bluuebunny/crossref_metadata_2025 huggingface dataset:
Three Cases of Massive Fetomaternal Hemorrhage Presenting Without Clinical Suspicion
Authors: Pourbabak Sam , Rund Chad R. , Crookston Kendall P.
Published: February 2021

Fetomaternal hemorrhage (FMH) is a common obstetrical occurrence most often associated with small volumes of blood transferred across the placenta. Fetomaternal hemorrhage leads to alloimmunization of Rh D-negative mothers, resulting in an increased risk of hemolytic disease of the newborn. Massive FMH involving volumes of blood greater than 30 mL can cause substantial fetal morbidity and mortality. Massive FMH may present with signs and symptoms such as decreased movement, sinusoidal heart rhythms, or fetal anomalies. We present 3 cases of clinically unexpected massive FMH of 206, 88, and 155 mL. The treating clinicians were unaware of any fetal or maternal signs or symptoms of FMH until contacted by the laboratory. These cases illustrate the necessity for FMH quantitation, even in the absence of clinical suspicion. Additional studies are needed to find better ways to identify these patients in advance. Development of criteria allowing identification of patients at risk would be of benefit to both mother and baby.
Balamuthia mandrillaris Meningoencephalitis in an Immunocompetent Patient: An Unusual Clinical Course and a Favorable Outcome
Authors: Jung Sungmi , Schelper Robert L. , Visvesvara Govinda S. , Chang Howard T.
Published: February 2021

Balamuthia mandrillaris meningoencephalitis is a rare but often fatal infection; only 2 survivors have been reported to date worldwide. We report the case of an apparently immunocompetent patient (72-year-old woman) who developed several episodes of seizures without prior history of respiratory or skin infections. Magnetic resonance imaging with contrast revealed 2 ring-enhancing lesions, one in the right precentral region and the other in the left posterotemporal region. Open biopsy revealed Balamuthia encephalitis. The patient was treated with combination antibiotics (pentamidine, 300 mg intravenously once a day; sulfadiazine, 1.5 g 4 times a day; fluconazole, 400 mg once a day; and clarithromycin, 500 mg 3 times a day) and was discharged home. There have been no significant neurological sequelae at this writing (6 months after biopsy). We present this case with unusual clinical course to raise awareness of this infectious disease, which may have a more favorable outcome if diagnosed and treated in its early states.
Human Papillomavirus Typing of Rare Cervical Carcinomas
Authors: Matthews-Greer Janice , Dominguez-Malagon Hugo , Herrera Guillermo A. , Unger James , Chanona-Vilchis José , Caldito Gloria , Turbat-Herrera Elba A.
Published: February 2021

Context.—Most cervical tumors are classified as squamous cell carcinoma or adenocarcinoma, both of which are associated with persistent human papillomavirus (HPV) infection. Although other (rare) types represent less than 5% of all cervical carcinomas, it is necessary that these more unusual tumors be studied in the current era of papillomavirus vaccine development, especially in regions with high incidence of cervical cancer.

Objective.—To compare papillomavirus types found in histologically rare cervical carcinomas (n = 29) with those types found in common cervical carcinomas (n = 14) archived at the Institute of Cancer in Mexico City, Mexico.

Design.—Paraffin-embedded tissues were received and sectioned at the Louisiana State University Health Sciences Center at Shreveport. One section for each block was stained and examined by 2 pathologists. Specific histologies were categorized into 2 broad groups: common (squamous cell carcinoma or adenocarcinoma) or rare (adenosquamous, papillary, villoglandular, anaplastic, transitional, spindle, adenoid basal, colloid, neuroendocrine, and glassy cell carcinomas). Papillomavirus typing results were based on Roche Molecular Systems line-blot assay.

Results.—No significant difference was found for dual HPV types (21% of both groups), positivity for HPV-16 (66% of rare tumors and 71% of common tumors), or absence of HPV types 16 or 18, although the rare cancers had a greater tendency toward more unusual HPV types (8/29 rare tumors and 1/14 common tumors had no HPV- 16 or HPV-18 DNA). Non–HPV-16/18 types found only in rare tumors included HPV types 52, 84, 26, 35, and 58.

Conclusions.—Rare types of cervical carcinoma also are associated with papillomavirus, most with types similar to those found in common cervical neoplasias.
Plasmablastic Lymphoma of the Cervical Lymph Nodes in a Human Immunodeficiency Virus–Negative Patient: A Case Report and Review of the Literature
Authors: Lin Fan , Zhang Kai , Quiery Albert T. , Prichard Jeffrey , Schuerch Conrad
Published: February 2021

We report a case of plasmablastic lymphoma presenting in cervical lymph nodes in an 82-year-old, human immunodeficiency virus–negative man. Cytologic and histologic examinations demonstrated a large cell lymphoma with plasmacytic differentiation. The tumor cells were positive for CD138, CD38, epithelial membrane antigen, CD30, and lysozyme, but lacked expression of leukocyte common antigen, T-cell, and B-cell markers. Abundant Epstein-Barr virus–encoded RNA transcripts were identified by in situ hybridization. A monoclonal rearrangement of κ-light- chain gene was demonstrated. The cytologic, histologic, immunohistochemical, and molecular features of plasmablastic lymphoma are reviewed. The potential diagnostic pitfalls and differential diagnoses, especially in a fine-needle aspiration specimen, are addressed.
Continuous Monitoring of Stat and Routine Outlier Turnaround Times: Two College of American Pathologists Q-Tracks Monitors in 291 Hospitals
Authors: Novis David A. , Walsh Molly K. , Dale Jane C. , Howanitz Peter J.
Published: February 2021

Context.—The laboratory test turnaround times (TATs) that exceed the expectations of clinicians who order those tests, the so-called outlier test reporting rates, may be responsible for perceptions of inadequate laboratory service.

Objective.—To monitor outlier test reporting rates for emergency department stat potassium results and routine inpatient morning blood tests.

Design.—In 2 different monitors, each conducted for 2 years, laboratory personnel in institutions enrolled in the College of American Pathologists (CAP) Q-Tracks program tracked the percentages of emergency department stat potassium results and/or the percentages of morning rounds routine test results that were reported later than self-imposed reporting deadlines.

Setting.—A total of 291 hospitals participating in 2 CAP Q-Tracks monitors.

Results.—Participants monitored 225 140 stat emergency department potassium TATs, of which 33 402 (14.8%) were outliers, and 1 055 040 routine morning test reporting times, of which 123 554 (11.7%) were outliers. For both monitors, there was a significant (P < .05) downward trend in the outlier rates as the number of quarters in which participants submitted data increased.

Conclusion.—Outlier reporting rates for emergency department stat potassium and routine morning test results decreased during the 2-year period of continuous monitoring. The CAP Q-Tracks program provides an effective vehicle by which providers of laboratory services may improve the timeliness with which they deliver the results of laboratory tests.
Expression of Cysteine Protease Protein 32 in Prostatic Adenocarcinoma Correlates With Tumor Grade
Authors: Anwar Shahgul , Ambros Robert A. , Jennings Timothy A. , Ross Jeffrey S. , Beza Anton , Mian Badar , Nazeer Tipu
Published: February 2021

Context.—Controlled cell death is mediated by apoptosis-specific genes, tumor suppressor genes, and oncogenes. The caspase family is a group of at least 15 known cysteine proteases that serve as initiator and effector molecules of the apoptosis pathway. On activation, caspases cause cell shrinkage, condensation of chromatin, fragmentation of DNA, and the formation of blebs in the cytoplasmic membrane.

Objectives.—The patterns of cysteine protease protein (CCP) 32 (caspase-3) expression have been determined in normal human tissues and a variety of tumors, and have been shown to correlate with the outcome in breast cancer and linked to resistance to chemotherapy in other tumors. This study was performed to determine whether CPP32 is expressed in prostatic adenocarcinoma and to define its relationship with outcome variables.

Design.—Formalin-fixed, paraffin-embedded radical prostatectomy specimens from 211 patients with prostatic adenocarcinoma were evaluated for CPP32 expression by immunohistochemistry. Hematoxylin-eosin–stained slides were reviewed, and tumors were graded based on the Gleason grading system. Tumors were scored for CPP32 expression semiquantitatively, based on the staining intensity and distribution patterns. These results were compared with Gleason grade and clinical and pathologic stages.

Results.—One hundred thirty-three (63%) of 211 cases showed high expression of CPP32, whereas expression was low in 78 (37%) cases. One hundred three (49%) of 211 cases had a high Gleason score (7 and above). Of 103 cases with a high Gleason score, 74 (72%) showed high CPP32 expression. Strong cytoplasmic staining for CPP32 in high-grade tumors was statistically significant (P = .01). Also, by linear regression analysis a significant correlation was seen between the Gleason score and the cytoplasmic CPP32 expression (P = .001). Expression of CPP32 did not correlate with either clinical stage (P = .28) or pathologic stage (P = .60); however, this study included very few patients with stage IV disease.

Conclusion.—The correlation between CPP32 and high tumor grade suggests a CPP32-related high turnover rate in high-grade prostatic adenocarcinoma. Moreover, strong correlation with Gleason grade, a powerful predictor of disease progression and overall survival, suggests potential usefulness of CPP32 as a prognostic factor, especially in limited biopsy samples.
Transforming Growth Factor α and Epidermal Growth Factor Receptor in Reactive and Malignant Mesothelial Proliferations
Authors: Cai Yun-Cai , Roggli Victor , Mark Eugene , Cagle Philip T. , Fraire Armando E.
Published: February 2021

Background.—Growth factors such as transforming growth factor α (TGF-α) and epidermal growth factor receptor (EGFR) play an important role in cell proliferation. The immunohistochemical expression of these factors has been extensively studied in malignant tumors including mesothelioma. However, the comparative expression of these growth factors in mesothelioma and reactive mesothelial proliferations has been less well studied.

Objective.—To evaluate the possible role of TGF-α and EGFR in the clinically important distinction between reactive mesothelial proliferations and malignant mesothelioma.

Methods.—The expression of TGF-α and EGFR was studied in 39 cases of mesothelioma and 30 cases of reactive mesothelial proliferations by means of immunohistochemistry.

Results.—Fourteen (70%) of 20 reactive mesothelial proliferations tested and 29 (76%) of 38 mesotheliomas tested expressed TGF-α. One (3%) of 30 reactive mesothelial proliferations and 17 (45%) of 39 mesotheliomas expressed EGFR.

Conclusions.—These results suggest an up-regulation of EGFR in mesothelioma as compared with reactive mesothelial proliferations. This up-regulation further suggests a possible use of EGFR as an adjunct immunohistochemical test in the differential diagnosis of mesothelioma and reactive mesothelial proliferations.
Differential Trends in the Intestinal and Diffuse Types of Gastric Carcinoma in the United States, 1973–2000: Increase in the Signet Ring Cell Type
Authors: Henson Donald Earl , Dittus Christopher , Younes Mamoun , Nguyen Hong , Albores-Saavedra Jorge
Published: February 2021

Context.—During the last 50 years, the incidence and mortality of gastric cancer has declined in many countries. This decline has primarily included the intestinal type (Lauren classification). However, there is an impression among pathologists that the diffuse type, especially the signet ring cell subtype, has become more prevalent.

Objectives.—Using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, we analyzed the trends of the 2 primary types (intestinal and diffuse) of gastric carcinomas from 1973 through 2000.

Design.—Trends in age-adjusted rates were determined for gastric carcinomas through the SEER statistical program (SEER*Stat), which is available on the Internet to the public.

Results.—During the period studied, the intestinal type continued to decline in males, females, African Americans, and whites. The intestinal type was more common in males than in females and more common in African Americans than in whites. In contrast, a consistent increase in the rate of the diffuse type of gastric carcinoma was seen during this period. The rate increased from 0.3 cases per 100 000 persons in 1973 to 1.8 cases per 100 000 persons in 2000. This increase was seen in males, females, African Americans, and whites. The predominant increase occurred in the signet ring type.

Conclusions.—The results indicate a progressive decrease in the incidence of the intestinal type of gastric cancer and an increase in the diffuse type of gastric carcinoma, especially the signet ring cell type. The clinical implications of the increase are considered.
Primary Basal Cell Carcinoma of the Nipple
Authors: Gupta Chakshu , Sheth Dharti , Snower Daniel P.
Published: February 2021

Basal cell carcinoma arising from the nipple of the breast is an uncommon malignancy, with only a handful of cases reported in the literature. The diagnosis is, however, important because basal cell carcinoma in this location can mimic breast cancer, may behave aggressively, and there is a relative lack of consensus in its treatment. A case of basal cell carcinoma of the nipple is described in a 67-year-old man with a brief review of the literature.
Intrascrotal Lipoblastoma With a Complex Karyotype: A Case Report and Review of the Literature
Authors: Somers Gino R. , Teshima Ikuko , Nasr Ahmed , Cook Anthony , Khoury Antoine E. , Taylor Glenn P.
Published: February 2021

Lipoblastoma is a tumor of adipose tissue that usually occurs in young children. Most lipoblastomas occur on the extremities, trunk, and head and neck, and most have rearrangements of the 8q region. We describe a lipoblastoma in a 12-month-old boy who presented with a rapidly enlarging scrotal mass. Electron microscopy revealed features consistent with immature adipocytes, and cytogenetic analysis revealed the following karyotype: 57,XY,+4,+6,+7,der(8)t(8;12) (q22;q13), +der(8)t(8;12) (q22;q13), +9,+10,+12,−16,+17,+der(18)t(8;18)(q22;q23),+19,+20. Interestingly, the breakpoint on chromosome 12 (q13) is the same as that seen in lipoblastomas. To our knowledge, this is the first reported case of such a complex karyotype in lipoblastoma and adds to the expanding list of karyotypic abnormalities seen in such tumors.
Small Intestinal Angiosarcoma Leading to Perforation and Acute Abdomen
Authors: Kelemen Katalin , Yu Qing Qing , Howard Lydia
Published: February 2021

A 76-year-old man presented to the emergency room with abdominal pain and fatigue. The patient had a history of gastrointestinal bleeding. An abdominal computed tomographic scan showed collections of free air in the abdomen with obstruction of the distal small intestine and multiple masses in the liver. Laparotomy revealed a widespread malignant neoplasm in the abdomen, with multiple tumor nodules in the ileal wall, mesentery, and liver. The ileal wall was perforated within the area of one of the tumors. Pathologic examination of the lesion showed a neoplasm composed of solid sheets of spindle and undifferentiated cells, forming interlacing delicate vascular channels with atypical endothelial cells. The tumor cells were positive for the endothelial marker CD31, whereas reactivity for a broad panel of epithelial and other endothelial markers was negative. This case demonstrates that although angiosarcomas of the gastrointestinal tract are rare, they should be considered in cases of intestinal perforation or severe bleeding, especially in the elderly. A broad panel of immunochemical markers might be necessary to establish the pathologic diagnosis.
Progression of Chronic Myeloid Leukemia to Blast Crisis During Treatment With Imatinib Mesylate
Authors: Xu Yin , Wahner Andrea E. , Nguyen Phuong L.
Published: February 2021

Context.—Previous investigators have reported discrepancies between hematologic, marrow morphologic, and cytogenetic responses to imatinib mesylate among patients with chronic myeloid leukemia (CML). In addition to disease refractoriness, rare instances of disease progression from chronic phase to blast crisis during imatinib therapy have recently been anecdotally reported.

Objectives.—To describe the clinicopathologic features of 3 patients with CML who rapidly progressed from chronic phase to blast crisis while taking imatinib and to perform a review of the literature.

Design.—Morphologic, immunophenotypic, and cytogenetic analyses were performed on the 3 patients at the time of initial diagnosis, during imatinib therapy, and at blast crisis.

Results.—The 3 patients were men, aged 39, 42, and 43 years. Two had been treated with hydroxyurea for 16 and 21 months before imatinib therapy, while 1 was started on a regimen of imatinib following diagnosis. Despite a hematologic response in all 3 patients, none of them achieved cytogenetic remission, and all progressed to blast crisis at 7 to 10 months of imatinib therapy. Blood findings during blast transformation were heterogeneous, including normal blood morphologic findings in 1 patient, leukocytosis with circulating blasts and basophilia in 1, and marked pancytopenia in 1. All 3 marrow specimens demonstrated moderate to marked diffuse reticulin fibrosis with more than 20% blasts. Clonal cytogenetic evolution was evident in 2 of the 3 patients and included an extra Philadelphia chromosome in both. All 3 patients underwent allogeneic bone marrow transplantation. One was alive with no evidence of disease at 14 month follow-up, while 2 had residual disease after bone marrow transplantation and died of complications at 4 and 5 months after transplantation.

Conclusions.—Blood data did not always reflect marrow status. Therefore, bone marrow follow-up is critical for monitoring of response. Our findings suggest that significant progression of marrow reticulin fibrosis during imatinib therapy can be an indicator for a return or progression of CML and, in some patients with CML, imatinib may promote cytogenetic clonal evolution, resulting in a poor response to treatment.
Angioimmunoblastic T-Cell Lymphoma With Cutaneous Involvement: A Case Report With Subtle Histologic Changes and Clonal T-Cell Proliferation
Authors: Huang Chien-Tai , Chuang Shih-Sung
Published: February 2021

Angioimmunoblastic T-cell lymphoma is a nodal peripheral T-cell lymphoma that rarely involves the skin. We describe a 62-year-old Taiwanese man who developed a second relapse of angioimmunoblastic T-cell lymphoma with generalized erythroderma and numerous plaquelike and nodular lesions. Biopsy of the erythematous skin lesion demonstrated mild infiltrate of atypical small lymphocytes, some with clear cytoplasm. The lymphoid infiltrate was located mainly around skin appendages and in the upper dermis without epidermotropism. Immunohistochemically, these atypical lymphocytes expressed CD3. Polymerase chain reaction analysis for T-cell receptor γ-chain gene rearrangement using paraffin section showed the same-sized monoclonal bands in the skin and 2 previous nodal biopsies. We conclude that the histologic features of angioimmunoblastic T-cell lymphoma involving skin may be very subtle, showing only mild lymphoid infiltrate. Awareness of the history of angioimmunoblastic T-cell lymphoma with ancillary studies, including clonality testing for T-cell receptor gene rearrangement, is crucial for reaching an accurate diagnosis.
Chordoid Glioma: Clinicopathologic Profile and Differential Diagnosis of an Uncommon Tumor
Authors: Buccoliero Anna Maria , Caldarella Adele , Gallina Pasquale , Lorenzo Nicola Di , Taddei Antonio , Taddei Gian Luigi
Published: February 2021

Chordoid glioma is an uncommon low-grade brain neoplasm arising in the third ventricular region, predominantly in middle-aged women. It characteristically shows chordoma-like histologic features and glial fibrillary acidic protein immunoreactivity. We present a case of chordoid glioma in a previously healthy 56-year-old woman admitted to our hospital because of a cranial trauma subsequent to an incidental fall. Radiologic examinations revealed a well-demarcated, partially cystic, enhancing mass at the level of the lamina terminalis. The lesion was surgically removed. The patient remained alive and well 8 months after the surgery. Histologically, the tumor consisted of clusters and cords of epithelioid cells embedded in a mucinous matrix. Lymphoplasmacytic infiltrates and Russell bodies were prominent. Immunohistochemically, the tumor cells were positive for glial fibrillary acidic protein, neurofilaments, and neuron-specific enolase, suggesting a divergent neuronal and glial differentiation. The Ki-67 index was low. The clinicopathologic profile and the differential diagnosis of this tumor are discussed.
Isolated Gastric Malakoplakia: A Case Report and Review of the Literature
Authors: Gustavo Lastra-Camacho , Robert Marie E. , Lamps Laura W. , Lagarde Suzanne P. , Jain Dhanpat
Published: February 2021

A 62-year-old African American woman presented with weight loss and dyspepsia. She did not have any clinical evidence of immunodeficiency. Upper gastrointestinal endoscopy revealed multiple small polypoid lesions in the gastric body and fundus that appeared larger and more erythematous than usual fundic gland polyps. Examination of biopsy specimens revealed an infiltrate of large histiocytes with eosinophilic granular cytoplasm located in the lamina propria and containing Michaelis-Gutmann bodies. These histologic findings were diagnostic of gastric malakoplakia. Gastrointestinal malakoplakia is uncommon, and exclusive gastric involvement is extremely rare. Because occult bacterial infection has been postulated as the underlying cause of malakoplakia, the presence of Helicobacter pylori infection was investigated using immunohistochemical and serologic techniques, and the presence of Yersinia enterocolitica or Yersinia pseudotuberculosis infection was investigated by polymerase chain reaction assay. There was no evidence of H pylori, Y enterocolitica, or Y pseudotuberculosis in these biopsy specimens, and there was no evidence of malakoplakia or concurrent malignancy at any other site. Follow-up examination 12 months later revealed no endoscopic or histologic improvement.
Disseminated Microsporidiosis in a Pancreas/Kidney Transplant Recipient
Authors: Carlson James R. , Li Li , Helton Cathleen L. , Munn Robert J. , Wasson Katherine , Perez Richard V. , Gallay Brian J. , Finkbeiner Walter E.
Published: February 2021

Human microsporidiosis has been described most commonly in patients with acquired immunodeficiency syndrome and only rarely in those with other forms of immunosuppression. Only 11 cases of microsporidiosis have been reported previously in solid transplant recipients. To our knowledge, this is the first report to describe a case of microsporidiosis in a pancreas/kidney transplant recipient in whom multi–organ system dissemination was observed. This infection was not detected until postmortem examination of stained tissue sections revealed microsporidian spores that were identified as Encephalitozoon species by transmission electron microscopy. It is suspected that leakage from the duodenal anastomosis to the bladder may have contributed to the dissemination of this infection.
Primary Glomangioma of the Liver: A Case Report and Review of the Literature
Authors: Jaiswal Vilkesh R. , Champine Julie G. , Sharma Suash , Molberg Kyle H.
Published: February 2021

Glomangiomas are a subset of glomus tumors that have a rich vascular network. Although a majority of the glomus tumors occur in the skin of the hand, they have also been reported in the deep soft tissue, bone, lungs, and gastrointestinal tract, especially the stomach. To our knowledge, only one such case has previously been reported primarily occurring in the liver. We report a case of a glomangioma primarily arising in the liver of a 57-year-old man who presented with right flank pain of several months' duration. A 3.0-cm hepatic mass was excised and consisted of numerous, small-to-medium branched vessels with the stroma containing small, round, regular cells with sharply outlined round-to-oval nuclei. Immunostains showed the tumor cells to be diffusely positive for vimentin and smooth muscle actin and to be focally positive for calponin. Collagen IV stained the pericellular matrix. The immunostain for CD34 highlighted the vascular network as well as outlined the tumor cells in many areas. Coexpression of actin and CD34 in glomus tumors, although unusual, has recently been reported in the literature. Despite its bland histology, the large tumor size and deep visceral location were suggestive of aggressive behavior; thus, a close clinical follow-up was recommended. The patient had an unremarkable postoperative course and has no evidence of metastatic disease 12 months after the procedure. An accurate diagnosis and an understanding the biology of this rare disease, especially in an unusual location, are crucial to its management.
Trends in Blood Culture Contamination: A College of American Pathologists Q-Tracks Study of 356 Institutions
Authors: Bekeris Leonas G. , Tworek Joseph A. , Walsh Molly K. , Valenstein Paul N.
Published: February 2021

Context.—Blood culture contamination extends hospital stays and increases the cost of care.

Objectives.—To measure blood culture contamination rates in a large number of institutions over time and to elucidate practice patterns and demographic factors associated with sustained reduction in contamination rates.

Design.—Longitudinal cohort study of 356 clinical laboratories that provided quarterly data about blood culture results, using a uniform definition of contamination. Mixed linear model analysis of the 1999 through 2003 data set.

Results.—Blood culture contamination was significantly higher in institutions that used nonlaboratory personnel to collect blood (P = .03) and significantly lower in facilities that used a dedicated phlebotomy team (P < .001). Higher volume of blood collection was significantly associated with lower contamination rates (P < .001). Continued participation in the Q-Tracks monitoring program was associated with significant and progressive reduction in contamination rates. By the fifth year of participation, the median institution had reduced its blood culture contamination rate by 0.67% (P < .001).

Conclusions.—Institutions that use decentralized patient-centered personnel rather than dedicated phlebotomy teams to collect blood cultures experience significantly higher contamination rates. Long-term monitoring of contamination is associated with sustained improvement in performance.
Point-of-Care Testing Error: Sources and Amplifiers, Taxonomy, Prevention Strategies, and Detection Monitors
Authors: Meier Frederick A. , Jones Bruce A.
Published: February 2021

Context.—In a survey performed 4 years ago, testing venues doing only point-of-care testing (POCT) made up 78% of sites for patient testing licensed under federal regulations.

Objectives.—To identify sources of POCT error, to present a classification of such errors, to suggest strategies to prevent errors, and to describe monitors that assess and reduce the frequency of errors.

Design.—To identify sources of POCT error, large studies of error among US Federal Certificate of Waiver laboratories (CoWs) and practitioner-performed microscopy certificate holders were reviewed. To facilitate investigation and management of POCT error, a taxonomy of such errors (modified from a classification previously published by Gerald Kost) was used to identify 4 steps with error potential in each of the 3 phases (ie, preanalytic, analytic, and postanalytic) of the POCT process. To prevent observed POCT errors, 4 strategies are suggested: direct observation of instrument/method functionality, structured observation of method performance, proficiency testing/use of relevant test scenarios, and autonomation. To assess frequency of errors, a quartet of indices are introduced as detection monitors: order documentation, patient identification, specimen adequacy, and result integrity.

Results.—Three sources of POCT error were identified: operator incompetence, nonadherence to test procedures, and use of uncontrolled reagents and equipment. Three other characteristics of many point-of-care tests amplify their risk of error: incoherent regulation, rapid availability of results, and the results' immediate therapeutic implications. Two members of the quartet of detection monitors, order documentation and specimen adequacy, are relatively difficult to measure and are controversial, but the other 2, patient identification and result integrity, are easier to assess and are relatively widely accepted.

Conclusions.—Point-of-care testing errors are relatively common, their frequency is amplified by incoherent regulation, and their likelihood of affecting patient care is amplified by the rapid availability of POCT results and the results' immediate therapeutic implications. The modified Kost taxonomy offers a reasonable approach to the identification of POCT errors. Direct observation of test functionality, structured observation of test performance, and testing the competence of POCT operators, as well as autonomation of devices, are strategies to prevent such errors. In this context, we suggest monitoring POCT order documentation, patient identification, specimen integrity, and result reporting to detect errors in this sort of testing.
Solitary Testicular Myofibroma: A Case Report and Review of the Literature
Authors: Fine Samson W. , Davis North J. , Lykins Lawrence E. , Montgomery Elizabeth
Published: February 2021

Myofibromas are benign mesenchymal neoplasms of myofibroblastic origin. Most present as solitary lesions at any age, but the presentation of multiple lesions in newborns and infants is known as infantile myofibromatosis. Multicentric lesions commonly involve soft tissues and bone and may involve internal organs, where they are associated with an unfavorable prognosis. Solitary lesions involving the viscera are rare. We report a case of a 3-month-old male infant with a left testicular mass detected during an evaluation for suspected torsion. The patient underwent orchiectomy, revealing a nodular mass with grossly evident foci of necrosis. Histologically, the lesion exhibited small fascicles of plump eosinophilic, smooth muscle actin–positive spindle cells, alternating with larger areas of primitive cells with vesicular nuclei and scant cytoplasm arranged around a hemangiopericytoma-like vasculature. To our knowledge, this is the first report of a myofibroma localized within the testis.
Review and Update of Uncommon Primary Pleural Tumors: A Practical Approach to Diagnosis
Authors: Granville Laura , Laga Alvaro C. , Allen Timothy Craig , Dishop Megan , Roggli Victor L. , Churg Andrew , Zander Dani S. , Cagle Philip T.
Published: February 2021

Objective.—We address the current classifications and new changes regarding uncommon primary pleural tumors. Primary pleural tumors are divided according to their behavior and are discussed separately as benign tumors, tumors of low malignant potential, and malignant neoplasms.

Data Sources.—Current literature concerning primary pleural neoplasms was collected and reviewed.

Study Selection.—Studies emphasizing clinical, radiological, or pathologic findings of primary pleural neoplasms were obtained.

Data Extraction.—Data deemed helpful to the general surgical pathologist when confronted with an uncommon primary pleural tumor was included in this review.

Data Synthesis.—Tumors are discussed in 3 broad categories: (1) benign, (2) low malignant potential, and (3) malignant. A practical approach to the diagnosis of these neoplasms in surgical pathology specimens is offered. The differential diagnosis, including metastatic pleural neoplasms, is also briefly addressed.

Conclusions.—Uncommon primary pleural neoplasms may mimic each other, as well as mimic metastatic cancers to the pleura and diffuse malignant mesothelioma. Correct diagnosis is important because of different prognosis and treatment implications for the various neoplasms.
Nasal Chondromesenchymal Hamartoma in Older Children and Adults: Series and Immunohistochemical Analysis
Authors: Ozolek John A. , Carrau Ricardo , Barnes E. Leon , Hunt Jennifer L.
Published: February 2021

Context.—Nasal chondromesenchymal hamartoma is a benign mass lesion of the nasal cavity predominantly described in young infants. These unusual lesions are composed of a proliferation of mesenchymal and cartilaginous elements. Their pathogenesis is unknown, but they may be derived from embryologic rests. To our knowledge, only 1 case in an older child has been reported, and no cases have been reported in adults.

Objective.—To report 4 cases of nasal chondromesenchymal hamartoma occurring in older children and adults, including immunohistochemical analysis of these unusual lesions.

Design.—Cases identified from our archives were examined to confirm the diagnosis of nasal chondromesenchymal hamartoma. Immunohistochemical analysis was performed using a panel of antibodies (epithelial membrane antigen, smooth muscle actin, all muscle actin, cytokeratin, S100, and KP1) to evaluate for epithelial, smooth muscle, neural, chondroid, and histiocytic differentiation.

Results.—Four cases of nasal chondromesenchymal hamartoma in patients of 11, 69, 17, and 25 years of age demonstrated histologic evidence of mesenchymal and cartilaginous elements underlying a chronically inflamed respiratory mucosa. Bony and adipose elements and rare glandular elements were interspersed. Cartilaginous elements stained strongly with S100, whereas mesenchymal regions showed variable and weaker staining. Smooth muscle differentiation was seen primarily in the mesenchymal areas. Epithelial membrane antigen was focally positive in all cases.

Conclusions.—Nasal chondromesenchymal hamartomas can rarely occur in the older child and adult. Mesenchymal areas show both myofibroblastic and cartilaginous differentiation. We speculate that inflammation or a recapitulation of developmental signals may be components in the pathogenesis of these lesions.
The Centennial Anniversary of the Frozen Section Technique at the Mayo Clinic
Authors: Gal Anthony A.
Published: February 2021

The frozen section technique has become an invaluable tool to assist the surgeon with intraoperative diagnosis. Although there were various descriptions of frozen section technique before and after the turn of the 20th century, the publication by Louis B. Wilson, MD, at the Mayo Clinic in 1905 heralded the beginning of a new era in intraoperative diagnosis. This historical review traces the circumstances that led to this landmark publication 100 years ago.
Phenotype Matching of Donor Red Blood Cell Units for Nonalloimmunized Sickle Cell Disease Patients: A Survey of 1182 North American Laboratories
Authors: Osby Melanie , Shulman Ira A.
Published: February 2021

Context.—The transfusion of donor red blood cell units (RBCs) that lack certain red cell antigens (such as C, E, and K) when the corresponding antigens are absent from the recipient's red cells has been shown to reduce the risk of red cell alloimmunization in sickle cell disease patients. However, data are limited regarding the extent to which transfusion services routinely perform red cell antigen phenotype testing of nonalloimmunized sickle cell disease patients, and then use that information to select donor RBCs lacking 1 or more of the red cell antigens that the patient's red cells do not express.

Objective.—To determine the extent to which transfusion services routinely perform red cell antigen phenotype testing of nonalloimmunized sickle cell disease patients, and then use that information to select donor RBCs lacking 1 or more of the red cell antigens that the patient's red cells do not express.

Design.—An educational subsection of a College of American Pathologists Proficiency Testing Survey (J-C 2003) assessed transfusion service practices regarding performance of red cell antigen phenotype testing of nonalloimmunized sickle cell disease patients and how transfusion services use this information for the selection of donor RBCs. The data analysis of the survey included 1182 North American laboratories.

Results.—Data from 1182 laboratories were included in the survey analysis, of which the majority (n = 743) reported that they did not routinely perform phenotype testing of sickle cell disease patients for antigens other than ABO and D. The other 439 laboratories reported that they did routinely perform phenotype testing of sickle cell disease patients for antigens in addition to ABO and D. The majority of these 439 laboratories (three fourths; n = 330) reported that they used these patient data for prophylactic matching with donor RBCs when sickle cell disease patients required transfusion. When phenotype-matched donor RBCs were used, the antigens most commonly matched (85% of the time) were C, E, and K.

Conclusions.—The majority of North American hospital transfusion service laboratories do not determine the red cell antigen phenotype of nonalloimmunized sickle cell disease patients beyond ABO and D. Those laboratories that do determine the red cell phenotype of nonalloimmunized sickle cell disease patients beyond ABO and D most commonly match for C, E, and K antigens when phenotype-matched donor RBCs are used.
Estrogen Receptor Expression in Papillary Urothelial Carcinoma of the Bladder and Ovarian Transitional Cell Carcinoma
Authors: Croft Philip R. , Lathrop Sarah L. , Feddersen Richard M. , Joste Nancy E.
Published: February 2021

Context.—Relatively little is known about estrogen receptor (ER) expression in papillary urothelial carcinoma (PUC) of the bladder. Greater understanding of this feature of PUCs could aid with the treatment and identification of the origin of metastases, particularly with relation to the morphologically similar entity of ovarian transitional cell carcinoma (TCC).

Objective.—To assess the presence of ERs in PUC of the bladder, its metastases, and ovarian TCC.

Design.—Formalin-fixed, paraffin-embedded archival tissue from 92 primary bladder PUCs, 11 PUC metastases, and 11 primary or metastatic ovarian TCCs was immunostained with a monoclonal antibody against the human ER β-molecule. The ER-positive and ER-negative tumors were compared by the patients' sex and age, tumor grade, and the presence or absence of invasion. Statistical analysis was performed on the PUC results, first defining a positive result as staining of at least 10% of nuclei and then repeated using any percentage of staining as a positive result.

Results.—By the 10% criterion, 11% of PUCs of the bladder were ER positive. Invasive PUCs were more likely to be ER positive (P = .10). Women with ER-positive PUCs were older than their male counterparts (P = .03). By the second criterion, 22% of all PUCs were ER positive, and both higher grade and the presence of invasion were significantly associated with ER expression (P = .004 and .01, respectively). All 11 PUC metastases were totally ER negative. Ten of the 11 ovarian TCC cases exhibited strong and diffuse ER expression.

Conclusion.—Depending on the criterion used, up to 22% of bladder PUCs were ER positive. Higher grade and the presence of invasion were significantly associated with ER expression in these bladder carcinomas. In contrast, almost all of the ovarian TCCs marked strongly for ERs, a characteristic that may help differentiate these lesions from PUCs metastatic to the ovary.
An Algorithmic Approach to the Brain Biopsy—Part I
Authors: Kleinschmidt-DeMasters B. K. , Prayson Richard A.
Published: February 2021

Context.—The formulation of appropriate differential diagnoses for a slide is essential to the practice of surgical pathology but can be particularly challenging for residents and fellows. Algorithmic flow charts can help the less experienced pathologist to systematically consider all possible choices and eliminate incorrect diagnoses. They can assist pathologists-in-training in developing orderly, sequential, and logical thinking skills when confronting difficult cases.

Objective.—To present an algorithmic flow chart as an approach to formulating differential diagnoses for lesions seen in surgical neuropathology.

Design.—An algorithmic flow chart to be used in teaching residents.

Results.—Algorithms are not intended to be final diagnostic answers on any given case. Algorithms do not substitute for training received from experienced mentors nor do they substitute for comprehensive reading by trainees of reference textbooks. Algorithmic flow diagrams can, however, direct the viewer to the correct spot in reference texts for further in-depth reading once they hone down their diagnostic choices to a smaller number of entities. The best feature of algorithms is that they remind the user to consider all possibilities on each case, even if they can be quickly eliminated from further consideration.

Conclusions.—In Part I, we assist the resident in learning how to handle brain biopsies in general and how to distinguish nonneoplastic lesions that mimic tumors from true neoplasms.
Aplicação da hipótese de fragilidade financeira na economia brasileira: uma análise do problema fiscal do governo Dilma Rousseff
Authors: Souza Eduardo Prado , Arend Marcelo
Published: February 2021

O presente trabalho tem como principal objetivo aplicar a hipótese de fragilidade financeira no setor público brasileiro para conseguir analisar e buscar possíveis justificativas para o problema fiscal do governo de Dilma Rousseff, sendo dessa forma necessária uma análise dos governos anteriores, bem como trazer o arcabouço pós keynesiano através do indicador de fragilidade financeira desenvolvido por Fabio Terra e Ferrari Filho para fundamentação desta. O que se concluiu é que as variáveis fiscais corroboram o problema fiscal, e mesmo que o indicador de fragilidade financeira tenha resultado em um valor especulativo, é denotado uma situação relativamente frágil para o setor público, que é basicamente justificado pelas políticas adotadas durante o governo de Dilma Rousseff, mas que também são justificados pelas atuações de governo anteriores.
Algumas considerações a condução da Política monetária do Novo Consenso Macroeconômico a luz da visão keynesiana
Authors: Saraiva Paulo Jose
Published: February 2021

Neste artigo são abordados, brevemente, os principais elementos teóricos do Novo Consenso Macroeconômico pré e pós crise américa de 2007. Como contraponto, se apresenta a visão pós keynesiana, bem como as implicações desta para a condução da política monetária. Para tanto, são debatidos os objetivos e instrumentos da política monetária, no que se refere ao papel desempenhado pelos bancos e pelas firmas não bancárias no mecanismo de transmissão da política monetária, além de suas implicações em relação ao investimento e o crescimento econômico. Por fim, são elencadas as críticas keynesianas a visão tradicional.
Para uma metodologia de incubação de grupos de consumo responsável – alternativas para a comercialização na economia solidária e agroecologia
Authors: Cruz Antônio Carlos Martins da
Published: February 2021

As incubadoras tecnológicas de cooperativas populares (ITCPs) existem, hoje, em aproximadamente cinquenta universidades brasileiras. Elas dão apoio ao surgimento e consolidação de empreendimentos econômicos solidários (EES), em geral no setor produtivo (manufatura, agricultura, serviços, reciclagem). Entretanto, a comercialização dos EESs enfrenta grandes obstáculos nos circuitos convencionais, relacionados especialmente às escalas e aos preços de venda (que em geral ignoram as especificidades dos produtos). Por outro lado, há um número crescente de consumidores/as preocupados em apoiar esses empreendimentos e seus produtores a partir de critérios relacionados à sustentabilidade, à saude e ao desenvolvimento local. Por este motivo, nos últimos dez anos, se multiplicar os grupos de consumo responsável (GCRs): formas associativas dirigidas ao consumo ético. A aliança entre EES e GCRs permite a consolidação de ‘circuitos locais de comercialização solidária’ (CLCS). Esta vinculação, porém, uma prévia organização dos produtores entre si, e/ou dos consumidores entre si. O presente artigo apresenta os resultados preliminares da experiência de uma microrrede de ITCPs no processo de incubação de um GCR na cidade de Pelotas (RS, Brasil), em parceria com aproximadamente 35 EES afiliados a uma organização de comercialização solidária (a Associação Bem da Terra – Comércio Justo e Solidário).
Reflexões sobre a competência comunicativa e a formação de professores de língua estrangeira e suas competências
Authors: Padilha Emanuele Coimbra
Published: February 2021

Este trabajo objetiva reflexionar sobre las consecuencias de la aparición del concepto de competencia comunicativa para la formación de profesores de lenguas extranjeras. Para tanto, se presentan los principales puntos de la teoría de Hymes (1995) y Canale (1995), acerca la relación de este término con la enseñanza/aprendizaje de lengua extranjera y segunda lengua; y el impacto de la ampliación de esta teoría para la construcción de las competencias de los profesores de lenguas. Partiendo de la finalidad inicial de esta investigación es posible afirmar que la formación inicial de profesores debe desarrollar en los estudiantes no sólo la competencia gramatical, sino también la discursiva, la sociolingüística y la estratégica, que forman parte de la competencia comunicativa.
Estudo comparativo entre o Ciclo de ensino/aprendizagem da LSF e a Sequência didática do ISD: construtos teóricos e procedimentos metodológicos
Authors: Almeida Michele Mafessoni de
Published: February 2021

A publicação dos Parâmetros Curriculares Nacionais para ensino fundamental e para o ensino médio (BRASIL, 1999) iniciou uma discussão sobre a necessidade de realizar uma mudança de perspectiva no ensino de línguas no Brasil. As orientações desses documentos propuseram que o foco das tarefas não estivesse apenas em aspectos do sistema linguístico, mas no trabalho com a construção de sentido por meio dos textos (BRASÍLIA, 2010). Este artigo propõe-se a discutir o ensino de Língua Adicional (LA), pautado pelos gêneros, de acordo com dois modelos de didatização: o Ciclo de Ensino/Aprendizagem (CEA) (MARTIN; ROSE, 2012; ROSE, 2013) e a Sequência Didática (SD) (SCHNEUWLY; DOLZ, 2004; DOLZ, 1999). Para isso, metodologicamente, realiza-se uma revisão teórica dos conceitos centrais dessas perspectivas, a fim de compreender o modo como constroem sua proposta didática. Após cotejá-las, pôde-se observar que apresentam semelhanças, uma vez que estabelecem o gênero como elemento organizador e intermediador da aprendizagem escolar. Além disso, ambas entendem que a aprendizagem ocorre na ZDP, facilitada pelo andaimento. No entanto, observa-se uma diferença na sua estruturação procedimental. Enquanto a SD organiza-se a partir de uma primeira produção escrita ou oral, o CEA é sistematizado a partir de uma atividade de leitura e análise textual. Isso significa que, antes do aluno realizar a tarefa, o professor mostra-lhe como fazê-la. A opção por uma ou outra metodologia para o ensino de LA poderá variar de acordo com a proficiência dos estudantes e/ou com o conhecimento que o professor possui das competências que precisam ser desenvolvidas pelos discentes.