
Published: February 2021

Artificial intelligence (AI) systems have significantly changed the audit process; nevertheless, the AI revolution opponents view this growth as a step-back as many auditors will fail to adapt to this new environment and will drop behind. Our descriptive study examines the perceived ease of use, usefulness, and contribution to the audit quality of different AI’s types. To address local audit firms concerns about their readiness to use AI systems in auditing processes and to advance auditing research, we examine whether perceived ease of use, usefulness, and contribution to audit quality vary by AI systems type (Assisted, Augmented, and Autonomous). An online questionnaire was used to collect data from 124 auditors representing local audit firms in Jordan. Our results indicate that auditors perceive Assisted and Augmented AI systems as ease of use in auditing while perceiving Autonomous AI systems as complicated to use. Besides, Auditors are underestimating Autonomous AI systems’ capabilities and perceived it as not useful for auditing. The results also reveal a significant difference between the perceived contribution to audit quality by the three AI systems types. This study contributes to the existing literature on AI and auditing by developing and testing a measure for AI systems’ perceived contribution to audit quality. This study also provides empirical evidence on how Jordan local firms auditors perceive AI use in auditing.
Testing a Model of the Threat of Street Sexual Harassment in Egypt: Implications for Social Work Education
Authors: Soliman Hussein , Koran Jennifer , Abdelmonem Amal Abdelmordi
Published: February 2021

This study tested a model of Egyptian women’s well-being and perception of the threat of sexual harassment. The model was drawn from multiple theoretical frameworks, including the vulnerability perspective, objectification theory, and religious perspectives. Nine variables in the model reflect societal, interpersonal, and cultural variables that are believed to relate to women’s views about threats and social risks related to sexual harassment. A total of 1,977 Egyptian women aged 19-45 years voluntarily participated in the study. Path analysis showed that exposure to street sexual harassment was the strongest predictor of both perception of the threat of sexual harassment and a sense of vulnerability to sexual harassment. However, more nuanced results from the model had implications for social work education and research. This study fills an important gap in social work education related to sexual harassment by examining a complex web of interpersonal, environmental, and cultural factors relevant to women’s view of the threat of sexual harassment.
IMPLANTAÇÃO DO IMPOSTO SOBRE VALOR AGREGADO NO BRASIL: PERSPECTIVAS DOS DOCENTES E DISCENTES DO CURSO DE CIÊNCIAS CONTÁBEIS E PROFISSIONAIS DE CONTABILIDADE
Authors: De Souza Davi Vieira , Pereira da Silva Annandy Raquel , Soares do Nascimento Ítalo Carlos , Varela de Melo Geison Calyo , Moreira Caritsa Scartaty
Published: February 2021

O atual sistema tributário brasileiro enfrenta vários problemas, como sua complexidade e a alta carga tributária imposta, e muito se tem estudado nos últimos anos sobre uma reforma tributária que pudesse mudar esse cenário. Tendo em vista em que em muitos países desenvolvidos, em seus ordenamentos jurídicos, utilizam o Imposto Sobre Valor Agregado (IVA), que apresenta uma característica de ser um imposto neutro, logo esse imposto é cobrado em todas as etapas do processo de produção e comercialização, garantindo assim em cada etapa, o crédito correspondente ao imposto debitado na etapa anterior, o presente estudo tem como objetivo principal analisar as perspectivas de docentes e discentes do curso de ciências contábeis e profissionais de contabilidade, da cidade de Mossoró-RN sobre a implantação do IVA no Brasil. De natureza quantitativa, quanto ao objetivo se trata de uma pesquisa descritiva, e quanto aos procedimentos pode ser classificada com um survey, tendo como instrumento de coleta um questionário. Os dados foram analisados através da estatística descritiva. Com os resultados, constatou-se que os discentes, docentes e profissionais de contabilidade possuem uma visão clara sobre a implantação do IVA no sistema tributário nacional, que o mesmo pode trazer benefícios para o desenvolvimento econômico seja por sua harmonização no cenário mundial, por sua simplificação que torna o sistema tributário mais eficiente e ágil no combate a fraudes fiscais, e pela redução da carga tributária sobre o consumo.
O DÉFICIT DA CONTABILIDADE: A FALTA DE INTERESSE DOS ESTUDANTES NA ÁREA ACADÊMICA
Authors: Cerqueira Lima Herberty
Published: February 2021

Apesar do aumento no número de estudantes de graduação em Ciências Contábeis no Brasil, o ingresso de estudantes na carreira acadêmica é inversamente proporcional, ocasionando assim a carência de professores da área contábil nas instituições de ensino superior públicas e privadas. Esta pesquisa propõe-se em analisar os fatores intrínsecos e extrínsecos que contribuem para com que os discentes não escolham a área de ensino como ramo de atuação. Desta forma a partir da aplicação do questionário à discentes de graduação em Ciências Contábeis numa universidade estadual verificou-se que a motivação extrínseca por controle externo e por identificação, bem como a motivação intrínseca por saber são fatores relevantes para a tomada de decisão em não ingressar em programas de pós-graduação stricto sensu (acadêmico); ademais a pesquisa identificou que apenas 6,1% da amostra tem o desejo de seguir na carreira acadêmica. Por fim, com base na análise dos dados concluiu-se que existe semelhança entre a escolha de atuação na área de ensino e os semestres inicias do curso de graduação, bem como, que a motivação pessoal é fator predominante entre os estudantes na escolha da área de ensino.
Impactos do CPC 06 (R2) - Operações de Arrendamento Mercantil em uma Indústria de Revestimentos Cerâmicos
Authors: Mandelli Maike Bordignon , Monteiro Januário José , Ritta Cleyton De Oliveira
Published: February 2021

Com a aprovação da norma pronunciamento CPC 06 (R2) - Operações de Arrendamento Mercantil com vigência a partir de 2019, em conformidade International Financial Reporting Standards (IFRS) 16 - Leases, as empresas brasileiras passam por mudanças acerca do reconhecimento, mensuração e evidenciação contábil das operações de arrendamento. Este artigo tem por objetivo analisar os impactos da aplicação do CPC 06 (R2) - Operações de Arrendamento Mercantil em uma indústria de revestimentos cerâmicos a partir do ano de 2019. A metodologia da pesquisa caracteriza-se por natureza descritiva, com abordagem qualitativa e estudo de caso com pesquisa documental e entrevistas informais. Os resultados mostraram que os ativos de direito de representam o montante de R$ 10.132.760,00 e possuem representatividade de 1% em relação ao ativo total. As novas práticas exigiram o reconhecimento de ativos de direito de uso no ativo patrimonial e de obrigações de arrendamento nos passivos circulante e não circulante da empresa. A situação econômico-financeira foi afetada, pois ocorreu a redução da liquidez corrente, o aumento do endividamento com terceiros e da imobilização de recursos não correntes. Diante dos resultados conclui-se que o impacto da implantação do CPC 06 (R2) não foi tão significativo, visto que o montante de ativos oriundo de contratos de arredamentos operacionais é baixo em relação ao ativo total da empresa. Entretanto, as práticas contábeis requeridas pelo CPC 06 (R2) exigiram mudanças relevantes na elaboração das informações contábeis, principalmente, quanto ao reconhecimento, mensuração e evidenciação desses ativos no contexto organizacional da Alfa. Tais evidências reforçam que o impacto do CPC 06 (R2) é dependente do segmento econômico de atuação das organizações que podem demandar por maior utilização de ativos de direito de uso como suporte às operações
Formulário de Avaliação (165-166)
Authors: Klein Luciana
Published: February 2021

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Opening address
Authors: O'Dea Patrick
Published: February 2021

Proceedings of the seminar on the social and economic effects of earthquake prediction, 12 October, 1977.
MEDICAL STUDENTS’ KNOWLEDGE AND SENSITIVITY TO DYSMORPHIC FEATURES OF A CHILD WITH CRANIOFACIAL MICROSOMIA (CFM)
Authors: Milska Katarzyna A. , Rudnik Agata , Mański Arkadiusz , Wierzba Jolanta
Published: February 2021

The aim of the study was to examine the level of knowledge and sensitivity to dysmorphic features in a child with facial and body dysmorphia on the part of students of medicine and dentistry.

We tested 70 students of medicine and 70 students of dentistry. A photograph of a child with craniofacial microsomia (CFM)was shown to all the tested students. Their task was to detect and name those facial deformities and describe the child in terms of selected features not related to the child’s health condition. As a tool was used the Overgeneralization Effect Scale and a questionnaire designed by the author relating to facial deformities.

Significant differences were observed in the level of knowledge and sensitivity to dysmorphic features between students of medicine and dentistry. Future dentists detected more dysmorphic features in the face of the photographed child when compared to students of medicine. Interestingly, this sensitivity to abnormalities was found to noticeably increase with each subsequent year of study for dentistry students, while the opposite was observed for the stu dents of medicine. Importantly, a relationship was observed be tween the sensitivity to dysmorphic features and the general evaluation of the child in terms of non-medical aspects by the group of dentistry students. With the increase in the students’ skills to recognize dysmorphic features, the overall evaluation of the child tended to decrease.

The results obtained indicate that the skills related to recognizing dysmorphic features are better in students of dentistry than in students of medicine. The sensitivity to abnormalities evidently increase with each subsequent year of study for dentistry students, while the opposite was observed for medical students.
Generation of clinical data on the safety and performance of medical devices through clinical research in accordance with the current and future legislation
Authors: Bozic Mijo , Zenner Hans P. , Sander Gerald G.
Published: February 2021

In this paper, the authors provide a quick overview of current and future legislation operating in Germany and the European Union which regulates clinical research into medical devices intended for human use. It also briefly discusses the importance of data protection provisions and the relevance of international standards and guidelines for proper performance of clinical research.
Police activities in severe crises
Authors: Gwardyński Robert
Published: February 2021

The Police Forces are supposed to ensure people’s security and maintain public safety
and order. Some of their activities are performed under conditions of a specific threat
to human life, health, property, and national wealth. This article aims to indicate appropriate
forms of Police operations in severe crises.
The level of security of the society in Poland. Progressive stepwise regression model for the overall crime rate
Authors: Socha Robert , Migała-Warchoł Aldona
Published: February 2021

The aim of this article is to analyze the level of security of the Polish society using crime rates collected from the Local Data Bank of the Central Statistical Office. The data was collected for individual Polish voivodships for the year 2016. In the second part of the article, the model of progressive stepwise regression was created for the overall crime rate, as well as conducting an analysis of the relationship between the crime rate and selected economic measures. The results were obtained with the application of the Statistica 12 program.
Frozen Section and the Surgical Pathologist: A Point of View
Authors: Taxy Jerome B.
Published: February 2021

Frozen section is a prominent point of intersection between surgeons and pathologists. It is regarded as the most definitive—but not the sole—form of intraoperative consultation. Its role in tissue triage, diagnosis, and intraoperative management should not be misconstrued as a shortcut to a definitive diagnosis. Although the pathologist remains in control of the tissue disposition, frozen sections are ideally requested and executed as a collaborative effort. Frivolous requests with no direct consequences for the conduct of a given procedure should not be honored. Frozen section plays a material role in resident education and may be the last vestige of general surgical pathology in an era of organ system specialization. Frozen section will retain its relevance only in the context of broad clinical knowledge by the pathologist and judicious utilization by the surgeon, both in the ultimate service of the patient.
Corrections of Clinical Chemistry Test Results in a Laboratory Information System
Authors: Wang Sihe , Ho Virginia
Published: February 2021

Context.—The recently released reports by the Institute of Medicine, To Err Is Human and Patient Safety, have received national attention because of their focus on the problem of medical errors. Although a small number of studies have reported on errors in general clinical laboratories, there are, to our knowledge, no reported studies that focus on errors in pediatric clinical laboratory testing.

Objective.—To characterize the errors that have caused corrections to have to be made in pediatric clinical chemistry results in the laboratory information system, Misys. To provide initial data on the errors detected in pediatric clinical chemistry laboratories in order to improve patient safety in pediatric health care.

Design.—All clinical chemistry staff members were informed of the study and were requested to report in writing when a correction was made in the laboratory information system, Misys. Errors were detected either by the clinicians (the results did not fit the patients' clinical conditions) or by the laboratory technologists (the results were double-checked, and the worksheets were carefully examined twice a day). No incident that was discovered before or during the final validation was included. On each Monday of the study, we generated a report from Misys that listed all of the corrections made during the previous week. We then categorized the corrections according to the types and stages of the incidents that led to the corrections.

Results.—A total of 187 incidents were detected during the 10-month study, representing a 0.26% error detection rate per requisition. The distribution of the detected incidents included 31 (17%) preanalytic incidents, 46 (25%) analytic incidents, and 110 (59%) postanalytic incidents. The errors related to noninterfaced tests accounted for 50% of the total incidents and for 37% of the affected tests and orderable panels, while the noninterfaced tests and panels accounted for 17% of the total test volume in our laboratory.

Conclusion.—This pilot study provided the rate and categories of errors detected in a pediatric clinical chemistry laboratory based on the corrections of results in the laboratory information system. A direct interface of the instruments to the laboratory information system showed that it had favorable effects on reducing laboratory errors.
Vascular Invasion and Herniation by Hepatocellular Carcinoma in Cirrhosis: A Wolf in Sheep's Clothing?
Authors: Quaglia Alberto , Etessami Nazanin , Sim Rosalind , Difford John , Dhillon A. P.
Published: February 2021

Context.—Vascular invasion is an important diagnostic and prognostic feature of hepatocellular carcinoma (HCC) in cirrhosis. Intravascular free-floating tumor clusters (IvCs) of HCC are found histologically in the vicinity of HCC. Thrombus formation is not seen morphologically in association with these IvCs, which are usually covered by endothelium.

Objective.—Our hypothesis is that these IvCs are the result of a nondestructive form of vascular invasion by HCC, and we tried to define this aspect of microvascular invasion more accurately.

Design.—Tissue sections were stained with hematoxylin-eosin, and consecutive sections were stained for fibrin (Martius scarlet blue, fibrinogen), platelets (factor XIIIa), smooth muscle actin, and endothelium (CD34). We studied cirrhotic livers removed at transplantation between 1997 and 1999. Of the livers studied, 35 of 81 consecutive cirrhotic livers contained HCC, and 17 showed microscopic vascular invasion. Five of these 17 cases showed IvCs and were subjected to the study.

Main Outcome Measure.—Presence or absence of thrombus formation in association with IvC.

Results.—Usually, IvCs were covered by endothelium, and no associated thrombus formation was seen. In 1 case of HCC, thrombus formation was seen focally in association with disruption of the endothelial coating.

Conclusions.—We propose that the endothelial-lined trabecular structure of HCC everts, frondlike, via vascular structures within the tumor capsule into peritumoral vascular lumens without destruction of the endothelial coating. This may protect these HCC tumor projections from thrombus formation but may also act as a barrier to tumor extravasation, and this may be exploited from a therapeutic point of view.
Addressing the Maintenance of Certification Challenge: The College of American Pathologists Response
Authors: Hammond M. Elizabeth H. , Filling Constance M. , Neumann Ann R. , Homburger Henry A.
Published: February 2021

Context.—The American Board of Medical Specialties Maintenance of Certification (MOC) process will become effective in 2006. The College of American Pathologists (CAP) Education Committee defined pathology-specific competencies within MOC categories and used data from a survey of pathologists to create education courses targeted to each MOC category.

Objective.—To define pathology-specific competencies within MOC categories and to identify priority learning needs for pathologists.

Design.—A 5-step process was completed for defining pathology-specific competencies within MOC categories and creating education courses targeted to competencies identified in each MOC category. A random survey was distributed to identify priority learning needs based on the gap between the importance rating of each knowledge and skill statement and a rating of current level of proficiency in 3 areas.

Results.—Specific competencies and knowledge and skill statements were identified for each MOC competency category. Findings indicate pathologists believe they are poorly prepared for practice in competency categories related to systems-based practice and practice-based learning and improvement.

Conclusions.—The CAP has focused education efforts on identifying a process for defining and responding to the MOC challenge. Pathologists have told us that they have significant needs for learning in specified areas and the CAP will focus development of education courses to meet those identified needs.
A Comparison of Interobserver Reproducibility of Gleason Grading of Prostatic Carcinoma in Japan and the United States
Authors: Oyama Tetsunari , Allsbrook William C. , Kurokawa Kohei , Matsuda Hadzki , Segawa Atsuki , Sano Takaaki , Suzuki Keiji , Epstein Jonathan I.
Published: February 2021

Context.—Gleason grading is now the sole prostatic carcinoma grading system recommended by the World Health Organization. It is imperative that there be good interobserver reproducibility within this system worldwide. To our knowledge, there are no studies, using the same specimens, that compare the interobserver reproducibility of Gleason grading in Japan and the United States.

Objective.—To compare the interobserver reproducibility of Gleason grading of prostatic carcinoma in Japan and the United States using, in Japan, images from the identical biopsy glass slides that were originally graded in the United States.

Design.—Microsopic images from 37 needle biopsies of prostatic carcinoma were placed on CD-ROM and distributed to 14 Japanese pathologists for grading. These 14 physicians included 8 general pathologists and 6 pathologists with a special interest in urologic pathology. The needle biopsies had been previously reviewed so that a consensus diagnosis could be formed by a panel of urologic pathologists in the United States and Canada. Interobserver agreement with the consensus diagnoses was calculated by determining the overall κ coefficient for the Japanese pathologists and then compared to the interobserver agreement among American general pathologists who had previously graded identical needle biopsies from which the CD-ROM images had been taken.

Results.—The interobserver agreement with the consensus diagnoses for the 4 Gleason grading groups (Gleason grades 2–4, 5–6, 7, and 8–10) among the Japanese urologic pathologists in this series of cases was substantial (overall κ = 0.68), and for the Japanese general pathologists, it was moderate (overall κ = 0.49), similar to that reported in the earlier study of American general pathologists (overall κ = 0.44). The major interobserver reproducibility problem for both Japanese and American general pathologists is undergrading. The major areas of undergrading are the underdiagnosis of Gleason scores 5–6 as Gleason scores 2– 4, and the underdiagnosis of cribriform sheets and fragments of cribriform Gleason pattern 4 carcinoma as Gleason pattern 3.

Conclusions.—The interobserver reproducibility of the Gleason grading for this collection of specimens was similar among Japanese and American general pathologists. The overall κ values for these generalists of 0.44 and 0.49 are only in the moderate (0.41–0.60) range of interobserver agreement when compared to 0.68, substantial (0.61– 0.80) agreement, for Japanese urologic pathologists. Educational efforts to improve Gleason grading have been shown to be effective and are clearly warranted.
A Practical Approach to Pediatric Patients Referred With an Abnormal Coagulation Profile
Authors: Acosta Monica , Edwards Rachel , Ian Jaffe E. , Yee Donald L. , Mahoney Donald H. , Teruya Jun
Published: February 2021

Context.—Workup for prolonged prothrombin time (PT) and activated partial thromboplastin time (PTT) is a frequent referral to a Hematology and Coagulation Laboratory. Although the workup should be performed in a timely and cost-effective manner, the complete laboratory assessment of the coagulation state has not been standardized.

Objective.—To determine which clinical and laboratory data are most predictive of a coagulopathy and to formulate the most efficient strategy to reach a diagnosis in patients referred for abnormal coagulation profiles.

Design.—Retrospective case review. Medical records of 251 patients referred for prolonged PT and/or PTT to our Hematology Service between June 1995 and December 2002 were reviewed.

Results.—The study included 135 males and 116 females with a mean age of 7.0 years. A personal history of bleeding was reported in 137 patients, and a family history of bleeding was reported in 116 patients. Fifty-one patients (20%) had a coagulopathy (ie, a bleeding risk). Factors predictive of a bleeding risk were a positive family history of bleeding (P < .001) and a positive personal history of bleeding (P = .001). Of 170 patients with findings of normal PT and PTT values on repeat testing, 14 were subsequently diagnosed with a coagulopathy. Two of these patients reported no positive personal or family history of bleeding.

Conclusions.—Coagulopathy was identified in 20% of the children referred for abnormal PT and/or PTT. In the absence of a personal or family history of bleeding, a normal PT and/or PTT on repeat testing has a negative predictive value of more than 95%.
Distinguishing Pseudoepitheliomatous Hyperplasia From Squamous Cell Carcinoma in Mucosal Biopsy Specimens From the Head and Neck
Authors: Zarovnaya Elena , Black Candice
Published: February 2021

Context.—The differentiation of pseudoepitheliomatous hyperplasia from invasive squamous cell carcinoma is a difficult and frequently encountered distinction, especially in biopsy specimens from head and neck mucosa. The problem is compounded by inflamed and often poorly oriented tissue sections.

Objective.—To distinguish pseudoepitheliomatous hyperplasia from invasive squamous cell carcinoma, utilizing a panel of antibodies to various epithelial and stromal elements (p53, matrix metalloproteinase 1, E-cadherin, and collagen IV) that has been shown to be useful in differentiating intestinal adenomas with invasive adenocarcinoma from displaced adenomatous epithelium.

Design.—Thirty-three archival specimens (16 squamous cell carcinoma [12 with invasion and 4 with microinvasion] and 17 pseudoepitheliomatous hyperplasia) from head and neck mucosal locations were immunostained and examined by the authors.

Results.—We found increased nuclear staining of the invasive tumor cells with p53. There was decreased staining within invasive tumor nests with E-cadherin. There was highly significant increased staining within tumor cells and adjacent stroma with matrix metalloproteinase 1 (P < .001). The only antibody in our panel that did not show a reliable staining pattern was collagen IV. It appeared fragmented in benign inflamed and malignant areas and therefore was not useful.

Conclusions.—p53, matrix metalloproteinase 1, and E-cadherin showed significant staining trends independent of inflammation and suboptimal tissue orientation. Although a properly oriented hematoxylin-eosin–stained section was our gold standard, we found this immunoperoxidase panel useful as a diagnostic adjunct in difficult cases.
Primitive Neuroectodermal Tumor of the Stomach
Authors: Soulard Raoulin , Claude Valère , Camparo Philippe , Dufau Jean-Philippe , Saint-Blancard Patrick , Gros Philippe
Published: February 2021

Ewing sarcoma/primitive neuroectodermal tumor is classically a tumor of the soft tissue or bone in children and young adults, but several cases have been described in patients of all ages. Within the last decade, the clinicopathologic spectrum of Ewing sarcoma/primitive neuroectodermal tumor has been markedly expanded by recognition that the tumor may also have a visceral origin. We describe a case of primitive neuroectodermal tumor arising in the stomach of a 66-year-old woman. The neoplasm was excised using a radical surgical procedure. Microscopically, the tumor was made up of solid nests and sheets of round cells. Immunohistochemically, the tumor cells showed immunoreactivity for CD99, S100, neuron-specific enolase, and vimentin. A multiplex real-time polymerase chain reaction assay detected an EWS-ERG fusion. To our knowledge, this is the first description of a primitive neuroectodermal tumor arising in the stomach.
CDX2 Is a Useful Marker of Intestinal-Type Differentiation: A Tissue Microarray–Based Study of 629 Tumors From Various Sites
Authors: De Lott Lindsey B. , Morrison Carl , Suster Saul , Cohn David E. , Frankel Wendy L.
Published: February 2021

Context.—CDX2, a critical nuclear transcription factor for intestinal development, is expressed in intestinal epithelium and adenocarcinomas.

Objectives.—To determine if CDX2 is a useful marker for intestinal-type differentiation and to correlate tumor histology with CDX2 staining in colorectal adenocarcinomas.

Design.—Tissue microarrays from 71 colorectal adenocarcinomas, 31 hepatocellular carcinomas, 47 lung adenocarcinomas, 55 squamous cell carcinomas of the lung, 69 neuroendocrine carcinomas of the lung and 43 of the pancreas, 57 pancreatic adenocarcinomas, and 256 endometrial adenocarcinomas were stained with antibody against CDX2.

Results.—CDX2 staining was positive in 51 (71.8%) of 71 colorectal cancers, including 38 (74.5%) of 51 well- or moderately differentiated tumors and 13 (65.0%) of 20 high-grade tumors. Of the high-grade tumors, 5 (71.4%) of 7 mucinous, 3 (100%) of 3 signet ring cell, and 5 (50.0%) of 10 poorly differentiated tumors were positive. Other tumors showing occasional CDX2 staining included 1 of 30 well- or moderately differentiated neuroendocrine carcinomas of the lung and 2 of 43 from the pancreas, 1 of 47 lung adenocarcinomas, 3 of 57 pancreatic adenocarcinomas, and 15 of 256 endometrial carcinomas. Hepatocellular, poorly differentiated neuroendocrine carcinoma of the lung and squamous cell carcinomas of the lung were not immunoreactive for CDX2.

Conclusions.—CDX2 is a useful marker for intestinal-type differentiation, is rarely seen in tumors from the other sites evaluated, and may be useful in determining the site of origin for some metastatic tumors. However, CDX2 is not a sensitive marker for poorly differentiated colorectal carcinoma.
Overcoming the Limitations of Integrated Clinical Digital Imaging Solutions
Authors: Sinard John H. , Mattie Mark E.
Published: February 2021

Context.—Digital imaging is increasingly common in medicine. Vendors of anatomic pathology software have addressed this need by integrating digital image acquisition and storage into their products. While offering a number of advantages, these solutions cannot be easily adapted to accommodate the existing work flow for many pathology departments.

Objective.—To describe a novel solution that maintains the advantages of these integrated solutions but offers many additional flexibilities, making it more compatible with the work flow in most clinical departments.

Design.—This solution involves separating the image acquisition step from the image archiving process and creating dual-image storages for greater usability. Software needed to deploy this modular and scalable solution is described.

Results.—We have deployed this solution at our institution and achieved widespread acceptance and use, with minimal training required. Deployment in the surgical pathology gross specimen room, in particular, has resulted in a significant increase in the number of photographs taken and the percentage of cases documented photographically.

Conclusions.—The complete clinical digital imaging solution described herein is an effective, scalable solution for pathology imaging at a departmental level. Although developed and implemented in an anatomic pathology department, the method described is generally applicable to digital imaging in any large multiuser environment.
Evaluation of Stroma in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome–Affected Bone Marrows and Correlation With CD4 Counts
Authors: O'Malley Dennis P. , Sen Joy , Juliar Beth E. , Orazi Attilio
Published: February 2021

Context.—Little is known about cellular and extracellular composition of fibrosis in bone marrows in the context of human immunodeficiency virus/acquired immunodeficiency syndrome.

Objective.—To evaluate the stromal composition of bone marrows affected by human immunodeficiency virus/ acquired immunodeficiency syndrome and to correlate this with laboratory parameters including CD4 lymphocyte counts.

Design.—We evaluated extracellular matrix and stromal cell composition in bone marrows and correlated these results with hematologic parameters. Extracellular matrix, stromal cells, and smooth muscle differentiation were evaluated by immunohistochemistry for collagen type IV expression and reticulin staining, an antibody directed against low-affinity nerve growth factor receptor (a marker of adventitial reticular cells), and actin staining, respectively. Concurrent laboratory information was collected, including white blood cell count, hemoglobin, platelet count, CD4 count, CD8 count, CD4/CD8 ratio, and absolute lymphocyte count.

Patients.—Bone marrows of 35 patients with human immunodeficiency virus/acquired immunodeficiency syndrome were evaluated.

Main Outcome Measures.—Correlation of reticulin, low-affinity nerve growth factor receptor, actin, and collagen IV staining with hematologic parameters.

Results.—More than half of the bone marrows showed moderate to severe reticulin fibrosis. The degree of reticulin fibrosis was correlated with the degree of low-affinity nerve growth factor receptor expression (P = .048). Actin expression was identified in only 3 of 35 cases and collagen IV in only 5 of 35 cases. No statistical relationship between degree of fibrosis and CD4 count was identified. Lower levels of low-affinity nerve growth factor receptor expression were associated with CD4 counts of >100 (P = .04). Marrow fibrosis was present in almost all cases studied (97%), and the staining of adventitial reticular cells correlated with the degree of reticulin fibrosis.

Conclusions.—There does not appear to be a correlation between CD4 count and degree of fibrosis, suggesting that the mechanism of fibrosis is independent of disease status.
A Simple, Focused, Computerized Query to Detect Overutilization of Laboratory Tests
Authors: Weydert Jamie A. , Nobbs Newell D. , Feld Ronald , Kemp John D.
Published: February 2021

Context.—Although there is nearly universal agreement that laboratory tests are overutilized, the degree of overutilization in a given institution is difficult to quantify and monitor across time.

Objective.—To detect and clearly document repetitive daily ordering of a commonly ordered laboratory test (serum sodium) by employing a simple, focused, computerized query of a test result database followed by chart review and validation.

Design.—A retrospective computerized query of our clinical data repository was performed to find inpatients who displayed normal serum sodium test results on 4 or more consecutive days, without any abnormal values during the same admission. The search was limited to a 1-month period. A subset of these patients was selected for chart review.

Results.—One hundred sixteen patients met our criteria, and the tests ordered for those patients comprised 5.1% of the monthly volume of serum sodium tests ordered in our institution. Chart review revealed a consistent lack of documentation of medical necessity for repeat testing as well as persistence of repeat serum sodium orders until the end of the patients' hospital course.

Conclusions.—We conclude that a focused query of data derived from a clinical data repository can detect and document overutilization of a common laboratory test in a convincing fashion within a given institution.
Molecular Characterization of Glucose-6-Phosphate Dehydrogenase Gene Defect in the Kuwaiti Population
Authors: AlFadhli Suad , Kaaba Salim , Elshafey Alaa , Salim Matra , AlAwadi Anwar , Bastaki Layla
Published: February 2021

Context.—Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common human enzyme deficiencies. More than 130 different molecular abnormalities have been described worldwide, with considerable variation in the enzyme among various racial groups. Data from Kuwaiti populations are scarce, and the studies available are the result of screening male blood donors who may not be truly representative of the Kuwaiti population.

Objective.—The objective of this study was to investigate the mutation spectrum of the G6PD gene among Kuwaiti Arabs.

Design.—DNA was extracted from 82 G6PD-deficient Kuwaiti subjects (75 men and 7 women) and screened for gene mutations using polymerase chain reaction/restriction fragment length polymorphism and polymerase chain reaction/single-strand conformation polymorphism followed by direct sequencing. A total of 1209 randomly selected Kuwaiti adult subjects of both sexes were then screened for any characterized mutation.

Results.—G6PD Mediterranean563C→T, and A−202G→A,376A→G genotypes were characterized as the most common variants among the G6PD-deficient population, representing 0.742 and 0.124 allele frequencies, respectively. The 2 previously described mutations, G6PD Chatham1003G→A and Aures143T→C, were found at lower frequencies (0.101 and 0.034, respectively). The allele frequencies for these 4 G6PD variants among the randomly selected Kuwaitis were 0.035, 0.0074, 0.0046, and 0.0023 for Mediterranean, A−, Chatham, and Aures, respectively.

Conclusion.—This study has characterized the molecular heterogeneity of G6PD variants among ethnic Kuwaitis. The findings suggest that gene flow from the Indian subcontinent, sub-Saharan African, and other parts of the Mediterranean may have contributed to the observed G6PD mutations seen in the Kuwaiti population.
Intraoperative Assessment of the Breast: Guidelines and Potential Pitfalls
Authors: Laucirica Rodolfo
Published: February 2021

Context.—Intraoperative evaluation of breast tissue has changed as newer imaging techniques and surgical approaches to the treatment of breast cancer have placed the pathologist in a pivotal role in the management of this disease. Assessment of the index lesion and surgical margins are but two of the many tasks we face when the specimen arrives in the surgical pathology laboratory. We are also called on to correlate changes in the mammogram with the gross pathology, particularly in those cases in which the lesion is nonpalpable. More recently, pathologists have been asked to analyze 1 or more sentinel lymph nodes at the time of frozen section to look for metastatic disease. This review discusses many of these issues and also provides a simplified approach to the differential diagnosis of a variety of breast lesions one may encounter intraoperatively.

Objective.—To provide guidelines for and address potential pitfalls in the intraoperative management of the breast.

Data Sources.—Author's experience and pertinent literature.

Conclusions.—Careful assessment of the gross specimen coupled with prudent utilization of frozen sections is pivotal to reducing intraoperative error rates and preventing needless anxiety for the patient.
Intraoperative Pathology Consultation for Kidney and Urinary Bladder Specimens
Authors: Truong Luan D. , Krishnan Bhuvaneswari , Shen Steven S.
Published: February 2021

Context.—Intraoperative pathology consultation for kidney and urinary bladder specimens is relatively infrequent. Scant literature is devoted to this topic.

Objective.—The clinical indications and diagnostic usefulness and pitfalls of intraoperative pathology consultation of kidney and urinary bladder specimens will be reviewed, based on literature and personally encountered cases.

Data Sources.—The indications for intraoperative pathology consultation for renal lesions included (1) surgical margins in partial nephrectomy specimens, (2) solid renal mass in unusual clinical or radiologic settings, (3) synchronous renal and extrarenal masses, (4) cystic renal lesions, (5) ureteral surgical margin for transitional cell carcinoma, (6) multiple renal masses, (7) solid mass in a diffusely cystic kidney, and (8) evaluation of renal injury. The indications for urinary bladder included (1) status of the surgical margins, (2) diagnosis of bladder tumor biopsy, (3) diagnosis of extravesical tumors with vesical extension, (4) diagnosis of extravesical mass, including pelvic lymph nodes encountered during cystectomy, and (5) status of bladder neck margin during radical prostatectomy for cancer. The frequent problematic areas for the kidney included misdiagnosis or incorrect classification of cystic tumors or spindle cell tumors, and confusion of clear cell renal cell carcinoma with inflammatory lesions. The problematic areas for urinary bladder included the differential diagnoses of high-grade dysplasia/carcinoma in situ with reactive changes at the ureteral or urethral surgical margins.

Conclusions.—Distinctive indications and diagnostic pitfalls are recognized for intraoperative consultation of renal or urinary bladder lesions. Awareness of the pertinent problems should improve diagnostic accuracy and facilitate the proper management of these lesions.
Pitfalls in Salivary Gland Fine-Needle Aspiration Cytology: Lessons From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology
Authors: Hughes Jonathan H. , Volk Emily E. , Wilbur David C.
Published: February 2021

Context.—We use data from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology to identify common diagnostic errors in salivary gland fine-needle aspiration (FNA).

Objective.—To identify salivary gland FNA cases with poor performance characteristics in the Nongynecologic Cytology Program surveys, so that the most common diagnostic pitfalls can be avoided.

Design.—A retrospective review of the College of American Pathologists Nongynecologic Cytology Program's cumulative data from 1999 to 2003 revealed the most common false-positive and false-negative interpretations on FNA for common salivary gland lesions. Slides that performed poorly were then reviewed to identify the cytologic characteristics that may have contributed to their poor performance.

Results.—A total of 6249 participant responses with general interpretations of benign (n = 4642) or malignant (n= 1607) were reviewed. The sensitivity and specificity of the participant responses for correctly interpreting the cases as benign or malignant were 73% and 91%, respectively. Benign cases with the highest false-positive rates were monomorphic adenoma (53% false-positive), intraparotid lymph node (36%), oncocytoma (18%), and granulomatous sialadenitis (10%). Malignant cases with the highest false-negative rates were lymphoma (57%), acinic cell carcinoma (49%), low-grade mucoepidermoid carcinoma (43%), and adenoid cystic carcinoma (33%). Selected review of the most discordant individual cases revealed possible explanations for some of the interpretative errors.

Conclusions.—These data confirm the difficulty associated with interpretation of salivary gland FNA specimens. Cytologists should be aware of the potential false-positive and false-negative interpretations that can occur in FNAs from this organ site in order to minimize the possibility of diagnostic errors.