bluuebunny/crossref_metadata_2025 huggingface dataset:
How the Pediatric Autopsy Yields Valuable Information in a Vertically Integrated Health Care System
Authors: Newton David , Coffin Cheryl M. , Clark Edward B. , Lowichik Amy
Published: February 2021

Context.—Although autopsy rates have declined significantly in recent decades, studies continue to validate the autopsy as an important source of clinically relevant information, a teaching tool, and a quality assurance measure. A recent review of autopsy series showed a decline in the number of serious errors likely to have affected clinical outcome detected at autopsy during the past 46 years, with a current major error rate of 8.4% to 24.4%.

Objective.—Our hypothesis was that the pediatric autopsy would uncover a significant number of major unexpected findings at the high end of the spectrum predicted by a recent review. This study assesses the unexpected findings at a pediatric hospital whose autopsy service handles both in-house (tertiary care) and referral (mostly perinatal) cases for a vertically integrated health care system.

Design.—Data were analyzed from an autopsy effectiveness report completed for all autopsies performed in 2000. The data from this series include concordance of premortem and postmortem diagnoses, with the autopsy considered the criterion standard. The autopsy effectiveness report also provided logistic information, such as problems with consents, medical records, specimen identification, and prosection.

Setting.—Pediatric autopsies were performed by members of the Pediatric Pathology Division in a freestanding children's hospital in the Intermountain West of the United States with a large rural catchment area. This hospital is part of a large health maintenance organization serving the surrounding urban and rural areas.

Patients.—A sample of all in-house and referral autopsies for the year 2000 was examined.

Main Outcome Measure.—The percentage of cases with a major or minor diagnostic discrepancy or unexpected pathologic finding using the autopsy as the criterion standard.

Results.—The overall autopsy rate was 40% (39 hospital autopsies and 15 forensic autopsies per 135 total deaths) and was 32% excluding forensic cases. Twenty-two additional referral autopsies from outside institutions were performed. Of 61 autopsies, 12 (20%) revealed a major diagnostic discrepancy or unexpected pathologic finding, 17 (28%) had a minor unexpected finding or additional diagnosis, 41 (67%) clarified the differential diagnosis, 46 (75%) confirmed or verified a major diagnosis, and 21 (34%) provided information regarding treatment effects. Additionally, 3 (5%) had problems with identification, and 12 (20%) had problems with consent, all of which were resolved prior to initiation of the autopsy.

Conclusions.—These data confirm the value of the pediatric autopsy in a children's hospital and a vertically integrated health care system. It is an important medical and quality assurance procedure for assessing the accuracy of diagnoses, clarifying differential diagnoses, yielding unexpected findings, and providing feedback regarding therapeutic outcomes.
Combinatorial Genetic Technology for the Development of New Anti-infectives
Authors: Laios Eleftheria , Waddington Marny , Saraiya Ashesh A. , Baker Kris Ann , O'Connor Elizabeth , Pamarathy Deepika , Cunningham Philip R.
Published: February 2021

Context.—We previously developed a novel technology known as instant evolution for high-throughput analysis of mutations in Escherichia coli ribosomal RNA.

Objective.—To develop a genetic platform for the isolation of new classes of antiinfectives that are not susceptible to drug resistance based on the instant evolution system.

Design.—Mutation libraries were constructed in the 16S rRNA gene of E coli and analyzed. In addition, the rRNA genes from a number of pathogenic bacteria were cloned and expressed in E coli. The 16S rRNA genes were incorporated into the instant-evolution system in E coli.

Setting.—The Department of Biological Sciences, Wayne State University, Detroit, Mich.

Main Outcome Measures.—Ribosome function was assayed by measuring the amount of green fluorescent protein produced by ribosomes containing mutant or foreign RNA in vivo.

Results.—We have developed a new combinatorial genetic technology (CGT) platform that allows high-throughput in vivo isolation and analysis of rRNA mutations that might lead to drug resistance. This information is being used to develop anti-infectives that recognize the wild type and all viable mutants of the drug target. CGT also provides a novel mechanism for identifying new drug targets.

Conclusions.—Antimicrobials produced using CGT will provide new therapies for the treatment of infections caused by human pathogens that are resistant to current antibiotics. The new therapeutics will be less susceptible to de novo resistance because CGT identifies all mutations of the target that might lead to resistance during the earliest stages of the drug discovery process.
Flow Cytometric Evaluation of Posttransplant B-Cell Lymphoproliferative Disorders
Authors: Kaleem Zahid , Hassan Anjum , Pathan M. Hanif , White Glenda
Published: February 2021

Context.—Posttransplant B-cell lymphoproliferative disorders (PTLDs) constitute a heterogeneous group that includes hyperplastic and unique polymorphic lesions at one end of the spectrum and monomorphic lymphoid proliferations indistinguishable morphologically from conventional B-cell non-Hodgkin lymphomas (NHLs) at the other end. Almost all the PTLDs are of B-cell origin, with only rare examples of T-cell phenotype described. Despite a plethora of information available on the morphologic spectrum, pathogenetic role of Epstein-Barr virus, and various treatment options, a detailed flow cytometric immunophenotypic evaluation of PTLDs is largely lacking.

Objective.—To evaluate the immunophenotypic profiles of various PTLDs using multiparameter flow cytometric analysis to compare and contrast with conventional de novo B-cell lymphoproliferative disorders and to identify any immunophenotypic patterns useful in diagnosis.

Design.—We retrospectively analyzed data on the immunophenotype of 25 cases of pediatric and adult PTLD (12 cases of monomorphic PTLD [m-PTLD] and 13 cases of polymorphic PTLD [p-PTLD]) using multiparameter flow cytometry in addition to routine morphologic and immunohistochemical evaluation. The flow cytometric immunophenotypic data were also compared and contrasted with 334 cases of various de novo B-cell NHLs during the same period as a control group.

Results.—We observed a much higher incidence of lack of surface immunoglobulin light chains and CD20 expression in B-cell PTLDs using multiparameter flow cytometry in comparison with de novo B-cell NHL as a group (with the exception of small lymphocytic lymphoma). Four (16%) of 25 cases of PTLD (3 m-PTLD and 1 p-PTLD) showed almost complete lack (CD20%/CD19% ratio < 1:9) of CD20 expression in contrast to only 8 (∼2%) of 334 cases of de novo B-cell NHL (P = .007). Several other cases of both m-PTLD and p-PTLD also showed partial and dim expression of CD20. Nine (36%) of 25 cases, including 5 cases of m-PTLD and 4 of p-PTLD, showed either an almost complete lack (light chains%/CD19% ratio < 1:9) or significant loss (>50% loss) of surface immunoglobulin light chains in contrast to less than 5% incidence of light-chain negativity in conventional de novo B-cell NHL. Immunoglobulin light-chain clonality was observed in 9 cases (5 m-PTLD and 4 p-PTLD). Seven cases (5 p-PTLD and 2 m-PTLD) had polyclonal expression of immunoglobulin κ and λ light chains. The m-PTLD showed expression patterns of CD5, CD10, and CD23 similar to their de novo counterparts.

Conclusions.—Both polymorphic and monomorphic PTLDs show a higher incidence of lack of CD20 and surface immunoglobulin light-chain expression. The lack of CD20 expression in these lesions may have therapeutic implications, since anti-CD20 antibody has increasingly become an important modality in the treatment of B-cell lymphoproliferative disorders, including posttransplant disorders.
Allelic Loss of the Active X Chromosome During Bladder Carcinogenesis
Authors: Cheng Liang , MacLennan Gregory T. , Pan Chong-Xian , Jones Timothy D. , Moore Curtiss R. , Zhang Shaobo , Gu Jian , Patel Namrata B. , Kao Chinghai , Gardner Thomas A.
Published: February 2021

Context.—Previous studies have shown that loss of the X chromosome is involved in the carcinogenesis of certain human malignancies.

Objective.—To determine whether X-linked allelic losses occur during bladder tumorigenesis and whether such losses involve the active or the inactive X chromosome.

Design.—We analyzed the deletion status of the X-linked human androgen receptor gene locus in 6 female patients who underwent radical cystectomies for muscle-invasive urothelial carcinoma of the urinary bladder. Four patients had coexisting urothelial carcinoma in situ. Analysis for inactivation of the X chromosome was carried out in parallel.

Results.—Three cases were informative. Invasive tumor samples showed loss of heterozygosity involving the active allele at the androgen receptor locus in all 3 positive cases, whereas carcinoma in situ showed nonrandom X chromosome inactivation but not allelic deletion.

Conclusions.—Our data suggest that allelic loss of the activated X chromosome is involved in bladder carcinogenesis and cancer progression.
Advanced Gastric Carcinoma With a Complete Intestinal Metaplasia Phenotype Associated With Early Intestinal-Type Carcinoma
Authors: Rivera-Hueto Francisco , Lag-Asturiano Encarnación , Utrilla-Alcolea JoséC. , Herrerías-Gutiérrez Juan M.
Published: February 2021

An unusual case of synchronous gastric carcinomas occurred in a 28-year-old man with a family history of gastric disease. Two tumor foci were identified: a well-differentiated advanced carcinoma with the phenotypic properties of complete intestinal metaplasia and an early intestinal-type carcinoma. Histochemical and immunohistochemical stains to demonstrate complete intestinal metaplasia, ie, Alcian blue pH 2.5/periodic acid–Schiff, high iron diamine/Alcian blue pH 2.5, CD10, and MUC2, were all positive in the advanced adenocarcinoma. Of all markers used, only high iron diamine/Alcian blue pH 2.5 and Alcian blue pH 0.5 were positive in the early carcinoma. In these cases, mistakes frequently are made during examination of endoscopic biopsies. Fortunately, the advanced adenocarcinoma was low grade (the patient has shown no signs of disease at 6 years postsurgery). Histopathologic, histochemical, and immunohistochemical findings suggest that an extensive substrate of complete intestinal metaplasia (corpus) and of complete and incomplete intestinal metaplasia (antrum) can be associated with two independent tumors with different phenotypes.
Chronic Abdominal Pain Caused by Heterotopic Ossification With Functioning Bone Marrow: A Case Report and Review of the Literature
Authors: Wang Ding , Shurafa Muhammad S. , Acharya Radhika , Strand Vernon F. , Linden Michael D.
Published: February 2021

Heterotopic ossification is rarely seen after midline abdominal surgery. The etiology of heterotopic ossification is unknown. Although it is well recognized that heterotopic ossification may contain osteogenic cells and/or hematopoietic cells, to our knowledge, no case has ever been reported to have histologic evidence of hematopoiesis. We report the occurrence of heterotopic bone with bone marrow showing normal trilineage hematopoiesis in the incision scar of a woman who underwent gastric reduction surgery for the treatment of obesity. The literature regarding heterotopic ossification and extramedullary hematopoiesis is reviewed in this report, and discussion focuses on the mechanism of this pathophysiologic process.
Primary Anaplastic Lymphoma Kinase–Negative Anaplastic Large Cell Lymphoma of the Brain in a Patient With Acquired Immunodeficiency Syndrome
Authors: Rowsell Edward H. , Zekry Nazila , Liwnicz Boleslaw H. , Cao Jeffrey D. , Huang Qin , Wang Jun
Published: February 2021

Anaplastic large cell lymphoma is a unique diagnostic subcategory of the T-cell lymphomas in the current World Health Organization classification. Representing approximately 3% of adult and 10% to 30% of childhood non-Hodgkin lymphomas, anaplastic large cell lymphoma classically consists of CD30+ large lymphoid cells with abundant cytoplasm and pleomorphic, often horseshoe-shaped or kidney-shaped nuclei. Among the reported nodal and extranodal sites of occurrence, the gastrointestinal tract and central nervous system have rarely been noted. We report a case of primary anaplastic lymphoma kinase–negative anaplastic large cell lymphoma in the brain of a 46-year-old patient with acquired immunodeficiency syndrome. T-cell lineage was confirmed by T-cell receptor γ chain gene rearrangements using polymerase chain reaction, and extra copies of the anaplastic lymphoma kinase gene of chromosome 2 were demonstrated by fluorescence in situ hybridization analysis. To our knowledge, primary anaplastic large cell lymphoma of the brain has not previously been reported in acquired immunodeficiency syndrome.
Solitary Fibrous Tumor of the Spinal Nerve Rootlet: Report of a Case Mimicking Schwannoma
Authors: Piana Simonetta , Putrino Innocenza , Cavazza Alberto , Nigrisoli Evandro
Published: February 2021

We report a case of solitary fibrous tumor involving the spinal nerve root at the L1-L2 level in a 67-year-old man. The patient presented with lumbar pain and weakness in his right lower extremity. Histologically, the tumor was composed of a proliferation of monomorphous spindle cells in an abundant collagenous stroma; neither necrosis nor mitoses were evident. These cells were strongly immunoreactive with CD34, Bcl-2, CD99, and vimentin, but were negative with S100 protein, smooth muscle actin, and epithelial membrane antigen. Such an immunohistochemical profile was consistent with a solitary fibrous tumor of the spinal nerve rootlet and ruled out the main differential diagnoses, schwannoma and meningioma. The present case suggests that solitary fibrous tumor should be considered in differentiating spindle cell lesions of the spinal cord and nerve rootlet.
Diagnostic and Prognostic Value of Cardiac Troponin I Assays in Patients Admitted With Symptoms Suggestive of Acute Coronary Syndrome
Authors: Apple Fred S. , Quist Heidi E. , Murakami Mary Ann M.
Published: February 2021

Context.—Increasing numbers of patients are presenting to emergency departments with symptoms suggestive of an acute myocardial infarction.

Objective.—To demonstrate the comparative performance of the Ortho Vitros Troponin I and Beckman Access AccuTnI assays used to detect myocardial infarction and to develop risk stratification schemes for all-cause death in patients who presented with myocardial ischemia symptoms that were suggestive of acute coronary syndrome (ACS).

Design.—The prospective enrollment of patients with ACS and the measurement of serial plasma samples by 2 commercial cardiac troponin I (cTnI) assays.

Setting.—A metropolitan medical center that admitted patients with ACS during a 2-month period.

Patients.—The study population consisted of 200 consecutively admitted patients who presented with symptoms that were suggestive of ACS.

Results.—Correlation scatterplots showed no significant bias between cTnI assays based on 659 specimens across the dynamic range of each assay. Only minor differences in slopes and intercepts were observed between assays when correlations were based across selected concentration ranges. The receiver operating characteristic curve areas for the detection of myocardial infarction were not significantly different (Ortho, .991; Beckman, .995). At the 99th percentile (Beckman, 0.04 μg/L; Ortho, 0.08 μg/L), each assay demonstrated 100% sensitivity with 78% and 80% specificity, respectively. Kaplan-Meier survival curves and the log-rank test were used to compare time-to-event data. Patients with increased baseline cTnI values had higher odds ratios of death than did those with normal concentrations. For Ortho, the 99th percentile cutoff was 5.9, and the 10% coefficient of variation cutoff was 10.3; for Beckman, the 99th percentile cutoff was 31.4, and the 10% coefficient of variation cutoff was 15.3.

Conclusions.—Comparable diagnostic and risk stratification abilities were demonstrated in patients with ACS by the Ortho Vitros and Beckman Access cTnI assays, with no significant analytic bias between cTnI assays.
Urachal Malignant Fibrous Histiocytoma: A Case Report and Review of the Literature
Authors: Wang Beverly Y. , Boag Alexander H. , Idrees Muhammad , Young Iain D. , Unger Pamela D.
Published: February 2021

Pathologic processes involving the urachus are usually related to inflammatory or sinofistular conditions. Neoplasms rarely arise within this structure, and when they do occur, they are typically epithelial, with mucinous adenocarcinoma being the most common. Mesenchymal lesions, both benign and malignant, have rarely been described in this location. We report the case of a 66-year-old white man who presented with a primary urachal malignant fibrous histiocytoma and died of metastatic disease 20 months after the initial diagnosis. This is an unusual case of malignant fibrous histiocytoma arising in a urachal remnant.
Recurrent Solitary Fibrous Tumor of the Pleura With Malignant Transformation
Authors: Kanthan Rani , Torkian Bahman
Published: February 2021

Recurrent solitary fibrous tumor of the pleura with malignant progression occurs rarely. We report a case of solitary fibrous tumor of the pleura in an 85-year-old white woman that recurred 4 times during a span of 10 years and subsequently underwent malignant transformation. The accurate diagnosis of solitary fibrous tumor is aided by ancillary techniques, such as immunohistochemical staining; however, with malignant transformation, such tools may be of limited value. Long-term clinical follow-up is recommended for all patients with solitary fibrous tumor because of the potential adverse biological behavior of this tumor, which may lead to repeated recurrences and/or malignant transformation.
Fluids—Good and Bad Actors: Observations From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology
Authors: Moriarty Ann T. , Stastny Janet , Volk Emily E. , Hughes Jonathan H. , Miller Theodore R. , Wilbur David C.
Published: February 2021

Context.—Body cavity fluid examination presents a common and sometimes difficult diagnostic challenge in daily cytology practice. Separating benign from malignant cellular changes may require meticulous screening, careful scrutiny of cellular features, and an understanding of the range of reactive changes. We use the data from the College of American Pathologists (CAP) Interlaboratory Comparison Program in Nongynecologic Cytology (NGC) to identify characteristics of fluids that place them at opposite ends of the diagnostic spectrum.

Objective.—To assess the features of individual body cavity fluid slides that demonstrated good performance characteristics and compare them to slides that were poor performers.

Design.—A databank of 10 396 laboratory responses, including a variety of malignant and benign cases obtained from 1997 through 2001, was used to select cases. A cumulative slide history was used to identify slides that performed well or poorly in each reference diagnosis. Cases were confirmed by consensus of 4 CAP Cytopathology Resource Committee members. Observations and characterizations of good and bad performers in each category were recorded and summarized.

Results.—Percentage of concordance of poor performers ranged from 0% to 58%. Conversely, good performers were identified with high concordance of laboratory diagnosis in each reference category (>80%). Several patterns emerged. Poorly performing cases of adenocarcinoma consisted of slides with rare tumor cells, hypercellular malignant cases without 2 cell populations, and cases with single cells. Poor performance in confirmed squamous cell carcinoma cases related to rare cells without keratinization. Small cell carcinoma and melanoma cases performed poorly when there were few malignant cells. Lymphoma cases demonstrated poor performance when there were abundant pleomorphic lymphoid cells or when rare Reed- Sternberg–like cells were present. Reactive or negative slides performed best with a polymorphous population; poor performers were those with a predominant lymphocyte population mistaken for a hematopoietic neoplasm.

Conclusion.—Close attention to classic cytologic criteria and careful examination of slides may enhance the educational experience of participants and the performance characteristics of body cavity fluid specimens in the CAP NGC program. Lessons from bad actors in the CAP NGC program may increase awareness of potential diagnostic problems in daily practice or help identify areas for laboratory quality improvement.
Multifocal Polypoid Endometriosis Presenting as Huge Pelvic Masses Causing Deep Vein Thrombosis
Authors: Laird Lisa A. , Hoffman James S. , Omrani Aziza
Published: February 2021

We describe a case of multifocal polypoid endometriosis presenting with advanced bulky disease at a variety of pelvic sites. The extent of tumor and clinical features such as vaginal bleeding and pulmonary embolus were suggestive of a malignant process. Histopathology demonstrated glands that were neither crowded nor complex, with intervening fibromatous stroma that contained occasional endometrial stromal cells. These features were consistent with the newly described condition of polypoid endometriosis. Despite the endometrioid appearance of this tumor, there was florid ciliary cell change. An association has been suggested between polypoid endometriosis and prior tamoxifen use, although this patient had no history of prior hormone use.
Polarizable Placental Particles: A Case Study and Brief Review of the Literature
Authors: Jarzembowski Jason A. , McHugh Jonathan , Lieberman Richard W.
Published: February 2021

Two otherwise healthy pregnant women presented with intrauterine fetal demise and underwent unremarkable induction of labor. Histopathologic examination of both placentas revealed polarizable foreign material with minimal associated tissue reaction in the membranes and adjacent maternal decidua. No overt foreign body giant cell reaction or inflammation was seen, suggesting recent introduction of the material. Further review of the histories showed that both women had undergone cervical ripening with laminaria. These are strips of collagenous seaweed placed in a closed cervix, where they absorb moisture and swell, dilating the cervix and hastening the onset of labor. Microscopic examination and polarization of known laminaria fragments identified this substance as the likely source of the polarizable material within the placental membranes. Laminaria fragments should be distinguished from other polarizable materials such as talc, suture, and retained foreign bodies on the basis of their histologic appearance and the acute nature of the accompanying tissue reaction.
Myocardial Involvement in Erdheim-Chester Disease
Authors: Loeffler Agnes G. , Memoli Vincent A.
Published: February 2021

Erdheim-Chester disease (lipoid granulomatosis) is a rare type II (non-Langerhans cell) histiocytosis with systemic manifestations. The disease causes nonspecific disturbances in the function of multiple extraosseous organs, most commonly the eyes, lungs, pituitary gland, and kidneys. Diagnosis is usually made on the basis of radiologic evidence of cortical expansion of long bones. While the osseous and systemic changes have been well documented in the current literature, pathologic changes in the myocardium have not been well characterized since Erdheim and Chester's first description of this disease in 1930. In the 2 autopsy cases from Dartmouth-Hitchcock Medical Center (Lebanon, NH) reported in the present study, myocardial involvement was severe and had contributed significantly to the patients' morbidity and death. We describe the autopsy results and correlate them with Erdheim's original descriptions of this disease. In neither of our cases was bony involvement characteristic of the disease, and the diagnosis was made postmortem on the basis of soft tissue findings at autopsy.
A 59-Year-Old Woman With Immunotactoid Glomerulopathy, Heavy-Chain Disease, and Non-Hodgkin Lymphoma
Authors: Jacobson Erica , Sharp Gregory , Rimmer Jeffrey , MacPherson Bruce
Published: February 2021

Immunotactoid glomerulopathy is one of several renal disorders characterized by the extracellular deposition of nonamyloid fibrillary deposits. There is considerable debate as to whether immunotactoid glomerulopathy should be distinguished from fibrillary glomerulonephritis, a closely related entity. Currently, the distinction is based on fibril size and arrangement. We report the case of a 59-year-old woman in whom a diagnosis of immunotactoid glomerulopathy was made after a 2-year history of proteinuria. Electron microscopy of her renal biopsy showed randomly arranged microtubular subepithelial and mesangial deposits, which measured 34 nm in average diameter. She was later discovered to have circulating immunoglobulin G heavy chains without associated light chains (γ-heavy-chain disease) and, subsequently, non-Hodgkin lymphoma, follicular lymphoma, grade I (World Health Organization classification). Approximately 100 cases of γ-heavy-chain disease have been reported in the literature since it was originally described by Franklin in 1964. However, while there are 10 reports in the literature of heavy-chain disease with fibrillary deposits in the kidney, none fit the criteria for immunotactoid glomerulopathy.
Clear Cell Ductal Adenocarcinoma of Pancreas: A Case Report and Review of the Literature
Authors: Ray Sourav , Lu Zhengbin , Rajendiran Swaminathan
Published: February 2021

We present a unique carcinoma of the pancreas with predominantly clear cell morphology (>95% clear cells). Mucicarmine stain revealed abundant intraluminal and intracytoplasmic mucin. Immunohistochemically, the cells were positive for the epithelial markers cytokeratin 7 and CAM 5.2, and were focally positive for cytokeratin 20. These cells also expressed monoclonal carcinoembryonic antigen. Stains for the neuroendocrine markers synaptophysin and chromogranin were negative, as were stains for vimentin, p53, HMB-45, and CD10. An additional outstanding feature was the presence of dense intraluminal and intracytoplasmic hyaline globules, which were immunohistochemically positive for α1-antitrypsin. Sequencing of the K-ras oncogene revealed a point mutation in codon 12, providing molecular evidence of ductal origin. In the proper morphologic context supported by immunohistochemistry, clear cell carcinoma can be regarded as a rare variant of ductal adenocarcinoma.
Oncocytic Transformation in Pituitary Adenomas: Immunohistochemical Analyses of 65 Cases
Authors: Niveiro María , Aranda Francisco Ignacio , Payá Artemio , Boix Evangelina , Peiró Gloria , Picó Antonio
Published: February 2021

Context.—Oncocytic change in pituitary adenomas has been evaluated by electron microscopy and more recently by immunohistochemistry. The clinical significance of this change is not well known, although some reports suggest a relationship with more aggressive behavior.

Objective.—To assess the frequency of oncocytic change in pituitary adenomas and to correlate this finding with clinicopathologic factors.

Design.—We studied oncocytic change in a series of 65 pituitary adenomas by immunohistochemistry. According to the percentage of oncocytic cells stained by antimitochondrial antibody, adenomas were classified in 3 groups: 50% or more, 10% to 49%, and 1% to 9% of oncocytic cells.

Results.—Eight cases (12.3%) showing at least 50% of oncocytic cells were classified as oncocytic adenomas: 6 were gonadotroph adenomas and 2 were null-cell adenomas. Among the remaining cases, 9 (14%; all gonadotroph adenomas) showed 10% to 49% oncocytic cells, and in 14 cases (21.5%; 5 gonadotroph adenomas, 6 somatotroph adenomas, 2 corticotroph adenomas, and 1 thyrotroph adenoma) between 1% and 9% were shown. Patients with adenomas that showed oncocytic change presented more frequently at a higher average age (P = .05), but no relationship with extrasellar extension or proliferative activity measured by Ki-67 was observed. In somatotroph adenomas, cases with oncocytic change showed higher percentages of Ki-67 (P = .05) but no correlation with extrasellar extension or cytokeratin staining (dot pattern versus perinuclear) was found.

Conclusion.—Adenomas with oncocytic change present more frequently in older patients, but they are not clinically more aggressive. In addition, somatotroph adenomas with oncocytic cells show similar cytokeratin pattern and higher proliferative activity, which is not correlated with local aggressiveness.
Phlegmonous Gastritis Associated With Kaposi Sarcoma: A Case Report and Review of the Literature
Authors: Yu Qing Qing , Tariq Amina , Unger Stephen W. , Cabello-Inchausti Beria , Robinson Morton J.
Published: February 2021

We report a case of phlegmonous gastritis associated with Kaposi sarcoma in a 37-year-old, human immunodeficiency virus (HIV)–positive man who presented with an acute abdomen. Computed tomographic scan revealed free fluid in the abdominal cavity and a thickened gastric wall. A partial gastrectomy was performed. The resected portion of stomach had a hemorrhagic, necrotic thickened wall and showed extensive, acute suppurative inflammation, especially in the submucosa, with focal transmural involvement. Beneath an area of healing ulceration, a focus of Kaposi sarcoma was present. Group A β-hemolytic streptococcus was grown from peritoneal fluid, and treatment with numerous antibiotics was initiated. After a difficult postoperative course that responded to 8 weeks of antibiotic therapy, the patient was medically stable and discharged from the hospital on antiretroviral therapy for HIV. Phlegmonous gastritis is a rare and rapidly progressive bacterial infection of the gastric wall. Kaposi sarcoma is one of the most common malignancies in HIV-positive patients, and gastric involvement is relatively common in those patients with systemic Kaposi sarcoma. To our knowledge, this is the first reported case of phlegmonous gastritis associated with Kaposi sarcoma, and it represents a rare survival following surgical and antibiotic therapy.
Bronchial Epithelial-Myoepithelial Carcinoma
Authors: Ru Kun , Srivastava Amitabh , Tischler Arthur S.
Published: February 2021

Epithelial-myoepithelial tumor is extremely rare as a pulmonary neoplasm. Only 20 cases have been reported to date, of which 14 were malignant. We report a case of intrabronchial epithelial-myoepithelial carcinoma in a 73-year-old man with a history of heavy smoking. The tumor was well-circumscribed and caused distal airway obstruction. Histologically, the tumor showed glandular and solid architecture. The glands were composed of an inner layer of epithelial cells and an outer layer of myoepithelial cells. The solid areas consisted of spindle-shaped myoepithelial cells. Immunohistochemical staining was positive for p53 and c-Kit (CD117). Focal atypia and increased mitotic activity were present, but no vascular invasion or nodal metastasis was identified.
Intraocular Inflammatory Myofibroblastic Tumor With ALK Overexpression
Authors: O'Malley Dennis P. , Poulos Christopher , Czader Magdalena , Sanger Warren G. , Orazi Attilio
Published: February 2021

We report a case of an intraocular inflammatory myofibroblastic tumor nearly filling the vitreous cavity of the eye of a 50-year-old man. The tumor was composed of a mixture of spindle cells and mixed inflammatory elements, including numerous plasma cells. The differential diagnosis included inflammatory pseudotumor and neoplastic mimics of this condition. Further investigation with immunohistochemistry revealed the mass to be composed of myofibroblasts, positive for smooth muscle actin stains and with weak anaplastic lymphoma kinase (ALK) expression in some tumor cells. Evaluation by fluorescence in situ hybridization revealed the tumor cells to have multiple copies of chromosome 2 and ALK but no rearrangement of the ALK gene. The authors propose that multiple copies of the ALK gene may be involved in inflammatory myofibroblastic tumor tumorigenesis, in addition to ALK gene rearrangements.
Primary Adenocarcinoma of Cutaneous Vesicostomy 40 Years Later: A Rare Case
Authors: Yohannes Paulos , Hunter William , Prasad Malini
Published: February 2021

We present a case of adenocarcinoma developing at the vesicocutaneous edge of a vesicostomy, 40 years after it was created, in a patient who underwent cadaveric kidney transplant. Although transitional and squamous cell carcinoma of a vesicostomy have been reported, to our knowledge, the presence of adenocarcinoma at the vesicostomy edge has not been reported previously.
Extraosseous (Extramedullary) Plasmacytoma of the Adrenal Gland
Authors: Rogers Craig G. , Pinto Peter A. , Weir Edward G.
Published: February 2021

Plasmacytomas are clonal proliferations of atypical plasma cells that manifest a localized osseous or extraosseous growth pattern. Although many represent solitary lesions of bone, fewer arise in extraosseous (extramedullary) tissues. We report a case of a primary extraosseous plasmacytoma of the adrenal gland. Magnetic resonance imaging (MRI) with contrast revealed a 3.5-cm, right adrenal mass with heterogeneous enhancement. Although the mass was small and nonfunctioning, concern for malignancy based on MRI findings prompted laparoscopic resection. Histologic and immunohistochemical findings were consistent with a plasmacytoma. This is the third reported case, to our knowledge, of a primary plasmacytoma of the adrenal gland. The present case is unique in that a contrast MRI was performed, which showed heterogeneous enhancement of the mass, providing further evidence beyond heterogeneous hyperintensity on T2-weighted images for a possible malignant process. Another unique feature is that a biopsy specimen of the lesion was taken, although it was nondiagnostic.
Pathology Expert Witness Testimony and Pathology Practice: A Tale of 2 Standards
Authors: Foucar Elliott
Published: February 2021

Context.—Pathologists work in an environment in which, to the extent possible, diagnostic decisions are based on scientific principles. It can therefore be a rather shocking experience when a pathologist finds one of his or her diagnostic decisions being evaluated by a legal system developed and controlled by lawyers and judges rather than by scientists or pathologists. This experience can be even more troubling when a key participant in the proceedings is a fellow pathologist guiding a jury toward an unfamiliar interpretation of the pathology standard of care.

Objective.—To provide the interested pathologist with the background information necessary to (1) understand the role of expert testimony in malpractice litigation and (2) understand why there can be a gap between expert opinions expressed in court and expert opinions expressed in a medical care context.

Data Sources.—Medical literature review supplemented by review of subspecialty position papers, selected articles from newspapers and magazines, and legal decisions. The medical literature review was limited to articles published in English and was based largely on articles retrieved using the MeSH terms expert testimony/legislation & jurisprudence, and pathology/legislation & jurisprudence.

Conclusions.—Medical error has become an increasingly important topic for pathologists, and although errors or allegations of error are evaluated in many ways, the evaluation with the most impact on the individual pathologist is a malpractice case. During the last decade physicians have increasingly become aware of the critical role played by expert testimony in malpractice litigation. Some physicians have asserted that providing expert testimony is the practice of medicine, and that it is unacceptable for juries to be presented with expert testimony that incorrectly describes medical practice standards. However, this opinion has been vigorously opposed by attorneys who feel that juries are best able to come to a correct conclusion if they base their deliberations on a broad spectrum of opinion. Gaining an increased role in the oversight of expert testimony would allow physicians to establish a closer alignment between opinions expressed in court testimony and opinions expressed in clinical practice. However, despite some physician success in inserting themselves into the oversight process, both physicians and physician organizations attempting to take action against misleading expert testimony continue to be vulnerable to legal attack.
Detection of Mitochondrial Respiratory Dysfunction in Circulating Lymphocytes Using Resazurin
Authors: Abu-Amero Khaled K. , Bosley Thomas M.
Published: February 2021

Context.—Laboratory methods currently available for detecting mitochondrial respiratory dysfunction are labor-intensive, require large amounts of isolated mitochondrial protein, invasive (require a skeletal muscle biopsy), and usually produce conflicting results.

Objective.—To develop a rapid, reliable, and noninvasive method for detecting oxidative phosphorylation activity without the need to isolate mitochondrial fractions.

Design.—Lymphocytes from 6 patients with mitochondrial disorders (3 with mitochondrial myopathy and 3 with Leber hereditary optic neuropathy) and 51 normal control subjects were incubated with 6μM resazurin without and with mitochondrial inhibition by amiodarone (200μM), and the fluorescence intensity resulting from resazurin reduction was monitored spectrofluorometrically over time. Mitochondrial respiratory activity was calculated as the difference between uninhibited and inhibited measurements.

Results.—Mitochondrial respiratory activity was established for 51 normal control subjects and was decreased in all 6 patients with mitochondrial syndromes. Mitochondrial respiratory activity values for patients 1 through 6 compared to the control group after 240 minutes' incubation with resazurin were 55%, 71%, 49%, 61%, 68%, and 59%, respectively (mean mitochondrial respiratory activity of patients, 13.6% or 60.5% of control mean; P < .001).

Conclusion.—This resazurin-based technique proved to be a fast and reproducible method for quantifying mitochondrial activity and identifying respiratory functional defects in patients with mitochondrial disorders.
Immunohistochemical Diagnosis of Epithelioid Mesothelioma: An Update
Authors: Ordóñez Nelson G.
Published: February 2021

Objective.—Several new immunohistochemical markers that can assist in the diagnosis of mesotheliomas have been recognized recently. This article reviews the current information available on these markers and also provides a practical approach to the immunohistochemical diagnosis of epithelioid mesotheliomas.

Data Sources.—Current literature concerning immunohistochemical markers for epithelioid mesotheliomas was collected and reviewed.

Study Selection.—Literature emphasizing immunohistochemical diagnosis of epithelioid mesotheliomas was selected.

Data Extraction.—Data deemed helpful to the general surgical pathologist for the diagnosis of epithelioid mesothelioma were included in this review.

Data Synthesis.—Markers identified as potentially useful in the diagnosis of epithelioid mesothelioma include positive markers (namely, calretinin, keratin 5/6, D2-40, podoplanin, mesothelin, and Wilms tumor 1 protein [WT1]) and negative markers (namely, carcinoembryonic antigen, MOC-31, B72.3, and Ber-EP4). Thyroid transcription factor 1 (TTF-1) can assist in determining the lung origin of a carcinoma, and renal cell carcinoma marker (RCC Ma) may help establish its renal origin.

Conclusions.—D2-40 and podoplanin are the 2 most recently recognized markers that have been found to be useful in the diagnosis of epithelioid mesotheliomas. Since D2-40 and podoplanin appear to be highly sensitive and specific for epithelioid mesotheliomas, either may be considered for inclusion in the battery of antibodies currently recommended for distinguishing epithelioid mesotheliomas from metastatic carcinomas. However, it should be kept in mind that their utility has not yet been fully determined in routine diagnostic work.
Hepatic Follicular Dendritic Cell Sarcoma Without Epstein-Barr Virus Expression
Authors: Torres Ulises , Hawkins William G. , Antonescu Cristina R. , DeMatteo Ronald P.
Published: February 2021

Follicular dendritic cell sarcoma of the liver is an uncommon pathologic entity, and only 5 cases have been reported previously. Herein, we report the first case, to our knowledge, of hepatic follicular dendritic cell sarcoma without evidence of Epstein-Barr virus infection. The patient is an elderly man who was found to have an incidental liver mass and then developed weight loss and fever. The diagnosis was based on the typical morphologic appearance of spindle cell proliferation associated with a brisk lymphoplasmacytic infiltrate and strong immunoreactivity to CD21 and CD35. Based on our experience and a review of the published reports, we summarize the clinical and pathologic features of hepatic follicular dendritic cell sarcoma and its surgical management.
Recurrent and De Novo Glomerular Immune-Complex Deposits in Renal Transplant Biopsies
Authors: Gough James , Yilmaz Asli , Yilmaz Serdar , Benediktsson Hallgrimur
Published: February 2021

Context.—Recurrent and de novo glomerulonephritis is an important cause of renal allograft failure, but estimates of its prevalence vary widely. One reason for such variability is the inconsistency with which electron microscopy and immunofluorescence are used in assessing renal allograft biopsies.

Objective.—To determine the prevalence of immune-complex deposits in all renal allograft biopsies performed during a 1-year period and to correlate their presence with clinical data.

Design.—Our center accessioned a total of 118 renal allograft biopsies during 1 year from 88 patients. All biopsies were examined by both electron microscopy and immunofluorescence in addition to conventional light microscopy. Patient and donor characteristics were obtained as well as follow-up data for a minimum of 26 months after the index biopsy.

Results.—Eight cases of immunoglobulin (Ig) A nephropathy were found (recurrent in 7 and de novo in 1). There were 9 instances of what we designate “IgM-positive immune deposits” without specific features of a recognized glomerulonephritis. To the best of our knowledge, the latter has not hitherto been described and may be part of a heterogeneous group of glomerulopathies. Other unexpected findings included de novo fibrillary glomerulonephritis and de novo membranous glomerulonephritis, the latter occurring at 3 months after engraftment.

Conclusions.—A high proportion (19.5%) of unselected renal allograft biopsies show immune-complex deposits both with and without a recognized glomerulopathy. These require both electron microscopy and immunofluorescence for detection. IgM-positive deposits of uncertain etiology are relatively frequent.
Mixed Hepatoblastoma in an Adult
Authors: Kasper Hans-Udo , Longerich Thomas , Stippel Dirk L. , Kern Michael A. , Drebber Uta , Schirmacher Peter
Published: February 2021

We report a case in an elderly adult of a highly malignant liver tumor with blastoid features that resembled hepatoblastoma. A liver tumor with a diameter of 23 cm was removed in a 78-year-old woman. The tumor showed highly differentiated epithelial hepatocellular and poorly differentiated epithelial and mesenchymal components. The blastoid nature and pluripotent differentiation potential were supported by immunohistologic analysis and suggest an origin of a poorly differentiated pluripotent hepatic cell with the potential to mature. We believe that this case of a mixed hepatoblastoma in an adult should be added to the growing number of presumed hepatic precursor cell neoplasms in adults.
Polyclonal B-Cell Lymphocytosis Mimicking Malignant Lymphoma in a Newborn
Authors: Wong Kit Fai , Yuen Hui Leung , Leung Jennifer N. S. , Chan John K. C.
Published: February 2021

We describe a 17-day-old newborn with fever and peripheral blood lymphocytosis. The circulating lymphocytes were large with lobulated and nucleolated nuclei. Their immature and uniform appearance raised the possibility of malignant lymphoma in the leukemic phase. Immunophenotypic study, however, showed that the lymphocytes were CD19+ B cells with expression of both κ and λ light chains. Molecular biology study confirmed a polyclonal nature of the immunoglobulin heavy-chain gene. Cytogenetic analysis showed a normal karyotype, and viral cultures and serologic studies yielded negative results. The polyclonal lymphocytosis was self-limiting and disappeared within a month.
Ichthyosis Uteri: A Case Report and Review of the Literature
Authors: Bewtra Chhanda , Xie Qing M. , Hunter William J. , Jurgensen William
Published: February 2021

Squamous metaplasia of endometrium is mostly manifested by morules or nodules of benign nonkeratinizing squamous cells intimately mixed with benign or malignant endometrial glands. It has been described with low-grade adenocarcinoma of the endometrium, as well as with various benign conditions, including hyperplasia, chronic endometritis, and endometrial polyps. However, extensive plaquelike, keratinizing squamous change is distinctly uncommon. To our knowledge, we describe the first case of extensive benign squamous keratinization with underlying endometrial adenocarcinoma.
COMERCIAIS LGBT+: UMA ANÁLISE SOBRE FREQUÊNCIA DE ABORDAGEM DA TEMÁTICA E FATORES RESULTANTES EM COMERCIAIS
Authors: Pozzebon Martina , Reginatto Andrea Ad
Published: February 2021

A maior parte dos brasileiros passa horas de seu dia em frente a uma televisão, cuja programação é intercalada por inúmeros comerciais. O presente artigo tem por finalidade analisar os comerciais com temática LGBT+, recuperando também antigas análises para comparação, para que, através de observação de 15 comerciais veiculados na mídia televisiva entre 2015, 2016 e 2017 (5 a cada ano) a fim de avaliar como está sendo apresentada a imagem dessa comunidade. A análise está ancorada no método de observação, análise de conteúdo  e pesquisa bibliográfica. Os resultados revelam um aumento no número dos casos de abordagem da temática, uma diminuição da estereotipagem, mas que traz à tona o questionamento das intenções por trás das empresas quanto ao “uso” da luta LGBT+ nas propagandas.
A pesquisa-ação em estudos sobre (multi)letramentos publicados na Revista Brasileira de Linguística Aplicada
Authors: Rodrigues Ludmila Corrêa Pinto , Santiago Maria Elizabete Villela
Published: February 2021

A pesquisa qualitativa é utilizada nas investigações em Linguística Aplicada como forma de compreender de forma mais profunda os fenômenos relacionados ao ensino e aprendizagem de línguas. Dentre os métodos adotados, a pesquisa-ação é empregada com o intuito de modificar as práticas pedagógicas, alterando, consequentemente, o contexto social dos professores e aprendizes. O objetivo deste artigo é, por meio de uma pesquisa bibliográfica em artigos da Revista Brasileira de Linguística Aplicada sobre (Multi)Letramentos, analisar como a pesquisa-ação é desenvolvida nessa área e de que forma contribui para o aprimoramento do ensino de línguas. Como resultado, este trabalho mostrou que o uso da pesquisa-ação é uma importante ferramenta como método intervencionista para pesquisas em Linguística Aplicada e que desta forma há aspectos positivos que contemplam todos os participantes.