bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA Topoisomerase II-α and Cyclin A Immunoexpression in Meningiomas and Its Prognostic Significance
Authors: Korshunov Andrey , Shishkina Lyudmila , Golanov Andrey
Published: January 2021

Context.—Routine pathologic examination cannot distinctively predict the clinical course of meningiomas because even histologically benign tumors may recur after gross total resection. Therefore, numerous efforts have been made to evaluate the meningioma growth fraction and its prognostic value. However, a universally applicable proliferative marker for meningioma outcome is not yet a reality.

Objective.—To investigate the prognostic utility of 3 proliferative markers, namely, Ki-67, DNA topoisomerase II-α (topoII), and cyclin A in a representative series of intracranial meningiomas.

Design.—Two hundred sixty-three adult patients with intracranial meningiomas (208 benign, 42 atypical, and 13 anaplastic) were studied retrospectively. Tumor specimens were immunohistochemically examined with antibodies to Ki-67 (MM-1), topoII, and cyclin A. A computerized color image analyzer was used to count immunostained nuclei.

Results.—The topoII and cyclin A scores exhibited a close correlation with Ki-67 immunostaining. Significant differences between the indices for all 3 markers were noted among the 3 grades of meningiomas. The scores for all 3 markers were significantly different between recurrent and nonrecurrent meningiomas, including benign tumors that were treated with gross total resection. Recurrence-free survival was significantly reduced for cases with a Ki-67 labeling index (LI) of 4.4% or greater, a topoII LI of 3.2% or greater, and a cyclin A LI of 3.1% or greater. Multivariate analysis revealed that the risk of recurrence for the entire meningioma cohort was significantly associated with tumor grade (hazard ratio = 2.7; P = .004), topoII LI of 3.2% or greater (hazard ratio = 5.5; P < .001), and a cyclin A LI of 3.1% or greater (hazard ratio = 2.4; P = .01).

Conclusions.—There is a close correlation in the expression of these 3 proliferative markers in meningiomas, and all of the markers showed a significant association with tumor grade, recurrence rate, and recurrence-free survival. Consequently, in addition to Ki-67, immunoexpression of topoII and cyclin A is available for predicting meningioma recurrence. Moreover, the topoII and cyclin A staining scores were found to be more sensitive predictors for meningioma progression than Ki-67 and, therefore, either of these 2 markers may prove to be clinically informative and useful.
Dedifferentiated Acinic Cell Carcinoma of the Parotid Gland With Myoepithelial Features
Authors: Piana Simonetta , Cavazza Alberto , Pedroni Corrado , Scotti Rosa , Serra Luigi , Gardini Giorgio
Published: January 2021

Dedifferentiated acinic cell carcinoma of the salivary gland is an uncommon variant of acinic cell carcinoma, characterized by the coexistence of both an usual low-grade acinic cell carcinoma and a high-grade dedifferentiated component, as well as by an accelerated clinical course. We describe a case of acinic cell carcinoma of the parotid gland in a 67-year-old woman, which recurred 4 times after surgery and radiotherapy. The recurrences consisted of residual foci of acinic cell carcinoma intermingled with a high-grade epithelial proliferation; the latter was focally constituted by cells with morphologic and immunohistochemical features of myoepithelium.
Molecular Events in the Progression of Recurrent Respiratory Papillomatosis to Carcinoma
Authors: Lele Subodh M. , Pou Anna M. , Ventura Karyna , Gatalica Zoran , Payne Deborah
Published: January 2021

Context.—Identification of the type of human papillomavirus (HPV) by polymerase chain reaction and sequencing to determine coinfection or superinfection (by more than 1 HPV type) and other molecular events have not been reported in a series of patients exhibiting the morphologic spectrum of recurrent respiratory papillomatosis progressing to carcinoma.

Design.—Four cases of juvenile-onset recurrent respiratory papillomatosis progressing to carcinoma (no history of smoking or irradiation in 2 cases) were studied. Morphologically distinct foci (squamous papilloma, pulmonary papillomatosis, squamous dysplasia subjacent to carcinoma, and squamous carcinoma) were subjected to laser capture microdissection and polymerase chain reaction amplification using general primers in addition to type-specific primers for HPV types 16 and 18. Direct sequencing of polymerase chain reaction products identified the type of HPV. The tissue sections were immunostained using antibodies to p53, pRb, p21WAF1, and p16 proteins with a semiquantitative assessment.

Results.—Human papillomavirus 11 was the only type of HPV identified in all lesions of all cases associated with recurrent respiratory papillomatosis. There was a marked increase in p53 protein expression in foci of dysplasia and carcinoma as compared to squamous papilloma and pulmonary papillomatosis. An inverse correlation between p53 and p21WAF1 protein expression was noted in all lesions. pRb protein expression increased from the benign to the malignant end of the spectrum. p16 protein was expressed in all lesions.

Conclusions.—Infection by HPV-11 may be an early event associated with progression of recurrent respiratory papillomatosis to carcinoma. Increased expression of p53 and pRb proteins and a reduced expression of p21WAF1 protein appear to be significant subsequent events.
Mitotically Active Juvenile Xanthogranuloma
Authors: Miguélez Ana , Rodríguez-Peralto Jose Luis , Santos-Briz Angel , Vargas Javier , López-Ríos Fernando
Published: January 2021

Juvenile xanthogranuloma is a histiocytic inflammatory disorder capable of presenting different histologic patterns. The classic form consists of sheets of foamy histiocytes and numerous multinucleated Touton-type giant cells containing no to very few mitotic figures. Nonlipidized juvenile xanthogranuloma consists of a diffuse monomorphic histiocytic infiltrate and usually shows a slightly higher mitotic index. Histologic hematoxylin-eosin staining techniques were used after excision of a pink ulcerated nodule in a 2-year-old girl. Histopathologic examination showed a nonencapsulated cellular proliferation mainly occupying dermis, but extending into the subcutaneous tissue as well. Most of the cells were epithelioid histiocytes, but foamy and Touton giant cells were also evident. The most striking feature was the presence of a high number of mitotic figures, as many as 23 per 10 high-power fields. We present an unusual case of classic juvenile xanthogranuloma with areas similar to those found in the nonlipidized type and with a high mitotic index.
The Contact System
Authors: Kitchens Craig S.
Published: January 2021

Objectives.—To review the literature for conditions, diseases, and disorders that affect activity of the contact factors, and further to review the literature for evidence that less than normal activity of any of the contact factors may be associated with thrombophilia.

Data Sources.—MEDLINE search for English-language articles published from 1988 to 2001 and pertinent references contained therein, as well as search of references in recent relevant articles and reviews.

Study Selection.—Relevant clinical and laboratory information was extracted from selected articles. Meta-analysis was not feasible because of heterogeneity of reports.

Data Extraction and Synthesis.—Evidence for association of altered levels of the contact factors and thrombophilia was sought. A wide variety of disorders is associated with decreased activity of the contact factors; chief among these disorders are liver disease, hepatic immaturity of newborns, the antiphospholipid syndrome, and, for factor XII, being of Asian descent. These disorders are more common than homozygous deficiency. The few series and case reports of thrombophilic events in patients homozygous for deficiency of contact factors are not persuasive enough to support causality. The apparent association between levels consistent with heterozygosity (40%–60% of normal) of any of the contact factors (but especially factor XII) in persons with antiphospholipid antibodies appears to be due to falsely decreased in vitro activity levels of these factors, which are normal on antigenic testing. The apparent association with thrombosis is better explained by the antiphospholipid syndrome than by the modest reduction of the levels of contact factors.

Conclusions.—Presently, it is not recommended to measure activity of contact factors during routine evaluation of patients who have suffered venous or arterial thromboembolism or acute coronary syndromes.
Diagnosis and Subclassification of Breast Carcinoma by Fine-Needle Aspiration Biopsy
Authors: Young Nancy A. , Mody Dina R. , Davey Diane D.
Published: January 2021

Context.—The College of American Pathologists Interlaboratory Comparison Program in Non-Gynecologic Cytopathology is a popular educational program for nongynecologic cytology that had 1018 participating laboratories by the end of 2000. Data generated from this program allow for tracking performance on slides in a diverse group of laboratories.

Objective.—We reviewed the performance of participating laboratories on fine-needle aspiration biopsies of the breast with particular interest in the ability of participants to accurately subclassify breast carcinoma.

Design.—We reviewed the responses of participating laboratories for glass slides of breast fine-needle aspiration biopsies for the year 2000. We analyzed benchmarking data provided for each specific diagnosis.

Results.—The overall false-negative rate for laboratories was 6.2%, and the overall false-positive rate was 1.1%. Most of the breast carcinomas were correctly identified as malignant on the general diagnosis, but participants had more difficulty subclassifying types of breast carcinoma. The rate of correct exact diagnosis was 65% for ductal adenocarcinoma, 20% for lobular adenocarcinoma, 12% for medullary carcinoma, and 27% for mucinous carcinoma.

Conclusions.—This study shows that fine-needle aspiration biopsy of the breast is a reliable method for the diagnosis of breast carcinoma, but difficulties still exist in our ability to determine tumor subtype.
Testing for Group A Streptococci
Authors: Dale Jane C. , Novak Robert , Higgens Patricia , Wahl Elmer
Published: January 2021

Context.—Laboratory diagnosis of group A streptococcal pharyngitis in physician office and small-hospital laboratories.

Objective.—To characterize laboratory practices for the diagnosis of group A streptococcal pharyngitis and to identify opportunities for improvement.

Design.—Voluntary self-assessment questionnaire, used to assess the laboratory practices of 790 laboratories subscribing to the College of American Pathologists Excel Microbiology Proficiency Testing Program.

Results.—We observed discrepancies between self-reported and recommended specimen collection and laboratory testing practices for some laboratories. The most notable discrepancies were failing to provide a written specimen-collection procedure (17.8%), sampling the tongue and oral mucosa (2%), failing to always perform back-up cultures when rapid antigen test results were negative (57.5%), and finalizing culture reports within 24 hours or less (34.0%). Additionally, among those respondents who used the bacitracin disk, 57.9% (277 respondents) applied the disk directly onto a primary plate.

Conclusions.—Opportunities exist to improve testing practices for the diagnosis of group A streptococcal pharyngitis for some physician office and small-hospital laboratories.
Implementation of a Point-of-Care Satellite Laboratory in the Emergency Department of an Academic Medical Center
Authors: Lee-Lewandrowski Elizabeth , Corboy Daniel , Lewandrowski Kent , Sinclair Julia , McDermot Steven , Benzer Theodore I.
Published: January 2021

Context.—Emergency department (ED) overcrowding has reached crisis proportions in the United States. Many hospitals are seeking to identify process reengineering efforts to reduce crowding and ED patient length of stay (LOS).

Objectives.—To investigate the impact of a point-of-care testing (POCT) satellite laboratory in the ED of a large academic medical center.

Setting.—The ED of the Massachusetts General Hospital, Boston, Mass.

Design and Outcome Measures.—Evaluation of physician satisfaction, turnaround time (TAT), and ED LOS before and after implementation of a POCT laboratory. ED LOS was measured by patient chart audits. TAT was assessed by manual and computer audits. Clinician satisfaction surveys measured satisfaction with test TAT and test accuracy.

Results.—Blood glucose, urine human chorionic gonadotropin, urine dipstick, creatine kinase–MB, and troponin tests were performed in the ED POCT laboratory. Test TAT declined an average of 87% after the institution of POCT. The ED LOS decreased for patients who received pregnancy testing, urine dipstick, and cardiac markers. Although these differences were not significant for individual tests, when the tests were combined, the decreased LOS was, on average, 41.3 minutes (P = .006). Clinician satisfaction surveys documented equivalent satisfaction with test accuracy between the central laboratory and the POCT laboratory. These surveys also documented dissatisfaction with central laboratory TAT and increased satisfaction with TAT of the POCT program (P < .001).

Conclusions.—The POCT satellite laboratory decreased test TAT and decreased ED LOS. There was excellent satisfaction with test accuracy and TAT.
Malignant Mesothelioma Does Not Demonstrate Overexpression or Gene Amplification Despite Cytoplasmic Immunohistochemical Staining for c-Erb-B2
Authors: Horvai Andrew E. , Li Li , Xu Zhidong , Kramer Miranda J. , Jablons David M. , Treseler Patrick A.
Published: January 2021

Background.—Previous studies have shown conflicting results regarding the expression of c-Erb-B2 in malignant mesothelioma. Overexpression of the c-erb-B2 gene product in a subset of mesothelioma may have prognostic or therapeutic implications.

Objective.—To determine whether malignant mesothelioma demonstrates c-Erb-B2 overexpression and, if so, whether such overexpression correlates with gene amplification.

Methods.—Immunohistochemistry, reverse transcription-polymerase chain reaction, and fluorescent in situ hybridization were used to analyze archived tissue from 37 cases of malignant mesothelioma.

Results.—Although immunohistochemical staining for c-Erb-B2 was detected in most mesotheliomas, the staining was cytoplasmic and was not consistent between the 2 different primary antibodies used. Moreover, even cases with strong cytoplasmic staining for c-Erb-B2 did not demonstrate increased messenger RNA levels or gene copy numbers compared to cases that demonstrated no staining.

Conclusions.—Cytoplasmic immunoreactivity for c-Erb-B2 in mesothelioma does not represent gene overexpression or amplification and may be an immunohistochemical artifact.
Indolent Neuroendocrine Tumor Involving the Bone Marrow
Authors: Schlette Ellen , Medeiros L. Jeffrey , Beran Miloslav , Bueso-Ramos Carlos E.
Published: January 2021

We report a unique case of a patient with a neuroendocrine tumor localized to the bone marrow. The patient had a history of hairy cell leukemia, and the neuroendocrine tumor was detected in a bone marrow biopsy specimen obtained to assess response to 2-chlorodeoxyadenosine therapy. The neuroendocrine tumor was present as nodules that replaced approximately 15% of the bone marrow medullary space and was composed of round cells with fine chromatin, indistinct nucleoli, and relatively abundant, granular, eosinophilic cytoplasm. Histochemical stains showed cytoplasmic reactivity with Grimelius and Fontana-Masson stains, and immunohistochemical studies showed positivity for keratin and chromogranin. The histologic, cytochemical, and immunohistochemical features resembled a carcinoid tumor, and metastasis to the bone marrow was considered initially. The patient was asymptomatic without diarrhea, flushing, or cardiac valve disease. Serotonin production, assessed by the measurement of serum 5-hydroxyindoleacetic acid and substance P levels, was normal. Extensive clinical and radiologic work-up and endoscopy of the gastrointestinal tract to detect a primary site other than the bone marrow were negative. Follow-up bone marrow biopsy 7 years after the initial diagnosis was positive for persistent neuroendocrine tumor. The patient has not received any therapy specific for the neuroendocrine tumor and has had no clinical symptoms or evidence of progression after 9 years of clinical follow-up. We suggest that this neuroendocrine tumor may have arisen in the bone marrow.
Pathologic Features of Mycobacterium kansasii Infection in Patients With Acquired Immunodeficiency Syndrome
Authors: Smith Michael B. , Molina Claudia P. , Schnadig Vicki J. , Boyars Michael C. , Aronson Judith F.
Published: January 2021

Context.—Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium that may infect patients with human immunodeficiency virus (HIV) late in the course of acquired immunodeficiency syndrome (AIDS). The clinical features of pulmonary and extrapulmonary infections have been described in the literature; however, the pathology of infection has not been adequately addressed.

Objective.—This report describes the pathologic features of 12 cases of M kansasii infection in patients with AIDS.

Design.—The medical records, autopsy protocols, cytologic material, and histologic material from patients with AIDS and concomitant M kansasii infection at a tertiary-care medical center during 1990–2001 were reviewed.

Results.—Twelve cases were identified, 6 by autopsy, 5 of which were diagnosed postmortem. Four of the 12 cases had cytologic material and 4 cases had histologic biopsies available for review. Pulmonary infection was most common (9/12), and all patients in whom thoracic lymph nodes were assessed showed involvement (7/7). Abdominal infection was less frequent, with only 1 of 6, 2 of 6, and 2 of 6, demonstrating liver, spleen, and abdominal lymph node infection, respectively. Isolated infections without documented pulmonary infection included brain abscess (n = 1), ulnar osteomyelitis (n = 1), and paratracheal mass (n = 1). Cytologic and histologic material showed a wide range of inflammatory reactions, including granulomas with and without necrosis, neutrophilic abscesses, spindle-cell proliferations, and foci of granular eosinophilic necrosis. The M kansasii bacillus was characteristically long, coarsely beaded, and frequently showed folded, bent, or curved ends. Intracellular bacilli were randomly or haphazardly distributed within histiocytes.

Conclusion.—Mycobacterium kansasii infection produces predominately pulmonary infection in late-stage AIDS with a high incidence of thoracic lymph node involvement and a much lower incidence of dissemination to other sites. Infection is manifest as a wide variety of inflammatory reactions on cytology and histology; however, the characteristic appearance of the bacillus on acid-fast bacilli stain and its intracellular arrangement in histiocytes can allow a presumptive identification.
CD79b Expression in Chronic Lymphocytic Leukemia
Authors: Schlette Ellen , Medeiros L. Jeffrey , Keating Michael , Lai Raymond
Published: January 2021

Context.—CD79b is a relatively newly characterized B-cell marker that is expressed in a minority of chronic lymphocytic leukemia (CLL) cases.

Objective.—To systematically correlate CD79b expression with specific morphologic and immunophenotypic findings and trisomy 12.

Design.—We assessed CD79b expression in 100 consecutively accrued CLL cases that were also analyzed by conventional cytogenetics. Based on the association between trisomy 12 and CD79b expression, we then assessed 43 additional CLL cases with trisomy 12. CD79b expression was correlated with morphology and expression of other immunophenotypic markers.

Results.—Eighteen (18%) of 100 consecutively accrued cases were CD79b positive. No significant association was found between CD79b expression and atypical morphology. CD79b expression correlated with CD22 and FMC7 positivity. Eight (8%) cases had trisomy 12; 4 (50%) of these were CD79b positive, suggesting an association with trisomy 12. Examination of a second group of 51 CLL cases with trisomy 12 (including 8 cases from the initial study group) showed that CD79b was positive in 26 cases (49%), a frequency significantly higher than that of the consecutively accrued CLL cases without trisomy 12 (P < .05).

Conclusions.—We conclude that CD79b immunoreactivity is positive in approximately 20% of CLL cases and that expression correlates with trisomy 12 and atypical immunophenotypic findings.
Incidental Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia in Pelvic Lymph Nodes Excised at Radical Prostatectomy
Authors: Weir Edward G. , Epstein Jonathan I.
Published: January 2021

Context.—Incidental non-Hodgkin lymphoma is often unrecognized at the time of radical prostatectomy in patients with prostate cancer because of nonspecific symptoms and an inconspicuous pathology. The early identification of lymphoma allows optimal long-term management and prevention of significant morbidity.

Objective.—To show the subtlety of pathologic findings in cases of non-Hodgkin lymphoma in pelvic lymph nodes and the need for scrupulous attention to detail for diagnostic accuracy.

Design.—Histologic and immunohistochemical profiles of 18 consecutive cases of small lymphocytic lymphoma (SLL) incidentally identified in pelvic lymph node dissections were reviewed and compared with 22 cases of benign pelvic lymph node dissections.

Results.—Malignant nodes were grossly enlarged and averaged 3.2 cm in their greatest dimension. Histologically, 16 of the SLL cases were characterized by diffuse architectural effacement with obliterated sinuses and rare cortical follicles. Twelve of these cases showed evidence of pseudofollicles. Two cases showed an interfollicular growth pattern with occasional small pseudofollicles. In contrast, benign pelvic lymph nodes averaged 1.7 cm in their greatest dimension. Although most were architecturally distorted by fibrosis, all benign nodes were notable for patent sinuses. Immunohistochemistry was diagnostically helpful in several cases with equivocal morphology. All malignant cases had a B-cell phenotype with aberrant coexpression of T-cell–related antigens typical of SLL.

Conclusion.—Incidental low-grade non-Hodgkin lymphoma identified at radical prostatectomy is often overlooked by both the urologist and the pathologist. Although malignant pelvic lymph node dissections frequently lack overt manifestations of lymphoma, attention to subtle morphologic features coupled with lymph node size and immunohistochemical findings should permit diagnostic accuracy.
Investigations of the Immunoglobulin Subtype Transformation of Anti–Heparin-Platelet Factor 4 Antibodies During Treatment With a Low-Molecular-Weight Heparin (Clivarin) in Orthopedic Patients
Authors: Ahmad Sarfraz , Bacher H. Peter , Lassen Michael R. , Hoppensteadt Debra A. , Leitz Helen , Misselwitz Frank , Walenga Jeanine M. , Fareed Jawed
Published: January 2021

Context.—It is now widely accepted that the pathophysiology of heparin-induced thrombocytopenia (HIT) syndrome is mediated by the generation of a wide array of functional and molecularly heterogeneous anti–heparin-platelet factor 4 (AHPF4) antibodies that may mediate platelet and/or endothelial cell activation/destruction.

Objective.—We investigated the differential prevalence and functionality of AHPF4 immunoglobulin subtypes (IgA, IgG, and IgM) in plasmas obtained from orthopedic patients immobilized with Plaster-Cast and treated with clivarin (a low-molecular-weight heparin) in comparison to a placebo for the prophylaxis of deep-vein thrombosis.

Design and Methods.—Clivarin was administered subcutaneously at a fixed daily dosage of 1750 U without any adjustment or loading dosage. Citrated plasmas were obtained at baseline, at 10 to 14 days, and at postbrace procedure (5–12 weeks). An enzyme-linked immunosorbent assay (ELISA) was used to quantitate the AHPF4 antibody titers. The functionality of the ELISA-positive samples was determined by a 14C-serotonin release assay (SRA).

Results.—In the ELISA test, 16 of 1073 samples (1.5%; 6 in clivarin and 10 in placebo groups) were positive for AHPF4 antibodies (mean optical density [OD] = 0.46 ± 0.02). None of the ELISA-positive samples for AHPF4 antibodies could mediate platelet activation responses as determined by the SRA (0%–3% serotonin release, P > .10, n = 16). Through differential immunoglobulin subtype analysis of the samples positive for (cumulative) AHPF4 antibodies, we determined that their relative prevalence in plasma were as follows: IgM (mean OD = 0.71 ± 0.13) > IgG (0.31 ± 0.08) > IgA (0.14 ± 0.02). Although there was no significant difference in the total antibody titers between clivarin and placebo groups, the antibody subtyping data showed conversion trends (ie, IgA [clivarin to placebo], IgG [placebo to clivarin], and IgM [clivarin to placebo]).

Conclusion.—These observations indicate that even at reduced dosages, clivarin can shift the immunogenic up-regulation toward the IgG subpopulation; however, the IgG subtype is of a nonfunctional type of AHPF4 antibody and thus may not cause any HIT-related pathogenic responses.
Primary Pulmonary Pleomorphic Adenoma
Authors: Ang Keng Leong , Dhannapuneni Venkata Ramana , Morgan William Ellis , Soomro Irshad Nabi
Published: January 2021

Primary pleomorphic adenoma of the lung is an uncommon condition. We present a case of primary pulmonary pleomorphic adenoma and its immunohistologic features. The presence of immunoreactivity to both anticytokeratin and antivimentin antibodies for its epithelial components is suggestive of a primary pulmonary lesion. Its high proliferation index and its immunoreactivity to tumor regulatory gene p16(INK4A) are features that, to our knowledge, have not been reported previously. They may have a role in the frequent recurrence of these tumors many years after their apparently complete excision. Detailed genetic investigation and long-term follow-up of this rare tumor will aid in the characterization of its biologic profile.
A Case of Myxoid Adrenocortical Carcinoma With Extensive Lipomatous Metaplasia
Authors: Izumi Miki , Serizawa Hiromi , Iwaya Keiichi , Takeda Kazuhiro , Sasano Hironobu , Mukai Kiyoshi
Published: January 2021

We report a combination of unusual myxoid change and extensive lipomatous metaplasia of an adrenocortical carcinoma. The patient was a 38-year-old man with hypertension and heart failure. Radiographic examination revealed the presence of a left adrenal tumor, and adrenalectomy was performed. The tumor weighed 380 g and appeared encapsulated. The cut surface was predominantly gelatinous. Histologically, the tumor was composed of atypical round cells with eosinophilic to vacuolated cytoplasm. The tumor was diagnosed as adrenocortical carcinoma. The stroma accumulated copious mucinous material. In addition, individual to nodular mature adipocytes were admixed throughout the tumor. The transition from carcinoma cells to mature adipocytes was recognized. Myxoid change is a very rare phenomenon in adrenocortical carcinoma, and only 10 similar cases have been reported to date. Lipomatous metaplasia is another peculiar feature of adrenocortical lesions that has been reported only in benign conditions. To our knowledge, this is the first reported case of adrenocortical carcinoma with lipomatous metaplasia.
Lymph Node Infarction
Authors: Strauchen James A. , Miller Lorraine K.
Published: January 2021

Context.—The etiology of lymph node infarction may be difficult or impossible to determine by histologic examination. Lymph node infarction is followed by malignant lymphoma in some but not all patients. The role of immunohistochemistry in the evaluation of lymph node infarction is not well defined. Although it is widely believed that necrotic tissue is not suitable for immunohistochemical study, this view may be inaccurate.

Objective.—To determine whether lymphoid antigens are preserved in infarcted lymph nodes and to determine the utility of immunohistochemical staining in the evaluation of lymph node infarction.

Design.—Retrospective immunohistochemical study of infarcted lymph nodes using archival formalin-fixed, paraffin-embedded tissue.

Setting.—Academic medical center.

Patients.—Eleven adult patients with lymph node infarction retrieved from pathology files.

Main Outcome Measures.—Results of immunohistochemistry, diagnosis of lymphoma.

Results.—Preservation of lymphoid antigens was observed in 4 of 6 cases of lymph node infarction associated with malignant lymphoma, including 3 of 5 cases of diffuse large B-cell lymphoma and 1 case of peripheral T-cell lymphoma. Nonspecific staining was not encountered. In 1 case, in which an infarcted lymph node showed a benign pattern of lymphoid antigen expression, lymphoma has not developed after 5 years.

Conclusion.—Lymphoid antigens are frequently preserved in cases of lymph node infarction, and immunohistochemical study of infarcted lymph nodes may provide clinically useful information.
Umbilical Cord Lesions in Early Intrauterine Fetal Demise
Authors: Singh Vivekanand , Khanum Sufia , Singh Meenal
Published: January 2021

Context.—The cause for intrauterine fetal demise (IUFD) occurring in early gestation in a high percentage of spontaneous abortions is unknown.

Objective.—To determine the association, if any, of umbilical cord abnormalities with early IUFD.

Design.—All cases of IUFD occurring within 16 weeks of gestation that presented to our hospitals between August 1998 and July 2001 were prospectively studied. Once the fetal demise was diagnosed, pregnancy was terminated by medical induction, such that the products of conception were largely delivered intact. Cases with an intact umbilical cord connecting the fetus and placenta were considered in the study, whereas disrupted cord and curettage material was excluded from the study.

Results.—A total of 153 early IUFD cases were seen during the period of study. The medical induction yielded intact products of conception in 122 cases, whereas 31 cases had to be completed by curettage, as the expulsion of the conceptus was incomplete. Thirteen of the 122 IUFD cases showed abnormalities of the umbilical cord. The cord lesions most frequently encountered were constriction and coiling abnormalities. Other lesions seen included hemorrhage, thrombosis, edema, and amniotic band.

Conclusions.—A significantly high number (10.7%) of IUFD in early gestation are associated with umbilical cord abnormalities. Routine assessment of umbilical cords in early pregnancy might help to detect pregnancies at risk.
Molecular Evidence Supporting the Neoplastic Nature of Some Epidermoid Cysts of the Testis
Authors: Younger Cheryl , Ulbright Thomas M. , Zhang Shaobo , Billings Steven D. , Cummings Oscar W. , Foster Richard S. , Eble John N. , Cheng Liang
Published: January 2021

Context.—Loss of heterozygosity (LOH) on chromosomes 9p and 12q is common in germ cell tumors of the testis. Loss of heterozygosity of 17p13 has also been demonstrated in germ cell tumors. The incidence of LOH in epidermoid cysts, a possible special form of teratoma, has not been previously determined.

Objective.—To determine the frequency of LOH in epidermoid cysts.

Design.—Eight testicular epidermoid cysts and surrounding parenchyma were microdissected from formalin-fixed, paraffin-embedded tissue, and the genomic DNA was extracted using proteinase K. Polymerase chain reaction analysis targeted regions on chromosome 9p21 (D9S177 and D9S161 loci), chromosome 12q22 (D12S1051 locus), and chromosome 17p13 (TP53 locus). Gel electrophoresis followed by autoradiography was used to detect LOH.

Results.—All 8 of the epidermoid cysts were informative at a minimum of 1 of 4 loci. Three demonstrated LOH. In 2 tumors, LOH occurred on chromosome 9, and the third tumor demonstrated LOH on chromosome 12. Loss of heterozygosity on chromosome 17p13 was not present in any of the tumors.

Conclusions.—Epidermoid cysts harbor allelic loss at some of the same loci identified in malignant testicular germ cell tumors. Our findings support that some examples of epidermoid cysts are neoplastic, although their low frequency of LOH also supports that they are genetically different from malignant germ cell tumors.
Malignant Peripheral Nerve Sheath Tumor With Divergent Differentiation
Authors: Huang Li , Espinoza Carmen , Welsh Ronald
Published: January 2021

Right posterior thigh malignant peripheral nerve sheath tumor with malignant glandular and rhabdomyoblastic components was diagnosed in a 24-year-old African American man. Malignant glands and rhabdomyoblastic cells were admixed with the spindle cells. Immunohistochemistry demonstrated spindle cells positive for S100 and vimentin; the glandular component was positive for chromogranin, and rare cells were positive for CK20 but negative for CK7. Rhabdomyoblastic cells were positive for muscle-specific actin and desmin. A single pulmonary metastasis occurred 5 months after surgical resection of the tumor. Death occurred 1 month later and was probably due to a pulmonary embolus.
Pseudothrombocytopenia Associated With Infectious Mononucleosis
Authors: Hsieh A. T. , Chao T. Y. , Chen Y. C.
Published: January 2021

A 22-year-old man was hospitalized for assessment of thrombocytopenia and fever. Examination showed that he had infectious mononucleosis and moderately severe thrombocytopenia that was asymptomatic. Examination of blood smears revealed that the thrombocytopenia was caused by the clumping of platelets. We made a diagnosis of ethylenediaminetetraacetic acid–dependent pseudothrombocytopenia after excluding other infectious mononucleosis–related mechanisms of thrombocytopenia. When the patient recovered from infectious mononucleosis 2 months later, his thrombocytopenia improved, and no platelet clumping in peripheral blood smears was noted. Ethylenediaminetetraacetic acid–dependent pseudothrombocytopenia should always be considered as a possible cause of reported low platelet counts, even in patients with infectious mononucleosis and splenomegaly.
Epithelial-Myoepithelial Carcinoma of the Lung
Authors: Doganay Latife , Bilgi Selcuk , Ozdil Asli , Yoruk Yener , Altaner Semsi , Kutlu Kemal
Published: January 2021

Primary lung tumors mimicking the salivary gland–type neoplasms are extremely rare. These types of tumors originate from submucosal bronchial glands. Epithelial-myoepithelial carcinoma is an uncommon tumor in this group, and only 7 cases have been reported. It is considered to be a low-grade malignant neoplasm. We report a case of epithelial-myoepithelial carcinoma of bronchial gland origin in a 73-year-old man who presented with coughing and dyspnea. The bronchus of the left lower lobe contained a tumor mass that had a polypoid growth pattern. The tumor also extended into the pulmonary parenchyma, forming a well-circumscribed mass with a pushing margin. The tumor consisted of epithelial and myoepithelial cells. The epithelial cells were positive for cytokeratins and epithelial membrane antigen, while the myoepithelial cells were positive for S100 protein and muscle-specific actin. According to these findings, we diagnosed epithelial-myoepithelial carcinoma. After undergoing pneumonectomy, the patient has been disease free for 34 months.
Granulocyte Colony-Stimulating Factor–Producing Undifferentiated Sarcoma Occurring in Previously Fractured Femur
Authors: Marui Takashi , Yamamoto Tetsuji , Akisue Toshihiro , Hitora Toshiaki , Yoshiya Shinichi , Kurosaka Masahiro
Published: January 2021

We examined the case of a 52-year-old man presenting with a sarcoma accompanied by severe leukocytosis, which developed many years after a femoral fracture. Histologic, histochemical, immunohistochemical, and ultrastructural analysis of the tumor revealed that the sarcoma could not be classified by any of the bone or soft tissue tumor classifications currently in use. The tumor cells were isolated from surgical specimens and subcultured in vitro. The concentration of granulocyte colony-stimulating factor in the culture medium was constantly elevated to considerably high levels during 20 cell passages. A genomic study using reverse transcription–polymerase chain reaction showed that the cells retained messenger RNA expression of granulocyte colony-stimulating factor. The aberrant overexpression of granulocyte colony-stimulating factor clearly represented a paraneoplastic phenomenon of the neoplastic cells.
Favorable Outcome After Infusion of Coagulase-Negative Staphylococci–Contaminated Peripheral Blood Hematopoietic Cells for Autologous Transplantation
Authors: Nifong Thomas P. , Ehmann W. Christopher , Mierski Joseph A. , Domen Ronald E. , Rybka Witold B.
Published: January 2021

Bacterial contamination of peripheral blood hematopoietic cells collected for autologous bone marrow transplantation occurs sporadically. Although transfusion of contaminated hematopoietic cells without adverse clinical sequelae has been reported, detailed guidelines for transfusing cells with contamination are not available. We report a case of autologous hematopoietic cell transplantation that necessitated using multiple aliquots of peripheral blood hematopoietic cells known to be contaminated with coagulase-negative Staphylococcus bacteria. Prophylactic intravenous antibiotic therapy was given with the infusion of contaminated hematopoietic cells. The patient had positive results on a blood culture, but engraftment was successful, and serious adverse effects did not occur. With appropriate microbial identification and prophylactic antibiotic therapy, contaminated hematopoietic products can be safely infused when necessary with a good clinical outcome.
Primary Acinic Cell Carcinoma of the Lung With Lymph Node Metastasis
Authors: Lee Hwei-Yee , Mancer Kent , Koong Heng-Nung
Published: January 2021

We report the case of a 30-year-old woman who presented with a subpleural mass in the lower lobe of the right lung, which was found incidentally on a routine chest radiograph. A wedge biopsy followed by lobectomy and lymph node staging revealed an acinic cell carcinoma with involvement of a hilar lymph node. The subcarinal and mediastinal lymph nodes were free of tumor. Perineural invasion was identified at the periphery of the tumor. There was no evidence of origin from salivary gland or involvement of any other organ. The patient was well 12 months postoperatively. To our knowledge, this is the second case report featuring lymph node metastasis in an acinic cell carcinoma of the lung and the first to demonstrate perineural invasion.
Benign Heterotopic Epithelial Inclusions in Axillary Lymph Nodes
Authors: Resetkova Erika , Hoda Syed A. , Clarke James L. , Rosen Paul Peter
Published: January 2021

Benign heterotopic epithelial inclusions in axillary lymph nodes are an extremely rare condition that must be differentiated from metastatic carcinoma. We describe 2 histologically different examples of benign epithelial inclusions in nonsentinel axillary lymph nodes, each with an unusual clinical presentation.
Primary Plasmacytoma Arising in an Endocervical Polyp With Detection of Neoplastic Cells on Papanicolaou Test
Authors: Fischer Edgar G. , Bocklage Thèrése J. , Rabinowitz Ian , Smith Harriet O. , Viswanatha David S.
Published: January 2021

Primary plasmacytomas of the female genital tract are extremely rare and present a substantial diagnostic challenge. Five cases morphologically representing plasmacytomas and localized to the uterine cervix have been reported previously; however, only 1 was shown to be monotypic for immunoglobulin light-chain expression. We report the case of a 37-year-old woman who had highly atypical plasma cells on her Papanicolaou test. A clinically detected endocervical polyp was removed and revealed a plasmacytoma, the diagnosis of which was substantiated by demonstrating monotypic λ-light-chain restriction and a clonal immunoglobulin heavy-chain gene rearrangement. The cytologic and histopathologic findings of plasmacytomas of the uterine cervix are discussed, including the utility of immunophenotypic and molecular techniques to confirm the neoplastic diagnosis.
Hidradenoma Papilliferum of Nasal Skin
Authors: Smith Fred B. , Shemen Larry J. , Guerrieri Claudio , Ismail Sherif S.
Published: January 2021

Pathologic examination of an excisional biopsy specimen of a subepidermal nodule from the nasal tip of a 37-year-old black man demonstrated papillae covered by eosinophilic columnar epithelial cells, suggesting cylindric cell papilloma or well-differentiated papillary adenocarcinoma of nasal mucosa. The patient did not submit to further investigation of the sinonasal tract but sought attention 15 months later because of local recurrence of the lesion. A protuberant, 3-cm, cystic nodule of the subcutis over the left nasal ala and tip was excised completely and found to have characteristics of hidradenoma papilliferum, an apocrine gland neoplasm most commonly occurring in the anogenital skin of white women. This case demonstrates how easily an apocrine neoplasm arising near a mucocutaneous junction can be confused with a mucosal tumor, potentially leading to inappropriate treatment.
When Culture and Change Collide In Higher Education: A Case Study at One University
Authors: Petersen Steven , Bartel Susan
Published: January 2021

Leaders in higher education regularly find themselves at the intersection of change, torn between their institution’s history and culture, the intrinsic value of education, market needs, and the desires of alumni, current, and prospective students. Higher education is often labeled reluctant to change, and many believe any change initiative not aligned with the institution’s culture is almost certain to fail. This study provides evidence that leaders in higher education can implement change that is incongruent with organizational culture while maintaining harmony among the institution’s ideals and constituents. University X, a medium-sized, highly regarded public institution located in a rural area, implemented its first fully online degree program, which was widely perceived as being incongruent with the organization’s culture. A detailed analysis of eight environmental factors and an adaptation of Kotter’s (1996) eight-step change model contributed to the overall success of this change. The keys to implementation were developing an in-depth understanding of the culture while ensuring there was both a need for change and adequate support among stakeholders. Developing a group to champion and sustain the initiative was also critical. The common thread throughout the entire change process was the frequent and effective communication maintained by the organizational leaders. The culture shift initiated by the change also allowed the institution to move quickly to transition to alternative teaching methods during the COVID-19 pandemic of 2020.
Mediering af politiseret religiøs identitet blandt den tunesiske diaspora i Europa
Authors: Shehata Mostafa
Published: January 2021

Under overgangen fra autokrati til demokrati har religiøs identitet været et centralt emne på den tunesiske dagsorden, både for folk i Tunesien og den tunesiske diaspora. Denne artikel undersøger fra et interkulturelt kommunikationsperspektiv, hvordan medier kan påvirke den eksisterende religiøse identitet hos borgere med tunesisk baggrund, der er bosat i Europa (den tunesiske diaspora). Analysen viser, at effekten, medier har haft i forhold til religiøs identitet, har været informativ og ekspressiv, ikke regulerende. Den religiøse identitet er hovedsageligt blevet formet af politisk tilknytning samt forholdene i både oprindelseslandet og opholdslandet. Artiklen foreslår, at der sandsynligvis opstår et asymmetrisk, gensidigt og cirkulært forhold mellem mediebrug, religiøs identitet og politisk tilknytning.
Educación formal e informal en confinamiento: una creciente desigualdad de oportunidades de aprendizaje
Authors: Bonal Sarró Xavier , González Sheila
Published: January 2021

El cierre de escuelas en Cataluña para contener los efectos de la COVID-19 obligó a las escuelas y las familias a reaccionar en poco tiempo y sin planificación previa ante un nuevo escenario de enseñanza. Este artículo evalúa el impacto del cierre escolar sobre la desigualdad de aprendizaje entre niños de diferentes contextos sociales en Cataluña. A partir de los datos de una encuesta en línea realizada entre el 26 y el 30 de marzo (n = 35.419) a familias con hijos entre 3 y 18 años, nuestro análisis muestra que las oportunidades de aprendizaje varían significativamente en función de las características del alumnado. Durante el confinamiento, algunas escuelas consiguieron adaptarse a las nuevas circunstancias con mejores medios que otras. De igual forma, el capital socioeconómico y cultural de las familias comportó diferencias significativas en las oportunidades de aprendizaje para los niños de diferentes orígenes sociales. Las familias de clase media pudieron mantener estándares más altos de calidad educativa en un contexto crítico, mientras que aquellas socialmente desfavorecidas mostraron una menor exposición a las oportunidades de aprendizaje, tanto en tiempo como en experiencias (tareas escolares y actividades extracurriculares). Los resultados difieren según el tipo de escuela (público/privada), el capital social y cultural y las condiciones de vida familiares. En la parte final del artículo, destacamos la importancia del papel de la escuela para garantizar oportunidades de aprendizaje para los niños de bajos niveles socioeconómicos y discutimos algunas de las implicaciones políticas de nuestros resultados.
Den teatrale kroppen – i spennet mellom disiplinering og lek
Authors: Storsve Kristine
Published: January 2021

Sammendrag

I denne artikkelen undersøker jeg hvordan utvalgte grunnlagsøvelser i drama- og teaterpraksis aktiviserer den teatrale kroppen i spennet mellom den disiplinerte og den lekende kroppen. Studien undersøker elevens erfaring og dramapedagogens egen praksis. Datamaterialet er fra forskningsprosjektet «Demokratiske og estetiske rom» som består av videoopptak av grunnlagsøvelser, elevintervjuer og forskerdagbok fra feltarbeid i to syvendeklasser. Begrepet kroppsliggjort kompetanse (Frambaugh-Kritzer et al., 2015) diskuteres, og Foucault og Gadamers teorier anvendes i perspektiver på den disiplinerte og den lekende kroppen. Studien viser at aktivisering av den teatrale kroppen innebærer trening i tilstedeværelse, samspill, respons og mottagelighet med kropp som meningsskapende verktøy og kommunikativt formspråk. Samtidig kan noen grunnlagsøvelser resultere i karikering av allerede stereotype ideer om rollekategorier. Videre gir grunnlagsøvelsenes fiksjonelle ramme, gjennom «det teatrale blikket», elevene muligheter i «lekerommet» til å aktivisere den teatrale kroppen. Fokus på spontanitet og å redusere blokkeringer har betydning for å styrke elevenes selvforvaltning. Jeg ønsker å utvide diskursen og plassere drama- og teaterpraksis inn i et utvidet fysisk aktivitetsperspektiv.