bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge, Attitude and Practices of Pesticides Use and Serum Cholinesterase Level Among Farm Workers in Bhaktapur – A Cross Sectional Study
Authors: Suwal R , Bataju M , Shrestha V L , Shrestha A
Published: October 2024

Introduction/Objective

Pesticides use has been an integral part of modern agricultural practices. Lack of knowledge and unsafe handling of pesticides uses have kept the farm workers in the frontline of vulnerability. Serum cholinesterase show a dose-exposure relationship with organophosphorus. This study aims to identify the existing knowledge, attitude and practices of pesticides use among farm workers and to measure the serum cholinesterase level before and after spraying of the pesticides.

Methods/Case Report

This is a cross-sectional study carried out among farm workers of Madhyapur Municipality, Bhaktapur, Nepal. Ethical clearance was obtained from Nepal Health Research Council, Nepal. House hold survey was carried out for the knowledge, attitude and practices of pesticides use using structured questionnaires. Written consent was taken. Blood was collected twice, before and after spraying season for 97 farm workers. Serum cholinesterase was analyzed in the vitros 4600 biochemistry analyzer. Paired t-tests and chi square tests were used for statistical analysis.

Results (if a Case Study enter NA)

The mean cholinesterase of farm workers before and after pesticide spraying was 6.92±1.47 U/mL and 6.49±1.47 U/mL respectively, with p value of <0.001. There were also significant differences of serum cholinesterase level among farm workers before and after pesticide spraying on the basis of education level, type of involvement either full time or part time and prior integrated pest management training. This study found that 63% of respondents had good knowledge on pesticides while 25% had average and 12% had poor knowledge.

Similarly, this study also found that 54% of respondents had good knowledge on pesticides use while 26% had average and 20% had poor knowledge. However, this study showed that only 44% of farm workers had good practice. Association between knowledge of pesticide and practices and between knowledge of pesticides use and practices were statistically significant with p-value of 0.001 and 0.001 respectively.

Conclusion

There is a significant difference in the level of serum cholinesterase before and after spraying pesticides in farm workers. Lack of education, lack of integrated pest management training and poor practices of pesticides use are the reasons behind the difference in the serum cholinesterase level.
The enigma of KMT2A gene in hematological disorders
Authors: Zehra S A , Mansoor N
Published: October 2024

Introduction/Objective

Presence of distinct MLL rearrangements is an independent dismal prognostic factor. Rearrangements of the histone lysine [K]- MethylTransferase 2A gene (KMT2A) on chromosome 11q23, formerly known as the mixed-lineage leukemia (MLL) gene, are found in 10% and 5% of adult and children with acute leukemia respectively. Chromosome 11 breakpoints are typically localized to band 11q23.3, frequently altering the proto- oncogene KMT2A/MLL whereas partner chromosomes involved in translocation may vary. More than 80 different gene partners involved in this fusion have been described, although the majority of leukemias results from 6 common partner genes. KMT2A gene rearrangement are associated with poor prognosis in both Lymphoid and Myeloid leukemia.

Methods/Case Report

A retrospective study conducted in Cytogenetic laboratory of The Indus hospital, Karachi. All karyotype cases (age 1-60 year) with chromosome 11 aberrations were included from October 2020 to December 2022. Karyotype and FISH performed using G-banding and break a part probe for MLL respectively.

Results (if a Case Study enter NA)

Total of 923 cases received for karyotyping out of which 32(3.4%) cases were reported for 11q23 abnormalities. The median age was 5 (1.25-12.5) years, majority 15 (47%) were 1-10 years, 9(28%) were >10 years and 7(22%) were <1 years. M:F ratio was 1.9:1. B-ALL were 19(59.4%), AML 8(25%), and 5 (15.6%) were others. FISH performed in 23(72%) cases, 21 (91%) showed concordance with karyotype. The t(9;11) was the commonest 7(22%), followed by t(4;11) and (1;11). Chromosome 9 was the most common partner identified in B-ALL. Loss of 11q23 observed in 3 (13%) cases.

Conclusion

The findings underscore the heterogeneity of partner chromosomes involved in KMT2A gene rearrangements and emphasize the importance of employing both FISH and karyotyping for comprehensive detection. The high concordance rate between the two methods supports their complementary roles in clinical diagnostics.

Understanding the specific translocations and partner chromosomes associated with MLL gene rearrangements contributes valuable insights for prognostication and targeted therapeutic strategies in acute leukemia. FISH and karyotype showed 91% concordance to detect this aberration.
Culture failure and suboptimal analysis in cytogenetics: A data review as a quality improvement metric from a resource-limited country
Authors: Mansoor N
Published: October 2024

Introduction/Objective

Conventional cytogenetic failures can affect hematological cancer diagnosis and prognosis. Resource-constrained regions without contemporary genetic testing facilities may experience this impact more. The effectiveness of this technique is contingent on cultural success, availability of metaphases, and morphological adequacy. The results can be influenced by the underlying diagnosis, inherent biological features of the leukemic clone, sample conditions, and transit time. Culture failure (CF) and suboptimal analysis (SOA) data can identify problems and set standards. Thus, we designed a cohort to find areas of improvement and reduce negative contributing factors, making this cytogenetic technique more accessible and cost-effective.

Methods/Case Report

A retrospective study was conducted at Cytogenetics laboratory at Indus hospital, Karachi. From January 2021 to March 2023, 1234 blood and bone marrow samples were processed. CF was defined as no growth, whereas suboptimal cases showed a low mitotic index or poor morphology. Data analysis included collection and processing time, sample volume, cell count, specimen type, in-house or out-reach sample, and diagnosis.

Armonk, NY-based IBM SPSS 24.0 used to analyze the data. Chi-square used to find association of various factors with karyotyping. A p-value < 0.05 indicated significance.

Results (if a Case Study enter NA)

Of 1234 samples, 1110 (90%) were bone marrow and 124 (10%) were peripheral blood. There were 32/1234 (2.6%) CF cases. Each CF case was found in bone marrow samples, making the true incidence 32/1110 (2.9%). Constitutional blood tests found no CF in 124 samples. Additionally, chromosomal analysis quality was assessed. SOA occurred in 105/1234 (8.5%) instances, with 58% having poor morphology and 31% having a low mitotic index. Among 137 CF and SOA patients, 134/1110 (12%) were found in marrow and 3/124 (2.4%) in blood.

Conclusion

Lower CF rates suggest that appropriate standards and quality management may reduce cytogenetic failure rates despite resource constraints and newly established services.
Cardiac Angiosarcoma with Unusual Cytologic Features Causing Cardiac Tamponade in a Young Adult Patient
Authors: Chiu R , Salehiazar S , Miranda-Taylor M M , Peng S , Yap C G
Published: October 2024

Introduction/Objective

Cardiac angiosarcoma is a rare endothelial malignancy with poor prognosis, frequent metastasis, and short median survival of only a few months. The disease has a wide age spectrum and can occur in young adult patients. The cytological diagnosis of cardiac angiosarcomas is challenging as cases are rare and its cytology is not extensively described or reported in literature. Here, we describe a rare case of cardiac angiosarcoma with unusual cytologic features.

Methods/Case Report

Our patient is a 30 year old male presenting with three days of worsening dyspnea and palpitations and was discovered on ultrasound to have large pericardial effusion compressing the right ventricle and causing cardiac tamponade. CT/MRI imaging revealed a 4.5 x 4.3 x 2.6 cm mass inside the right ventricle with extra- cardiac invasion through the pericardium and into the anterior mediastinum. Pericardiocentesis yielded 1.5 liters of hemorrhagic, brown, pericardial fluid with elevated LDH and protein levels. Cytology of the pericardial fluid revealed numerous tumor cells occurring singly or in monolayered, acinar clusters or cohesive spheres containing amorphous, eosinophilic cores made of collagen as evidenced on trichrome stain. The tumor cells possessed hyperchromatic, irregular, variably sized nuclei, prominent nucleoli, and cytoplasmic vacuoles. The tumor cells were positive for vimentin, CD31, and CD34, and showed high Ki67 proliferation index > 50%. A catheter-mediated biopsy of the right ventricular mass revealed spindled and epithelioid tumor cells strongly positive for CD31, CD34, and vimentin, focally positive for Factor VIII and AE1/AE3, and showing high Ki67 proliferation index of roughly 50%. The cytological, histological, and immunohistochemical findings were most consistent with cardiac angiosarcoma as the diagnosis.

The patient eventually developed worsening chronic left chest pain and expired from cardiac arrest six months after his diagnosis.

Results (if a Case Study enter NA)

NA

Conclusion

We report a rare case of cardiac angiosarcoma with unusual cytologic features, manifesting as acinar clusters and cohesive spheres with collagenous cores that are not typical of malignant endothelial neoplasms.

Currently there are no effective, standardized therapies that can significantly prolong survival for this malignancy, and treatment is often palliative. The cytological diagnosis of cardiac angiosarcoma is challenging given the rarity of this disease and the paucity of literature describing its cytology.
ONYCHOMATRICOMA, A RARE NAIL TUMOR
Authors: Tahir M , Phung T , Nguyen Luu T
Published: October 2024

Introduction/Objective

Nail apparatus tumors are rare and can pose diagnostic challenges. Onychomatricoma (also called onychomatrixoma) is a rare tumor first described in 1992. It is a benign biphasic fibroepithelial tumor of the nail. It has been reported in Caucasians, often in females with a peak incidence in the fifth decade of life. Rare cases are also reported in children. The common location is in the fingernail (75%), presenting with yellowing of the nail plate (xanthonychia) and thick longitudinal band. Cutaneous horn, melanonychia, nail bleeding, and nail deformity with or without bony extension can also be seen. Histologic findings show increased nail thickness surrounded by a layer of Malpighian epithelium. The fibroepithelial tumor shows hyperplasia of two components including onychogenic epithelium and mesenchymal stroma.

Methods/Case Report

A 65-year-old Vietnamese female presented with longstanding dark yellowish ridging discoloration, thickening and nail plate deformity of the left fourth fingernail with appearance of onychomycosis. However, KOH mount and fungal cultures of the nail plate were negative for fungal microorganisms. There was no history of pain, trauma, or prior treatment.

Microscopic analysis of transverse and longitudinal sections of the nail shows a biphasic neoplasm that penetrates the nail plate with multiple digitations. There was deep finger-like epithelial cell strands that form anastomosis as well as invaginations into the dermis. Characteristic filiform projections are lined by onychogenic epithelium composed mostly of basal and supra-basal cells that lack granular and corneum layers. The stroma was hypercellular and fibrillary with spindle-shaped fibroblastic cells, and a deep layer with dense collagen. Immunohistochemical stains of the lesion show diffuse expression for CD10 and CD34 in the stroma and negativity for Periodic Acid Schiff staining.

Results (if a Case Study enter NA)

N/A

Conclusion

While most of the literature on onychomatricoma has been reported in Caucasian population, little is known about this tumor in non-Caucasians. This case report of onychomatricoma in a Vietnamese woman contributes to the emerging literature of this rare nail apparatus tumor in non-Caucasian population. Clinical and histopathologic correlation is important to achieve prompt and correct diagnosis since delay would result in nail dystrophy and deformity.
Medical students’ perceptions of live versus recorded pathology lectures at a South African medical school during the Covid-19 pandemic: unique lessons for undergraduate pathology education in a diverse student population
Authors: McGrath N G
Published: October 2024

Introduction/Objective

The morphological depiction and interactive learning vital to the core discipline of anatomical pathology posed specific challenges during emergency remote teaching (ERT) in the COVID 19 pandemic. Using voice-over PowerPoint presentations (VoPPPs) in anatomical pathology at Wits University in Johannesburg, South Africa during this time provided a unique opportunity to determine students’ perceptions of this teaching and learning modality.

Objective

To determine a South African medical students’ perceptions of live lectures vs online learning with VoPPPs during the Covid-19 pandemic.

Methods/Case Report

A descriptive, cross-sectional, online survey was sent to 326 4th year medical students in 2020. The questionnaire consisted of closed- and open-ended questions. Descriptive and inferential statistical tests were conducted on the quantitative data. Content analysis was performed on the open-ended responses.

Results (if a Case Study enter NA)

The survey response rate was 56.75%. Respondents preferred the traditional lecture format to the exclusive use of VoPPPs (48.6% to 34.6%) for pathology learning. Respondents appreciated the flexibility of learning from VoPPPs, resulting in blended learning being the preferred approach (45.9% vs 44.3 for live lectures only and 9.7% for VoPPPs only, respectively). Respondents indicated a need for more effective use of VoPPPs regarding the depiction of pathology images, more opportunities for feedback, and more online learning modalities in addition to VoPPPs. Some respondents from rural areas stated that their home study environments were not conducive to online learning modalities.

Conclusion

Blended learning combines the interactivity possible in contact sessions with the time benefits of online learning for undergraduate pathology education. However, educators should use various online methods rather than relying solely on VoPPPs. This is especially important when considering the visual nature of pathology lectures.

Where VoPPPs are used, they should be used effectively, mainly using good quality, labelled images to depict morphology. The preference for blended learning offers exciting possibilities for developing integrated learning platforms in the future, however, these must be tailored to suit the needs of students from economically and ethnically diverse backgrounds.
Enhanced Antidiabetic Effects of Gymnema sylvestre and Probiotics in Alloxan-Induced Diabetic Rats
Authors: Abdelmonem M , Wasim H , Ghanem A , Elebeedy D , Abdelmaksoud A , Badawy I
Published: October 2024

Introduction/Objective

Introduction: Gymnema sylvestre is a well-known herbal remedy for diabetes, with its anti-diabetic properties attributed to gymnemic acids isolated from its leaves. Probiotics, such as Lactobacillus acidophilus and Lactobacillus casei, have also shown potential in managing diabetes. This study aims to evaluate the combined antidiabetic effects of G. sylvestre and probiotics in alloxan-induced diabetic rats.

Methods/Case Report

Methods: Experimental rats were divided into seven groups: negative control, untreated diabetic control, L. acidophilus-treated, L. casei-treated, G. sylvestre-treated, a combination of L. casei and G. sylvestre-treated, and a combination of L. acidophilus and G. sylvestre-treated. Blood glucose levels, lipid profiles, and reduced glutathione levels were measured, and histopathological examination of pancreas and kidney tissues was performed.

Results (if a Case Study enter NA)

Results: In the third week of the experiment, the combined administration of G. sylvestre and probiotics showed the most significant reductions in glucose levels (250 mg/dL), alkaline phosphatase (ALP) (613.3 U/L), urea (31 U/L), serum creatinine (0.77 U/L), and superoxide dismutase (SOD) (854.7 UMOL). G. sylvestre alone exhibited the lowest levels of glutamate pyruvate transaminase (GPT) (30 U/L), cholesterol (41 mg/dL), triglycerides (101.3 mg/dL), very-low-density lipoprotein (VLDL) (22.9 mg/dL), and malondialdehyde (MDA) (119.3 U MOL/SEC). Probiotic treatment alone resulted in the lowest levels of uric acid (UA) (4.4 U/L) and low-density lipoprotein (LDL) (95.06 mg/dL). G. sylvestre demonstrated the highest level of high-density lipoprotein (HDL) (44 mg/dL), while probiotics exhibited the highest catalase (CAT) activity (92 UMOL/SEC). Histopathological examination revealed the preservation of normal pancreatic and renal tissue morphology with G. sylvestre treatment.

Conclusion

Conclusion: The combination of G. sylvestre and probiotics enhances the antidiabetic activity compared to G. sylvestre alone in alloxan-induced diabetic rats. These findings suggest a potential synergistic effect of combining herbal and probiotic therapy for diabetes management.
Clinical Rarity Unveiled: Adenocarcinoma with Enteroblastic Differentiation at the Gastroesophageal Junction in a Young Patient - A Diagnostic Challenge Shaping Therapeutic Paradigms
Authors: Baban Y , Kumar V , Ganesan S , Loeffler A , Wang Y
Published: October 2024

Introduction/Objective

This report details a case of a young patient diagnosed with an adenocarcinoma with enteroblastic differentiation at the gastroesophageal junction (GEJ), characterized by Alpha-Fetoprotein (AFP) production. This manifestation previously rarely documented in young patients (25-44 years old), underscores the critical role of precise pathology diagnosis in guiding effective patient management.

Methods/Case Report

The patient’s clinical presentation included chest pain, abdominal pain, and weight loss, prompting imaging studies revealing liver masses, lesions in the lung and adrenal gland, and retroperitoneal adenopathy with unremarkable testicular findings. Rapidly progressing dysphagia led to a liver biopsy and esophagogastroduodenoscopy (EGD), where a fungating mass extending from the distal esophagus into the stomach was biopsied. A subsequent serologic test unveiled an elevated serum AFP level (approximally 31, 000 ng/ml).

Results (if a Case Study enter NA)

Histological examination revealed similarities between the liver and distal esophageal tumors, characterized by moderately differentiated carcinoma with solid and glandular growth patterns. The tumor cells, resembling fetal gut epithelium, exhibited positive immunostaining for SALL4, AFP, CK8-18, CK19, and CDX2. A diagnosis of adenocarcinoma with enteroblastic differentiation at the GEJ was determined, correlating with clinical and radiological assessments. Despite initiating one cycle of gastrointestinal related chemotherapy, the patient succumbed to tumor lysis syndrome within a month of diagnosis.

Conclusion

This case highlights the critical need for a comprehensive differential diagnosis when encountering young patients with AFP-producing malignancies. Although metastatic non-seminomatous germ cell cancer is a primary consideration, upper gastrointestinal adenocarcinoma with unique characteristics, as demonstrated in this case, requires distinct therapeutic approaches, emphasizing the importance of accurate and timely diagnosis.
Malakoplakia, a rare inflammatory condition presenting as a colon polyp
Authors: Hassan A , Bandara K , Hamidpour S , Hamdan H
Published: October 2024

Introduction/Objective

Malakoplakia is a rare histiocytic disease caused by defects in phagocytic or degradative functions of histiocytes in response to gram negative coliforms (E. coli or Proteus) that results in chronic inflammatory state, followed by intracellular deposition of iron and calcium (known as Michaelis-Gutmann bodies). It’s more common in immunocompromised patients and the mean age at diagnosis is fifth decade. It occurs in all organs, common in GU tract, particularly bladder, but also seen in gastrointestinal tract (most commonly colon, followed by stomach and duodenum), central nervous system and female genital tract. In gastrointestinal tract, it can present as a polyp with diffuse mucosal involvement, submucosal thickening, and even may cause mass.

Methods/Case Report

A 60 -year-old male smoker presented to our hospital with history of colon polyps; colonoscopy revealed a 6 mm sessile polyp at the hepatic flexure. A biopsy was performed which showed numerous epithelioid histiocytes with granular eosinophilic cytoplasm, abundant Michaelis-Gutmann bodies and increased lymphocytes. Immunohistochemical stains showed diffuse positivity for CD68; and PAS stain was positive for histiocytic cytoplasmic granules. Based on this data, the diagnosis of Malakoplakia was confirmed. Malakoplakia is treated with antibiotics that concentrate in macrophages (quinolones or trimethoprim-sulfamethoxazole), antibiotics directed against E. coli, surgery and possibly discontinuation of immunosuppressive drug therapy.

Results (if a Case Study enter NA)

Malakoplakia, in this case, was presented clinically as a sessile colon polyp and histologically showed numerous epithelioid histiocytes with granular eosinophilic cytoplasm, with Immunohistochemical stains (CD68; and PAS stain) the correct diagnosis was made. Other presentations of Malakoplakia include diffuse mucosal involvement, submucosal thickening, or mass. Histologically, it may rarely be mistaken as signet ring carcinoma. These variable presentations in GU tract or colon can be interpreted as malignancy with consequent unnecessary interventions. Hence, awareness of Malakoplakia with careful histopathologic examination and the use of immunohistochemical studies are advisable in that cases.

Conclusion

We would like to emphasize that Malakoplakia can be clinically and histologically misdiagnosed as a malignant condition; therefore histopathologic and immunohistochemical studies are needed to correctly diagnose this entity.
Pathologist Workload Assessment in Gastrointestinal Subspecialty: A Pilot comparative study in an academic setting
Authors: Razzano D , Wang C , Shen J , Chada A
Published: October 2024

Introduction/Objective

There are no official guidelines regarding the workload to be received by pathologists, and it is challenging to distribute equivalent workloads across subspecialties. This study aims to determine whether slide count is a reliable workload metric in gastrointestinal (GI) pathology. Additionally, we seek to compare the time allocation differences between GI pathologists involved in medical resident teaching and those dedicated only to anatomical pathology duties.

Methods/Case Report

This is an observational retrospective cohort study. We recorded the first two hours of a workday of three experienced GI pathologists at Stanford Healthcare in 2022, two of whom were engaged in teaching. The authors carefully retrospectively reviewed the recorded videos to extract relevant information: teaching activities, number of histological slides, specimens, types of tissues analyzed, and resultant diagnosis.

Results (if a Case Study enter NA)

Two attendings (2 and 3) signed out with residents, while only one worked alone (1). The mean time spent on each case was 199 and 486 seconds different between attendings 1 and 2 and 1 and 3, respectively (p<.01). There was a strong positive correlation between the number of slides and time spent analyzing each case, r =.607. The number of slides per case statistically explained 36.8% of the time spent per case, p <.001.

Conclusion

In conclusion, the slide count metric only explains 36.8% of the time expenditure, suggesting that more sophisticated workload assessment methods must be developed, particularly if used for workload distribution purposes. Also, GI pathologists involved in medical training take longer to sign out cases than GI pathologists who are not, suggesting that this is an essential factor that should be considered when distributing workloads.
Adenoma, Hamartoma, or Something Else? Unique Diagnostic Challenges in Mixed Epithelial-Mesenchymal Lesions of the Gastrointestinal Tract
Authors: NIGAM A , AYDIN H B , DABAGHIAN A , PACHECO R , Lee H
Published: October 2024

Introduction/Objective

Mixed epithelial-mesenchymal lesions (MEMLs) are well-known in the gynecologic tract and, to a lesser extent, in the lungs and kidneys. However, the literature is mostly lacking in the GI tract. These cases pose significant diagnostic challenge when encountered upon, as there are many pitfalls and gray areas exist in characterization. Amongst other entities, hamartomas can account for a portion of these cases. Herein, we present a unique case of MEML identified in duodenum, which was reported as a hamartoma.

Methods/Case Report

A 59-year-old male presented with persistent upper GI bleeding requiring multiple transfusions. Initial upper GI endoscopy revealed an oozing ulcer as part of a 30 mm polyp in the second portion of duodenum opposite to ampulla. Epinephrine was injected for homeostasis. After repeat endoscopy failed to completely resect the lesion, the patient underwent exploratory laparotomy with resection of the 2nd portion of duodenum. The sections showed a submucosal proliferation of epithelial and mesenchymal elements. The epithelial component consisted of bland-appearing foveolar type mucinous glands, partly showing cystic dilation, while the mesenchymal component consisted of lymphovascular and neural structures as well as a population of small round cells that showed patchy SMA immunolabeling and low Ki67 proliferation index. The case was reported as hamartoma, however, a Brunner’s gland cyst and pericytic tumors (i.e. glomus tumor) were also considered. While the histologic features did not suggest malignancy, the patient had been followed-up closely for 6 months. Recurrence or malignant transformation was not reported.

Results (if a Case Study enter NA)

NA

Conclusion

MEMLs in the GI tract are always challenging to diagnose due to their rarity, unknown etiology and natural history, and lack of established risk factors. Furthermore, mesenchymal component is often difficult to characterize due to multiple differentiations and patchy/unrevealing immunohistochemistry. We report this unique case to enhance the awareness and recognition of MEMLS in the GI tract.
Crystal-Storing Histiocytosis of the Stomach
Authors: Shealy L , Khatskevich K , Magri J , Hajar C , Lewin D
Published: October 2024

Introduction/Objective

Crystal-storing histiocytosis (CSH) is an infrequently seen lesion comprised of eosinophilic histiocytes filled with refractile crystalline structures that most often have been characterized as IgG kappa restricted monoclonal immunoglobulins. The etiology for the mechanism of accumulation of the immunoglobulins is incompletely elucidated but numerous mechanisms have been postulated, including overproduction, faulty secretion, and impaired breakdown. Though CSH itself is a benign lesion, it has repeatedly been noted to be a harbinger of a concurrent or developing lymphoproliferative disorder. Literature review revealed a wide age range of presentations with no gender predilection and reports of this lesion occurring most commonly in the bone, kidneys, lungs, lymph nodes, and head and neck region. The gastrointestinal tract is uncommonly involved, with the stomach being the most frequently cited location. Reports of CSH in this setting have noted simultaneous infections with Helicobacter pylori and a range of associated lymphomas.

Methods/Case Report

We report a lesion from the stomach of a 45 year old female endoscopically described as containing patchy atrophic and nodular mucosa that was biopsied for gastric mapping in a patient with a reported history of autoimmune atrophic gastritis but without confirmatory antibodies on serology. Immunohistochemical stains highlighted a CD68 positive, smooth muscle myosin and cytokeratin negative, population of cells with cytoplasmic kappa positivity. CSH was diagnosed in a background of chronic inactive gastritis of both the antrum and fundus without evidence of H. pylori via staining or associated extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue on biopsy. Recent imaging revealed no concerning lymphadenopathy, lytic lesions, or masses.

Results (if a Case Study enter NA)

NA

Conclusion

Increasing pathologists’ awareness of this entity and its potential to be a paraneoplastic lesion is crucial, as further work-up is needed to exclude an underlying hematolymphoid neoplastic process.
A case of EBV-Negative Primary Intestinal Diffuse Large B Cell Lymphoma Involving Multiple Anatomic Sites and Lymph Nodes
Authors: Han F , Lakhani K , Harris J
Published: October 2024

Introduction/Objective

Extranodal lymphomas in the gastrointestinal tract are rare, with colonic lymphomas representing less than 0.5% of colorectal neoplasms. The most common type is Non-Hodgkin lymphoma. Treatment typically involves chemotherapy and surgical resection, with prognosis depends on various factors including age, genetic alteration, and bone marrow involvement.

Methods/Case Report

An 82-year-old female patient presented with abdominal pain and constipation. Radiological imaging revealed a mass in the ascending colon extending to the ileum. Histological examination following biopsy revealed to be a diffuse large B-cell lymphoma (DLBCL) of germinal center origin. The resected specimen showed two separate centrally ulcerated fungating masses in the ileum (4 x 4 x 1 cm) and ascending colon (8.5 x 5 x 4 cm).

Microscopic examination showed a diffuse infiltrate of large, discohesive, atypical lymphoid cells with vesicular chromatin and prominent nucleoli. Abundant mitoses and apoptotic bodies are evident. The lesional cells were diffusely infiltrating into the lamina propria, submucosa, muscularis propria, and serosa associated with geographic necrosis. The appendix was also transmurally involved by the neoplastic cells. Multiple pericolonic lymph nodes were also involved by the lesional cells (6/15). Immunnohistochemical stains showed the neoplastic cells are positive for CD20, CD10, BCL6, while negative for MUM1, BCL2, C-MYC, and EBER. Ki67 index was 70%. CMV was negative. FISH result for MYC gene rearrangement with reflex to BCL2 and BCL6 was negative, which excludes double/triple-hit high grade B-cell lymphomas. The patient received chemotherapy with R-CHOP after the surgery and stayed recurrence-free for 15 months.

Results (if a Case Study enter NA)

NA

Conclusion

We reported a case of EBV-negative primary intestinal diffuse large B-cell lymphoma with germinal center cell origin involving multiple anatomic sites and pericolonic lymph nodes in an elderly immunocompetent woman.
Rare Seminal Vesicle Cystadenoma: Case Report and Literature Review
Authors: Mohammed I , Garrett F
Published: October 2024

Introduction/Objective

Primary neoplasms of seminal vesicles (SV) are rare, with the majority being metastatic tumors, often from prostatic carcinoma. SV cystadenoma is an exceedingly rare benign epithelial tumor that arises from the remnants of the Mullerian duct. The tumor formed of cysts of variable sizes lined by bland cuboidal epithelium. Herein we present a case of SV cystadenoma in a 38-year-old male, underscoring its rarity and risk of progression to higher grades, as outlined in literature review.

Methods/Case Report

A 38-year-old male with a history of left atrophic kidney and intermittent pelvic pain due to recurrent obstruction of the SV. Pelvic Magnetic Resonance Imaging revealed a 5.3 cm benign unilocular cyst within the SV, along the posterior aspect of the urinary bladder. The patient underwent successful laparoscopic excision of the left SV. Gross examination of the excised SV demonstrated a 3.5X 2.7X 1.5 cm cyst within the SV. Microscopic examination displayed a benign cyst lined by single to multiple layers of cuboidal epithelium, surrounded by unremarkable SV stroma. The epithelial lining cells exhibited round nuclei with inconspicuous nucleoli, lacking dysplasia. Immunohistochemistry revealed positive staining for cytokeratin 7 and PAX 8 in the epithelial cells, whereas prostatic specific antigen staining was negative.

Results (if a Case Study enter NA)

NA

Conclusion

Cystadenoma and mixed epithelial stromal tumors of the SV (MEST) are rare entities, with approximately 30 reported cases. This case demonstrates classic histologic features consistent with low-grade MEST, as per recently proposed grading criteria. Notably, a recent case report has suggested a potential for malignant transformation to high-grade dysplasia and adenocarcinoma in SV cystadenoma, as evidenced by focal epithelial dysplasia.
A Quality Improvement Study for Cervical Cancer Screening: Estimating the use of cotesting versus Reflex HPV testing at the time of screening
Authors: Waqar S , Hirschhorn J W , Wolk D
Published: October 2024

Introduction/Objective

The recommendations for cervical cancer screening have changed over the years. One of the major changes include inclusion of HPV testing in the screening protocols. A brief scan of our lab data indicated that during the period of Jan-Oct 2023, a small group of women over the age of 30 have not been co-tested. While cytology alone is acceptable, it is less sensitive than other recommended screening options. Therefore, the quality of care these women receive is acceptable but not preferred. We aim to quantify those cases, find reasons why HPV testing was not ordered, and estimate the usage of reflex HPV testing.

Methods/Case Report

A retrospective analysis was performed of patients screened for cervical cancer with pap testing over 10 months (Jan - Oct 2023) at Geisinger Medical Laboratories. Out of 32849 patients screened for cervical cancer, we identified 546 cases without HPV testing. A chart review of the cases was performed, followed by sending a survey to the respective providers to find out when they prefer reflex HPV testing over cotesting.

Results (if a Case Study enter NA)

Data analysis showed that 546 out of 32849 cases were screened without co- testing by 102 providers. These providers checked the “HPV if ASCUS” option in the HPV permission section of the cytology requisition form. These cases were diagnosed as Negative for Intraepithelial Lesion on a pap test. We sent a survey to the providers, and responses showed that the reflex HPV testing option is used for patients younger than 30 years by 90% of the providers. Only 10% of providers use cytology alone due to cost issues for patients over 30. Most providers (60%) do not want the reflex testing option to be removed from the HVP permission section.

Conclusion

The majority of the women above 30 years of age are screened for cervical cancer with co-testing, but a small group (1.6%) is tested with cytology alone mainly due to cost-benefit hence compromising on the sensitivity of the screening test. We recommend the following changes to our cytology requisition form. If the provider selects HPV Reflex testing, the HPV test should be performed in the following scenarios: a) The pap test’s final diagnosis is NIL, and the patient is between ages 30-64. b) The pap test’s final diagnosis is ASCUS, and the patient is between ages 21 and 64. c) The pap test’s final diagnosis is LSIL; the patient is non-pregnant and between ages 25 and 64. Modifying the HPV Reflex option will improve the quality of our patient care and align our practices with current recommendations.
Anaplastic transformation of papillary thyroid carcinoma in the cervical lymph nodes showing a variety of rhabdoid, epithelioid and spindle cell phenotype
Authors: Yu Q , Husson M
Published: October 2024

Introduction/Objective

Anaplastic thyroid carcinoma (ATC) is a rare undifferentiated tumor of thyroid follicular cells with a dismal prognosis. Most ATCs derive from pre-existing, well-differentiated thyroid carcinomas, most commonly papillary thyroid carcinoma (PTC). In nearly all instances, ATC arises within the thyroid gland. Completely divergent morphologies of this tumor between the bilateral cervical nodes as well as the almost exclusive presence of ATC in the metastatic and nodal locations are very unusual and are reported here.

Methods/Case Report

A 67-year-old man presented with a rapidly enlarging left cervical mass, hoarseness, dry cough, and drooping left eye. MRI demonstrated bilateral enlarged cervical lymph nodes spanning levels II to V, and nodules in thyroid lobes. Subsequent total thyroidectomy with bilateral radical neck dissection was performed.

Histologically, the left lateral cervical masses revealed undifferentiated tumor cells with rhabdoid, epithelioid and spindle cells features. Conversely, the tumor within the thyroid lobes and the right cervical lymph nodes exhibited PTC with tall cell features.

All undifferentiated tumor components stained positive with AE1-3, CK7, PAX8, and negative with thyroglobulin, EMA, CD34, S100, Melan-A, Sox 10, desmin, myogenin, and P40. INI-1 staining is retained. Only the spindle cell component stained positive with TTF1. Based on the morphology and immunoprofile, a diagnosis of anaplastic thyroid carcinoma was rendred.

Results (if a Case Study enter NA)

NA

Conclusion

Diagnosing anaplastic thyroid carcinoma outside the thyroid lesion can be challenging. In our case, only extensive sampling of the surgical specimen identified a small focus of well-differentiated PTC, staining positive for thyroglobulin, in the left cervical anaplastic carcinoma component, identifying its origin. This case adds to the scarce literature documenting unilateral anaplastic transformation in the left cervical metastatic lymph nodes, while the right cervical lymph nodes contained pure well differentiated PTC. This represents a significant potential pitfall in presurgical fine needle aspiration (FNA) evaluation of patients with ATC.
Navigating Uncharted Territory: High-Grade B-Cell Lymphoma Coexisting with Warthin Tumor – Lessons Learned from an Unusual Encounter
Authors: Pham T , Vo T , Rao R
Published: October 2024

Introduction/Objective

High-grade B-cell lymphomas (HGBCL) coexisting with Warthin tumors (WT) are infrequently encountered, yet each case offers valuable insights. This introduction sets the stage by highlighting the rarity of such occurrences and emphasizing the importance of thorough evaluation in diagnosing and managing salivary gland neoplasms.

Methods/Case Report

We present the case of a 78-year-old man with longstanding bilateral parotid gland masses, initially presumed to be benign WT based on prior biopsies. However, surgical intervention unmasked a surprising twist – concurrent presence of HGBCL within the WT. This rare juxtaposition posed a diagnostic and management conundrum, underscoring the importance of thorough evaluation and consideration of atypical presentations.

Pathological examination revealed a landscape of large-sized cells with aberrant expression profiles, including CD20, Pax-5, BCL2, and MUM-1 positivity, along with a MYC rearrangement. Despite the rarity of this phenomenon, the case serves as a poignant reminder of the necessity for comprehensive assessment in seemingly benign conditions.

Results (if a Case Study enter NA)

N/A

Conclusion

By dissecting this unique encounter, we glean invaluable lessons in diagnostic vigilance, emphasizing the need for heightened awareness and multidisciplinary collaboration in the management of salivary gland neoplasms. This case underscores the significance of recognizing unusual presentations and leveraging them to refine diagnostic and therapeutic approaches, ultimately enhancing patient outcomes and guiding future clinical practice.
Fibrin-Associated Large B-Cell Lymphoma in a Young Patient in the Setting of Pleural Effusion
Authors: Bladek P , Frederiksen J K , Ananthanarayanan V
Published: October 2024

Introduction/Objective

Fibrin-associated large B-cell lymphoma (FA-LBCL) is a proliferation of EBV-positive large B- cells in association with fibrinous debris, typically in the context of prostheses, hematomas, pseudocysts and myxomas. It is a newly described entity and is extremely rare, with no deaths reported as a direct result. It is indolent and not visible on imaging, instead being found incidentally on microscopy. It is mainly a diagnosis of exclusion and is characterized by sheets of neoplastic lymphocytes contained within a fibrin background. The median age of presentation is 55, with 75% of cases being reported among elderly patients. The prognosis is excellent and surgery is considered curative. It needs to be distinguished from malignant lymphomas, mainly diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI), which is also EBV-positive but occurs in elderly patients with a longstanding history of inflammation. The two have identical immunohistochemical profiles but vastly different clinical presentations and outcomes.

Methods/Case Report

A 35-year-old male with end-stage renal disease and a history of recurrent pleural effusions presented with dyspnea. CT showed a large loculated right-sided pleural effusion with no lymphadenopathy. Pleural fluid cytology was negative for any malignant cells. He underwent decortication to relieve pleural rind constriction.

Microscopy revealed small layers of fibrin with an infiltrate of atypical, EBV-positive B-cells with a Ki-67 index of 60%. As the morphological findings and clinical presentation did not fit other known lymphomas, the case was signed out as FA-LBCL. The patient has followed up with oncology and PET scans have been negative for any malignancy. He is currently on the waiting list for a renal transplant.

Results (if a Case Study enter NA)

NA

Conclusion

FA-LBCL is a rare benign neoplasm, identified incidentally and cured by surgical resection. It is mainly diagnosed in the elderly, but the number of cases is limited and the age distribution may be skewed. This case involved a much younger patient and is the first known diagnosis in the pleural setting. It is important to differentiate this entity from DLBCL-CI, which is aggressive and requires intense oncological treatment. In addition, patients with FA-LBCL can undergo immediate solid organ transplantation, whereas those with DLBCL-CI need to be in remission for at least three years before receiving a transplant.
Plasma Cell Leukemia with atypical CCND1/IGH fusion and Monocytoid morphology; A Rare Case Finding
Authors: Hanan A , Altaf S , Zhang X , Sheikh-Fayyaz S
Published: October 2024

Introduction/Objective

Plasma cell leukemia (PCL) is a rare and aggressive form of plasma cell dyscrasia, often presenting as a variant of multiple myeloma (MM). It is characterized by the presence of ≥5% circulating plasma cells in peripheral blood, either as a primary or secondary manifestation of MM.

Methods/Case Report

Our case is of a 77-year-old male who presented with epigastric tenderness and bi-basilar crackles. Laboratory results showed severe hypercalcemia, elevated creatinine, leukocytosis, and elevated absolute neutrophil and lymphocyte counts. Imaging revealed widespread lytic lesions in the ribs, scapulae, thoracolumbar spine, and bony pelvis. Peripheral blood smear showed significant macrocytic anemia with rare polychromatophilic cells, numerous immature plasmacytoid cells (>20% of total cell count) and monocytoid morphology. Flow cytometry confirmed a population of monotypic plasma cells (28% of total cells). Bone marrow biopsy revealed a hypercellular plasma cell infiltrate with complex clonal karyotypic abnormalities, including the t(11;14)(q13;q32), rearrangements of 1p, and gain of 1q. FISH analysis showed an atypical CCND1/IGH fusion in 57% of cells, with one fusion, two orange (CCND1), and two green (IGH) signals. The case presented demonstrates a rare instance of an atypical CCND1/IGH fusion in plasma cell leukemia with monocytoid morphology, which poses diagnostic challenges. Prompt and accurate diagnosis is essential for managing the condition, given its consistently poor prognosis despite advancements in therapy over the past decade.

Results (if a Case Study enter NA)

NA

Conclusion

Our case highlights the importance of recognizing rare molecular abnormalities in PCL and suggests that further research into the molecular pathways involved in the disease is needed to improve diagnosis, treatment options and clinical outcomes.
Rare Adult acute leukemia with Coexisting myeloblastic (basophilic differentiation) & B-lymphoblastic subpopulations Case Study
Authors: Elywa A K , Ghaleb F
Published: October 2024

Introduction/Objective

Acute basophilic leukemia is a very rare subgroup of acute myeloid leukemia that is defined in the 2022 WHO classification by presence of at least 20% blast cells in peripheral blood or bone marrow with immature and maturing cells of basophil lineage. The simultaneous occurrence of two hematological malignancies in a middle- aged adult patient is quite a rare event as evidenced by the rare cases reported in the literature. To our knowledge, this is the first case to be reported with concomitant acute basophilic and B-lymphoblastic leukemia in adult patients. these findings necessitates the comprehensive systematic approach to attain accurate diagnosis and plan the appropriate treatment protocol.

Methods/Case Report

Bone marrow aspiration & biopsy procedure was performed under local anesthesia and marrow samples were subjected to: lieshman staining of marrow films and direct examination. Immunophenotypic analysis of marrow aspirate by FACS Canto II flow cytometer. Cytogenetics studies were done as karyotyping and gene mutation detection by FISH.

Results (if a Case Study enter NA)

NA

Conclusion

Morphology of marrow films: 50% Blast cells, group of them are medium to larg-cells with high nucleocytoplasmic ratio and immature chromatin and the other group shows blast cells with sparse basophilic granulations, plus 20% immatue and maturing basophils.

IPT shows two populations:

the Myeloblast population (basophilic differentiation) is Positive for CD45dim, CD34het, CD13, CD33, CD117prt, CD25het, CD123het, cyt MPO part, HLA-DR partial.

the B lineage lymphoblast population is Positive for CD45dim, CD34het, CD19, CD79a, TdT, CD20het, CD38. Cytogenetics studies: hyperploidy 56, (X, Y, 9, 10, 12, 13, 15, 18, 22, mar+ extra-chromosomes)

FISH: +ve for FLT3-ITD mutation.

the picture is by morphology & IPT consistent with biclonal leukemia, myeloid clone (acute basophilic leukemia) & ProB-ALL.

The systematic laboratory approach from careful morphological examination of peripheral blood and bone marrow smears to confirmatory immunophenotypic analysis of marrow specimens by flow cytometry, and the comprehensive cytogenetics analysis, has a vital role in diagnosing such rare and aggressive phenomenon and provide a good chance for planning the appropriate treatment protocol with critical timesaving and cost effectiveness.