bluuebunny/crossref_metadata_2025 huggingface dataset:
Employee Competence and Performance-Based Assessment
Authors: Howanitz Peter J. , Valenstein Paul N. , Fine Glen
Published: January 2021

Objective.—To survey employee competence assessment practices in departments of pathology and laboratory medicine and provide suggestions for improvement.

Design.—A 3-part study consisting of a questionnaire about current competence assessment practices, an evaluation of compliance with stated competence assessment practices using personnel records of 30 employees, and a written appraisal of competence of 5 specimen-processing staff members per institution.

Setting.—A total of 522 institutions participating in the College of American Pathologists 1996 Q-Probes program.

Main Outcome Measures.—Institutional competence assessment practices, compliance of each institution with their own practices, and determination of competence of specimen-processing personnel.

Results.—Of the participating institutions, 89.8% had a written competence plan and 98.1% reported reviewing employee competence at least yearly. General competence was reviewed by direct observations (87.5%), review of test or quality control results (77.4%), review of instrument preventive maintenance (60.0%), written testing (52.2%), and/or other methods (20.8%). In 8.6% of institutions, employees who failed competence assessment were not allowed to continue their usual work. On review of records of 14 029 employees for adherence to the laboratory's general competence plan, adherence was 89.7% for direct observations, 85.8% for review of quality control and test results, 78.0% for review of instrument records, and 74.0% for written testing. Employee failure rate ranged from 0.9% to 6.4%, depending on the competence evaluated. Adherence to an institution's plan was 90.4% for new employees, 93.1% for computer skills, 95.8% for laboratory safety, and 92.1% for continuing education. When a written competence assessment was given to 2853 specimen-processing staff members, 90.0% responded satisfactorily.

Conclusions.—Opportunities for improvement in employee competence assessment are numerous, and we provide several specific suggestions.
Uterine Smooth Muscle Tumors
Authors: Layfield Lester J. , Liu Katharine , Dodge Richard , Barsky Sanford H.
Published: January 2021

Context.—Accurate categorization of uterine smooth muscle neoplasms by light microscopic examination is difficult. Multiple classification schemes have been proposed based on mitotic rate, nuclear atypia, and the presence or absence of necrosis. None of these classification systems has been entirely successful. Multiple ancillary techniques have been tested for their ability to predict behavior of uterine smooth muscle tumors.

Objective.—We assayed 45 smooth muscle neoplasms for a variety of proliferation markers, oncogene protein products, and DNA ploidy level to determine if these markers supplied prognostically useful information over and above that obtained by routine light microscopic assessment.

Study Design.—Forty-five uterine smooth muscle neoplasms were assessed for DNA ploidy; silver-staining nucleolar organizer regions (AgNORs); percent nuclear proliferating cell nuclear antigen (PCNA); expression of p53, Her-2/neu, and MDM-2 protein; mitotic rate; and nuclear grade. These markers were correlated with histologic diagnosis and the occurrence of a clinically adverse event (death, metastasis, or recurrence).

Results.—Diagnostic category (P < .001), nuclear grade (P < .002), mitotic activity (P < .001), mean AgNORs (P < .001), percent nuclear PCNA (P = .02), and expression of p53 (P = .02) all correlated with clinical outcome. No statistically significant correlation between clinical outcome and the categories MDM-2 expression, Her-2/neu expression, or DNA ploidy was seen. Nuclear grade, p53 expression, mitotic rate, AgNORs, and percent nuclear PCNA correlated with diagnosis.

Conclusions.—Diagnostic category, mitotic rate, AgNOR counts, PCNA, and p53 expression dichotomized uterine smooth muscle neoplasms into prognostically favorable and unfavorable groups. Although highly significant, the category AgNORs was no more successful than mitotic rate in dividing uterine smooth muscle neoplasms into prognostically favorable and unfavorable groups. Expression of p53 and percent nuclear PCNA dichotomized uterine smooth muscle neoplasms into prognostic groups, but neither technique reached the level of significance achieved by mitotic rate. Our data indicate that mitotic rate and the classification system of Kempson and Bari are at least as effective as the tested markers in separating uterine smooth muscle neoplasms into prognostic categories.
Erythrocyte Fy Antigen Phenotyping Helps Differentiate So-called Benign Tertian Malarias
Authors: Wenk Robert E. , Stephens Ina
Published: January 2021

Isolated cases of malaria are increasing in frequency in nonendemic countries. Blood film examination remains a mainstay of diagnosis of these sporadic cases because immunologic and molecular methods are unavailable, expensive, and problematic. Two tertian malarial species, Plasmodium vivax and Plasmodium ovale, may appear to be similar morphologically. Plasmodium ovale infection is infrequent, and misdiagnosis of this species is common. Plasmodium vivax infection can be ruled out, however, if a patient's erythrocytes phenotype as Fy(a−b−), because these cells completely resist entry by the latter species.
Primary Malignant Melanoma of the Common Bile Duct
Authors: Wagner Monica S. , Shoup Margo , Pickleman Jack , Yong Sherri
Published: January 2021

Primary malignant melanoma of the common bile duct is rare. To our knowledge, only 6 cases have been reported previously. The pathologic diagnosis of primary malignant melanoma in extracutaneous sites often requires the use of confirmatory immunohistochemical stains and electron microscopy studies, as well as tests to rule out other possible remote or concurrent primary sites. The presence of junctional activity adjacent to the tumor is another important requisite for the diagnosis of this entity. Nevertheless, absolute exclusion of a metastatic melanoma from an unknown occult site or regressed site is not entirely possible. We describe our observations in a case of primary malignant melanoma of the common bile duct in a 48-year-old man and discuss the criteria for diagnosis of primary melanoma.
Analytical and Clinical Performance of an Improved Qualitative Troponin T Rapid Test in Laboratories and Critical Care Units
Authors: Hirschl Michael M. , Herkner Harald , Laggner Anton N. , Sylvén Christer , Rasmanis Gundars , Collinson Paul O. , Gerhardt Willie , Leinberger Robert , Zerback Rainer , Müller-Bardorff Margit , Katus Hugo A.
Published: January 2021

Objective.—To evaluate the performance of a visual troponin T rapid test in the hands of nontraditionally trained personnel of 2 critical care units in comparison to 3 laboratories.

Methods.—Method comparisons of the troponin T rapid test versus cardiac troponin T enzyme-linked immunosorbent assay were performed with 804 samples from 510 patients with suspected acute coronary syndromes. Cross-reactivity with skeletal troponin T was studied up to 5000 μg/L.

Results.—Laboratories and critical care units obtained comparable results in the analytical cutoff of the test (0.11 and 0.10 μg/L) and in the diagnostic sensitivities in the detection of acute myocardial infarction (96% and 93% after 8 hours) and of high-risk patients with unstable angina pectoris (100% and 100%). Different percentages of false-positive results (0.2% and 3%) were found, which may reflect different objectives and strategies in these hospital units. The cross-reactivity with skeletal troponin T was less than 0.01%.

Conclusions.—The troponin T rapid test gives reliable results not only when used by laboratory personnel experienced in the execution of analytical methods, but also in the hands of nurses and physicians working in clinical units outside the laboratory.
A Web-Based Teaching Program for Laboratory Diagnosis of Coagulation Disorders
Authors: Nguyen Andy N. D. , Uthman Margaret O. , Johnson Kathy A.
Published: January 2021

Objective.—To implement an interactive program for teaching coagulation disorders on the World Wide Web.

Design and Results.—The core materials in this program were derived from a personal computer software program previously designed by the authors. Three modules were developed in this program: (1) a coagulation profile to display typical results of coagulation screening tests for each disorder; (2) a differential diagnosis module to generate a list of diagnoses that fit the test results in a given case; and (3) a synopsis of coagulopathy and therapy to provide essential information on disorders and therapeutic options. A total of 41 coagulation disorders were included in the knowledge base.

Conclusions.—Since the World Wide Web is increasingly more accessible to computer users, it has become an ideal medium for teaching purposes. Our experience with this program in teaching medical students and pathology residents at our institution has been very encouraging.
Hyperplastic Mesothelial Cells in Mediastinal Lymph Node Sinuses With Extranodal Lymphatic Involvement
Authors: Isotalo Phillip A. , Veinot John P. , Jabi Maha
Published: January 2021

We describe a patient with hyperplastic mesothelial cells localized to mediastinal lymph node sinuses. These mesothelial cells were originally misdiagnosed as metastatic carcinoma, and the patient received radiotherapy. Histologic review, immunohistochemistry, and ultrastructural studies confirmed mesothelial cell origin. These nodal mesothelial cells were associated with pericardial and pleural effusions. Extranodal lymphatics also contained hyperplastic mesothelial cells, confirming their mode of lymphatic transport to node sinuses. This finding supports the theory that hyperplastic mesothelial cells derive from reactive serosal mesothelium and are dislodged into draining lymphatics. This is the first report, to our knowledge, that demonstrates the pathogenetic significance of this lymphatic transport mechanism. Awareness of intralymphatic and nodal benign hyperplastic mesothelial cells and their mimicry of invasive malignant neoplasms is important for accurate diagnoses and appropriate therapy.
Overestimation of Hemoglobin in a Patient With an IgA-κ Monoclonal Gammopathy
Authors: Roberts William L. , Fontenot Jo D. , Lehman Christopher M.
Published: January 2021

A patient with multiple myeloma had an automated blood count performed on a Coulter STK-S counter that repeatedly failed internal limits for both mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration. The calculated hematocrit agreed with a spun hematocrit, suggesting that the hemoglobin concentration was being overestimated by the automated counter. Measurement of the plasma hemoglobin concentration of the sample, which showed no visible hemolysis, gave a hemoglobin concentration of 32 g/L on the STK-S analyzer. Correction of the whole blood hemoglobin using the plasma hemoglobin gave a value consistent with the hematocrit. The corrected mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration values were within standard limits. This patient's paraprotein was characterized as IgA-κ and was present at a concentration of 61 g/L. The hemoglobin concentration measured on whole blood by Sysmex NE 8000 and Technicon H*1E autoanalyzers agreed reasonably well with the corrected result from the STK-S.
Acquired Hemophilia in Patients With Hematologic Malignancies
Authors: Sallah Sabah , Nguyen Nam P. , Abdallah Jorge M. , Hanrahan L. Robert
Published: January 2021

Objectives.—To evaluate the occurrence of acquired hemophilia in patients with hematologic malignancies and to assess their response to treatment.

Design.—Data on 8 patients with hematologic neoplastic disorders and inhibitor against factor VIII were analyzed retrospectively.

Setting.—Three large tertiary-care centers.

Results.—All 8 patients presented with spontaneous or posttraumatic hemorrhages. The mean inhibitor titer at the time of diagnosis was 79 Bethesda units (BU), and residual factor VIII activity was detectable in 3 patients. The inhibitor disappeared in 5 patients after a mean of 92 days, but persisted in the 3 other patients. The patients who achieved complete resolution of their circulating anticoagulant had lower mean inhibitor titers at the time of diagnosis than those who had persistent inhibitor (27 BU vs 167 BU, respectively). Two patients died as a result of major hemorrhages that did not respond to treatment.

Conclusions.—Antibodies against factor VIII may be responsible for some bleeding episodes in patients with lymphoid or myeloid malignancies. Acquired hemophilia in this setting should be differentiated from other causes of bleeding because the approach to treatment is different. No conclusion can be drawn regarding the association between the activity of the underlying illness and the inhibitor titer, although it appears that at least in some patients such a relationship may exist. The underlying pathogenetic mechanisms responsible for the production of autoantibodies against factor VIII remain unclear, but we provide a few explanations in this article.
Blastic Transformation of Splenic Marginal Zone B-Cell Lymphoma
Authors: Cualing Hernani , Steele Paul , Zellner David
Published: January 2021

To our knowledge, blastic transformation of splenic marginal zone lymphoma, a recently characterized low-grade lymphoproliferative disorder, has not been reported previously. In this regard, we report the unique case of a 70-year-old woman whose untreated splenic marginal zone lymphoma underwent blastic transformation 3 years after diagnosis. Her hematologic medical history started in 1988 as thrombocytopenia refractory to steroids associated with atypical lymphoid infiltrate in the bone marrow. She underwent splenectomy in 1989, which revealed splenic marginal zone lymphoma. One year later, the patient developed lymphadenopathy noted in the chest, axillary, abdominal, and retroperitoneal lymph nodes. Because she was asymptomatic, treatment was limited to a conservative supportive regimen. The nodal lymphoma cells had features associated with marginal zone lymphoma and expressed B-cell monotypic κ light chain. She was readmitted for the last time 2 years later with findings of 16% blasts in the peripheral blood and massive infiltration of the bone marrow by large blastoid cells. The blasts showed dispersed chromatin and prominent nucleoli, and possessed a moderate amount of clear cytoplasm. The blasts, like the previous nodal and splenic lymphomas, had a CD20-, CD19-, IgM-positive phenotype, but lacked reactivity for CD5, CD10, and CD23. The patient displayed clinical remission after treatment with vincristine and prednisone, but died of aspiration pneumonia 1 month later. These observations suggest that, similar to the other low-grade lymphoproliferative disorders, an untreated splenic marginal zone lymphoma may undergo high-grade blastic transformation.
Whole-Blood Glucose and Lactate
Authors: Kost Gerald J. , Nguyen Tam H. , Tang Zuping
Published: January 2021

Objective.—To assess the effects of 30 of the most commonly used critical care drugs on measurements obtained with trilayer electrochemical biosensors on a reference analyzer (ABL625-GL), to determine metabolic changes in glucose and lactate in vitro, and to formulate guidelines for whole-blood analysis of these 2 analytes.

Design.—Serial measurements were taken of changes in glucose and lactate levels caused by metabolism in whole blood in vitro over time. A parallel control study of drug interference with measurements of glucose and lactate in whole blood and of dose-response relationships in whole-blood samples and in plasma samples also was conducted.

Results.—At room temperature, whole-blood metabolism decreased glucose levels −2.3% at 15 minutes, −4.6% at 30 minutes, and −6.4% at 45 minutes. Metabolism increased lactate levels 11.4% at 15 minutes, 20.6% at 30 minutes, and 26.7% at 45 minutes in vitro. Paired differences between drug-spiked and control samples were calculated to determine interference (corrected for metabolism). The threshold for determination of interference was ±2 SD from within-day precision, equal to ±0.18 and ±0.10 mmol/L for glucose and lactate, respectively. Only mannitol (C6H14O6) interfered with glucose and lactate measurements. At a concentration of 24 mg/mL, mannitol decreased whole-blood glucose levels by an average of 0.711 mmol/L (12.8 mg/dL) and whole-blood lactate levels by 0.16 mmol/L (1.4 mg/dL). Mannitol interference with measurements may have resulted from suppression of hydrogen peroxide formation in the enzymatic reactions in the biosensors, repartitioning of water between erythrocytes and plasma, or from other mechanisms.

Conclusions.—Most critical care drugs had no significant effects on the trilayer electrochemical biosensors. Whole-blood analysis should be performed within 15 minutes for lactate and within 30 minutes for glucose because of metabolism in vitro. Mannitol effects on glucose measurements may be clinically significant in mannitol-induced acute renal failure and therefore should be considered for appropriate diagnosis and treatment of critically ill patients.
Bronchocentric Granulomatosis With Mucus Impaction Due to Bronchogenic Carcinoma
Authors: Houser Stuart L. , Mark Eugene J.
Published: January 2021

Objective.—To describe an unexpected inflammatory process associated with malignancy in the lung and to postulate a new mode of pathogenesis.

Design.—Retrospective review of surgical pathologic findings.

Setting.—Academic hospital pathology department.

Patients.—Four patients, 2 men and 2 women, ranging in age from 45 to 74 years, each of whom had a solitary mass on chest radiographs.

Interventions.—Pulmonary lobectomy.

Main Outcome Measure.—Histopathologic identification of bronchocentric granulomatosis.

Results.—Accompanying a bronchogenic carcinoma in each case was a necrotizing chronic granulomatous reaction centered around bronchioles that were plugged with mucus, necrotic detritus from the tumor, lipid, or a combination of these substances. Eosinophils were present in small numbers in one case. The pathologic findings characterize bronchocentric granulomatosis.

Conclusions.—The presence of bronchocentric granulomatosis in the biopsy of a mass does not exclude the presence of an accompanying bronchogenic carcinoma associated with obstruction of bronchioles. Bronchocentric granulomatosis in some cases may represent an immunologic response to tumor detritus or lipid, as well as to mucus impaction.
Inflammatory Pseudotumor of the Renal Pelvis
Authors: Leroy Xavier , Copin Marie-Christine , Graziana Jean Pierre , Wacrenier Agnès , Gosselin Bernard
Published: January 2021

We describe 2 cases of inflammatory pseudotumor of the renal pelvis. Case 1, the male patient, was 37 years old, and case 2, the female patient, was 54 years old. Both patients presented with macroscopic hematuria and flank pain. Computed tomographic (CT) scan and ureterocystoscopy revealed in case 1 a mass in the left renal pelvis and the calyces. In case 2, urography showed a lacuna of the renal pelvis, and CT scan showed an irregular thickening of the renal pelvis. In both cases, the preoperative clinical diagnosis was urothelial carcinoma, and both patients underwent nephrectomy. Microscopic examination revealed in case 1 a tumor of the renal pelvis composed of spindle cells with eosinophilic cytoplasm in a myxoid and vascular stroma with abundant inflammatory infiltrate. In case 2, the tumor was composed of densely basophilic spindle cells in a fascicular pattern intermingled with lymphocytes and plasma cells and involving the lamina propria of the renal pelvis. The spindle cells reacted strongly with antibody to vimentin and focally with antibodies to smooth muscle actin and muscle-specific actin. In the urogenital tract inflammatory pseudotumor involves preferentially the urinary bladder. Rare cases have been reported in the kidney. The 2 cases presented here are unusual due to the location in the renal pelvis, mimicking urothelial carcinoma.
Primary T-Cell–Rich B-Cell Lymphoma of the Ethmoid Sinus
Authors: Wang Jun , Sun Nora C. J. , Weinstein Sanford M. , Canalis Rinaldo
Published: January 2021

T-cell–rich B-cell lymphoma (TCRBCL) is an uncommon and recently recognized variant of B-cell non-Hodgkin lymphoma characterized by a few large neoplastic B cells amid a predominant population of reactive T lymphocytes and variable numbers of histiocytes. Morphologically, TCRBCL resembles a variety of non-Hodgkin lymphomas and Hodgkin disease. Accurate diagnosis and proper treatment are essential to assure a favorable prognosis. To our knowledge, this is the first report of ethmoid sinus presentation of TCRBCL in an Epstein-Barr virus–negative 51-year-old man. Combined chemotherapy and radiotherapy were administered based on the correct diagnosis. The patient has had a complete response with no recurrence during the 5-year follow-up.
Cefotetan-Induced Hemolytic Anemia
Authors: Moes Gregory Scott , MacPherson Bruce R.
Published: January 2021

Cefotetan disodium–induced hemolytic anemia has been reported previously, and some of these cases have been severe or fatal. We describe a case of severe hemolytic anemia that occurred in an 80-year-old woman who received cefotetan prophylactically after surgery for a small bowel obstruction. Eight days after the first dose of cefotetan, the patient developed a severe Coomb test–positive hemolytic anemia. Using flow cytometry, we demonstrated cefotetan-specific antibodies in her posttreatment serum, which were detectable at a serum dilution up to 1:10 000. The patient received corticosteroid therapy and blood transfusions, with improvement of her hematologic parameters, but died 54 days after admission for respiratory failure. To our knowledge, this is the first use of flow cytometry for the detection of cefotetan-induced red blood cell antibodies. This technique offers a sensitive, rapid, objective method for detecting drug-induced antibodies.
Epstein-Barr Virus RNA Detection and Glandular Differentiation in Nasopharyngeal Carcinoma
Authors: Jain Dhanpat , Parkash Vinita , Li Maomi , Gill James , Crouch Jill , Howe Greg , Tallini Giovanni
Published: January 2021

Most tumors arising in the nasopharynx are either squamous cell carcinoma or so-called undifferentiated carcinoma of the nasopharyngeal type. Primary adenocarcinomas of the nasopharynx are rare, and glandular differentiation in undifferentiated carcinoma of the nasopharyngeal type has not been reported to date. We report 2 cases of undifferentiated carcinoma of the nasopharyngeal type that show distinct glandular differentiation by light microscopy, histochemistry, immunohistochemistry, and ultrastructure. Both tumors showed equal positivity for Epstein-Barr virus latent membrane protein and in situ hybridization for Epstein-Barr virus genome in the undifferentiated areas of the tumor and those featuring glandular differentiation.
Emergence of an Unusual Bone Marrow Precursor B-Cell Population in Fatal Shwachman-Diamond Syndrome
Authors: Klupp Nikolaus , Simonitsch Ingrid , Mannhalter Christine , Amann Gabriele
Published: January 2021

The Shwachman-Diamond syndrome (SDS) is a rare congenital disorder for which inheritance by an autosomal recessive trait has been suggested. Shwachman-Diamond syndrome is defined by exocrine pancreatic insufficiency combined with severe neutropenia. Moreover, SDS patients are at risk to develop neoplastic hematologic diseases. We describe 2 SDS-affected daughters of consanguine parents who were born 1 year apart, at 35 and 36 weeks of gestation, and who died at the age of 4 and 3.5 months, respectively, due to respiratory infections. Histologic bone marrow evaluation of the second-born child revealed a diffuse proliferation of immature B cells, which comprised 40% of the total cellularity. These cells were identified as precursor B cells by immunophenotyping studies (CD79a+/CD10+/CD20−/CD22−/CD34−/terminal deoxynucleotidyl transferase−). Molecular determination of the immunoglobulin heavy-chain gene status did not reveal clonality. The emergence of this peculiar B-cell population was interpreted as a marked increase of hematogones. Although the clinical significance and the exact function of hematogones is still obscure, they may play a critical regenerative role in the regulation of hemopoiesis, but without malignant potential in SDS. Immunophenotyping and molecular studies, therefore, have potential value in the differential diagnosis of primary bone marrow failures. This report adds SDS to the spectrum of conditions in which a prominent number of hematogones may be observed.
Neuronal Hypertrophy in Acute Appendicitis
Authors: Xiong Shigang , Puri Prem , Nemeth Laszlo , O'Briain D. Sean , Reen Denis J.
Published: January 2021

Objective.—The pathogenesis of appendicitis remains poorly understood. However, there is increasing evidence of involvement of the enteric nervous system in immune regulation and in inflammatory responses. This study was set up to characterize the status of the enteric nervous system in normal and in inflamed appendixes.

Methods.—S100– and 2′,2′-cyclic nucleotide 3′ phosphodiesterase–positive Schwann cells, synaptophysin, and neuron-specific, enolase-positive nerve fibers and tryptase-positive mast cells were evaluated with immunohistochemical staining in surgically resected appendixes from 20 children with histologically proven acute appendicitis (HA), 10 histologically normal appendixes (HN) from patients with a clinical diagnosis of appendicitis, and 10 normal appendixes from patients undergoing elective abdominal surgery. Immunostained sections were subjected to quantitative image analysis. The number and size of ganglia and the number of nerve fibers, Schwann cells, and mast cells in each tissue compartment was quantitatively or semiquantitatively measured.

Results.—Increased numbers of fibers, Schwann cells, and enlarged ganglia, widely distributed in the muscularis externa and submucosa, were seen in all HA appendixes and in 4 of 10 HN appendixes. The number and size of ganglia in muscularis externa and in the submucosa of appendixes with HA were significantly greater compared with those in control appendixes (P < .001). A significantly increased number of individually stained nerve fibers and Schwann cells (P < .05) were present in the muscularis externa in HA appendixes compared with control appendixes. Significantly increased numbers of tryptase-positive mast cells (P < .05) were present in the submucosa, muscularis, and especially in the lamina propria in HA specimens, compared with that of control tissue.

Conclusions.—The significant increase in neural components and mast cells in acute appendicitis is unlikely to develop during a single acute inflammatory episode. This suggests an underlying chronic abnormality as a secondary reaction to repeated bouts of inflammation, obstruction, or both. These results challenge our current understanding of the pathophysiological processes that give rise to acute appendicitis.
Bone Metastases From Thyroid Carcinoma
Authors: Tickoo Satish K. , Pittas Anastassios G. , Adler Michael , Fazzari Melissa , Larson Steven M. , Robbins Richard J. , Rosai Juan
Published: January 2021

Context.—Only limited information exists on the pathologic aspects of thyroid carcinomas with bone metastases, most large studies having concentrated mainly on their clinical features.

Objective.—To study in detail the morphologic features of thyroid carcinomas with skeletal metastases.

Design.—Seventy-nine cases of thyroid carcinoma with bone metastases treated at Memorial Sloan-Kettering Cancer Center, New York, NY, between 1964 and 1998 were investigated, with emphasis on the pathology of the primary and/or metastatic tumors and comparison of the morphologic features of the tumors at both the sites, wherever possible. The tumors were also compared for various clinical parameters.

Results.—The cohort consisted of 22 papillary, 17 follicular, 16 insular, 10 anaplastic, 9 Hürthle cell, and 5 medullary carcinomas. Of these cases, 68% had poorly differentiated or undifferentiated features in the primary and/or metastatic tumors. The metastatic tumors were better differentiated than the primary in one third of the cases (6 of 18). Only one case showed a less differentiated metastasis. The overall 5- and 10-year survival probabilities after the bone metastases were 29% and 13%, respectively (Kaplan-Meier method). Although both the tumor type and differentiation seemed to affect survivals after bone metastasis (P = .007 and .012, respectively) (log-rank test), this was primarily due to the much worse prognosis in the cases of anaplastic and medullary carcinoma. Cases of Hürthle cell carcinoma showed the longest median survival. There was no significant difference in survival among patients up to or older than 45 years at the time of metastases (P = .31).

Conclusions.—Most thyroid carcinomas with bone metastases are of papillary type, and most have poorly differentiated or undifferentiated features. The influence of the microscopic tumor type and tumor differentiation on survival after bone metastasis primarily appears to be due to the much worse prognosis among anaplastic and medullary carcinomas. Age at diagnosis of bone metastases does not influence survivals.
Relationship of Myoma Cell Size and Menopausal Status in Small Uterine Leiomyomas
Authors: Cramer Stewart F. , Marchetti Carol , Freedman Joshua , Padela Aasim
Published: January 2021

Context.—Although myomas shrink after menopause, the cellular mechanism for this phenomenon has received little attention. It was recently demonstrated that fibrous degeneration is significantly associated with postmenopausal status in both small and large myomas.

Objective.—The purpose of the present study was to evaluate whether reduction in myoma cell size is also associated with postmenopausal status in small myomas.

Design.—Tumor size and patient age have also been related to fibrous degeneration in small (<1 cm) myomas. Therefore, in the present study, 10 pairs of premenopausal and postmenopausal small myomas were matched within 3 years for patient age, within 1 mm for size, and within 1 grade for degree of fibrous degeneration. Most of the women were in their 50s, the decade during which postmenopausal fibrous degeneration in small myomas is most prevalent. Myoma cell size was derived by morphometric evaluation of relative myoma cell area (correcting for percentage of stroma, as measured by point counting) and by direct counting of the number of myoma cells per unit area in trichrome-stained sections.

Results.—Small myomas from postmenopausal women had significantly (P < .05) smaller cell sizes than did size-matched myomas from age-matched premenopausal women. Myoma cell sizes and nucleus-cell (N/C) ratios were highly variable, especially in premenopausal myomas.

Conclusions.—Reduction in myoma cell size is significantly associated with postmenopausal status in small uterine leiomyomas and may be an important mechanism for postmenopausal shrinkage of myomas. In addition, the high variability of myoma cell size and N/C ratio may further support the somatic mutation theory (ie, the theory that diverse mutations may account not only for variations in the growth potential of uterine myomas, but also for variations in their cellular details).
Perceptions of the Ethical Acceptability of Using Medical Examiner Autopsies for Research and Education
Authors: Roberts Laura Weiss , Nolte Kurt B. , Warner Teddy D. , McCarty Teresita , Rosenbaum Lizabeth Stolz , Zumwalt Ross
Published: January 2021

Background.—Forensic pathologists face difficult moral questions in their practices each day. Consistent ethical and legal guidelines for autopsy tissue use extending beyond usual clinical and legal imperatives have not been developed in this country.

Objective.—To obtain the perceptions of medical examiners regarding the ethical acceptability of autopsy tissue use for research and education.

Method.—A written, self-report questionnaire was developed and piloted by a multidisciplinary team at the University of New Mexico, Albuquerque. All individuals who attended a platform presentation at the National Association of Medical Examiners Annual Meeting in September 1997 were invited to participate.

Results.—Ninety-one individuals completed the survey (40% of all conference registrants and approximately 75% of presentation attendees). Sixty-three percent of respondents had encountered an ethical dilemma surrounding autopsy tissue use, and one third reported some professional ethics experience. Perspectives varied greatly concerning the ethical acceptability of using autopsy tissues to demonstrate or practice techniques (eg, intubation, brachial plexus dissection) and of fulfilling requests to supply varying kinds and quantities of tissues for research and education. Most respondents indicated that consent by family members was important in tissue use decisions. Respondents agreed on the importance of basic values in education and research, such as integrity, scientific or educational merit, and formal institutional approval of a project. Characteristics of the decedent did not influence decisions to release tissues, except when the individual had died from a mysterious or very rare illness. Attributes of medical examiners, with the exception of sex, also did not consistently predict responses.

Conclusion.—Significant diversity exists in beliefs among medical examiners regarding perceptions of the appropriate use of autopsy tissues for education and research. There is need for further inquiry and dialogue so that enduring policy solutions regarding human tissue use for education and research may be developed.
Combined Pleomorphic Xanthoastrocytoma-Ganglioglioma of the Cerebellum
Authors: Evans Andrew J. , Fayaz Imran , Cusimano Michael D. , Laperriere Norman , Bilbao Juan M.
Published: January 2021

Combined pleomorphic xanthoastrocytoma-ganglioma is a rare neoplasm, occurring in patients younger than 30 years. The clinical course of these tumors is difficult to predict because of their rarity. We report a case of combined pleomorphic xanthoastrocytoma-ganglioma that, in addition to the patient's age, is unusual in several respects. The lesion was located in the cerebellar vermis of a 60-year-old man and was radiographically solid. Histologically, there was an admixture of markedly pleomorphic astrocytic cells and neoplastic ganglion cells, with permeation of the overlying leptomeninges and surrounding cerebellum. In addition, there was focal capillary endothelial proliferation. There was no necrosis, and mitotic activity was rare at 1 mitotic figure per 40 high-power fields. The patient underwent a near gross total resection and postoperative radiotherapy and remains well through 16 months of follow-up.
Role of Leukocytes and Endothelial Cells in the Development of Angiogenesis in Inflammation and Wound Healing
Authors: Lingen Mark W.
Published: January 2021

The basic signs and symptoms of inflammation and wound healing have been appreciated for thousands of years. However, the specific cells involved and their roles in this complex environment are still being elucidated today. In 1926, the origin of the phagocytic mononuclear ameboid wandering cell (macrophage) had not been determined. One popular theory was that the cells were differentiated from the endothelial cells of the nearby blood vessels, whereas others believed that the cells came from the peripheral blood or resting wandering cells. The purpose of this article is to review the seminal article published by Lang regarding this topic nearly 75 years ago. In addition, this article will review what is now known with regard to the role of the macrophage and endothelial cells in the development of angiogenesis, which is arguably the most critical component of successful inflammatory process or wound healing.
Synchronous Water-Clear Cell Double Parathyroid Adenomas
Authors: Kuhel William I. , Gonzales Donald , Hoda Syed A. , Pan Langxing , Chiu April , Giri Dilip , DeLellis Ronald A.
Published: January 2021

Water-clear cell hyperplasia is a rare but well-documented cause of primary hyperparathyroidism. Parathyroid adenomas of the water-clear cell type are exceptionally rare, and only 2 cases have been reported. We describe a patient with synchronous water-clear cell double parathyroid adenomas, an entity that has not previously been reported. In our case, the enlarged superior parathyroid glands were completely replaced by water-clear cells, with only a minute rim of extracapsular, histologically unremarkable parathyroid tissue. The inferior parathyroid glands were grossly unremarkable, and incisional biopsy specimens were histologically normal (no foci of water-clear cells were identified). The findings in this case are most consistent with the diagnosis of double adenomas of the water-clear cell type. We acknowledge that despite molecular proof of monoclonality of the 2 lesions, it is not possible to entirely exclude the possibility that this unusual case could be due to asymmetric hyperplasia.
Plasmablastic Lymphoma of the Lung
Authors: Lin Yuan , Rodrigues Gilberto D. , Turner John F. , Vasef Mohammad A.
Published: January 2021

Non-Hodgkin lymphomas associated with acquired immunodeficiency syndrome are heterogeneous. Recently, a novel subtype of non-Hodgkin lymphoma occurring mostly in patients with acquired immunodeficiency syndrome has been described and designated as plasmablastic lymphoma. The histomorphologic and immunophenotypic findings of this distinct subtype of non-Hodgkin lymphoma have been characterized previously. Most patients present with oral cavity involvement. We report a case of plasmablastic lymphoma presenting as a lung tumor. To our knowledge, this is the first case report of this unusual subtype of diffuse large B-cell lymphoma in this location.
Absence of Epstein-Barr Virus in Smooth Muscle Cells of Idiopathic Hypertrophic Pyloric Stenosis
Authors: Jenson Hal B. , Gulley Margaret L. , Puri Prem
Published: January 2021

Context.—The etiology of idiopathic hypertrophic pyloric stenosis (IHPS) is unknown. Epstein-Barr virus (EBV) infects smooth muscle cells and is associated with leiomyomas and leiomyosarcomas of immunocompromised persons, including persons with the acquired immunodeficiency syndrome.

Objective.—To determine whether EBV is causally associated with IHPS.

Design.—Biopsy samples of the pylorus were obtained from 10 infants with projectile vomiting and pyloric hypertrophy on ultrasound, with confirmation of hypertrophy at the time of pyloromyotomy. The presence of EBV infection was tested by in situ hybridization for EBV-encoded RNA 1 (EBER1) in smooth muscle cells of IHPS.

Setting.—Biopsy specimens were obtained from children treated for IHPS at a tertiary referral hospital and were tested in a clinical molecular diagnostics laboratory.

Results.—All of the 10 smooth muscle biopsies were negative for EBER1. Cellular U6 RNA was detected in all smooth muscle samples, confirming that the RNA in the specimens was intact and capable of detection by in situ hybridization.

Conclusions.—The absence of EBER1 in 10 cases of clinically diagnosed and histopathologically confirmed cases of IHPS effectively excludes EBV infection of smooth muscle cells as a causal factor in the pathogenesis of IHPS.
Nasal Chondromesenchymal Hamartoma in Children
Authors: Hsueh Chuen , Hsueh Swei , Gonzalez-Crussi Frank , Lee Ta-jen , Su Jen-liang
Published: January 2021

Hamartoma in the nasal cavity of children is especially rare. Most documented cases occurred in infants, with characteristic histologic features of a mixture of various mesenchymal tissues. McDermott et al designated it nasal chondromesenchymal hamartoma in 1998, and it has since been considered a distinct clinicopathological entity. We report 2 such examples in a full-term male newborn and a 9-month-old boy, respectively. Histologically, both cases were characterized by a mixture of various mesenchymal elements, including spindle cells, collagen fibers, and irregular islands of osseous and chondroid tissue. Immunohistochemical study showed positivity to vimentin and S100 protein. Ultrastructural examination of case 1 demonstrated fibroblastic and myofibroblastic differentiation in tumor cells. There were 11 cases of nasal chondromesenchymal hamartoma in children published to date. The tumor has a benign biological behavior, and complete resection is the treatment of choice. It is apt to be misdiagnosed because of overlapping histologic features shared with a number of benign and malignant soft tissue tumors. Awareness of this entity is essential for correct diagnosis and adequate therapy.
Malignant Solitary Fibrous Tumor of the Pleura With Liposarcomatous Differentiation
Authors: Bai Hongwei , Aswad Bassam I. , Gaissert Henning , Gnepp Douglas R.
Published: January 2021

Pleural solitary fibrous tumors (SFTs) are uncommon tumors. Although these tumors have been well characterized, malignant pleural SFTs with liposarcomatous differentiation have not been reported. We report an unusual malignant pleural SFT intermixed with foci of well-differentiated liposarcoma. The patient was a 66-year-old, white man with a large, solid right pleural mass that measured 13.5 × 10.3 × 8.5 cm. The tumor was composed of spindle-shaped and plump cells embedded in dense collagenous stroma. The tumor cells were arranged in interlacing fascicles or in a patternless pattern. Marked nuclear atypia, a high mitotic rate (21 mitoses per 10 high-power fields), and areas of prominent necrosis were evident. In addition, numerous adipocytes mixed with typical lipoblasts were seen scattered throughout portions of the tumor. Immunohistochemistry revealed the tumor cells were strongly positive for CD34 and vimentin and negative for cytokeratin, desmin, smooth muscle actin (IA4), and S100. To the best of our knowledge, this case represents the first example of a malignant SFT with liposarcomatous differentiation.
Malignant Gastrointestinal Stromal Tumor Showing Remarkable Whorl Formations
Authors: Yoneda En , Teramura Kazuhiro , Hiruma Shingo , Satou Takao , Hashimoto Shigeo
Published: January 2021

A case of malignant gastrointestinal stromal tumor (GIST) is reported. Histologically, spindle cell proliferation with remarkable whorl formations was predominant in the tumor. Immunohistochemically, the tumor cells were diffusely positive for CD117 (c-Kit) and vimentin and partially positive for CD34. Ultrastructurally, the desmosome-like structures and interdigitations occurred much more frequently in the areas with whorl formations. These organelles were considered to be closely associated with the whorl formations. Various kinds of cellular arrangements are revealed in GISTs, but remarkable whorl formations, such as in our case, are a rare variant pattern. Herein, we discuss the histopathologic differences between this and other tumors showing whorl formations and describe the meaning of this unique arrangement. GISTs are thought to be immature tumors, and, therefore, variations in histopathologic findings are recognized. Finally, the ultrastructural study of GISTs is useful for understanding the mechanisms forming whorl formations and the differentiation or pathogenesis of GISTs.
Fine-Needle Aspiration Biopsy Features in a Case of Giant Cell Fibroblastoma of the Chest Wall
Authors: Maitra Anirban , Timmons Charles F. , Siddiqui Momin T. , Saboorian M. Hossein
Published: January 2021

Giant cell fibroblastoma is an unusual tumor of childhood, primarily occurring in the superficial soft tissues. We describe the fine-needle aspiration biopsy features of a case of giant cell fibroblastoma of the chest wall in a 3-year-old child. The aspirates comprised bland spindle to oval cells entrapped in a metachromatic matrix, accompanied by rare multinucleated giant cells with wreathlike nuclei. Although we were unable to render a definitive diagnosis on fine-needle aspiration biopsy, surgical resection of the mass established the diagnosis of giant cell fibroblastoma. We review the distinctive cytologic features of some common soft tissue tumors arising in this age group that may give rise to a diagnostic conundrum on fine-needle aspiration biopsy.
Metastatic Prostatic Adenocarcinoma Within a Primary Solid Papillary Carcinoma of the Male Breast
Authors: Sahoo Sunati , Smith Roberta E. , Potz Joseph L. , Rosen Paul P.
Published: January 2021

We report the case of a 78-year-old man who developed a breast mass 12 months after hormonal therapy for palliation of prostatic adenocarcinoma. On histologic and immunohistochemical examination, the breast tumor revealed a unique collision tumor composed of metastatic prostatic adenocarcinoma and solid papillary breast carcinoma.
Pigmented Papillary Epithelial Neoplasm of the Pituitary Fossa
Authors: Fuller Christine E. , Smith Mark , Miller Douglas C. , Schelper Robert
Published: January 2021

Primary pigmented intracranial neoplasms are strikingly uncommon. The differential diagnosis is limited and includes both epithelial and nonepithelial tumors, most of which arise within or near the ventricular system. The authors describe a 42-year-old man who presented with a pigmented papillary epithelial lesion that arose within the sella and exhibited suprasellar extension and bony erosion. Following external beam radiotherapy and multiple surgical resections, tumor growth became rapid, necessitating additional debulking procedures. Pathologic evaluation of subsequent lesional tissue samples revealed an anaplastic lesion with malignant epithelial and spindle cell components. Occasional epithelial cells showed features reminiscent of the original papillary lesion, whereas others exhibited oncocytic morphologic features. This case represents the only report, to our knowledge, of a pigmented papillary epithelial neoplasm arising within the pituitary fossa. Although the histogenesis of this tumor is enigmatic, this appears to be a distinct lesion characterized by aggressive growth and the capacity for anaplastic progression.
Granulomatous Colitis Associated With Botryomycosis of Propionibacterium acnes
Authors: Wada Ryuichi , Kawamura Chizuko , Inoue Shigeaki , Watanabe Kunitomo , Kaimori Mitsuomi , Yagihashi Soroku
Published: January 2021

Propionibacterium acnes, an anaerobic, non–spore-forming, gram-positive bacillus, is a common inhabitant of the skin, and its virulence is considered to be low in humans. This report describes an unusual case of granulomatous colitis associated with P acnes infection in a 46-year-old woman. The affected cecum exhibited a tumor histologically characterized by massive transmural infiltrates of small lymphocytes and noncaseating epithelioid granulomas with multinucleated giant cells. Botryomycotic granules were also found in the muscular layer and paracolic connective tissues and consisted of gram-positive bacilli with filamentous growth. Polymerase chain reaction confirmed the presence of P acnes 16S ribosomal DNA in the surgical specimen of the colon. The patient developed a postoperative P acnes–induced peritonitis, which subsided with treatment with antibiotics and surgical drainage. The present case indicates that P acnes is one of the possible pathogens for granulomatous colitis.