bluuebunny/crossref_metadata_2025 huggingface dataset:
Biphasic Acute Myeloid Leukemia With Near-Tetraploidy and Immunophenotypic Transformation
Authors: Imkie Marwa , Davis Marilyn K. , Persons Diane L. , Cunningham Mark T.
Published: February 2021

This report describes a case of acute myeloid leukemia (subtype M1) with biphasic morphology. The bone marrow biopsy showed 2 distinct regions of blasts, one containing large cells and the other small cells. Morphometric and DNA ploidy analysis showed that the mean nuclear area and mean DNA index for the large cell region were 2-fold higher than those for the small cell region. Cytogenetic analysis showed an abnormal near-tetraploid clone. The tumor relapsed following aggressive therapy. The cells from the relapse specimen were similar to the original small cell region with respect to nuclear area and DNA index; however, there was immunophenotypic transformation with gain of CD7 and gain of CD56. Cytogenetically, the relapse specimen showed no evidence of the near-tetraploid clone, but instead had a previously unidentified abnormal clone containing 46 chromosomes and structural abnormalities of 2q and 7q. Biphasic morphology in acute myeloid leukemia may be predictive of a near-tetraploid subclone and immunophenotypic transformation.
Analysis of On-Line Clinical Laboratory Manuals and Practical Recommendations
Authors: Beckwith Bruce , Schwartz Robert , Pantanowitz Liron
Published: February 2021

Context.—On-line clinical laboratory manuals are a valuable resource for medical professionals. To our knowledge, no recommendations currently exist for their content or design.

Objective.—To analyze publicly accessible on-line clinical laboratory manuals and to propose guidelines for their content.

Design.—We conducted an Internet search for clinical laboratory manuals written in English with individual test listings. Four individual test listings in each manual were evaluated for 16 data elements, including sample requirements, test methodology, units of measure, reference range, and critical values. Web sites were also evaluated for supplementary information and search functions.

Results.—We identified 48 on-line laboratory manuals, including 24 academic or community hospital laboratories and 24 commercial or reference laboratories. All manuals had search engines and/or test indices. No single manual contained all 16 data elements evaluated. An average of 8.9 (56%) elements were present (range, 4–14). Basic sample requirements (specimen and volume needed) were the elements most commonly present (98% of manuals). The frequency of the remaining data elements varied from 10% to 90%.

Conclusions.—On-line clinical laboratory manuals originate from both hospital and commercial laboratories. While most manuals were user-friendly and contained adequate specimen-collection information, other important elements, such as reference ranges, were frequently absent. To ensure that clinical laboratory manuals are of maximal utility, we propose the following 13 data elements be included in individual test listings: test name, synonyms, test description, test methodology, sample requirements, volume requirements, collection guidelines, transport guidelines, units of measure, reference range, critical values, test availability, and date of latest revision.
Practice Patterns of Clinicians Following Isolated Diagnoses of Atypical Small Acinar Proliferation on Prostate Biopsy Specimens
Authors: Fadare Oluwole , Wang Sa , Rajan Mariappan M.
Published: February 2021

Context.—The controversial diagnostic term atypical small acinar proliferation (ASAP) has gained some acceptance as a legitimate way for pathologists to describe minute foci of small prostatic acini that raise the suspicion of carcinoma but that fail to attain the requisite diagnostic threshold for carcinoma.

Objective.—To investigate the practice patterns of clinicians following this diagnosis and to identify clinicopathologic parameters that may be of influence.

Design.—All cases with a diagnosis of ASAP on a prostate biopsy specimen during a 7-year period were retrieved from our computerized database. Cases with concurrent diagnoses of adenocarcinoma and/or prostatic intraepithelial neoplasia were excluded. Medical and pathologic records for the remaining patients were reviewed and correlated with pathologic data.

Results.—Fifty-five (2.8%) of 1964 prostate biopsies performed during this period provided the diagnosis of ASAP, of which 36 met our study criteria. The average age of the patients was 65 years, and the mean total prostate-specific antigen (PSA) level was 6.41 ng/mL. The rate of biopsy subsequent to an ASAP diagnosis was 67% (24/36), and the mean duration to subsequent biopsy was 246 days (median, 182 days; range, 71–728 days). Adenocarcinoma was diagnosed in 9 (38%) of 24 specimens taken during the subsequent biopsy. Neither age nor PSA level significantly predicted a greater likelihood for subsequent biopsy. Additionally, among patients who received a subsequent biopsy, the aforementioned parameters were not predictive of carcinoma in the second biopsy. The average number of cores following an ASAP diagnosis (6 cores) did not differ significantly from the average at initial biopsy (7.18 cores, P = .64). Pathology report characteristics, such as inclusion of a descriptive note or explicit recommendation of a second biopsy, did not significantly increase the likelihood of a subsequent biopsy. Reasons for a delay in or lack of a subsequent biopsy following an ASAP diagnosis were miscellaneous and attributable to the patients in most cases.

Conclusion.—The diagnosis of ASAP generates a subsequent biopsy in two thirds of cases after an average duration of 246 days. Although closer follow-up may be recommended based on the high rate of association with carcinoma on subsequent biopsy, we found no evidence that any delays in or lack of a subsequent biopsy is attributable to a lack of understanding on the part of urologists of the significance of the diagnosis.
Melanosis Coli Involving Pericolonic Lymph Nodes Associated With the Herbal Laxative Swiss Kriss: A Rare and Incidental Finding in a Patient With Colonic Adenocarcinoma
Authors: Ewing C. Alexander , Kalan Mohammed , Chucker Francis , Ozdemirli Metin
Published: February 2021

Melanosis coli is a well-known condition in which macrophages filled with a lipofuscin-like pigment are found in the colonic lamina propria. The condition has been associated with the ingestion of anthracene laxatives and is believed to be caused by increased epithelial apoptosis. Although melanosis coli is a frequent finding in colonic biopsies and resection specimens, to our knowledge the presence of identical pigment in macrophages of pericolonic lymph nodes has been reported in only 4 other patients in the English literature. We report the case of a patient who underwent a left hemicolectomy for colonic adenocarcinoma and was found incidentally to have melanosis coli associated with long-term use of the herbal laxative Swiss Kriss, not only in his colonic mucosa, but also in the colonic submucosa and in his pericolonic lymph nodes.
Epiglottic Histoplasmosis Presenting in a Nonendemic Region: A Clinical Mimic of Laryngeal Carcinoma
Authors: O'Hara Carolyn D. , Allegretto Michael W. , Taylor Geoffrey D. , Isotalo Phillip A.
Published: February 2021

Histoplasma capsulatum is a dimorphic fungus endemic to North America. Histoplasmosis is primarily an inhalation-acquired mycosis that is encountered rarely outside of endemic regions. In nonendemic regions, histoplasmosis may present a diagnostic challenge and both clinical and laboratory vigilance are required to accurately identify infection. Unusual clinical presentations with limited physical findings may compound the difficulty in diagnosis. We describe a 78-year-old retired soil science professor who presented with an eroded epiglottic mass secondary to disseminated histoplasmosis in a nonendemic region (Alberta). Clinically, this mass was thought to represent a primary laryngeal carcinoma, as no other buccal or oropharyngeal ulcers were identified. Histoplasmosis was confirmed by tissue biopsy and a positive immunodiffusion test for immunoglobulin G. Disseminated histoplasmosis is often associated with laryngeal and oropharyngeal disease; however, isolated epiglottic histoplasmosis is rare. Histoplasmosis should be included in the differential diagnosis of neoplasms and chronic ulcers of the upper aerodigestive tract.
Comparative Assays for the HER-2/neu Oncogene Status in Breast Cancer
Authors: Vera-Román JoséMaría , Rubio-Martínez Luis Alberto
Published: February 2021

Context.—Tumor marker assays, especially those used to indicate the right therapy, should be standardized.

Objective.—To analyze the current methods for the HER-2/neu (h2n) oncogene status by immunohistochemical (IHC) analysis, fluorescence in situ hybridization (FISH), and chromogenic in situ hybridization (CISH) and compare those results with the chromosome 17 copy number and the status of the topoisomerase II alpha (TPIIα) gene.

Design.—We tested 50 infiltrating ductal breast carcinomas (pTNM status varied from pT1 N0 to pT4 N1) using the Food and Drug Administration (FDA)–approved methods HercepTest and Pathway for overexpression of h2n. We also used FISH and CISH to test for h2n amplification and CISH to test for chromosome 17 (c17) and TPIIα. The p53 and Ki-67 factors were also evaluated by IHC analysis.

Results.—h2n overexpression (3+) and amplification were observed in only 6 (12%) of 50 cases by IHC analysis, FISH, and CISH. Three cases that initially scored 3+ and 2+ had 4 to 5.95 signals (equivocal) by FISH but when corrected by the h2n/c17 ratio were nonamplified. TPIIα isomerase was amplified in only 2 (4%) of the 50 cases. Nineteen (38%) of the 50 cases were aneuploidic. All h2n amplified cases had high proliferative activity, but only 2 of 6 had p53 protein alterations.

Conclusions.—The HercepTest and Pathway IHC assay h2n were fully concordant for the 3+ cases. The 3+ cases had to be confirmed in 75% of the tumor area examined. These 2 IHC assays were fully concordant with FISH and CISH. The 2 in situ hybridization (ISH) assays were 94% concordant for the 50 cases. The cutoff signal points for both ISH assays should be 6 or more. Thus, there is no need for the c17 ratio correction. Tumor heterogeneity appears not be a major problem, but our percentage of amplified cases is lower than previously reported. The FDA-approved IHC and ISH assays should give relatively uniform results when used following our recommendations.
Total Fibrous Obliteration of Main Portal Vein and Portal Foam Cell Venopathy in Chronic Hepatic Allograft Rejection
Authors: Jain Dhanpat , Robert Marie E. , Navarro Victor , Friedman Amy L. , Crawford James M.
Published: February 2021

Context.—Chronic hepatic allograft rejection is characterized by arteriopathy and bile duct loss. Pathology of the portal vein or its branches is not considered to play a major role in chronic rejection.

Objective.—A recent case of chronic rejection with total fibrous obliteration of the portal vein at the hilum and graft loss prompted us to retrospectively analyze cases of failed allografts for portal vein changes.

Design.—Six cases of failed hepatic allograft recorded in our files from 1994 to 1998 were selected for the study. For comparison, 4 cases of hepatitis C cirrhosis were included. Clinical features, including arteriograms or Doppler studies, were reviewed whenever available. Sections taken from the hilum and random parenchyma stained with routine hematoxylin-eosin, elastic van Gieson, and Masson trichrome were examined by 3 experienced liver pathologists in a randomized, blinded fashion.

Results.—Significant hepatic artery occlusion with foam cell change and bile duct loss was seen in all cases of chronic rejection (3/3), but not in the other cases. Foam cell change in the portal vein at the hilum (3/3) and occasionally into the distal branches (2/3) with variable occlusion of the lumen was seen only in cases of chronic hepatic allograft rejection. Mild luminal narrowing was observed in all the cases of cirrhosis (4/4) as a result of phlebosclerosis, most likely representing a change secondary to portal hypertension. Total obliteration of the portal vein at the hilum was seen in the index case (case 1) only.

Conclusion.—Portal venopathy can be a significant finding in chronic hepatic allograft rejection and may contribute to graft dysfunction or failure. Two-vessel disease must be considered in cases of chronic hepatic allograft rejection, and pathologists should thoroughly examine the hilum in explanted hepatic allografts.
Detection of Clonality With κ and λ Immunohistochemical Analysis in Cutaneous Plasmacytomas
Authors: Bayer-Garner Ilene B. , Prieto Victor G. , Smoller Bruce R.
Published: February 2021

Context.—Cutaneous plasmacytomas rarely occur in the setting of multiple myeloma. However, since poorly differentiated lesions may resemble other neoplasms, such as carcinoma, melanoma, and lymphoma, the diagnosis of cutaneous plasmacytoma may be difficult.

Objective.—To demonstrate clonality using κ and λ immunohistochemical analysis in cutaneous plasmacytomas and to ascertain whether or not interpretation is hindered by background staining.

Design.—Pathology reports of all patients with the diagnosis of multiple myeloma were reviewed. Twelve patients had cutaneous lesions diagnosed as plasmacytoma, and these lesions were analyzed for light chain restriction with κ and λ immunohistochemical analysis.

Results.—In most cases (11 of 12), monoclonality was demonstrated. In the remaining case, monoclonality could not be established because most cells did not stain for either κ or λ.

Conclusions.—Light chain restriction can be demonstrated in most multiple myeloma–related cutaneous plasmacytomas, establishing the neoplastic nature of the infiltrate.
Determination of Plasma Glycoprotein 2 Levels in Patients With Pancreatic Disease
Authors: Hao Ying , Wang Jing , Feng Ningguo , Lowe Anson W.
Published: February 2021

Context.—Blood tests possessing higher diagnostic accuracy are needed for all the major pancreatic diseases. Glycoprotein 2 (GP2) is a protein that is specifically expressed by the pancreatic acinar cell and that has previously shown promise as a diagnostic marker in animal models of acute pancreatitis.

Objective.—This study describes the development of an assay for GP2, followed by the determination of plasma GP2 levels in patients with acute pancreatitis, chronic pancreatitis, and pancreatic cancer.

Design.—Rabbit polyclonal antisera and mouse monoclonal antibodies were generated against human GP2 and used to develop an enzyme-linked immunosorbent assay. The assay was tested in patients with an admitting diagnosis of pancreatic disease at 2 tertiary care facilities. The diagnosis of acute or chronic pancreatitis and pancreatic cancer was determined using previously established criteria that incorporated symptoms, radiology, pathology, and serology. Plasma GP2 levels were determined in 31 patients with acute pancreatitis, 16 patients with chronic pancreatitis, 36 patients with pancreatic cancer, and 143 control subjects without pancreatic disease. Amylase and lipase levels were also determined in patients with acute pancreatitis.

Results.—The GP2 assay's sensitivity values were 0.94 for acute pancreatitis, 0.81 for chronic pancreatitis, and 0.58 for pancreatic cancer, which were greater than the 0.71 for acute pancreatitis and 0.43 for chronic pancreatitis (P = .02) observed for amylase. The lipase assay sensitivity for acute pancreatitis was 0.66. The accuracy of the GP2 assay was greater than that of the amylase or lipase assays for acute pancreatitis (GP2 vs lipase, P = .004; GP2 vs amylase, P = .003) when analyzed using receiver operator characteristic curves. When daily serial blood samples were obtained for 13 patients with acute pancreatitis, GP2 levels remained abnormally elevated for at least 1 day longer than the amylase or lipase levels.

Conclusion.—The GP2 assay is a useful new marker for acute and chronic pancreatitis.
Malignant Melanoma With a Rhabdoid Phenotype: Histologic, Immunohistochemical, and Ultrastructural Study of a Case and Review of the Literature
Authors: Abbott Jared J. , Amirkhan Robin H. , Hoang Mai P.
Published: February 2021

Malignant melanoma is known to display tremendous histologic diversity. One rare variant is the rhabdoid phenotype, so called because of the appearance of cells resembling rhabdomyoblasts seen in malignant rhabdoid tumors of the kidney. We present the histologic, immunohistochemical, and ultrastructural features of a malignant melanoma composed entirely of rhabdoid cells. A 62-year-old man presented with a 6.5-cm lung mass. Although presumed to be a metastatic lesion, extensive workup failed to reveal a primary tumor site. Histologic sections showed a mass composed entirely of polygonal neoplastic cells with prominent nucleoli and large hyaline cytoplasmic inclusions. The tumor cells were strongly immunoreactive with S100 protein, vimentin, and CD56, and were focally reactive with Mart-1. Tumor cells were negative for Melan-A, tyrosinase, HMB-45, AE1/AE3, cytokeratin (CK) 7, CK8/ 18, CK20, CK903, CAM 5.2, epithelial membrane antigen, smooth muscle actin, desmin, leukocyte common antigen, Bcl-2, CD3, CD20, CD30, CD138, κ and λ light chains, CD68, CD34, factor VIII, synaptophysin, and glial fibrillary acidic protein. Electron microscopy showed cytoplasmic whorls of intermediate filaments containing entrapped rough endoplasmic reticulum, mitochondria, and lipid. Recognition of this rare variant of malignant melanoma is important in the evaluation of tumors with rhabdoid morphology.
Dedifferentiated Liposarcoma With a Paraganglioma-like Histologic Pattern: A Case Report and Review of the Literature
Authors: Liu Dating , Quinonez Guillermo , Latosinsky Steven
Published: February 2021

A 53-year-old man presented with a 4-month history of increasing abdominal discomfort and distension. A large retroperitoneal mass was found on imaging. Image-guided needle core biopsy demonstrated a poorly differentiated malignant neoplasm. A 30 × 32 × 33-cm soft tissue mass was removed. Microscopically, the tumor consisted of predominantly epithelioid malignant cells arranged in a paraganglioma-like growth pattern. Immunohistochemically, these cells were strongly positive for neuron-specific enolase. Stains for synaptophysin and chromogranin, however, were negative. There was no ultrastructural evidence of neuroendocrine differentiation. Adjacent sarcomatous areas were composed of spindled cells arranged in storiform and fibrosarcoma-like growth patterns. A small area of well-differentiated liposarcoma was identified, and a diagnosis of dedifferentiated liposarcoma was established. To the best of our knowledge, this represents the first reported case of dedifferentiated liposarcoma with a paraganglioma-like histologic pattern. A brief review focusing on the morphologic variations of dedifferentiated liposarcoma is also presented.
Solitary Fibrous Tumor of Nasal Cavity in Patient With Long-Standing History of Cocaine Inhalation
Authors: Chauhan Suman S. , Krishnan Jayshree , Heffner Denis K.
Published: February 2021

We report a solitary fibrous tumor in the nasal cavity of a 48-year-old woman who presented with a history of bilateral nasal obstruction and long-standing cocaine inhalation. Physical examination revealed a large mass involving the right nasal cavity and extending into the posterior aspect of the left nasal cavity. The computed tomography scan showed opacification of airways. During surgery, the mass was found to involve the entire nasal cavity, with extension to the right maxillary sinus, posterior nasal airways, and left nasal cavity. The mass was completely excised. Pathologic examination revealed a polypoid mass 3.7 × 3.0 × 1.2 cm. This tumor was composed of spindle cells that were cytologically bland in a background of ropey and nodular collagen, giving a “patternless” pattern. Immunohistochemically, the neoplastic cells stained for CD34 and vimentin but not for S100 protein, keratin, desmin, HMB-45, and c-Kit. This immunohistochemical pattern confirmed the diagnosis of solitary fibrous tumor. Although solitary fibrous tumors are usually found in the pleura, they can occur in various other locations, such as the orbit, nasal cavity, paranasal sinuses, mediastinum, breast, vagina, meninges, and soft tissues. This case is of interest because the tumor occurred in a patient with prolonged cocaine inhalation. Such an association has not been previously described. The exact causal relationship between cocaine inhalation and the tumor is not known.
Pigmented “Black” Pheochromocytoma of the Adrenal Gland: A Case Report and Review of the Literature
Authors: Bellezza Guido , Giansanti Michele , Cavaliere Antonio , Sidoni Angelo
Published: February 2021

A pigmented “black” mass was discovered incidentally in a 72-year-old woman. The tumor, which was detected near the upper pole of the left kidney, was cystic and intensely black throughout with the presence of abundant, coarse, dark brown to black pigment granules. Histologic examination showed a proliferation of monomorphous neoplastic cells arranged in a typical zellballen growth pattern. These features indicated a diagnosis of pheochromocytoma. Immunostains for chromogranin A, synaptophysin, and neuron-specific enolase were positive. The immunostain for HMB-45 was negative. Electron microscopy showed neurosecretory-type granules and larger pleomorphic granules, which were considered most consistent with neuromelanin, a waste product of catecholamine metabolism. The evidence of melanin or melanin-like pigment in the adrenal gland has been described in only 10 cases in the literature and is always a microscopic finding. The case reported here is unique for the characteristic black macroscopic appearance and the abundance of pigment.
Clear Cell Papulosis of the Skin: A Case Report From Singapore
Authors: Kumarasinghe Sujith Prasad Wanniarachchi , Chin Giam Yoke , Kumarasinghe Marian Priyanthi
Published: February 2021

Clear cell papulosis of the skin is a rare condition; to our knowledge only 12 cases have been reported. Here, we report for the first time a case of clear cell papulosis with cytokeratin 7 expression and provide a comprehensive literature review. A 16-month-old girl presented with 3 hypopigmented lesions in the pubic region that were 3 to 9 mm in diameter; 1 lesion was papular, and the other 2 were macular. A skin biopsy revealed acanthosis with a proliferation of clear cells along the basal and suprabasal layers of the epidermis occurring in small clusters and singly. The cells had round to oval regular nuclei with abundant to moderate lightly eosinophilic to clear cytoplasm and intracytoplasmic mucin. Immunostaining produced positive results for carcinoembryonic antigen, AE1/3, epithelial membrane antigen, cell adhesion molecule 5.2, and cytokeratin 7 and negative results for gross cystic fluid disease protein, S100, and HMB-45. Clear cells of clear cell papulosis are mucin-positive and S100-negative glandular-secretory epithelial cells with histogenetic features of Toker cells of nipple and Paget cells. Immunohistochemical features support an eccrine secretory cell origin because the clear cells are consistently and strongly positive for carcinoembryonic antigen, positive for cell adhesion molecule 5.2, and negative or rarely positive for gross cystic fluid disease protein.
Solitary Fibrous Tumor of the Auditory Canal
Authors: Rezk Sherif , Yousef Mohammad , Zamansky Marshall , Khan Ashraf
Published: February 2021

Solitary fibrous tumor (SFT) is an uncommon spindle cell neoplasm of increasing incidence that was originally described to be of pleural origin; however, more recently, SFT has been reported in extrapleural sites, including the orbit, liver, salivary glands, tongue, nose, paranasal sinuses, larynx, retroperitoneum, meninges, and thyroid. The increase in the number of SFTs does not necessarily mean increased incidence of this tumor but rather an increased understanding of this tumor, especially recognition of this tumor in extrapleural locations, which has been aided by immunohistochemical analysis. We report a case of SFT in the auditory canal, which to our knowledge has not been previously reported, as evident by morphologic findings and immunophenotype.
Carcinosarcoma of the Urinary Bladder Following Cyclophosphamide Therapy
Authors: Mukhopadhyay Sanjay , Shrimpton Anthony E. , Jones Lee A. , Nsouli Imad S. , Abraham Naif Z.
Published: February 2021

We report a case involving a 45-year-old man with a 12-year history of Wegener granulomatosis, who developed a carcinosarcoma of the urinary bladder after long-term cyclophosphamide therapy. Cyclophosphamide is well recognized as an etiologic agent for urothelial carcinoma of the urinary bladder. However, only 5 cases of carcinosarcoma of the urinary bladder following cyclophosphamide therapy have been reported. We used loss of heterozygosity studies and microsatellite markers to define the molecular basis of this rare neoplasm. These studies revealed evidence supporting a monoclonal origin for the 2 components of this tumor. We also demonstrated allelic loss of chromosome 9p. This loss associated with carcinosarcoma of the urinary bladder is in agreement with previous studies, suggesting a possible role for the tumor suppressor gene p16 in the pathogenesis of this tumor.
Error and Error Reduction in Pathology
Authors: Sirota Ronald L.
Published: February 2021

Context.—Since publication of the Institute of Medicine's report on medical error in late 1999, there has been widespread interest in improving patient safety and in error reduction in all disciplines of medicine. In fields other than medicine, considerable knowledge has been obtained concerning error and error reduction. This body of knowledge can be successfully applied to pathology in order to make the specialty safer and less error prone.

Objectives.—To review the fundamental conclusions of the Institute of Medicine's report on medical error, to provide a taxonomy of error that can be adapted to pathology, to provide a framework for studying and analyzing error in pathology, to contrast different approaches to error, and to explain the concept of a culture of safety.

Design.—Review of pertinent literature, analysis of concepts of error reduction and safety used in other disciplines, analysis of pathology workflow, and adaptation of safety practices to the practice of pathology.

Results.—A taxonomy for error is described and adapted to pathology, a framework for error in the specialty is described, and characteristics of a culture of safety for pathology are proposed.

Conclusions.—Fundamental concepts of error reduction and safety improvement exist in other disciplines and can successfully be adapted to pathology.
An Insurer's Perspective on Error and Loss in Pathology
Authors: Troxel David B.
Published: February 2021

Objectives.—To identify errors in surgical pathology practice that lead to malpractice claims, and to define the frequency and severity of pathology malpractice claims and discuss the implications.

Design.—Three hundred seventy-eight pathology malpractice claims reported to The Doctors Company of Napa, Calif, between 1998 and 2003, were reviewed. Nuisance claims and autopsy claims were excluded; the 335 remaining claims were analyzed.

Results.—Pathology claim frequency is low. Pathology claim severity is high, especially for claims involving a misdiagnosis of melanoma or a false-negative Papanicolaou test. Fifty-seven percent of claims involved the following 5 categories: breast specimens, melanoma, Papanicolaou smears, gynecologic specimens, and operational error. Sixty-three percent of claims involved failure to diagnose cancer, resulting in delay in diagnosis or inappropriate treatment.

Conclusion.—A false-negative diagnosis of melanoma is the single most common reason for filing a malpractice claim against a pathologist. Nearly one third of misdiagnoses involve melanoma misdiagnosed as Spitz nevus, “dysplastic” nevus, spindle cell squamous carcinoma, atypical fibroxanthoma, and dermatofibroma.
Anatomic Pathology Databases and Patient Safety
Authors: Raab Stephen S. , Grzybicki Dana M. , Zarbo Richard J. , Meier Frederick A. , Geyer Stanley J. , Jensen Chris
Published: February 2021

Context.—The utility of anatomic pathology discrepancies has not been rigorously studied.

Objective.—To outline how databases may be used to study anatomic pathology patient safety.

Design.—The Agency for Healthcare Research and Quality funded the creation of a national anatomic pathology errors database to establish benchmarks for error frequency. The database is used to track more frequent errors and errors that result in more serious harm, in order to design quality improvement interventions intended to reduce these types of errors. In the first year of funding, 4 institutions (University of Pittsburgh, Henry Ford Hospital, University of Iowa, and Western Pennsylvania Hospital) reported cytologic-histologic correlation error data after standardizing correlation methods. Root cause analysis was performed to determine sources of error, and error reduction plans were implemented.

Participants.—Four institutions self-reported anatomic pathology error data.

Main Outcome Measures.—Frequency of cytologic-histologic correlation error, case type, cause of error (sampling or interpretation), and effect of error on patient outcome (ie, no harm, near miss, and harm).

Results.—The institutional gynecologic cytologic-histologic correlation error frequency ranged from 0.17% to 0.63%, using the denominator of all Papanicolaou tests. Based on the nongynecologic cytologic-histologic correlation data, the specimen sites with the highest discrepancy frequency (by project site) were lung (ranging from 16.5% to 62.3% of all errors) and urinary bladder (ranging from 4.4% to 25.0%). Most errors detected by the gynecologic cytologic-histologic correlation process were no-harm events (ranging from 10.7% to 43.2% by project site). Root cause analysis identified sources of error on both the clinical and pathology sides of the process, and error intervention programs are currently being implemented to improve patient safety.

Conclusions.—A multi-institutional anatomic pathology error database may be used to benchmark practices and target specific high-frequency errors or errors with high clinical impact. These error reduction programs have national import.
Capillary Hemangioma of the Endometrium: A Case Report and Review of the Literature
Authors: Johnson Cary , Reid-Nicholson Michelle , Deligdisch Lianne , Grinblat Svetlana , Natarajan Suneetha
Published: February 2021

A 39-year-old woman with menorrhagia of 7 years' duration was found to have a capillary hemangioma of the endometrium. Initial diagnosis by curettage was considered questionable but was later confirmed at hysterectomy. A thorough search and review of the literature was performed.
Testing for Defective DNA Mismatch Repair in Colorectal Carcinoma: A Practical Guide
Authors: Burgart Lawrence J.
Published: February 2021

Context.—Significant bench and clinical data have been generated during the last decade regarding DNA mismatch repair in colorectal carcinoma.

Objectives.—To review clinically relevant aspects of defective DNA mismatch repair in colorectal carcinoma and to suggest testing algorithms for identification of these tumors in the sporadic and familial settings.

Data Sources.—This article is based on literature review and clinical testing experience of more than 2000 patient samples.

Conclusions.—Approximately 15% of colorectal carcinomas arise as a result of defective DNA mismatch repair. Ninety percent of these carcinomas are sporadic, arising as a result of methylation of the MLH1 gene promoter, silencing expression. These sporadic carcinomas have improved stage-specific prognosis and can be identified by demonstrating aberrant loss of expression with an MLH1 immunoperoxidase stain. Familial colorectal carcinomas with defective DNA mismatch repair (Lynch syndrome) are due to a germline defect in one of several DNA mismatch repair genes. The familial carcinomas are best identified with a combination of immunohistochemistry and molecular microsatellite analysis. This testing facilitates subsequent directed genetic testing of the proband and family members.
Attenuated Familial Adenomatous Polyposis: A Case Report With Mixed Features and Review of Genotype-Phenotype Correlation
Authors: Ionescu Diana N. , Papachristou Georgios , Schoen Robert E. , Hedge Madhuri , Richards C. Sue , Monzon Federico A.
Published: February 2021

Familial adenomatous polyposis represents approximately 1% of all colorectal cancers and is caused by germline mutations in the adenomatous polyposis coli (APC) gene. Most mutations are located within the first 2000 codons, and several mutational hot spots have been identified. The relative location of the mutation may be associated with the number of polyps and partially predicts specific phenotypic expression. Mutations associated with the attenuated phenotype are found predominantly in the 5′ region of the gene or in the last third. We describe a patient with a mutation in codon 161 of the APC gene, which displays a phenotype most closely resembling the attenuated form of familial adenomatous polyposis, and review the literature, the implications of this mutation, and the importance of the molecular testing in the proper and more complete characterization of these patients. Differences in the APC mutation sites alone cannot completely account for intrafamilial and interfamilial variation in the polyposis phenotypes.
The Genesis of Barrett Esophagus: Has a Histologic Transition From Gastroesophageal Reflux Disease–Damaged Epithelium to Columnar Metaplasia Ever Been Seen in Humans?
Authors: Riddell Robert H.
Published: February 2021

Has a histologic transition from gastroesophageal reflux disease–damaged epithelium to columnar metaplasia ever been seen in humans? The answer to this question seems to be that it has but that we either do not readily recognize it or it is not readily recognizable with regular light microscopy. There are at least 3 possible mechanisms for the genesis of Barrett esophagus. The first is ulceration at the gastroesophageal junction with subsequent repair by an epithelium that differentiates into Barrett epithelium. The second is metaplasia through multilayered epithelium. The third is creeping columnar metaplasia at the Z-line proximally followed by intestinalization. These 3 hypotheses may not be mutually exclusive, and all may be operative, depending on the local circumstances, amount of inflammation, erosion, ulcers, healing, acid and alkaline reflux, and use of proton pump inhibitors. Any of the epithelial types involved could be stable and not progress. They might even be reversible, which may also in part explain the mosaic of epithelial types that typify Barrett esophagus, and may be modified by any of the molecular mechanisms that turn protein transcription on and off (eg, promoter methylation, mutations). These mechanisms ultimately may also be involved in the genesis of neoplastic transformation.
What Is Dysplasia in the Gastrointestinal Tract?
Authors: Appelman Henry D.
Published: February 2021

Dysplasia in the gastrointestinal tract is considered both a carcinoma precursor and a marker of high cancer risk for the site at which it is found. Dysplasia is defined as unequivocally neoplastic epithelium, yet the specific criteria for making that determination are imperfectly defined. The current criteria actually include a mix of architectural and cytologic features, all of which occur in different intensities in different epithelia that are given the same diagnosis. Gastrointestinal dysplasias are divided into 2 grades, but there are problem areas in diagnosis at the lower end where low-grade dysplasias overlap with regenerating epithelia and in the middle where low- and high-grade dysplasias overlap. The diagnosis of dysplasia is too subjective with less than optimal reproducibility to be as useful a marker as needed. Pathologists need a dysplasia stain or a whole set of new markers of high cancer risk, presumably molecular and/or genetic, that are not dependent on pathologists' diagnoses of dysplasia and their inherent subjectivity.
Lung Transplantation Biopsy Specimens With Bronchiolitis Obliterans or Bronchiolitis Obliterans Organizing Pneumonia Due to Aspiration
Authors: Miyagawa-Hayashino Aya , Wain John C. , Mark Eugene J.
Published: February 2021

Context.—Bronchiolitis obliterans (BO) is generally thought to be a marker of chronic airway rejection in patients who have undergone lung transplantation. Bronchoscopic biopsy specimens, by virtue of their small size, may sample only BO and not a lesion of bronchiolitis obliterans organizing pneumonia (BOOP). A role for ongoing chronic infection or aspiration has also been suggested, and the distinction of these etiologies may be difficult clinically and pathologically.

Objective.—To investigate the etiology of BO and BOOP in lung transplantation patients who had chronic aspiration.

Design.—This is a clinicopathologic study of 7 patients who had undergone lung transplantation in which biopsy findings suggested the possibility of chronic airway rejection but in which aspiration was subsequently proven as a cause of the bronchiolar disease.

Results.—All patients were men, who ranged in age from 19 to 57 years. A clinical diagnosis of aspiration was considered based on history, acid reflux testing, and radiographic findings in all 7 patients. Three patients had BO and 4 patients had BOOP. Histiocytic giant cells or foreign material was absent. The interval from transplantation to BO ascribed to aspiration ranged from 2.5 months to 7 years. The patients were treated aggressively with medication for gastroesophageal reflux disease. Their respiratory function and chest radiography results improved.

Conclusion.—Although BO may be a manifestation of rejection, it may also be a manifestation of aspiration. Because the latter is potentially correctable, aspiration should be considered etiologically in lung transplantation patients with either BO or BOOP. Reliable distinction between aspiration-related or rejection-related BO and BOOP cannot be made on morphologic grounds alone. Clinical and radiologic correlations are indicated to establish the distinction.
News from the Field
Authors: Free David
Published: February 2021

GPO names Indiana University-Bloomington library as 2020 Library of the YearNew ACRL Framework for Impactful Scholarship and MetricsSIU’s Morris Library honors Carus family with new endowmentInternet Archive launches Open Library Explorer, acquires Michelson Cinema Research LibraryOverDrive expands magazine catalogProQuest One Business launches
Embraer: um caso de imitação à inovação
Authors: Araújo Caroline Giusti , Oliveira Fernando Henrique Franzi
Published: February 2021

O trabalho tem como objetivo apresentar o esforço inovativo da empresa Empresa Brasileira de Aeronáutica S.A. (Embraer). O estudo da cadeia produtiva aeronáutica justifica-se dada a relação direta com aspectos de segurança nacional e aceleração do progresso técnico da economia. A metodologia utilizada baseia-se no modelo da dinâmica do aprendizado tecnológico proposto por Kim (2005). Neste modelo, entende-se que o processo de catching-up e as mudanças tecnológicas ocorrem dentro da empresa. Nessa perspectiva serão analisadas no trabalho a evolução da base de conhecimento da empresa através de parcerias internacionais e a intensidade de esforço através da construção de crises. Conclui-se que apesar da Embraer ser uma empresa inovativa, não foi possível constatar uma relação direta entre seu potencial inovativo com o desenvolvimento econômico brasileiro, uma vez que a empresa está inserida na lógica global de produção, possui baixa nacionalização de fornecedores e é pouco integrada a cadeia produtiva nacional.
Desafios do ensino e da educação para uma cidadania consciente no Colégio Técnico Industrial de Santa Maria
Authors: Pereira Ascísio Dos Reis , Corte Marcele Dalla Flores , Lemos Paulo Rogério , Piveta Renan
Published: February 2021

Com o avanço das tecnologias e com as mudanças socioculturais a que se tem assistido, muito se fala sobre cidadania, embora poucos saibam o real o verdadeiro conceito e o real significado de tal palavra. Uma vez que o Projeto Político Pedagógico (PPP) do Colégio Técnico Industrial de Santa Maria (CTISM) traz como missão “Educar para uma Cidadania Consciente”, a intenção deste trabalho é verificar se as práticas docentes condizem com o que é previsto no PPP da escola, que busca oferecer uma formação cujo “produto final” seja não apenas um operário, mas um operário cidadão. Para tanto foram aplicados questionários a alunos e professores, interrogando sobre o que pensam acerca desse tema na escola. Os resultados indicam que a questão da educação para uma cidadania consciente é aplicada, porém de maneira indireta. Assim, o maior desafio do CTISM é consolidar o ajuste entre a educação tecnicista, que imprime no ensino fortes características de sua origem, com a missão prevista no seu PPP.
O contar da cor: a resistência através da história, das linguagens e da cultura dos negros africanos
Authors: Freitag Felipe , Alós Anselmo Peres
Published: February 2021

Um delineamento dos sinais de identidade nacional e de crítica social na "arte de tematização do urbano, ou citadino" aparece como o tema deste artigo, na medida em que se configura como uma linguagem de representação das culturas africanas. Foram selecionados para análise da composição, duas obras do artista plástico angolano Lino Damião, que de alguma forma parecem horizontalizarem-se sob símbolos específicos da cultura urbana em alguns países africanos, mais especificamente de Angola.
Alegria e festa colorida no "Día de Muertos": a cultura mexicana na aula de Língua Espanhola
Authors: Azevedo Cinara Leal , Lemes Debora , Maldonado Maria Cristina Torres , Marchesan Maria Tereza Nunes
Published: February 2021

Este trabalho tem por objetivo apresentar a sequência de uma aula desenvolvida para abordar um aspecto cultural de língua espanhola: o “Día de Muertos”, celebração tradicional da cultura mexicana comemorada no dia 02 de novembro. Este material foi desenvolvido pelos estudan-tes participantes do Programa Institucional de Bolsa de Iniciação à Docência (PIBID – Espa-nhol) da Universidade Federal de Santa Maria e foi trabalhado com alunos do Primeiro Ano do Ensino Politécnico do Colégio Estadual Manoel Ribas participante do projeto. .Para o planeja-mento do material didático o grupo contou com a participação de uma mexicana, aluna do pro-grama de pós- graduação do PPGL. .A sequência didática buscou contemplar a história, a tra-dição e o modo de celebração dessa data no México, contrastando-a com a cultura brasileira. Os alunos tiveram a oportunidade de pôr em prática os conhecimentos da língua espanhola a partir das atividades desenvolvidas em aula.
O PRIMEIRO ROMANCE PROLETÁRIO BRASILEIRO: PARQUE INDUSTRIAL, DE PATRÍCIA GALVÃO
Authors: Canto Daniela Schwarcke do , Alós Anselmo Peres
Published: February 2021

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A IMERSÃO DE NOVOS AUTORES NO MERCADO LITERÁRIO A PARTIR DA ESCRITA DE FANFICTIONS E O REFLEXO DA DEMANDA DE DIFERENTES GÊNEROS ENTRE OS JOVENS: UMA ANÁLISE DO SITE SPIRITFANFICS
Authors: Almeida Laura Coelho de , Pozzebon Martina , Powarchuk Viktória Bulsing , Simon Iuri Deves , Reginatto Andrea , Silva Sandra Rúbia da
Published: February 2021

Dentre diversas atuações, hoje visíveis no ciberespaço, surge uma prática a partir de um “ativismo de fãs”. O que hoje se denomina “fanfic”, história escrita por fãs (que têm seus próprios canais e vias de circulação), traz para a sociedade atual uma diferente visão de letramento e papel de jovens fãs. O presente artigo tem por finalidade analisar o site Spirit Fanfics e o comportamento de seu público para com o êxito de suas fanfics favoritas. O propósito da análise do site, por meio dos gêneros e fanfics mais procurados, adequa-se para entender o que o público jovem procura e sente falta de ler; um conteúdo diferente do que há hoje no mercado  literário. E, depois de encontrado o objeto de interesse, como essas fanfics são promovidas; e, se, combinadas com um bom domínio gramatical, há possibilidade de publicação e surgimento de novos autores através das plataformas. Neste propósito, optou-se por métodos de observação, análise e pesquisa bibliográfica, com resultados que comprovam a emergência de novos autores e inserção de conteúdos aclamados pelo público jovem no mercado literário.
EXPERIÊNCIAS VIVENCIADAS DURANTE O ESTÁGIO SUPERVISIONADO NA EDUCAÇÃO INFANTIL EM UMA ESCOLA DE EDUCAÇÃO BÁSICA EM IBIPITANGA-BA
Authors: Rocha Angelita Rosa de Oliveira , Miranda Selma Xavier de Oliveira
Published: February 2021

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O PAPEL DE PAREDE AMARELO
Authors: Fagundes de Oliveira Dileane
Published: February 2021

GILMAN, Charlotte Perkins. O papel de parede amarelo. 3. Ed. Trad. Diogo Henriques. Rio de Janeiro: José Olympio, 2017. 112 p.
VIOLÊNCIA E MEMÓRIA CORPORAL COMO DISPOSITIVO DE (RE) ORGANIZAÇÃO DE SUBJETIVIDADES NA LITERATURA DE HERTA MÜLLER
Authors: Yokoyama Adriana , Umbach Rosani Úrsula Ketzer
Published: February 2021

Resumo: O trabalho objetiva analisar as narrativas: O compromisso (2009), Fera d’alma (2013) e A raposa já era o caçador (2014), de Herta Müller, perscrutando as memórias da violência ditatorial e seus efeitos. As narrativas, embora diferenciadas, relatam a crueldade e a intolerância do regime liderado por Nicolae Ceuasescu (1965-1989), na Romênia. Assim, as experiências do medo da vida e da morte, e, sobretudo, a ausência de expectativas quanto ao futuro, são relatadas por Herta Müller. As análises partem não apenas das observações das personagens que compõem as narrativas, mas da escrita dissidente e resistente de uma escritora que traz em sua história as marcas do mesmo regime ditatorial sofrido por suas personagens. Nesse sentido, nosso intuito é demonstrar a construção de uma linguagem produzida por um discurso pautado pela necessidade de expurgação. Tal ação que pontua o estilo literário de Müller, reporta-nos aos conceitos de Hannah Arendt em relação à importância da ação e do discurso para a constituição humana. Além disso, os estudos memorialísticos de Aleida Assmann, contribuem para auxiliar a compreensão dos efeitos da violência imposta pelo regime na vida desses indivíduos e, sobretudo, as marcas inscritas em seus corpos. Desse modo, a escrita mülleriana, produzida sob os efeitos do terror e da crueldade humana, encontra na literatura a força para tentar dar conta do descalabro da humanidade e para que não haja reincidência deste crime
RETRATOS DA ESCRITA: ESPAÇOS DE ENUNCIAÇÃO, MEMÓRIA E LÍNGUA DE IMIGRAÇÃO.
Authors: Fiepke Carpenedo Rejane
Published: February 2021

O presente artigo apresenta os primeiro movimentos teórico-metodológicos de nossa pesquisa de doutorado, ainda em fase inicial de desenvolvimento. Os estudos já existentes relacionados às línguas de imigração, em sua maioria são voltados ao período da interdição linguística durante o Estado Novo, estudos fonéticos e fonológicos ou na área da análise de discurso. Assim, propomo-nos a pensar a língua de imigração alemã na perspectiva da Semântica do Acontecimento (Guimarães, 2002), e a partir disso pesquisar em que espaços de enunciação, públicos e privados, circula a língua de imigração alemã escrita, e quais os sentidos políticos e memórias da língua que circunscrevem estes espaços. O estudo se dá no município de Novo Machado, na região noroeste do Rio Grande do Sul, colonizado predominantemente por imigrantes alemães e italianos. O processo metodológico adota fotografias como materialidade de registro do corpus, para investigar quais os espaços de enunciação em que a língua de imigração alemã se inscreve atualmente. Até este momento da pesquisa, observamos registros de língua escrita em lápides de cemitérios (espaço público), e por meio de um movimento analítico inicial observam-se os sentidos políticos que circunscrevem este espaço de enunciação.