bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudomyogenic Hemangioendothelioma: A Case Report of a Rare Tumor with Unusual Presentation
Authors: Amer Y , Kumar G , Ayub S , Cai D , Loeffler A , Hammad A
Published: October 2024

Introduction/Objective

Pseudomyogenic hemangioendothelioma (PHE) is an extremely rare neoplasm recently categorized by the World Health Organization (WHO) as an intermediate-grade vascular soft tissue tumor affecting young adults. While most documented cases exhibit local aggressiveness, we present a case with unusual presentation characterized by multiple pelvic and femoral lytic bone lesions associated with documented liver metastases.

Methods/Case Report

A mid-forties female presented with progressive left hip pain persisting for 2 weeks. Radiological assessments showed multiple lytic lesions in the left superior pubic ramus, right iliac wing, and left greater trochanter with associated pathologic fractures and soft tissue involvement. Additionally, multiple indeterminate hepatic and splenic hypodensities were noted.

Histologic examination of the bone and liver biopsies revealed a neoplasm composed of spindled and epithelioid cells with hyperchromatic nuclei and eosinophilic cytoplasm. The neoplastic cells are arranged haphazardly and in short fascicles within a fibromyxoid stroma or sinusoidal spaces (in the liver) associated with scattered acute and chronic inflammation. Frequent mitoses are noted; however, no necrosis was identified. Tumor cells were positive for CD31, ERG, FOSB with equivocal staining for pankeratin and CK8/18. The top differential consideration was epithelioid hemangioendothelioma (EHE); however, sarcoma fusion next-generation sequencing panel exhibited features of a vascular neoplasm with WWTR1-FOSB, favoring PHE.

Results (if a Case Study enter NA)

NA

Conclusion

Pseudomyogenic hemangioendothelioma is a rare tumor that is prone for local recurrence and usually affect young adults (mean age: 30 years). Metastases are uncommon. To the best of our knowledge, we report a case of PHE with unusual presentation of early metastases to liver and possibly the spleen and highlights the complexity of PHE diagnosis.
Osteoblastoma Recurring as High-grade Osteosarcoma
Authors: AL-Kharouf I , Abdo M E , Hamza A , Meyer A R
Published: October 2024

Introduction/Objective

Osteoblastoma is a benign, bone-forming neoplasm that presents as a well-circumscribed lesion amenable to excision. The prognosis is good despite a 20% recurrence risk. Malignant transformation is very rare. Osteoblastoma-like osteosarcoma is a rare form of osteosarcoma that shares similar clinical, radiographic, and pathological characteristics

Methods/Case Report

A 24-year-old female presented with a large palpable mass in the posterior occiput. The lesion progressively enlarged over 2 years, finally becoming symptomatic. Magnetic resonance imaging demonstrated an extradural posterior fossa expansile skull mass measuring 6.0 x 5.7 x 4.7 cm that showed multiple fluid/fluid levels.

The mass was resected. Pathology demonstrated a well-circumscribed neoplasm that was cellular and composed of large polyhedral osteoblasts with eccentric oval nuclei and abundant amphophilic cytoplasm. Tumor cells were intimately associated with numerous small interconnecting, irregular bony trabeculae. Scattered mitotic figures of normal configuration were noted. The findings were compatible with an epithelioid osteoblastoma with prominent secondary aneurysmal bone cyst-like changes. The patient was lost to follow-up but presented 3 years later with severe migraines. Imaging demonstrated a large heterogeneous enhancing mass centered about the occipital cranioplasty with both intracranial and extracranial components. Reexcision was performed. Sections showed a well- circumscribed tumor, delineated by a rim of subperiosteal reactive bone, with an epithelioid morphology. However, it also demonstrated areas of necrosis, extensive sheet-like growth, conspicuous mitoses, and cytological atypia not seen in the previous specimen. Therefore, diagnosis of osteoblastoma-like osteosarcoma was rendered after expert consultation.

Results (if a Case Study enter NA)

NA

Conclusion

This case highlights the exceedingly rare evolving nature of osteoblastomas and their high-grade transformation potential.
Long-term outcomes of high-risk human papillomavirus in anal infection support HPV men vaccination
Authors: Rongioletti M , Vaccarella C , Mariani S , Bucossi S , D’Andrea B , Pietricola S , Squitti R
Published: October 2024

Introduction/Objective

The clinical laboratory in a local hospital has an important role in population surveillance. The clinical laboratory performs analyses on patients admitted to the hospital as inpatients or critical patients and it is also a reference point for people’s health check-ups and health surveillance. Infectious diseases normally have severe symptoms. To ensure benefits from therapeutic treatment, a timely diagnosis is necessary. The human papillomavirus (HPV) virus is among the most diagnosed sexually transmitted infections worldwide, and the male gender is not exempt from it. In fact, 1 out of 3 male individuals is infected with HPV and 1 out of 5 male individuals is infected with a high-risk strain (1).

In Italy, vaccination is underway for women only. Vaccine prevention extended to male individuals could lead to a halving of HPV cases.

Methods/Case Report

From 2018 to 2022, we performed 7362 HPV tests using DNA extraction technique (QiaSimphony) and real-time Multiplex PCR (SeeGene 28 strains).

Results (if a Case Study enter NA)

3762 out of 7362 HPV tests performed were positive for one (2059 patients) or more (1969 patients) HPV strains. Women, who are more aware of prevention, are more represented in our sample of subjects. The tests performed on women are 6499 and half (3331) are positive for at least one strain of HPV. Regarding men, 863 tests were performed. About half (431 patients) were positive for at least one HPV strain.

Noteworthy, out of 175 anal HPV tests, 48% were positive and 1 patient had squamous cell carcinoma. Furthermore, in our male patients tested 2 - 12% had low or medium-risk injuries.

In total, out of 7529 tests carried out from 2018 to 2022, over than 50% were found to be high-risk viral strains (5231). Of these, however, approximately half (2781) are now preventable with the monovalent HPV vaccine (strains covered: 6, 11, 16, 18, 31, 33, 45, 52, 58).

Conclusion

The Ospedale Isola Tiberina – Gemelli Isola is an Institution in the center of Rome, Italy. It is also a reference center for birthrates and women’s prevention. Therefore, our Institution is very efficient in raising awareness of the prevention of HPV-related cancer. Current data indicate that male cases are not negligible, being positive in almost 50% of anal tests, and associated with an increased risk of the related cancers. These data can have an important impact on the Italian population, both in terms of the spread of HPV and healthcare burden and in terms of high healthcare costs.
Standardizing Hypoglycemic Critical Values Across United States Hospitals
Authors: Hart S A , Pogue E , Wiencek J R , Nelson S D , Schell R F
Published: October 2024

Introduction/Objective

While previous diabetes studies have defined severe hypoglycemia as glucose < 50 mg/dL, the American Diabetes Association (ADA) classified glucose < 54 mg/dL as requiring immediate action in 2019. In response, some laboratories implemented 54 mg/dL as their hypoglycemia critical value. However, there is no standardization across the medical community.

Methods/Case Report

To investigate the variability of hypoglycemia critical values across hospitals in the United States, hypoglycemia critical value thresholds were collected from the top 50 hospitals from the Newsweek’s World’s Best Hospitals 2020 United States list via hospital websites or representatives from the clinical laboratory. To evaluate the potential burden to providers and laboratory staff of raising the hypoglycemia critical value at our institution, we retrospectively reviewed deidentified glucose laboratory data for inpatient and outpatient core laboratories and determined the volume of critical value alerts sent to ordering providers per month under different hypoglycemia critical value thresholds.

Results (if a Case Study enter NA)

Across the 45 hospitals included, median hypoglycemia critical value was 50 mg/dL (Range: 40-60 mg/dL). The hypoglycemia critical value was set at 40 mg/dL at 12 hospitals and 50 mg/dL at 21 hospitals. 22% of institutions set the hypoglycemia critical value at or above the ADA recommendation of 54 mg/dL. Increasing the hypoglycemia critical alert to 50 mg/dL at our institution would increase the average monthly alerts by 122 for inpatient and 41 for outpatient core laboratories, corresponding to 163 additional total core laboratory alerts per month. Increasing the critical alert to 55 mg/dL, would increase average monthly alerts by 243 for inpatient and 99 for outpatient core laboratories, corresponding to 342 total additional alerts per month.

Conclusion

Our analysis suggests standardizing 50 mg/dL as the hypoglycemia critical value across institutions to improve patient safety by reducing the risk of severe acute symptoms and long-term complications without adding excessive burden to laboratory staff and providers.
Evaluation of a Point of Care Urine Drug Test System for Application in Outpatient Pain Management Clinics
Authors: Overton J S , Kyle P
Published: October 2024

Introduction/Objective

Most states require testing for illicit and controlled substances in ambulatory, non-terminal pain management populations to ensure prescription compliance. Point of care (POC) urine drug testing (UDT) is a widely adopted testing method that assists with clinical decision making within minutes. However, these immunoassays may lack the sensitivity and specificity needed for potent medications such as fentanyl. This study compares the performance characteristics of a POC UDT to an in-house, high throughput, automated chemistry analyzer and the reference method, gas chromatography-mass spectrometry (GC-MS). Providers should be aware of the limitations of each methodology given the rise of synthetic opioid misuse, and the need to quantify multiple substances and metabolites within the same drug class.

Methods/Case Report

100 residual deidentified patient urine samples from an ambulatory pain management population were analyzed using GC-MS, Profile®-V MEDTOX Scan® POCT device (Burlington, NC), and a Beckman Coulter AU480® Chemistry Analyzer using EMIT® II Plus reagents (Beckman Coulter; Brea, CA). Drug classes on the Profile®-V included: amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolite, methamphetamine, methadone, opiates, oxycodone, cannabinoids and phencyclidine. Drug classes on the AU480® included the same except without a methamphetamine-specific immunoassay.

Results (if a Case Study enter NA)

The results from GC-MS showed that 99% (99/100) of the samples were positive for one or more of the drug classes. Overall, the AU480® was 90% sensitive and 98% specific while the MEDTOX Scan® was 87% sensitive and 98% specific. Both devices exhibited variable performance across drug classes.

Neither the AU480® nor the MEDTOX Scan® detected fentanyl in five specimens.

Conclusion

POCT-UDS systems like the Profile®-V MEDTOX Scan® can provide good accuracy and may offer a time and cost benefit when compared to higher throughput analyzers like the AU-480®. Due to the low reference values of immunoassays, definitive testing such as GC-MS is recommended for use in the pain management population.
Who Keeps Changing My Results? - A Case of Heterophile Antibody Interference
Authors: Nwadukwe A H , Palamalai V
Published: October 2024

Introduction/Objective

Heterophile antibodies are known to cause interference in immunoassays leading to misleading results causing diagnostic confusion and unnecessary testing and/or treatment. Many clinically important analytes are tested using antibody-based assays, as such, these are prone to interference.

Methods/Case Report

We describe a case of a 73 year old male who was referred with history of hypocalcemia and his previous lab tests were suggestive for idiopathic hypoparathyroidism, Hashimoto’s disease and Addison’s disease raising physician concern for a possible Type 1 autoimmune endocrinopathy. One of his results (cortisol) was outside the analytical measurement range and hence the sample was diluted and tested again, but the result was much less than what was expected, prompting an investigation. Investigation for an interfering substance included serial dilution and analysis of the same sample for the same analytes by different methods (different immunoassay, mass spectrometry or both). Based on non-parallelism in serial dilution results, discordant results with other methods, and loss of interference after dilution it was determined that the most likely cause was a heterophile antibody.

Results (if a Case Study enter NA)

NA

Conclusion

Awareness of the possibility that interference by heterophile antibodies can lead to erroneous laboratory results is important to prevent unnecessary testing and inappropriate diagnosis/management.
Beyond the Surface: Uncovering the PML::RARA Fusion in Cytogenetically Cryptic and FISH-Negative Acute Promyelocytic Leukemia- A Case Report and Review of the Literature
Authors: Delikkaya B N , Morton A , Mikkilineni S , Gong J Z , Liu J
Published: October 2024

Introduction/Objective

Chromosomal t(15;17)(q22;q21), resulting in a fusion between the PML gene on chromosome 15q22 and the RARA gene on chromosome 17q21, is the cytogenetic hallmark of acute promyelocytic leukemia (APL). Conventional karyotyping, along with fluorescence in situ hybridization (FISH), can detect the PML/RARA rearrangements in up to 98% of APL cases. Reverse transcriptase-polymerase chain reaction (RT-PCR) is often used to confirm the initial diagnosis. APL with PML::RARA fusion, which is negative with FISH and conventional karyotyping approaches but positive with RT-PCR, is extremely rare. Herein, we report a de novo APL case that was positive by RT-PCR but negative by cytogenetics and FISH studies. A comprehensive review of the literature was also performed.

Methods/Case Report

A 23-year-old male presented to the ED for left upper extremity weakness 2 days after post- dental cleaning. Upon admission, he developed intracranial hemorrhage, necessitating urgent decompressive hemicraniectomy. Blood smear revealed promyelocytes; flow cytometric analysis showed a CD13+, CD33+, MPO+, CD117+, CD34-, and HLA-DR- abnormal cell population. STAT interphase FISH analyses for PML/RARA fusion and RARA break-apart were negative. A diagnosis of APL was made based on abnormal promyelocytes and characteristic flow cytometry findings. ATRA was immediately administrated. However, the post-operative course was complicated by significant coagulopathy, pancytopenia, and multi-organ failure, and the patient expired 7 days later. RT-PCR returned positive for PML::RARA long fusion transcript; the conventional cytogenetics study was uninformative. The clinical, pathological, and genetic features of 31 cases of FISH/Cytogenetics-negative APL harboring cryptic rearrangements of PML-RARA, detected by RT-PCR in the literature, have been reviewed. Various detection methods were also discussed.

Results (if a Case Study enter NA)

N/A

Conclusion

Conventional cytogenetics, FISH and RT-PCR analysis are complementary studies for all clinical suspected APL cases. The clinicopathological characteristics also play critical roles in APL diagnosis when genetic confirmation of the PML::RARA fusion is unavailable.
Diagnostic workup of triple hit lymphoma by fine needle aspiration
Authors: Zhang L , Doan J V , Dinarvand P , Yared M , Zhang S
Published: October 2024

Introduction/Objective

Triple-hit lymphomas (THL) represent a rare and aggressive subset of high-grade B-cell lymphomas characterized by a triad of translocations involving MYC, BCL2, and BCL6. Patients with THL face poor outcomes when treated with the standard diffuse large B-cell lymphoma protocol. Thus, intensified regimens have emerged as a frontline strategy for managing these patients. Therefore, accurate diagnosis and molecular subclassification of these lymphomas are essential for guiding therapeutic decisions for these patients. Here, we report a case study detailing the diagnostic assessment of THL utilizing limited diagnostic material obtained through palpation-guided fine-needle aspiration (FNA).

Methods/Case Report

A 58-year-old male presented with a rapidly enlarging neck mass, accompanied by worsening dysphagia, pain, and fatigue over the course of two months. Laboratory testing showed leukocytosis and imaging studies revealed a partially necrotic, 7.8 x 9.1 x 9.4 cm right jugular nodal mass. The patient was referred to otolaryngology for further evaluation, where FNA of the mass was performed by the cytopathology team. The aspirate was sent for cytology with cell block and flow cytometry. The Romanowsky stain revealed abundant, large, discohesive cells with prominent nucleoli and scant cytoplasm with an abundance of lymphoglandular bodies in the background. Immunohistochemistry (IHC) on the cell block demonstrated BCL-2, BCL-6, and MYC expression, and a Ki-67 proliferation index >95%. Concurrent flow cytometric analyses showed an aberrant B-cell population expressing CD19, CD20, CD22, CD23 and surface lambda light chain. Further fluorescence in situ hybridization (FISH) analysis performed on the cell block confirmed gene rearrangements in BCL2, BCL6 and MYC, thereby classifying this patient’s disease as THL.

Results (if a Case Study enter NA)

NA

Conclusion

Diagnosing THL typically demands sufficient tissue for histology, cytology, flow cytometry, IHC, and molecular testing. Herein, we showcase a notable example where the diagnostic evaluation of THL was accomplished using limited material obtained from FNA. This case highlights the efficacy of conducting comprehensive diagnostic studies even when tissue availability is constrained. Utilizing cytologic samples not only streamlines the diagnostic process but also minimizes the need for patients to undergo additional invasive procedures, thus potentially reducing delays in diagnosis and therapeutic intervention.
Case Report: Aspirated Airway Foreign Body Mimicking Endobronchial Mass: A Diagnostic Challenge
Authors: Salehiazar S , Mirzaei Baboli K , Chiu R , Yap C G
Published: October 2024

Introduction/Objective

Despite advancements in imaging modalities, identifying retained foreign bodies within the lung remains arduous. Detecting small foreign bodies is crucial as they can serve as a focal point for subsequent infections. Initial assessments may mimic malignancy. Herein, we present a case of a retained foreign body masquerading as an endobronchial mass, accompanied by unilateral pleural effusion and persistent hypoxia.

Subsequent bronchoscopy showed a pearly white endobronchial mass partially obstructing the segmental bronchus at the posterior basal segment of the right lower lobe of lung with accompanying right pleural effusion and atelectasis.

Methods/Case Report

This is a 58-year-old male with history of hypertension, deep vein thrombosis, transient ischemic attack, and a recent motor vehicle accident with blunt chest trauma. He had a thoracic spinal cord transection with grade III blunt thoracic aortic injury, developed anasarca, hypoxia, right pleural fluid requiring multiple thoracentesis, and right sided hemothorax requiring massive transfusion protocol. Subsequent evaluations, including bronchoscopic transbronchial forceps biopsies and bronchial wash and pleural fluid cytologic examinations showed no malignant cells. Repeat bronchoscopy was concerning for enlarging mass and obstruction. Bronchoscopy almost 2 months after MVA revealed an endobronchial foreign body (tooth) lodged in the left lower lobe of lung posterior segment.

Results (if a Case Study enter NA)

N/A

Conclusion

While aspiration of foreign bodies into the tracheobronchial tree is not uncommon especially in children, foreign bodies, particularly teeth, are rare in adults. Bronchial foreign body aspiration may occur in trauma, with diagnosis typically relying on history and physical examination. Detection remains challenging despite imaging advancements, with implications including infection nidus formation. In our case, delayed diagnosis highlights the importance of considering unusual etiologies in persistent pulmonary pathology. Retrospective imaging analysis and CT findings suggested a foreign body, emphasizing the utility of imaging in suspected cases. Prompt surgical intervention is crucial to prevent complications such as recurrent infections.
Exploring Epidermodysplasia Verruciformis: A Case Report, Treatment Strategies, and Emerging Therapies
Authors: Christie-Nguyen P , Tschen J , mai B
Published: October 2024

Introduction/Objective

Epidermodysplasia verruciformis (EV) is a rare cutaneous disorder with both inherited and acquired forms. Inherited cases involve mutations in genes such as ERV1 and ERV2, crucial for HPV immunity, while acquired cases affect immunocompromised individuals. EV is linked to cutaneous squamous cell carcinoma (SCC), highlighting the need for prompt diagnosis and treatment.

Methods/Case Report

A 54-year-old HIV-positive man was referred with a persistent, itchy eruption on his forearms despite given ARV regimen, oral retinoids and topical therapies. Physical examination revealed hypopigmentation and hyperkeratotic plaques on both forearms. Histologic examination revealed large cells with blue-gray cytoplasm and perinuclear halo in the upper epidermis, consistent with EV. Although advised for papilloma virus vaccination and planned for a trial of topical cidofovir, the patient was lost to follow-up.

Treatment strategies for EV vary depending on lesion severity. Severe keratinized or precancerous lesions typically require surgical removal as the first-line approach. For early-stage EV with few small lesions, 5-FU, cidofovir, glycolic acid, and imiquimod is recommended. Tazarotene 0.5% cream used twice weekly has shown success in resolving lesions within 14 days. Topical imiquimod’s efficacy appears variable. In HIV-positive patients with EV, topical 1% cidofovir showed success in some cases. Systemic and topical retinoids are advised for diffuse lesions, with electrocautery or cryotherapy as options if initial treatments fail. HPV vaccination combined with oral acitretin, topical tretinoin and imiquimod led to lesion flattening. Continuous low-dose isotretinoin achieved prolonged remission of EV, but its efficacy in acquired EV remains unclear. Topical methyl aminolevulinate followed by photodynamic therapy has also shown promise.

Results (if a Case Study enter NA)

NA

Conclusion

Since its discovery in the 1970s, Acquired EV has been observed across diverse demographics, including HIV patients and organ transplant recipients. Advanced HPV typing and sequencing techniques aid in predicting SCC risk. Emerging treatments like topical cidofovir and combination therapies show promise, necessitating larger clinical trials for validation.
De-Differentiated Metastatic Melanoma: A Diagnostic Challenge
Authors: Raja F , ram B
Published: October 2024

Introduction/Objective

Melanoma is one of the common malignant neoplasms with several histological appearances. Its diagnosis is usually based on histomorphologic findings and immunohistochemistry (IHC). De-differentiated melanoma (DM) is a special form of malignant melanoma with different histo-morphologic and immunohistochemical characteristics than conventional malignant melanomas. It has a worse prognosis and can impose a diagnostic challenge.

Methods/Case Report

A 62-year-old male previously had melanoma on his chest, which was surgically removed with negative margins and no involvement of nearby sentinel lymph nodes. The patient presented two months later with a rapidly enlarging mass in the right axillary region. Subsequent lymph node dissection revealed several nodes, the largest measuring 14 cm with extensive necrosis. Microscopic examination of the largest mass revealed clusters of irregularly shaped cells displaying marked nuclear abnormalities, prominent nucleoli, and heightened mitotic activity. Immunohistochemical analysis of this mass showed negative results for SOX-10, HMB45, Melan-A, S100 protein, CAM5.2, BRAF, and myogenin. Conversely, the remaining lymph nodes exhibited typical signs of melanoma metastasis, expressing relevant melanoma markers. Given the patient’s history of melanoma and the presence of metastatic melanoma in nearby lymph nodes, the histological and immunohistochemical findings support the diagnosis of dedifferentiated cutaneous metastatic melanoma.

Results (if a Case Study enter NA)

N/A

Conclusion

The distinctive appearance and lack of typical markers in this type of melanoma pose considerable difficulties in distinguishing it from other malignancies like poorly differentiated carcinomas and high-grade sarcomas. Furthermore, dedifferentiated melanoma tends to be highly aggressive, often resisting standard and immunological treatments. Therefore, comprehensive clinical and histomorphological assessments are crucial for accurately diagnosing these complex and challenging cases.
Implementation and reception of a semi-structured resident interview to improve equity
Authors: Hu Y , Bharani K , Amponsah A , Shane-Sanchez J , Janczewski O , Kao S , Lowe A C
Published: October 2024

Introduction/Objective

To improve equity and inclusion in the residency candidacy interview process, we collaborated with our human resources and graduate medical education colleges to develop standardized interview questions based on best practices reported in corporate and medical literature. These standardized questions were piloted by resident interviewers during the 2023-2024 Pathology residency application cycle in a semi-structured interview format.

Methods/Case Report

With consultants from the graduate medical education and human resources, we identified favored qualities of expectational candidates (e.g., passion for pathology, interest in program, collaboration, reliability, and compassion) and developed a list of standardized questions with a corresponding answer scoring guide to guide objective assessment of answers for each quality. Residents and fellows (“interviewers”) who volunteer to interview Pathology residency candidates (“candidates”) received training on interviewing best practices, identifying and mitigating bias, and the new semi-structured interview format at the beginning of the interview season. Interviewers were encouraged to use a semi-structured interview format where at least one standardized question is included in addition to their usual ad hoc interview questions and discussions. After the interview season concluded, we surveyed all interviewers (n=39) and candidates (n=90) who participated in this process, for feedback on the semi-structured interview process.

Results (if a Case Study enter NA)

31/90 (34%) applicants provided feedback about their interview with 15/29 (52%) applicants agreeing that the semi-structured interview format enhanced their experience. 20/31 (65%) applicants agreed that their impression of Stanford would be positively affected if all interviews were conducted in a semi- structured format. 24/31 (77%) think faculty members should use standardized questions while 17/31 (55%) think residents should use standardized questions in either a semi-structured or structured formats. 17/31 (55%) feel that structured interviews contribute to improving equity. 12/39 (31%) of current residents provided feedback about their interviews. All 12 (100%) respondents used standardized questions in a semi-structured interview format. 10/12 (83%) interviewers think the new format improves our resident interview process.

Conclusion

Overall, responses from both resident interviewers and applicants support the implementation of semi- structured interviews and the continuation and expansion of this initiative.
Adopting Covid-19 and Flu Testing Strategies In An Underserved Community
Authors: Li B , Donnachie E , Adebusuyi T , Meshack A , Poon I
Published: October 2024

Introduction/Objective

The COVID-19 pandemic has had a significant impact on communities worldwide, while little is known about how medically underserved minority communities perceive and experience COVID-19 and/or COVID- 19/Flu combined testing. This research target at a medically underserved community in east Harris County, Texas, and was designed to 1) understand the perception of the single COVID-19 test as well as the COVID-19 and flu combined test, 2) implement different testing strategies in collaboration with the local community.

Methods/Case Report

Residents in the eligible communities who are age ≥ 18 years or older are recruited through community engagement groups and community originations. Participant’s demographic information, perception and histories of vaccination and testing were collected through a cross-sectional questionnaire. Participants willing to undergo testing were assisted by community health workers, who then collected feedback on test acceptability via follow-up questionnaires.

Results (if a Case Study enter NA)

A total of 325 individuals participated in the study from Sept 2022-June 2023. 52% of participants are minority ethnicity, including 35% African American and 17% Latino. 11% of participants are uninsured and 32% of participants are from households with income lower than 25,000 a year. We surveyed our participants on their opinion of COVID-19 and Flu testing and vaccination, majority of our participants have had more experience in COVID-19 (92% had been tested and 93% had been vaccinated) than Flu (64% had been tested and 85% had been vaccinated). 96% consider COVID-19 testing tolerable, with major barrier of being tested is fear of painful sampling (49%). PCR testing is the dominant testing method in the community (> 40%) for COVID-19, while only 16% received antigen testing.

Conclusion

Our findings suggest that while participants recognized the role of COVID-19 testing, there were significant barriers to access and uptake of testing, including concerns about painful sampling, inconvenience, and a lack of trust in the healthcare system. Participants also expressed a desire for clearer information about testing and more accessible testing sites. Participants have less experience with Flu testing and many of whom had never been tested in the past. Our study highlights the need for targeted community education and outreach efforts to increase testing uptake. Development and implementation of these efforts would better prepare us for combating other commutable diseases of public health significance in the future.
Benefits of Practicing Teaching as a Resident: A Single Institute Experience of a Formal Teaching Curriculum for Pathology Residents
Authors: Khatskevich K , Thompson C T , Baker T
Published: October 2024

Introduction/Objective

The practice of near-peer teaching, both in lecture style and small group formats, has been shown to have benefits for the educator in improving communication skills, gaining knowledge in a subject, and providing a tangible experience that may aid in applying for employment. The purpose of this study is to present the current curriculum and teaching opportunities at the Medical University of South Carolina (MUSC) and their impacts on developing pathology residents’ teaching skills and perceptions of their growth as educators.

Methods/Case Report

Data regarding curriculum format and learner surveys for various teaching programs at MUSC was gathered from residency program leadership and the MUSC College of Medicine. An anonymous survey was distributed to current MUSC pathology residents to assess their participation, current comfort level, and comfort level prior to the start of residency in regard to various teaching modalities.

Results (if a Case Study enter NA)

The resident curriculum offers teaching modalities such as small group co-leader for medical students, didactic presentations, and on-the-job teaching. On a Likert scale of 1 to 5, with 5 being very comfortable, residents reported an average comfort level with teaching before starting residency as 2.11 and a current comfort level with teaching as 2.67. Residents were split on their perception of what affect residency has had on their comfort in teaching. Medical student evaluations of their small group teaching sessions co-led by pathology residents averaged 77.6% approval per course.

Conclusion

Through providing an overview of required and voluntary teaching opportunities offered at one institute and residents’ perceptions on their experiences while teaching there, we hope to both provide curriculum examples for other institutions and to advocate for placing greater importance on providing opportunities for residents. Such opportunities to practice teaching help them develop skills to benefit them as pathologists and in their future employability.
Liver Metastasis Masking as Neuroendocrine Carcinoma (NEC) Predates Discovery of Intra/Peri-Thyroid Thymic Carcinoma (ITTC)
Authors: Agyapong Y O , Zaidi A , Sonawane S S , Guzman G , Sheikh U
Published: October 2024

Introduction/Objective

Intrathyroidal thymic carcinoma (ITTC) also known as Carcinoma showing Thymus-Like differentiation (CASTLE) is a rare malignancy comprising 0.1 to 0.15% of thyroid cancers. The WHO 5th Edition emphasizes that these tumors may also occur outside the thyroid typically at the lower pole

Methods/Case Report

Our aim is to show that NEC is a mimic of ITTC; that CD5, c-KIT (CD 117), p40, CK5/6 expression distinguishes ITTC from NEC, and that ITTC may at times express NE markers. Briefly, a 51-year-old man presented with hoarseness left neck mass and a PET avid liver lesion in 2016. Biopsy of the neck and liver masses revealed an infiltrating poorly differentiated “NEC” with similar morphology; positive for p53, chromogranin, and synaptophysin; negative for cam5.2, thyroglobulin, TTF-1, CD20, Pax5, CD3, CD5, S-100, calcitonin, CD56, p16, p63, c-KIT (CD117), AE1/3; and 100% staining for Ki-67. The patient underwent chemotherapy, responded well, remained under surveillance, and was symptom-free in the interim. A new 2.1 x 2.0 cm nodule appeared at the left thyroid lower pole after 6 years. The tumor was positive for CD5, CD117, p40, CK5/6, with > 95% Ki67 expression. Chromogranin, synaptophysin, CD56, thyroglobulin, calponin, TTF1, and Epstein Barr virus were negative and was overall diagnostic of ITTC

Results (if a Case Study enter NA)

NA

Conclusion

This shows the diagnostic dilemma of distinguishing ITTC from NEC which may share expression of neuroendocrine (NEC) markers and that positivity for CD5, c-KIT (CD117), p40, and CK5/6 are key diagnostic features of ITTC.
Teratoid hepatoblastoma with small cell undifferentiated histology in polysplenia patient: a case report
Authors: Tran T M , Mohamed R , Saulino D M , Bui C M
Published: October 2024

Introduction/Objective

Hepatoblastoma (HB) with teratoid is a uncommon variant of mixed epithelial and mesenchymal components. Conversely, HB with small cell undifferentiated (SCUD) is extremely rare, with only nine documented cases showing retained INI-1 expression in the literature. The prognosis of SCUD remains debatable. In this report, we describe the first case of combined teratoid HB with a SCUD component that preserved INI-1 expression with a favorable outcome.

Methods/Case Report

A 2-year-old girl with polysplenia syndrome presented with a right liver mass detected during ultrasound screening. The alpha fetoprotein levels were significantly elevated to 148,000. MRI revealed a 7.2 cm lesion, staged as Pre-Treatment Extent 2 (PRETEXT) in the right anterior liver. She underwent cholecystectomy and right hepatectomy. Resection specimen revealed a mixed neoplasm comprising epithelial components (fetal and embryonal) and mesenchymal components. Additionally, notable findings include small cell component and teratoid features, characterized by melanin pigment and neuroectodermal elements. All the neoplastic cells showed reactivity with CD34, reticulin, SALL4, beta-catenin, GPC-3, arginase-1, chromogranin, and glutamine synthetase. Notably, the teratoid area only displayed positivity for CD56 and NSE, while vimentin highlighted capillaries, vessels and focally staining small cells. Furthermore, CK19 highlighted the small cell components and the bile ducts in the background liver. Importantly, INI-1 staining was retained in all tumor cells, including the small cell component. Synaptophysin and Prussian blue were negative in all lesional cells. After a 2-year follow-up, no recurrence was observed.

Results (if a Case Study enter NA)

NA

Conclusion

This case underscores the diagnostic challenge posed by small cell undifferentiated (SCUD) hepatoblastoma. Moreover, it contributes to the understanding of this rare variant of hepatoblastoma and suggests a potential favorable prognosis associated with retained INI-1 staining in the SCUD component.
Gastric Epithelial Neoplasm of Fundic-Gland Mucosa Lineage: Showed the Same Genetic Lineage and Ki67 May Help in Their Identification
Authors: li H
Published: October 2024

Introduction/Objective

Gastric epithelial neoplasm of the fundic-gland mucosa lineages (GEN-FGMLs) are rare form of gastric tumors that encompasses oxyntic gland adenoma (OGA), gastric adenocarcinoma of the fundic-gland type (GA-FG), and gastric adenocarcinoma of the fundic-gland mucosa type (GA-FGM). There is no consensus on the clinicopathologica and molecular characteristics of GEN-FGMLs, and misdiagnosis is common because of similarities in symptoms.

Methods/Case Report

The NGS and immunohistochemical staining were performed on 37 cases diagnosed with GEN-FGMLs with a thorough histological evaluation. Gene alternations were analysed and compared across histological subtypes. we used an artificial intelligence approach for the recognition of the Ki67 immunohistochemistry stained.

Results (if a Case Study enter NA)

The patient’s ages ranged from 42 to 79 years, with a median age of 60. 17 were male and 20 were female. Morphologically, 19 OGAs, 16 GA-FGs, and two GA-FGMs were identified.

Histopathological similarities exist between GEN-FGMLs. The tumors demonstrated well-formed glands, expanding with dense growth patterns comprising pale, blue-grey columnar cells with mild nuclear atypia. The normal gastric pit epithelium covered the entire surface of the OGA and GA-FG, but the dysplasia pit epithelium covered the GA-FGM. Compared with OGA, GA-FG and GA-FGM were more prominent in the macroscopic view (p<0.05) and had larger sizes (p<0.0001). Additionally, GA-FG and GA-FGM exhibited higher Ki67 indices than OGA (p<0.0001). The heterogeneity of mutational signatures, somatic mutations, and copy number variations was revealed across histological subtypes. The top five mutational signatures in OGA were ROS1, CTNNA1, GNAS, BRCA2, and ZFHX3. The top five mutational signatures in GA-FG and GA-FGM were GNAS, MLL3, BRAF, MSH3, and EGFR. GNAS were both found in OGA, GA-FG and GA-FGM. Compared with well-differencent gastric adenocarcinoma, The top five mutational signatures in GEN-FGMLs were GNAS, BRAF, ROS1, MLL3, and MSH3. Recurrently mutated key signaling pathways across tumor types in GEN-FGML were Wnt signaling pathways.

Conclusion

GEN-FGMLs are a group of well-differentiated gastric tumors with favourable biological behaviours. Compared with OGA, GA-FG and GA-FGM have larger sizes and higher Ki67 proliferation indices, indicating that they play a critical role in the identification of GEN-FGML. GEN-FGMLs showed the same genetic lineage, the Wnt signalling pathway plays a role in the development and progression of GEN-FGMLs.
Expression of human epidermal growth factor receptor 2 (HER2) in colorectal cancer and its correlation with clinicopathological characteristic among Jordanian patients
Authors: Sughayer M A , Atieh Z , Obeidat M
Published: October 2024

Introduction/Objective

Human epidermal growth factor receptor 2 (HER2/neu) is a well-established therapeutic target in breast and gastric cancers. Currently HER2 expression is being considered in other solid tumors including colorectal cancer (CRC). We aimed to investigate HER2 expression in CRC among Jordanians and its association with clinicopathological variables.

Methods/Case Report

Formalin-fixed, paraffin-embedded tissue blocks of 69 CRC cases were retrieved with their clinicopathological data. Tissue microarray (TMA) were constructed and immunostained using anti-HER2/neu 4B5 monoclonal antibody (Ventana, Tucson, AZ). HER2 scoring was performed by two experienced pathologists using the HERACLES criteria (HER2 positivity: cases of (3+) in ≥10% of cells and FISH-positive equivocal cases). Fisher’s exact/Chi-square test was used to investigate the association between HER2 s and clinicopathological data such as age, gender, histological differentiation, node and metastasis (NM) stage, and tumor site. Survival analysis was evaluated using Kaplan–Meier curves.

Results (if a Case Study enter NA)

Any degree (score) of HER2/neu expression was seen in 43.5 % of the cases. In 25 (36.2%), 4 (5.8%) and 1 (1.5%) the HER2 score was 1+, 2+ and 3+ respectively. The rest of the cases, 39 (56.5%) were scored as 0. Two of the four cases with a score (2+) required ISH testing to confirm amplification which was not performed. No significant association was found between HER2/neu expression and clinicopathological parameters or with survival. However, survival analysis showed that combined 2+/ 3+ group tend to have worse overall (OS) and event -free survival than the (0/1+) group.

Conclusion

The prevalence of HER2 overexpression in CRC is low among Jordanian patients, with only 1.5% of the study sample exhibiting definite HER2 overexpression. This rate is lower than the 3-5% rate reported in general, however the small sample size and lack of FISH confirmation might have contributed to this low rate. There was a trend towards worse OS and EFS in HER2 positive cases
The umblicus says it all
Authors: Bandara K , Facile E , Lankachandra K , Galbraith R
Published: October 2024

Introduction/Objective

Umbilical nodules can be divided into benign and malignant. Malignant lesions of the umbilicus are very rare. They can arise from primary tumors or secondary to abdominal and pelvic malignancies. Literature review suggests that these umbilical lesions can present as primary tumor in 38% of the cases, endometriosis in 32%, and metastatic lesions in 30%. Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is known as Sister Mary Joseph’s nodule (SMJN). It is a very rare finding and the incidence of SMJN is 1- 3% in people diagnosed with intra-abdominal or pelvic malignancies.

Methods/Case Report

A 31-year-old male with no past medical history presented to the emergency room with 3 months history of umbilical nodule and 60 pounds weight loss. He experienced early satiety, abdominal pain, nausea and generalized fatigue. CT abdomen showed hepatomegaly with numerous hypoattenuating lesions throughout the liver with peripheral enhancement, and hypoattenuating mass within the pancreatic tail and body measuring approximately 2.1 x 5.8 cm that appears contiguous with hilar splenic lesion. CT chest showed multiple pulmonary metastases with prominent precarinal and subcarinal lymph nodes. Serologic tests revealed elevated Alpha fetoprotein, ALP, ALT, and CA19-9. Patient underwent umbilical nodule core biopsy and right liver core biopsy.

Microscopic evaluation of the specimens revealed pancreatic acinic cell carcinoma with two different morphological variants. Umbilical nodule with glandular pattern and liver lesion with trabecular pattern. Immunohistochemical stains were performed with tumor cells positive for CK 7, Trypsin and BCL-10 and negative for Glypican 3, CK 20, AFP and CD56. The prognosis is poor, with an average survival time of about 19 months. After the diagnosis patient underwent chemotherapy.

Results (if a Case Study enter NA)

NA

Conclusion

Umbilical nodules can be diagnosed with careful clinical and histopathological evaluation. The prognosis of patients presenting with SMJN is generally poor as it is a sign of advanced malignancy. Sometimes it may be the first and only sign of an internal neoplasm. Therefore, this is an important differential diagnosis to consider.
Navigating the HER2 Frontier: Advancing Gastrointestinal Adenocarcinoma Diagnosis through Updated NCCN Guidelines
Authors: Kumar D , Kiran F , Rao D
Published: October 2024

Introduction/Objective

HER2-status is routinely tested in breast and upper-gastrointestinal (GI) cancers. Studies have shown the importance of anti-HER2 therapy with HER2 being a negative predictive marker in advanced colorectal cancer (CRC). Thus, recent NCCN-guidelines recommend screening for HER2-status in such cases. To increase compliance with the NCCN recommendations, we performed a quality assurance project to screen for HER2 status by immunohistochemistry (IHC) in GI adenocarcinomas.

Methods/Case Report

We conducted a validation of HER2 IHC for GI adenocarcinomas. Surgical pathologists were informed via email discussing the criteria and significance of HER2 IHC in GI adenocarcinomas. A total of 50 GI adenocarcinoma cases were evaluated in our surgical-pathology service, from June to December 2023. Pathologists were periodically reminded, either through email or in-person meetings, to ensure HER2 IHC assessment, especially for cases initially missed.

Results (if a Case Study enter NA)

Out of 50 GI adenocarcinomas, HER2 IHC was performed on 27 out of 50 cases (54%) without any reminder. The pathologists were reminded to perform HER2 IHC on the remaining 23 cases, resulting in the IHC performance on an additional 22 cases, giving a yield of 98%. Of 49 cases, HER2 was negative in 46 cases and was positive (3+) in one case, and equivocal (2+) in two cases. Subsequent HER2 FISH analysis of equivocal cases showed HER2 amplification in one case. Thus, HER2 expression/amplification was present in 2 out of 50 cases (4%) including one case each in upper and lower GI tracts.

Conclusion

While we have long recognized importance of HER2 Status in upper GI adenocarcinomas, it’s now clear that understanding HER2 status is crucial in CRC too. New evidence highlights how anti-HER2 therapy can make a difference, especially for advanced cases. By screening for HER2 early, clinicians can enroll such patients in appropriate clinical trials and also guide them on the appropriate treatment options, offering hope and targeted care.