bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Clostridium septicum in Paraneoplastic Sepsis
Authors: Pelletier J. Peter R. , Plumbley Julie A. , Rouse Elizabeth A. , Cina Stephen J.
Published: January 2021

Context.—Clostridium septicum infections are rare but often associated with serious if not fatal outcomes. Clostridium septicum infection does not appear to be associated with a single specific defect in cellular or humoral immunity. It has been associated with multiple medical problems, including but not limited to leukemia, malignancy of the bowel, other solid tumors, cyclic neutropenia with enterocolitis, diabetes mellitus, and severe arteriosclerosis. Most cases of C septicum are associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 hours.

Objectives.—To evaluate outcomes of patients with C septicum bacteremia, whether treated medically or surgically or both, and to note associated conditions.

Design.—Retrospective evaluation of patients found to have C septicum bacteremia in the past 6 years.

Setting.—Two teaching hospitals, Brooke Army Medical Center (250 beds) and Wilford Hall Medical Center (292 beds), were the source of our patients.

Patients.—All patients found to have C septicum bacteremia during hospitalization or postmortem examination were included in the study. There were no exclusion criteria.

Main Outcome Measure.—Mortality associated with C septicum infection.

Results.—In our case series, mortality was 33%, which is slightly lower than reported in prior studies (43%–70%).

Conclusion.—Presumptive identification based on Gram stain, awareness of C septicum infection as a paraneoplastic syndrome, and prompt, clear communication between laboratory personnel and clinicians are necessary for early diagnosis of C septicum infection. Early institution of antibiotic therapy improves prognosis.
Effects of Restructuring on the Performance of Microbiology Laboratories in Alberta
Authors: Church Deirdre L. , Don-Joe Connie , Unger Barbara
Published: January 2021

Objective.—To evaluate the error rates of organism identification and antibiotic susceptibility proficiency testing challenges before, during, and after microbiology laboratory restructuring in Alberta.

Methods.—Alberta Health substantially reduced and redistributed laboratory funds to the regional health authorities in 1995, forcing a dramatic restructure of services. Many rural hospitals expanded their microbiology test menus, and urban centers consolidated microbiology testing into a centralized high-volume laboratory. The Laboratory Proficiency Testing Program of the College of Physicians and Surgeons of Alberta mailed regular test profile surveys to microbiology laboratories during the restructure period to determine the type and extent of changes in services. Based on the types of tests and the extent of analysis being done, most rural B-level and some C-level laboratories were reclassified to the A level. The Laboratory Proficiency Testing Program reviewed the error rates of proficiency challenges based on the performance of different levels of laboratories before and after the period of restructure.

Results.—Overall performance has improved according to the number of errors documented on identification and susceptibility challenges for laboratories that remained at the same classification (ie, A or C). The number of major identification errors for laboratories that were reclassified increased, but the rate of major susceptibility errors decreased. More reclassified laboratories do not have dedicated registered technologist(s) who perform microbiology testing and are not supervised by an on-site pathologist and/or medical microbiologist compared with laboratories that remained at the same classification.

Conclusions.—Microbiology laboratory restructuring will have adverse effects on the quality of complex testing if experienced technologists are not retained and services are not medically supervised.
Epithelioid Leiomyosarcoma With Osteoclast-like Giant Cells in the Rectum
Authors: Terada Tadashi , Endo Kanenori , Maeta Hiroyuki , Horie Satoshi , Ohta Tetsuo
Published: January 2021

We report a rare case of rectal epithelioid leiomyosarcoma with osteoclast-like giant cells. A 71-year-old Japanese man was admitted to a hospital with melena. Results of a colonoscopy test revealed a polypoid tumor in the rectum, and a biopsy specimen from the lesion showed a sarcoma; the patient underwent rectosigmoidectomy. At gross inspection, the tumor measured 8 × 7 × 4 cm and was polypoid with ulcerations. Necrotic and hemorrhagic foci were scattered. Microscopically, the tumor consisted of 2 cell types: malignant tumor cells with epithelioid features and benign-appearing osteoclast-like giant cells. The tumor cells were polygonal and epithelioid in shape and had eosinophilic or clear cytoplasms, with scattered giant tumor cells. Immunohistochemical examination revealed that the tumor cells were positive for vimentin, muscle actin, α-smooth muscle actin, and desmin, whereas the osteoclast-like giant cells were positive for CD68, leukocyte common antigen, and lysozymes. We diagnosed this case as epithelioid leiomyosarcoma with osteoclast-like giant cells. To the best of our knowledge, this is the first case of rectal epithelioid leiomyosarcoma with osteoclast-like giant cells.
Postanalytical Quality Improvement
Authors: Howanitz Peter J. , Cembrowski George S.
Published: January 2021

Objective.—To evaluate elevated patient calcium results as a postanalytic quality indicator of physician practices.

Design.—Participants prospectively identified hypercalcemic patient results for 4 months or until they found 320 hypercalcemic results, and then, after at least 3 days, reviewed the medical records of these patients. Hypercalcemia was defined as a calcium value that exceeded the upper limit of each laboratory's reference range by 0.12 mmol/L or more. Participants, as well a subset of their physicians who did not acknowledge or respond to elevated results in the medical record, answered a questionnaire about their practices.

Participants.—Five hundred twenty-five laboratories enrolled in the College of American Pathologists Q-Probes program.

Main Outcome Measures.—The presence of hyercalcemic results in patients' medical records and physicians' acknowledgement and response to those elevated results.

Results.—More than 5500 hypercalcemic results were identified, of which 53.2% represented a new finding. About 3.5% of results were not charted in the patients' records, and 23.1% of patient records did not contain clinician documentation of the abnormal result. Follow-up laboratory tests were not ordered for 13.8% of the elevated values. For 570 of the 808 results for which there was neither clinician documentation nor designated follow-up laboratory tests ordered, patients' physicians received written notification of the elevated calcium results along with a questionnaire. Responses were received from 386 physicians (68%). One hundred physicians indicated they did not order the specific calcium measurement, and of these 100, 85 responded it was part of a panel. The 286 physicians who ordered the test stated the results ultimately led to further testing (69%), a change of management (56%), or a new diagnosis (25%).

Conclusions.—We found that a high percentage of abnormal results (3.5%) were not documented in the patients' medical records, the diagnosis of hypercalcemia frequently was new (53.2%), and a high percentage of physicians did not respond to elevated calcium results by writing a note (23.1%) or ordering another test (13.8%). Opportunities for quality improvement at these postanalytical steps are far greater than at the analytical step. Laboratorians must help physicians identify and respond to clinically important laboratory results.
Expression of the Chemokine Receptor CXCR2 in Normal and Neoplastic Neuroendocrine Cells
Authors: Tecimer Tülay , Dlott Jeffrey , Chuntharapai Anan , Martin Alvin W. , Peiper Stephen C.
Published: January 2021

Background.—Chemokines effect their proinflammatory and growth regulatory roles through interaction with serpentine receptors. One such receptor, CXCR2, binds multiple CXC chemokines, including interleukin 8, GRO-α, GRO-β, GRO-γ, and NAP-2. We have previously identified CXCR2 expression on myeloid cells, notably mature granulocytes, and projection neurons.

Objective.—To determine the expression of CXCR2 by cells of the neuroendocrine system.

Design.—Archival specimens from normal neuroendocrine tissues and their malignant counterparts were analyzed by immunohistochemistry with monoclonal antibodies specific for CXCR1 and CXCR2.

Results.—Immunohistochemical analysis revealed high-level expression of CXCR2 by cells in the pituitary, adrenal medulla, pancreatic islets, thyroid C cells, scattered Kulchitsky cells in the bronchi, and counterpart neuroendocrine cells in the stomach, small bowel, colon, and appendix. Neuroendocrine neoplasms that demonstrated high-level CXCR2 expression included (1) primary carcinoids localized to the stomach, small bowel, colon, appendix, fallopian tube, ovary, and lung; (2) atypical carcinoids of the lung; (3) metastatic carcinoids; (4) pituitary adenomas; (5) pheochromocytomas; and (6) medullary carcinomas of the thyroid. Small cell lung carcinomas, large cell neuroendocrine carcinomas of the lung, small cell carcinoma of the cervix, Merkel cell carcinomas, neuroblastomas, and malignant melanomas lacked evidence of CXCR2 expression.

Conclusions.—The expression of CXCR2 by normal neuroendocrine cells and neoplastic counterparts that have retained phenotypic features of this differentiation program suggests that chemokines may play an important role in functions that are characteristic of this cell type. In addition, this raises the possibility that chemokines may modulate secretion of biologically active products of these cells and their neoplastic counterparts.
Metastatic Tumors to the Spleen
Authors: Lam K. Y. , Tang Victor
Published: January 2021

Objective.—The clinicopathologic features of splenic metastases have seldom been investigated. The aim of this study was to evaluate the clinical and pathological impact of splenic metastases.

Case Material.—We reviewed the clinical/autopsy records and pathologic features of 92 Chinese patients (58 men, 34 women) with secondary nonlymphoid splenic tumors recorded during a 25-year period.

Results.—The incidence of splenic secondary tumors at autopsy was 0.6% and at splenectomy, 1.1%. The lesions were often seen in elderly patients (mean age, 60 years). Seven (8%) of the splenic lesions were symptomatic. The symptomatic splenic lesions, as compared with asymptomatic lesions, were bigger and were found more often in women and younger patients. Two patients experienced spontaneous splenic rupture because of metastatic carcinoma. Eighty-seven (95%) of the secondary splenic tumors were carcinomas. Lung was the most common primary tumor site (21%), followed by the stomach (16%), pancreas (12%), liver (9%), and colon (9%). Rarely reported sources of primary tumor, such as esophageal carcinomas, nasopharyngeal carcinoma, and choriocarcinoma, were also found. Splenic metastases could be identified macroscopically in 74 (80%) of our patients. Grossly, splenic metastases involved the splenic capsule (n = 8) or were solitary (n = 31), multiple (n = 30), or diffuse (n = 8) lesions in the splenic parenchyma. Isolated splenic metastases were noted in 5.3% of the metastases found at autopsy. Many of the metastatic lesions in the spleen were identified shortly after primary tumors were detected (mean latent period, 6.7 months). The time from diagnosis of the primary tumor to metastasis to the spleen was more than 2 years in 14 patients.

Conclusions.—Splenic metastases are uncommon. A variety of clinical and pathologic patterns were noted in our series.
Qualitative Analysis of Value Judgments in Interpreting Cervicovaginal Smears Using The Bethesda System
Authors: Workman Linda , Schwartz Mary R. , McCullough Laurence B.
Published: January 2021

Context.—We hypothesize that there are unrecognized value judgments that influence cytopathologists in interpreting borderline cervicovaginal smears and that these judgments contribute to the well-documented variation among cytopathologists regarding such diagnoses.

Objective.—To identify and map these values.

Design.—Survey consisting of Kodachromes and histories for 5 borderline smears. Respondents were asked to give their diagnoses, recommendations for treatment, and reasoning.

Results.—We demonstrated a wide variation in interpretation of borderline smears similar to previous studies. We then used inductive qualitative analysis to identify the clinical reasoning and value judgments that influenced the responses.

Conclusions.—We mapped those diagnostic value judgments that should be used in evaluation borderline cases. We believe this map can be used to rigorously manage and standardize the use of such judgments.
The Spectrum of Neuroendocrine Differentiation Among Gastrointestinal Carcinoids
Authors: Moyana Terence N. , Xiang Jim , Senthilselvan A. , Kulaga Andrew
Published: January 2021

Context.—The advent of panneuroendocrine markers has helped to better depict the heterogeneity of gastrointestinal carcinoids. Consequently, it has been proposed that these tumors constitute a histologic spectrum that includes well-, moderately, and poorly differentiated carcinoids. However, the reproducibility of this grading system and its prognostic importance have sometimes been called into question.

Objective.—To investigate the potential utility of cell proliferation and oncoprotein markers in augmenting the histologic classification.

Design and Setting.—Retrospective study; tertiary care teaching hospital.

Methods.—Fifty-eight patients with 41 well-differentiated, 12 moderately differentiated and 5 poorly differentiated carcinoids from various topographic sites of the gastrointestinal tract were selected and immunostained for panneuroendocrine markers, MIB-1, p53, and bcl-2.

Main Outcome Measures.—Degree of association between histologic grading, MIB-1, p53, and bcl-2 immunoreactivity and carcinoid metastatic behavior.

Results.—The group comprised 30 males and 28 females whose mean age was 52.7 years (range, 14–81). Mean follow-up time was 85.8 months. All 58 patients tested positive for chromogranin A and/or synaptophysin. The group was divided into nonmetastatic (42/58, or 72.4%) and metastatic (16/58, or 27.6%) cases. Histologic grading tended to be associated with metastatic spread, but this occurrence of metastases did not attain statistical significance (P = .08). Positivity for MIB-1 (P = .004) and p53 (P = .04) was significantly associated with metastatic behavior, whereas bcl-2 was not (P = 0.63).

Conclusions.—Although an organoid pattern and neuroendocrine immunophenotype help to define the spectrum of gastrotestinal carcinoids, this study suggests that the histologic grading of these tumors has some limitations with respect to predicting metastatic behavior. However, MIB-1 and p53 can compliment histologic grading as prognostic indicators in this regard while bcl-2 appears to be less useful.
Sublingual Enteric Duplication Cyst
Authors: Tucker Raelynn , Maddalozzo John , Chou Pauline
Published: January 2021

We describe a case of enteric duplication arising from the floor of the mouth and base of the tongue of a 7-year-old child. This mass was asymptomatic and was detected on routine dental examination. The unusual location, possible etiology, and a brief review of the literature are discussed.
Extramedullary Manifestation of Multiple Myeloma (Systemic Plasmacytoma) That Simulates Hemangioma
Authors: Nandedkar Meenakshi A. , Abbondanzo Susan L. , Miettinen Markku
Published: January 2021

We describe 2 cases of a unique type of extramedullary manifestation of multiple myeloma (systemic plasmacytoma) that presented as subcutaneous nodules and mediastinal mass, respectively. Both lesions had a similar morphologic appearance, with dilated vascular-like lumina that was separated by thin fibrovascular septa, filled with erythrocytes, and lined by mature and immature plasma cells and plasmacytoid cells. The plasma and plasmacytoid lining cells showed κ light chain restriction in both cases, consistent with a B-cell monoclonal process. The lining cells were also focally positive for epithelial membrane antigen but were negative for endothelial cell markers. Abundant delicate capillaries were seen in the septa that separated the vascular lumina, mimicking a vascular tumor. Furthermore, we believe that our cases are different from the previously described blood lakes in a plasmacytoma by the presence of well-formed fibrovascular septa that separated the vascular-like spaces. Neoangiogenesis propagated by myeloma cells may contribute to this unusual morphologic manifestation of extramedullary manifestation of multiple myeloma.
Immunoperoxidase Detection of CD10 in PrecursorT-Lymphoblastic Lymphoma/Leukemia
Authors: Conde-Sterling Daniel A. , Aguilera Nadine S. I. , Nandedkar Meenakshi A. , Abbondanzo Susan L.
Published: January 2021

Context.—CD10 was originally reported in non–T-cell lymphoblastic lymphomas/leukemias. It has since been identified, however, in a minority of cases of T-lympho-blastic lymphoma/leukemia and other hematopoietic and nonhematopoietic entities. The usual method for the detection of CD10 previously required fresh tissue. A new antibody for CD10 (56C6) in paraffin embedded tissue sections, however, has recently become available.

Objective.—To study the expression of CD10 in paraffin sections of T-lymphoblastic lymphoma/leukemia using monoclonal antibody 56C6.

Design.—Twenty-four cases of T-lymphoblastic lymphoma/leukemia in various anatomic sites were studied. Immunohistochemical analysis with CD10 and a panel of other hematolymphoid antibodies was performed in all 24 cases. Gene rearrangement studies for the T-cell receptor by the polymerase chain reaction were performed in 18 of 24 cases.

Results.—All cases were positive with at least 2 T-cell markers. In 15 (63%) of 24 cases CD10 was positive. T-cell receptor gene rearrangement was detected in 10 of 18 cases.

Conclusions.—Immunodetection of CD10 in T-lympho-blastic lymphoma/leukemia using monoclonal antibody 56C6 is common. This finding is useful in the evaluation of T-cell neoplasms.
Granular Cell Traumatic Neuroma
Authors: Rosso Renato , Scelsi Mario , Carnevali Luciano
Published: January 2021

Background.—Granular cell changes can be observed in a variety of benign and malignant tumors, and are seen more commonly in granular cell tumors, which in about 5% of cases develop in the breast. Granular cells also have been observed in sites of previous trauma, such as surgery, and are found to be inflammatory reactions of histiocytic origin.

Methods and Results.—We investigated, morphologically and immunohistochemically, 2 granular cell lesions occurring in mastectomy scars after surgery for carcinoma. Both lesions were composed of strands and nests of large granular cells, haphazardly set in a background of fibrous tissue, with sparse inflammatory infiltrates. Several tortuous hypertrophic nerve bundles were also embedded in the fibrous tissue. A few of these nerve bundles showed degenerative changes and contained granular cells. Immunohistochemically, granular cells were positive for S100 protein, neuron-specific enolase, vimentin, and CD68 antigen.

Conclusions.—We consider these proliferative lesions of peripheral nerves to have the features of both granular cell tumor and traumatic neuroma. These cases indicate that traumatic neuroma can undergo extensive granular cell changes and constitute a previously unrecognized entity, which we provisionally label granular cell traumatic neuroma. Granular cell traumatic neuroma has to be taken into consideration when evaluating lesions occurring at mastectomy scars and should be differentiated from malignant tumors with granular cells, such as apocrine carcinoma and alveolar soft part sarcoma.
Human Papillomavirus Type, Proliferative Activity, and p53
Authors: Rabah R. , Sakr W. , Thomas R. , Lancaster W. D. , Gregoire L.
Published: January 2021

Context.—The predictive value of nuclear proliferation antigen (Ki-67), tumor suppressor gene product p53, and human papillomavirus type has not been evaluated for outcome of laryngeal papilloma.

Objective.—This study was designed to determine whether immunohistochemical analysis of Ki-67 and p53 and human papillomavirus typing by polymerase chain reaction are able to identify patients with a more aggressive course of laryngeal papillomatosis.

Design.—Immunohistochemistry and polymerase chain reaction were performed on archival, paraffin-embedded, laryngeal papillomatosis biopsy specimens at the time of diagnosis, at an intermediate time during treatment, and at the last procedure available. Staining indexes for Ki-67 and p53 were determined, and human papillomavirus type was analyzed for all biopsies.

Patients.—Twelve patients with recurrent laryngeal papillomatosis for at least 5 years were selected from patients treated at our institution during the last 20 years.

Main Outcome Measures.—Separate analyses were conducted comparing average Ki-67 and p53 indexes against disease outcome, viral type, or average number of procedures per year. Associations were analyzed between virus type, average number of procedures per year, outcome, and histology.

Results.—No statistically significant associations were noted in Ki-67 or p53 indexes and outcome. Weak associations were noted for p53 indexes and procedures per year and virus type. Weak associations also were noted between virus type and development of neoplasia.

Conclusions.—Our observations suggest that human papillomavirus typing may be helpful in identifying patients with aggressive recurrent laryngeal papillomatosis. The weak association between p53 indexes and procedures per year and virus type may have some predictive value in identifying aggressive lesions.
Retrorectal Cystic Hamartoma
Authors: Prasad Anil R. , Amin Mahul B. , Randolph Todd L. , Lee Chong S. , Ma Chan K.
Published: January 2021

Background.—Retrorectal cystic hamartomas, or tailgut cysts, are rare congenital lesions that typically present as presacral masses. These lesions are frequently clinically unrecognized and misdiagnosed. Malignant change is extremely rare. Only 10 additional cases with associated malignancy were recovered from the literature. We describe the clinicopathologic features of 5 cases, including 2 cases with malignant transformation.

Results.—All patients were women (age range, 36–69 years). The most common symptoms were pain with defecation and rectal bleeding. One patient was asymptomatic. All lesions presented as multicystic presacral masses and all were surgically resected. The lesions varied in size from approximately 2 to 12 cm (average, 9.5 cm) and overall had similar histology composed of a variety of epithelial linings (stratified squamous, transitional, and simple or ciliated pseudostratified columnar). Skin adnexa, neural elements, and heterologous mesenchymal tissue, discriminators between retrorectal cystic hamartoma and teratoma, were not identified. Arising in association with the cysts was a focus of adenocarcinoma in one case and a neuroendocrine carcinoma in another.

Conclusions.—The clinical diagnoses in our cases were often delayed, which in part may be due to unfamiliarity with this entity. The main diagnostic difficulty is distinction from presacral mature cystic teratomas and rectal duplication cysts. Tailgut cysts require complete surgical excisions to prevent future recurrences and to preclude possible malignant transformation. Meticulous gross examination and adequate sampling are important to document the exact nature of these cysts and to rule out possible coexisting malignancies, which may be focal.
Early Peripheral Lymph Node Involvement of Human Herpesvirus 8–Associated, Body Cavity–Based Lymphoma in a Human Immunodeficiency Virus–Negative Patient
Authors: Ariad Samuel , Benharroch Daniel , Lupu Lilliana , Davidovici Batya , Dupin Nicolas , Boshoff Chris
Published: January 2021

Human herpesvirus 8 (HHV-8), or Kaposi sarcoma–associated herpesvirus , is a gamma herpesvirus first detected in a specimen of Kaposi sarcoma from a human immunodeficiency virus (HIV)–positive patient. Human herpesvirus 8 is also found in an unusual clinicopathologic form of body cavity–based B-cell lymphoma, which has been named primary effusion lymphoma (PEL) and occurs primarily in HIV-positive patients. PEL is characterized by the formation of lymphomatous effusions, without obvious lymphadenopathy, tumor masses, or bone marrow involvement. Only a few cases of PEL in HIV-seronegative patients have been reported. We describe a case of an HHV-8–associated lymphoma, with ascites, pleural effusion, and axillary lymphadenopathy in an HIV-negative patient. The patient was a 68-year-old Jewish man of North African extraction, with a previous history of coronary bypass surgery and multiple blood transfusions. The pleural fluid contained large atypical lymphoid cells and was suggestive of lymphoma but could not provide a conclusive diagnosis of PEL. The lymph node contained groups of large anaplastic lymphoid cells. Polymerase chain reaction for HHV-8 performed on the lymph node specimen was positive, establishing the diagnosis of PEL. Polymerase chain reaction for Epstein-Barr virus was negative. Results of a gallium scan were normal. The patient did not respond to combination chemotherapy with cyclophosphamide, doxorubicin, vincristine sulfate, and prednisone and progressively developed, massive intra-abdominal solid tumor formation. To our knowledge, this is the first report of a case of PEL that demonstrates peripheral lymph node involvement at diagnosis and the first report of PEL in an Israeli patient.
The Challenge of Variation in Medical Practice
Authors: James Brent C. , Hammond M. Elizabeth H.
Published: January 2021

Medicine has been identified as a profession for almost 3000 years based on a core premise that physicians have the right to evaluate their own quality. Because medicine is a profession and because of the special privileges granted to physicians by society, quality-based principles that evolved in the manufacturing business have been difficult to adapt to medical practice. Physicians learn from other physicians and medical literature. This leads to wide variation in what is considered best practice. Variation has complex association, including the variation in expert opinion, the complexity of medical knowledge, the variation in physician decision-making potential, and human error. Guidelines or algorithms are a strategy that are finding favor as a solution. The control of variation through guideline development, iterative refinement of guidelines, and feedback to physicians will improve medical practice. By removing variation, physicians can honor the fiduciary trust that they have made to patients, make reasoned decisions, improve outcomes, and focus attention on making medical improvements.
Effects of Different Hematocrit Levels on Glucose Measurements With Handheld Meters for Point-of-Care Testing
Authors: Tang Zuping , Lee Judith H. , Louie Richard F. , Kost Gerald J.
Published: January 2021

Objectives.—To determine the effects of low, normal, and high hematocrit levels on glucose meter measurements and to assess the clinical risks of hematocrit errors.

Design.—Changes in glucose measurements between low and high hematocrit levels were calculated to determine hematocrit effects. The differences between glucose measured with meters and with a plasma glucose method (YSI 2300) also were compared.

Setting.—Six handheld glucose meters were assessed in vitro at low (19.1%), normal (38.5%), and high (58.3%) hematocrit levels, and at 6 glucose concentrations ranging from 2.06 mmol/L (37.1 mg/dL) to 30.24 mmol/L (544.7 mg/dL).

Results.—Most systems, regardless of the reference to which they were calibrated, demonstrated positive bias at lower hematocrit levels and negative bias at higher hematocrit levels. Low, normal, and high hematocrit levels progressively lowered Precision G and Precision QID glucose measurements. Hematocrit effects on the other systems were more dependent on the glucose concentration. Overall, Accu-Chek Comfort Curve showed the least sensitivity to hematocrit changes, except at the lowest glucose concentration.

Conclusions.—We strongly recommend that clinical professionals choose glucose systems carefully and interpret glucose measurements with extreme caution when the patient's hematocrit value changes, particularly if there is a simultaneous change in glucose level.
Expression of Cytokeratins 7 and 20 in Carcinomas of the Extrahepatic Biliary Tract, Pancreas, and Gallbladder
Authors: Duval Jennie V. , Savas Louis , Banner Barbara F.
Published: January 2021

Background.—Expression of cytokeratins 7 (CK7) and 20 (CK20) may help distinguish the site of origin for metastatic carcinomas. Little is known regarding their expression in biliary tract and pancreatic carcinomas. Our aim was to study the expression of CK7 and CK20 in these tumors.

Design.—Fifty-three carcinomas of the extrahepatic bile ducts (n = 8), ampulla of Vater (n = 7), gallbladder (n = 11), and pancreas (n = 27), were retrieved from the surgical pathology files of the University of Massachusetts Medical Center. Formalin-fixed, paraffin-embedded sections were immunostained with mouse monoclonal antibodies to CK7 and CK20 using an avidin-biotin immunoperoxidase technique with microwave antigen retrieval. The percentage of cells positive for each antibody was assessed on a scale of 0 to 3 (0, <10%; 1+, 10% to 50%; 2+, 51% to 90%; 3+, >90%).

Results.—The majority of carcinomas in all groups were positive for CK7 (CK7+) and negative for CK20 (CK20−). Of the CK7+ tumors, the majority of tumors in each group were 3+ positive.

Conclusions.—(1) Carcinomas of the extrahepatic biliary tract and pancreas are strongly positive for CK7 and negative for CK20 and can be included in the differential diagnosis of other carcinomas with this profile in metastatic sites. (2) The CK7/CK20 immunostaining profile will not identify the site of origin for tumors with extensive growth in the porta hepatis region.
Myelophthisis as a Solitary Manifestation of Failure From Rectal Carcinoma
Authors: Mathew Paul , Fleming Declan , Adegboyega Patrick A.
Published: January 2021

Rectal carcinoma is uncommonly associated with systemic metastases in the absence of liver metastases, reflecting the predilection for spread via the portal system. Occasionally, isolated lung metastases are seen, which are usually attributed to spread via the portosystemic anastomoses in the distal rectum. However, myelophthisis is an unreported complication of rectal cancer as an isolated form of systemic failure. We present a case of fatal myelophthisis associated with otherwise localized rectal carcinoma secondary to metastatic rectal cancer. This observation led to the hypothesis that spread to the bone marrow occurred via a “third circulation,” the Batson plexus, a network of deep pelvic veins with rich anastomoses to the vertebral plexus.
Tenascin Expression in Intraepithelial Neoplasia and Invasive Carcinoma of the Uterine Cervix
Authors: Iskaros Basem F. , Koss Leopold G.
Published: January 2021

Objective.—To determine whether the expression of the matrix protein tenascin (TN) is of diagnostic or prognostic value in cervical intraepithelial neoplasia (CIN).

Design.—Tenascin expression was evaluated in 75 formalin-fixed, paraffin-embedded biopsy and surgical specimens of the uterine cervix. Specimens included 15 low-grade squamous neoplastic lesions (CIN I), 30 high-grade squamous neoplastic lesions (CIN II and CIN III), 5 microinvasive carcinomas, and 15 invasive squamous carcinomas. Five normal cervices and 5 examples of cervicitis were used as controls. Expression of TN was studied by immunohistochemistry with a monoclonal mouse anti-human tenascin antibody. Tenascin expression in the basement membrane and in the stroma was arbitrarily graded as normal or slightly, moderately, or markedly increased.

Results.—In the normal cervix, TN formed a thin band along the basement membrane of the squamous epithelium, except for the transformation zone, where the bands splintered and delicate TN fibers were present in the adjacent stroma. In cervicitis, TN bands were splintered in the basement membrane and the protein was weakly expressed in the stroma infiltrated by inflammatory cells. In the 45 CIN lesions, regardless of grade, the TN bands in the basement membrane were slightly (25 cases) or moderately (20 cases) increased. In CIN lesions with chronic stromal inflammation, a slight increase in stromal staining was observed, similar to the findings in cervicitis. In microinvasive and frankly invasive squamous cell carcinomas, TN expression was markedly increased in the basement membrane and in the stroma surrounding the invasive nests of cancer cells.

Conclusion.—Tenascin expression may be of value in the assessment of early stromal invasion in cancer of the uterine cervix. Tenascin expression is of no value in distinguishing various grades of CIN and, therefore, is not a predictor of future behavior.
Malignant Craniopharyngioma
Authors: Kristopaitis Theresa , Thomas Chinnamma , Petruzzelli Guy J. , Lee John M.
Published: January 2021

Craniopharyngiomas are histologically and cytologically benign epithelial tumors of the central nervous system that may be locally aggressive and tend to recur after excision. Malignant change in craniopharyngiomas is extremely rare; we found only 4 such reports in the literature. In this report, we describe a case of squamous cell carcinoma arising in a previously benign craniopharyngioma in a 42-year-old woman. The patient was diagnosed with craniopharyngioma in 1982; during the subsequent 15 years she experienced 7 tumor recurrences, for which surgical resections and 3 courses of radiotherapy were performed. In 1998, the tumor recurred with involvement of the nasal cavity and sphenoid and ethmoid sinuses. Histologic evaluation revealed foci of typical adamantinomatous craniopharyngioma associated with a moderately differentiated squamous cell carcinoma. The transition of typical craniopharyngioma to squamous cell carcinoma was well demonstrated, suggesting that carcinoma arose from the underlying craniopharyngioma. Radiation may have been a contributing factor to carcinogenesis in this case.
Glandular Malignant Peripheral Nerve Sheath Tumor
Authors: Nagasaka Tetsuro , Lai Raymond , Sone Michihiko , Nakashima Tsutomu , Nakashima Nobuo
Published: January 2021

In this report, we describe a highly unusual case of glandular malignant peripheral nerve sheath tumor presenting as a neck mass in a previously healthy 29-year-old man. Grossly, the tumor was found to arise from a swollen peripheral nerve trunk. The tumor was largely composed of spindle cells that demonstrated marked nuclear pleomorphism and numerous abnormal mitotic figures. In addition, histologically malignant glandular structures lined by simple nonciliated columnar cells with goblet cells were found clustered in the center of the tumor. Examination of the swollen peripheral nerve trunk revealed the presence of a plexiform neurofibroma. The spindle cells were positive for S100. The glands were negative for S100 but positive for keratin, epithelial membrane antigen, and neuroendocrine markers (somatostatin, chromogranin, Leu-7, and calcitonin). This patient was subsequently diagnosed as having von Recklinghausen disease and died of tumor metastasis to the lungs 34 months after the presentation. To our knowledge, only 3 similar cases have been previously described in the literature.
Incidental Prostatic Adenocarcinomas and Putative Premalignant Lesions in TURP Specimens Collected Before and After the Introduction of Prostrate-Specific Antigen Screening
Authors: Mai Kien T. , Isotalo Phillip A. , Green Jerome , Perkins D. Garth , Morash Christopher , Collins John P.
Published: January 2021

Background.—Since the introduction of prostate-specific antigen (PSA) screening for the detection of prostatic adenocarcinoma (PCA), there has been an increase in the incidence of stage T1c PCA. The purpose of this study was to compare the frequency of incidental PCA found in transurethral resection of prostate (TURP) specimens for a 14-month period during 1989–1990 (before PSA screening was available) with the incidence of PCA for a 32-month period during 1997–1999 (after PSA screening became available).

Design.—Consecutive TURP specimens from the 2 time periods were reviewed to identify incidental PCA, prostatic intraepithelial neoplasia (PIN), and atypical adenomatous hyperplasia (AAH). Cases of TURP for palliative treatment of known advanced PCA were excluded from the study. All TURP specimens were fixed in 10% buffered formalin and were processed according to the same protocol.

Results.—We reviewed 533 and 449 TURP specimens for the time periods 1989–1990 and 1997–1999, respectively. Comparison of the results for these 2 time periods revealed that the combined prevalence of T1a and T1b PCA decreased over time from 12.9% to 8.0% (P = .06) with the introduction of PSA screening. A new group of T1c PCA was established in the post-PSA screening period of 1997–1999. There were no statistically significant differences in the incidences of T1a PCA, PIN, and AAH in TURP specimens for the 2 time periods.

Conclusion.—The decreased incidence of T1b PCA in TURP specimens for the 1997–1999 period represents a shift in PCA staging. Some PCAs previously staged as T1b are now staged as T2 carcinomas, as a result of PSA screening and earlier clinical detection. The introduction of PSA screening has had no influence on the incidence of T1a PCA, PIN, or AAH in TURP specimens.
Multiparameter Immunohistochemical Analysis of the Cell Cycle Proteins Cyclin D1, Ki-67, p21WAF1, p27KIP1, and p53 in Mantle Cell Lymphoma
Authors: Izban Keith F. , Alkan Serhan , Singleton Timothy P. , Hsi Eric D.
Published: January 2021

Background.—Mantle cell lymphoma (MCL) is characterized by overexpression of cyclin D1, a G1 cyclin that participates in the control of cell cycle progression at the G1 to S phase transition. In addition to cyclin D1, other cell cycle regulatory molecules may be involved in the proliferation and progression of MCL. Mutation of p53, deletion of p16INK4a, and loss of p21WAF1 expression have been reported in some cases of blastoid MCL.

Objective.—We sought to examine levels of expression of these proteins in typical and blastoid MCL and to determine whether differences were present between these subtypes of lymphomas.

Design.—A retrospective series of typical and blastoid MCLs was evaluated for expression of the cell cycle–related proteins cyclin D1, p21WAF1, p27KIP1, Ki-67, and p53, as well as mitotic index. Paraffin-embedded archival tissues from 24 MCL specimens (17 typical, 7 blastoid) were immunostained with antibodies to p21WAF1, p27KIP1, p53, Ki-67, and cyclin D1. The percentage of positive cells for each specimen was estimated by counting 1500 cells under oil immersion microscopy. Levels of antigen expression were compared for the typical and blastoid MCLs. The mitotic index was estimated using twenty 100× oil immersion fields (OIFs) for each specimen.

Results.—Cyclin D1 expression was seen in 22/24 specimens (92%). Blastoid MCLs were characterized by a significantly higher mean mitotic index (>20 mitoses/20 OIFs) and Ki-67 index (>45%) when compared with typical MCLs (P < .001 and P < .008, respectively; Fisher's exact test). High expression of p27KIP1 (>25% staining) was seen more frequently in typical MCLs than in the blastoid variants (P = .03; Fisher's exact test). No significant differences were found between typical and blastoid MCLs for the expression of p21WAF1 or p53.

Conclusions.—A significantly higher mitotic index and Ki-67 index were found in blastoid MCLs as compared with typical MCLs. Low p27KIP1 expression was associated with the blastoid MCL variant. These findings confirm the high proliferative nature of blastoid MCL and suggest a role for p27KIP1 in the negative regulation of the cell cycle in MCL.
Inflammatory Myofibroblastic Tumor (Inflammatory Fibrosarcoma) of the Bone
Authors: Watanabe Kazuo , Tajino Takahiro , Sekiguchi Mihoko , Suzuki Toshimitsu
Published: January 2021

Although inflammatory myofibroblastic tumors, originally described in the lung, have recently been recognized to occur in various sites, their origin in bone is exceptional. We present a case of inflammatory myofibroblastic tumor, so-called inflammatory fibrosarcoma, of the bone. The tumor occurred in the iliac bone of a 70-year-old woman. Standard radiographs and magnetic resonance imaging revealed a destructive bone tumor that expanded into the soft tissue. Although the patient underwent excision of the hemi-iliac bone, multiple pulmonary metastases were noted 1 year after the operation. On histologic examination, the tumor was found to be composed of a sarcoma-like cellular area and a hypocellular fibrous area. Inflammatory cell infiltration into the tumor was a distinctive feature and is analogous with that of conventional inflammatory myofibroblastic tumor or inflammatory fibrosarcoma of the soft tissue. This is the first report to our knowledge of an inflammatory myofibroblastic tumor of the bone with distant metastasis.
Adenoid Cystic Carcinoma of the Ovary
Authors: Zámečník Michal , Michal Michal , Čuřík Romek
Published: January 2021

We describe a case of ovarian adenoid cystic carcinoma (ACC) of the left ovary in a 23-year-old woman. The tumor had the typical cribriform pattern of ACC, lacked any component of surface epithelial carcinoma, and showed myoepithelial differentiation. The features of salivary gland–type tumor seen in this case are unusual and different from those of so-called ACC-like carcinomas of the ovary, which only resemble the salivary gland tumor histologically.
Hepatocellular Carcinoma and Non-Hodgkin Lymphoma in a Patient With Chronic Hepatitis C and Cirrhosis
Authors: Suriawinata Arief , Ye Ming Q. , Emre Sukru , Strauchen James , Thung Swan N.
Published: January 2021

Hepatitis C virus (HCV) is a hepatotropic virus, but its genome and replicative intermediates also have been detected in peripheral blood mononuclear cells in patients with chronic hepatitis C. Chronic HCV infection may lead to hepatocellular carcinoma and, in a small percentage of cases, to B-cell non-Hodgkin lymphoma. To our knowledge, coexistence of these 2 tumors has not been reported previously. We describe a case of chronic hepatitis C and cirrhosis with 2 small hepatocellular carcinomas and incidental non-Hodgkin lymphoma of a hilar lymph node found during liver transplantation. Although the mechanisms of HCV oncogenesis in hepatocellular carcinoma and in lymphoma are unclear, the presence of these 2 tumors in a single patient are in agreement with the tropism of HCV and its role in oncogenesis.
Effect of Image Compression on Telepathology
Authors: Marcelo Alvin , Fontelo Paul , Farolan Miguel , Cualing Hernani
Published: January 2021

Context.—For practitioners deploying store-and-forward telepathology systems, optimization methods such as image compression need to be studied.

Objective.—To determine if Joint Photographic Expert Group (JPG or JPEG) compression, a lossy image compression algorithm, negatively affects the accuracy of diagnosis in telepathology.

Design.—Double-blind, randomized, controlled trial.

Setting.—University-based pathology departments.

Participants.—Resident and staff pathologists at the University of Illinois, Chicago, and University of Cincinnati, Cincinnati, Ohio.

Intervention.—Compression of raw images using the JPEG algorithm.

Main Outcome Measures.—Image acceptability, accuracy of diagnosis, confidence level of pathologist, image quality.

Results.—There was no statistically significant difference in the diagnostic accuracy between noncompressed (bit map) and compressed (JPG) images. There were also no differences in the acceptability, confidence level, and perception of image quality. Additionally, rater experience did not significantly correlate with degree of accuracy.

Conclusions.—For providers practicing telepathology, JPG image compression does not negatively affect the accuracy and confidence level of diagnosis. The acceptability and quality of images were also not affected.
Fibroadenoma Mimicking Papillary Carcinoma on ThinPrep of Fine-Needle Aspiration of the Breast
Authors: Myers Timothy , Wang Helen H.
Published: January 2021

Objective.—To compare and contrast benign and malignant lesions of the breast that have similar appearances on fine-needle aspiration cytology and that constitute diagnostic pitfalls.

Design.—The cytology files (dated November 1995 through May 1998) of the Beth Israel Deaconess Medical Center were searched to identify cases of breast fine-needle aspiration biopsies that were highly cellular and composed of bland-appearing spindle/columnar cells and that could represent either epithelial or stromal cells; these cases were reported as indeterminate (atypical/suspicious) and had subsequent excisional biopsies taken.

Results.—Four such cases were found. Two were fibroadenomas and 2 were papillary carcinomas. Their appearances were strikingly similar on aspiration cytology. All cases were prepared with the ThinPrep method. On microscopic examination, all 4 cases were hypercellular and had many single cells and clusters of columnar/elongate cells. Immunocytochemistry proved these cells to be of epithelial origin. At least occasional bipolar stromal cells were seen in the background. The only appreciable difference between the benign and malignant cases was more significant nuclear atypia, which was barely discernible, in the malignant cases. Immunocytochemistry for smooth muscle actin was helpful in 2 cases that had sufficient material.

Conclusions.—Some cases of fibroadenomas and papillary carcinomas can be very difficult, if not impossible, to distinguish on fine-needle aspiration cytology. Immunocytochemistry may be helpful if sufficient material is available. To avoid false-negative or false-positive diagnosis on cytology, it is best to report such cases as atypical or suspicious with final diagnosis pending excisional biopsy.