bluuebunny/crossref_metadata_2025 huggingface dataset:
The barrier layer protecting wooden products against fire action with the use of component plywood
Part I Core material – plywood
Authors: Jóźwiak Mariusz , Fojutowski Andrzej
Published: February 2021

The barrier layer protecting wooden products against fire action with the use of component plywood Part I Core material – plywood. Research on the barrier layer protecting wooden products against fire action with the use of component plywood are presented on the example of the composite plywood. The composite plywood consisting of: 3-layer protected against fire component plywood and 9-layer core plywood - beech UF- industrial, classic – not protected against fire (thickness 14.5 mm) was produced. Fire resistance of the component plywood was sufficient to protect core plywood against fire. The combustion index ranged from 0.68 to 0.75 and the flammability index oscillated between 0.06 and 0.07 which allows to classify composite plywood as a hardly flammable material acc. to PN-96/B-02874. Component plywood can be a semi-finished product useful for the production of fireproof wood- based materials.
Can Muggles be Autistic?
Authors: Christensen Fie
Published: February 2021

This paper explores the tension between perceiving autism as a spectrum of traits or as a core. A spectrum is defined as a tension between two extremes. A core, on the other hand, is defined by an essence or a pervasive structure. I present the views of three autistic women that try to establish autism as a core, in which people with autism are separate from the rest of humankind and not extreme versions of humanity, the consequences of their statements are that there are no extreme versions of autism. Autism as a ‘core’ manifests itself in behavior (e.g. whether you hug others in distress or not, an example put forward by the women), which allows them to reevaluate the diagnoses of fellow autistic humans. I argue that the worldview of the three women is exemplified by their use of examples, and that what could be considered as ‘extreme examples’ on a ‘human spectrum’, might represent ‘ideal examples’ in their view of the ‘autistic spectrum’. Thinking about autism as a spectrum with its own examples allows us to understand the social dynamics of broadening the autism criteria. Furthermore, this article discusses how extreme examples can be used to create new wholes when spectrums are being broadened to the point of bursting.
A Clinicopathologic Evaluation of Follicular Lymphoma Grade 3A Versus Grade 3B Reveals No Survival Differences
Authors: Hsi Eric D. , Mirza Imran , Lozanski Gerard , Hill John , Pohlman Brad , Karafa Matthew T. , Coupland Robert
Published: February 2021

Context.—The World Health Organization classification recommends categorizing grade 3 follicular lymphomas based on the presence of centrocytes (grade 3A) or of sheets of centroblasts (grade 3B). The clinical significance of this practice is not known.

Objective.—To determine whether grade 3 follicular lymphoma subtype is associated with prognosis.

Design.—Multi-institutional retrospective case series.

Main Outcome Measure.—Overall survival.

Results.—Forty-five cases of grade 3 follicular lymphoma without diffuse large B-cell lymphoma were studied (35 cases of grade 3A, 10 cases of grade 3B) from 21 men and 24 women (median age, 67 years; mean age, 63.8 years; range, 26–86 years). Follow-up information from the time of diagnosis was available in all patients, with a median follow-up time of 24 months (mean, 34 months; range, 2– 115 months). Treatment information was available in 40 patients. There was no difference in age (P = .45, Wilcoxon test) or stage (P = .76, Fisher exact test) between patients with follicular lymphoma of grade 3A or grade 3B. Furthermore, the Cochran-Armitage test for trends showed no evidence that the proportion of patients with follicular lymphoma grade 3A or 3B increased or decreased with increasing stage at presentation. Kaplan-Meier analysis showed a median overall survival of 44 months from the time grade 3 follicular lymphoma was diagnosed, with no significant difference between cases diagnosed as grade 3A or grade 3B (P = .14, log-rank test). Univariable Cox proportional hazards modeling showed no evidence that an anthracycline-containing chemotherapy regimen or history of lower grade follicular lymphoma affected overall survival.

Conclusions.—In this retrospective series, subclassification of grade 3 follicular lymphoma into type 3A and 3B categories had limited clinical and prognostic significance. However, the study was limited by lack of statistical power. Since morphology often provides clues for progress in defining biologic differences, subtyping may still be useful, particularly in the setting of prospective clinical studies.
Noninvasive Carcinoma of the Breast: Angiogenesis and Cell Proliferation
Authors: Cao Ying , Paner Gladell P. , Kahn Leonard B. , Rajan Prabha B.
Published: February 2021

Context.—Angiogenesis and the cell proliferation index can predict the prognosis of invasive breast carcinoma; however, little is known of their roles in noninvasive tumor.

Objective.—To investigate the correlation of microvessel density and cell proliferation index with other histologic parameters (histologic type, nuclear grade, and mitotic count) in 65 cases of noninvasive carcinoma of the breast.

Design.—Formalin-fixed, paraffin-embedded tissues from 65 cases of carcinoma in situ of the breast were immunostained with antibody against factor VIII antigen and proliferation-associated nuclear antigen MIB-1. The microvessel density was measured by counting the total number of microvessels around the carcinoma in situ per 10 low-power microscopic fields. The cell proliferation index was calculated by counting MIB-1–positive nuclei in 100 tumor cells. A χ2 test and Spearman rank correlation test were used for statistical analysis.

Results.—The microvessel density and cell proliferation index of comedo-type, high-nuclear-grade ductal carcinomas in situ are significantly higher than those of either noncomedo type ductal carcinomas in situ or lobular carcinoma in situ (P < .001).

Conclusions.—Angiogenesis and the cell proliferation index are active biological processes and may be considered as markers to separate low- and high-risk patients with noninvasive breast carcinomas.
Sinusoidal Dilatation and Congestion in Liver Biopsy: Is It Always Due to Venous Outflow Impairment?
Authors: Kakar Sanjay , Kamath Patrick S. , Burgart Lawrence J.
Published: February 2021

Context.—Impairment of venous outflow manifests as zone 3 sinusoidal dilatation and congestion (SDC) in liver biopsy. However, the finding of SDC is not specific for venous outflow impairment.

Objectives.—To determine the specificity of SDC in liver biopsies for venous outflow impairment and to seek an explanation for SDC in patients without clinical or radiologic features of venous outflow impairment.

Design.—Liver biopsies from 51 patients with sinusoidal dilatation were reviewed. Biopsies from transplant recipients, patients with cirrhosis, and patients with hepatic neoplasms (primary or metastatic) were not included. Clinical records were reviewed for laboratory tests and final clinicopathologic diagnosis.

Results.—Thirty-four patients (66.7%) had confirmed venous outflow impairment. Of the 17 cases (33.3%) without clinical and/or radiologic evidence of venous outflow impairment, vascular causes were present in 5 cases (9.8%; nodular regenerative hyperplasia in 2 cases and portal vein thrombosis, congenital absence of the portal vein, and sickle cell anemia in 1 case each). Systemic inflammatory disorders were identified in 6 patients (11.8%). These included 2 cases of Castleman disease and 1 each of sarcoidosis, Crohn disease, rheumatoid arthritis, and Still disease. Three patients (5.9%) had tumors without direct involvement of the liver (1 case each of Hodgkin lymphoma, renal cell carcinoma, and pancreatic serous pseudopapillary tumor). In the remaining 3 patients, SDC was identified in wedge liver biopsies performed at the time of surgery, including gastric bypass surgery, cholecystectomy, and splenectomy. No other disease association was apparent in these cases.

Conclusion.—Sinusoidal dilatation and congestion in liver biopsy is associated with venous outflow impairment in two thirds of the cases. In the absence of clinical and/or radiological evidence of venous outflow, diagnostic considerations include other vascular conditions, such as portal vein insufficiency and nodular regenerative hyperplasia. Sinusoidal dilatation and congestion can also occur in the setting of systemic inflammatory diseases, granulomatous disorders, and neoplasms, as well as in wedge biopsies obtained during abdominal surgery.
Xanthogranulomatous Funiculitis and Orchiepididymitis: Report of 2 Cases With Immunohistochemical Study and Literature Review
Authors: Nistal Manuel , Gonzalez-Peramato Pilar , Serrano Alvaro , Regadera Javier
Published: February 2021

Two patients with xanthogranulomatous inflammation are described, one with involvement of the spermatic cord and the other with 1 testicle and epididymis affected. To our knowledge, only 12 cases of xanthogranulomatous orchiepididymitis have been reported previously, one of which also presented a xanthogranulomatous funiculitis. Clinically, our patients presented with spermatic cord enlargement (case 1) and chronic orchitis that did not respond to treatment with antibiotics (case 2). Histopathologically, both cases showed extensive xanthogranulomatous inflammation with numerous foamy macrophages that were associated with colonies of microorganisms suggestive of actinomyces in case 1. Additionally, Escherichia coli was cultured from the surgical specimen of case 2. The possible underlying pathology may be diabetes in case 1 and phlebitis associated with chronic orchitis in case 2. Differential diagnoses with other lesions that are rich in macrophages, such as malakoplakia, and those testicular neoplasms without serologic tumor markers are discussed.
Atypical Angiomyolipoma of Kidney in a Patient With Tuberous Sclerosis: A Case Report With p53 Gene Mutation Analysis
Authors: Ma Linglei , Kowalski Diane , Javed Khurram , Hui Pei
Published: February 2021

Angiomyolipoma (AML) is the most common benign mesenchymal tumor of the kidney. It belongs to the family of perivascular epithelioid cell tumors and is typically composed of blood vessels, adipose tissue, and smooth muscle– like cells, which are characteristically positive for HMB-45. Results of recent studies suggest that p53 mutation may play an important role in AML progression. Here, we describe a locally destructive renal AML in a patient with tuberous sclerosis. The tumor consisted of mostly epithelioid cells with marked nuclear pleomorphism and frequent mitoses and was positive for HMB-45. The diagnosis of atypical epithelioid AML was made. Codon alteration in the p53 gene was not detected, despite focal p53 immunoreactivity and single nucleotide polymorphism at exon 6. Our finding indicates no definite link between p53 abnormalities and the atypical appearance of AML. To the best of our knowledge, this is the second renal AML case investigated for p53 mutations.
Swyer-James (MacLeod) Syndrome With Placental Transmogrification of the Lung: A Case Report and Review of the Literature
Authors: Marchevsky Alberto M. , Guintu Rogelio , Koss Michael , Fuller Clark , Houck Ward , McKenna Robert J.
Published: February 2021

Swyer-James (MacLeod) syndrome is an acquired form of unilateral hyperlucency of the lung and is characterized by the development of severe emphysema, bronchiectasis, and/or bronchiolitis obliterans. It may develop as a complication of repeated episodes of pulmonary infection resulting in bronchiolitis obliterans and obstruction of small airways. Most patients with Swyer-James (MacLeod) syndrome can be managed clinically, and the pathologic features of the syndrome have been described in only a few reports. Placental transmogrification of the lung is a rare histopathologic finding that has been described in patients with severe emphysema associated with cigarette smoking, congenital bullous emphysema, and fibrochondromatous hamartomas of the lung and is characterized by the development of peculiar structures in the pulmonary parenchyma that resemble placental villi. To our knowledge, placental transmogrification of the lung has not been previously described in patients with Swyer-James (MacLeod) syndrome. We encountered a 32-year-old man with a history of childhood asthma who presented with progressively severe exertional dyspnea and had unilateral right lung hyperlucency. The patient underwent a right pneumonectomy. Examination of the lung revealed severe mixed centriacinar-panacinar emphysema in all lobes, bullous emphysema in the upper lobe, bronchiectases, mild interstitial pneumonia with fibrosis, and placental transmogrification of the pulmonary parenchyma of all 3 lobes. Here, we review the pathology of Swyer-James (MacLeod) syndrome and the possible pathogenesis of villous-like changes in the lung tissues.
Perivascular Epithelioid Cell Tumor of the Oral Mucosa
Authors: Koutlas Ioannis G. , Pambuccian Stefan E. , Jessurun Jose , Manivel J. Carlos , Gopalakrishnan Rajaram
Published: February 2021

Perivascular epithelioid cell tumors (PEComas) are a family of tumors defined by the coexpression of melanocytic and muscle markers. Examples have been reported in many organs, soft tissues, and bone. Further expanding the list of locations, we report a case arising in the hard palate. Histologically, the tumor was composed of large elongated or epithelioid cells with granular cytoplasm. Immunohistochemically, tumor cells were positive for HMB-45, Melan A/MART-1, CD10, smooth muscle actin, desmin, and calponin. Ultrastructural examination revealed stage I melanosomes, thin filaments, and dense plaques. Recurrence has not been reported after 20 months. To our knowledge, this is the first detailed description of an intraoral PEComa.
Haemophilus influenzaeLymphadenopathy in a Patient With Agammaglobulinemia: Clinical-Histologic-Microbiologic Correlation and Review of the Literature
Authors: Black Candice , Zavod Matthew B. , Gosselin Benoit J.
Published: February 2021

Agammaglobulinemia is the most common primary immunodeficiency, with an incidence of approximately 1 in 250 000 males in the United States. These patients are at risk for frequent recurrent infections, which may become fatal if untreated. Patients have increased susceptibility to encapsulated pyogenic bacteria. Haemophilus influenzae is second only to Streptococcus pneumoniae as the bacteria most frequently implicated in infections in these patients. We present a case involving an adolescent boy with X-linked agammaglobulinemia and H influenzae cervical adenopathy, confirmed twice by culture. We correlate the clinical, microbiologic, and histologic findings. Owing to the severity of infections in this population, surgical intervention is more common than in the immunocompetent population. This description may help the pathologist in considering a differential diagnosis when examining a diagnostic lymph node biopsy in these patients.
Distinguishing Primary and Metastatic Conventional Renal Cell Carcinoma From Other Malignant Neoplasms in Fine-Needle Aspiration Biopsy Specimens
Authors: Tabatabai Z. Laura , Staerkel Gregg A.
Published: February 2021

Context.—Differentiation of conventional renal cell carcinoma from other malignant neoplasms can be difficult, particularly with the limited sampling in fine-needle aspiration biopsies. Many studies have discussed the features of renal cell carcinoma in fine-needle aspiration biopsy specimens, but the significance of the cytologic features is not known.

Objective.—To define the significant cytologic findings that aid in differentiating renal cell carcinoma from other malignant neoplasms in fine-needle aspiration biopsy specimens.

Design.—Fine-needle aspiration biopsies from 35 patients with proven primary or metastatic conventional renal cell carcinoma and from 145 patients with proven primary or metastatic non–renal cell carcinoma malignant neoplasms were assessed for the presence or absence of the following cytologic features: the heterogeneous cell population, hemosiderin deposits, small cytoplasmic vacuoles, large cytoplasmic vacuoles, low nuclear-cytoplasmic ratio, prominent nucleoli, intranuclear inclusions, irregular nuclear membranes, and smooth nuclear membranes. Statistical analysis was performed to identify the features significant in distinguishing conventional renal cell carcinoma from non–renal cell carcinoma malignancies.

Results.—The presence of the heterogeneous cell population, hemosiderin deposits, small cytoplasmic vacuoles, and low nuclear-cytoplasmic ratio were each highly significant in conventional renal cell carcinoma when compared with non–renal cell carcinoma malignant neoplasms (P < .001) using univariate exact analysis. Features that were identified as being predictive of conventional renal cell carcinoma using multivariable logistic regression analysis included heterogeneous cell population, small cytoplasmic vacuoles, and hemosiderin deposits (P < .05).

Conclusions.—The presence of the heterogeneous cell population, small cytoplasmic vacuoles, hemosiderin deposits, and a low nuclear-cytoplasmic ratio aids in differentiating conventional renal cell carcinoma from other malignant neoplasms, including morphologically similar entities such as hepatocellular carcinoma, in fine-needle aspiration biopsy specimens.
Sessile Serrated Polyp Mimicry in Patients With Solitary Rectal Ulcer Syndrome: Is There Evidence of Preneoplastic Change?
Authors: Ball Chad G. , Dupre Marc P. , Falck Vincent , Hui Susan , Kirkpatrick Andrew W. , Gao Zu-Hua
Published: February 2021

Context.—Solitary rectal ulcer syndrome (SRUS) is associated with erythema and ulceration of the rectal wall. Serrated lesions of the colon are divided into conventional hyperplastic polyps and a new set of lesions that are variably called sessile serrated polyps (SSPs) and sessile serrated adenomas. The SSPs are epithelial proliferative lesions that appear to act as a unique pathway to colorectal carcinogenesis. No association between SRUS and SSPs has been previously reported.

Objective.—To assess a possible association between SRUS and morphologic features that mimic SSPs.

Design.—Twenty-six patients with SRUS, who presented to our institution between January 1, 1999, and November 14, 2004, were retrospectively reviewed for SSP-type morphologic features by 3 pathologists. Ki-67 and hMLH1 immunohistochemical stains were used. Control tissues included 10 conventional left-sided hyperplastic polyps, 10 right-sided large SSPs, 7 adenocarcinomas with known loss of hMLH1 gene expression, and 4 normal human tonsil tissues.

Results.—Ten (38%) of 26 SRUS specimens demonstrated histologic features consistent with SSPs. These features included exaggerated serration within the lower crypt compartments, crypt branching, hypermucinous appearance of epithelium, and horizontal extension of crypt bases along the muscularis mucosa. All 10 cases of SRUS had positive basal Ki-67 staining in 10% to 20% of cells. Two (20%) of the 10 cases demonstrated focal superficial loss of hMLH1 mismatch repair gene expression within areas of serrated morphologic features. One hyperplastic polyp superimposed on SRUS showed a reduced number of surface epithelial cells that express hMLH1 protein.

Conclusions.—Up to 38% of patients with SRUS have histologic changes that mimic SSPs. More importantly, 20% of these serrated lesions were found to have focal loss of hMLH1 gene expression, indicating a potential of preneoplastic change. This phenomenon may reflect an increased propensity for neoplastic progression in response to repeated trauma and repair process in certain cases of SRUS.
Primary Intraocular T-Cell–Rich Large B-Cell Lymphoma
Authors: Cummings Thomas J. , Stenzel Timothy T. , Klintworth Gordon , Jaffe Glenn J.
Published: February 2021

We report a primary intraocular T-cell–rich large B-cell lymphoma in a 57-year-old woman who underwent 3 diagnostic vitrectomies for a presumed diagnosis of panuveitis. She developed no light perception in the left eye and underwent enucleation. Histopathologic and immunohistochemical studies on the enucleated globe disclosed a primary intraocular large B-cell lymphoma involving the choroid, vitreous, and retina. A large population of T cells was identified among the neoplastic B-cell population. B-cell immunoglobulin gene rearrangement and T-cell receptor gene rearrangement studies using the polymerase chain reaction method indicated that a monoclonal immunoglobulin κ light chain population was present and that the T-cell population was not monoclonal. This case highlights the importance of interpreting cytologic features in vitreous aspirates in the context of the clinical situation.
Measuring the Significance of Participant Evaluation of Acceptability of Cases in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology
Authors: Renshaw Andrew A. , Mody Dina R. , Wang Edward , Wilbur David C. , Colgan Terence J.
Published: February 2021

Context.—The quality of gynecologic cytology slides within educational and proficiency testing programs may deteriorate during use. Participant evaluation of the acceptability of these slides subsequent to possible deterioration is not known.

Objective.—To assess participants' evaluation of the acceptability of slides circulating within an educational gynecologic cytology glass slide program.

Design.—The College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology is a peer comparison and educational program that evaluates the ability of the participants to correctly classify gynecologic cytology preparations. The program uses both expert review and field validation to select slides for the graded portion of the program. Participants were asked to assess the acceptability of slides within the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology, and their responses were assessed with respect to type of slide preparation, validation status, and reference diagnosis. In addition, we compared the cytodiagnostic discordancy rates of slides that were deemed acceptable by participants with those that were deemed unacceptable.

Setting—Participant assessments were derived from pathologists and cytotechnologists from cytology laboratories of all types.

Results.—A total of 17 210 slide interpretations were reviewed, and 2.91% of the cases were labeled unacceptable by participants. For all slides, the percentage of cases called unacceptable varied from 1.65% for cases with a reference interpretation of herpes to 45% for cases with a reference interpretation of unsatisfactory. The percentage of slides deemed unacceptable was higher for validated slides than for educational slides (3.27% vs 2.55%, P = .006). The discordancy rate (to reference diagnosis series) for cases deemed unacceptable was significantly higher than the discordancy rate for cases deemed acceptable for both validated (10.39% vs 1.76%) and educational slides (21.72% vs 3.53%, P < .001).

Conclusion.—Greater than 97% of all slides in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology were judged acceptable by participants. Despite expert review and field validation, a small percentage of slides (almost 3%) in this program were deemed unacceptable by participants. These results support the use of participant evaluation of cases to continually improve the quality of cases in this program.
Cytologic Features of Squamous Cell Carcinoma in Conventional Smears: Comparison of Cases That Performed Poorly With Those That Performed Well in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology
Authors: Renshaw Andrew A. , Henry Michael R. , Birdsong George G. , Wang Edward , Haja Jennifer , Hughes Jonathan H.
Published: February 2021

Context.—Characteristic cytologic features have been identified that distinguish cases that are always identified from those that are sometimes missed in the College of American Pathologists Gynecologic Cytology Program for a variety of different lesions and preparations.

Objective.—To compare the cytologic features of cases of squamous cell carcinoma in conventional smears that perform poorly and well.

Design.—The cytologic features of 8 conventional smear cases of squamous cell carcinoma that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 17 cases that performed extremely well.

Results.—A total of 2387 individual interpretations were recorded. Of the 86 incorrect responses, 6.2% were for repair, and 0.8% were for Trichomonas. Cases that performed well were significantly more likely to have greater than 1000 dysplastic cells (16/17 vs 4/8, P = .02) and be keratinized (13/17 vs 1/8, P = .007). Obscuring inflammation and cell size were not significant.

Conclusion.—Conventional smears with a diagnosis of squamous cell carcinoma that were always identified were significantly more likely to have greater than 1000 cells and be keratinized than cases that performed poorly.
Presence of Human Papillomavirus DNA in Testicular Biopsies From Nonobstructive Azoospermic Men
Authors: Martorell Miguel , Gil-Salom Manuel , Pérez-Vallés Ana , Garcia Jose Angel , Rausell Nuria , Senpere Alejo
Published: February 2021

Context.—Human papillomavirus (HPV) plays a major role in the etiology of many malignancies of diverse localization, such as uterine cervical carcinoma and its precursors. Human papillomavirus sequences have been detected throughout the male lower genitourinary tract, but the role of men as transmitters remains unclear.

Objective.—To investigate the relationship between azoospermia and the presence of HPV DNA in testicular cells.

Design.—One hundred eighty-five patients with azoospermia undergoing testicular biopsy were studied. Histologic study was done on formalin-fixed, paraffin-embedded samples from testicular biopsies, stained with hematoxylin-eosin. Molecular study to detect HPV sequences was performed on genomic DNA isolated from paraffin sections by standard protocols. Seven cases containing HPV sequences were studied after microdissection with PALM microlaser technology in order to determine the presence of HPV DNA sequences in different cells, as well as from seminal tubules or stromal (Leydig) cells.

Results.—Human papillomavirus DNA sequences were detected in testicular biopsies of 12 patients (6.48%). Human papillomavirus type 16 was the most common genotype encountered. Among the 92 patients who underwent bilateral testicular biopsy, HPV sequences were detected in 9 patients (9.78%), all of whom showed only unilateral testicular affection, more often in the left testicle (ratio, 2: 1). After microdissection, HPV DNA sequences were seen in Leydig and Sertoli cells; the presence of HPV in germinal cells could not be ruled out.

Conclusions.—Leydig cells, Sertoli cells, and probably germinal cells (cases 2, 3, and 4) harbored HPV DNA sequences. Such findings have not been previously described in testicular tissue.
Pulmonary Crystal-Storing Histiocytoma
Authors: Ionescu Diana N. , Pierson Diane M. , Qing Gefei , Li Maomi , Colby Thomas V. , Leslie Kevin O.
Published: February 2021

We describe the case of a 50-year-old woman with a lung tumor composed of crystal-storing histiocytes. These cells and associated plasma cells failed to show clonal light chain restriction, and the patient had no associated hematologic disorder. The differential diagnosis included crystal-storing histiocytosis, characterized by accumulation of crystallized immunoglobulins, a rare manifestation of monoclonal gammopathies/plasma cell dyscrasias. Crystal-laden histiocytes have previously been described in many organs. Four reports have described crystal-storing histiocytosis in the lung, always associated with a lymphoproliferative disorder. The present patient, 1 other case from our archive, and 1 case reported in the literature, all without an association with lymphoproliferative disorder, make a full description and definition of this lesion appropriate. The morphology, immunohistochemical profile, and electron microscopic features are described herein, and the term pulmonary crystal-storing histiocytoma is proposed. A practical algorithm is presented for the assessment of solitary lung masses composed of large histiocytic cells.
Angiolymphoid Hyperplasia With Eosinophilia Associated With Pregnancy: A Case Report and Review of the Literature
Authors: Zarrin-Khameh Neda , Spoden James E. , Tran Ruc M.
Published: February 2021

A case of angiolymphoid hyperplasia with eosinophilia (ALH) is reported in a 33-year-old woman who developed an auricular nodule during the second trimester of her pregnancy. Angiolymphoid hyperplasia with eosinophilia usually occurs on the head and neck of young adults and is more common in women than in men. Characteristic histologic features of ALH present in this case included proliferation of thick-walled blood vessels lined by prominent endothelial cells, infiltration of the interstitium by chronic inflammatory cells (mainly eosinophils), and presence of lymphoid follicles with germinal centers. The auricular tumor was completely excised. Thirteen months after excision, the patient remains tumor free. Although there are not many case reports on ALH during pregnancy or involving use of oral contraceptive pills, sex hormones may play a role in the pathogenesis of ALH. This hypothesis, in the context of cases previously described in the literature, and the differential diagnosis of ALH are discussed.
Collagen-Rich Crystalloids in a Scarred Vascularized Cornea
Authors: Afshari Natalie A. , Wright Tarra M. , Cummings Thomas J. , Proia Alan D.
Published: February 2021

Collagen-rich crystalloids, also referred to as collagenous crystalloids, are uncommon findings in benign salivary gland tumors with myoepithelial differentiation and in cutaneous neoplasms. Herein, we report the presence of collagen-rich crystalloids in the scarred, vascularized cornea of a 56-year-old woman. The patient underwent penetrating keratoplasty, and microscopic examination of hematoxylin-eosin–stained sections disclosed large aggregates of refractile material within the corneal stroma. The deposits were partially birefringent when viewed with polarized light and composed of radially arranged columns (long rectangles) with rounded to pointed tips. The deposits had tinctorial properties of collagen using Masson trichrome and the van Gieson method for collagen, and they stained with Alcian blue, pH 2.5, and Verhoeff elastic stain. They did not stain with Gomori methenamine silver, Snook reticulin stain, or tyrosine using the Baker modification of the Millon reaction. This is the first report, to our knowledge, of collagen-rich crystalloids in the cornea. Their presence in the cornea indicates that these structures may occur in the absence of neoplasia.
Frozen Section Diagnosis in Pediatric Surgical Pathology: A Decade's Experience in a Children's Hospital
Authors: Coffin Cheryl M. , Spilker Krista , Zhou Holly , Lowichik Amy , Pysher Theodore J.
Published: February 2021

Context.—Intraoperative consultations, including frozen sections (FSs), are essential for patient care and are a key quality component in anatomic pathology. Little data exists about the use, frequency, and type of discrepancies and deferral rates of FS diagnoses in pediatric and adolescent surgical pathology.

Objective.—The purpose of this study was to analyze indications, discrepancies, and deferrals for all FSs performed at a children's hospital during a 10-year period.

Design.—All FSs for 1995–2004 were reviewed for indications, discrepancies, deferred diagnoses, and turnaround time. Discrepancies were categorized into major and minor subtypes according to potential impact on patient care.

Results.—A total of 35 611 surgical pathology cases were accessioned, with 2839 intraoperative consultations, which included 2783 FSs and 56 nonmicroscopic consultations. Most frequent indications included questions related to neoplasms (tumor detection, specimen adequacy, triage, classification, and margins) and suspected Hirschsprung disease. In these consultations, 115 discrepancies (4%) were identified, of which 7 (0.2%) were major, with potentially significant clinical impact, and 108 (3.9%) were minor. The major discrepancies included tumor, ganglion cell, or organism detection. The minor discrepancies involved sampling error, reclassification of benign or malignant neoplasms without clinical consequences, tumor typing or grading, and ganglion cell identification without clinical impact. Deferrals in 718 FSs (25% deferral rate) included tumor classification from generic to specific, identification of organisms, and evaluation of lymph node biopsies for lymphoma. Turnaround time exceeded 20 minutes in 403 cases (14%).

Conclusions.—The FS rate of 7.8% overall and 5% of surgical pathology cases is similar in children's and general hospitals. The major discrepancy (discordance) rate is lower, which may reflect the different indications for FS in children and adolescents. Evaluation of colonic biopsies for ganglion cells is a diagnostic pitfall. The deferral rate of 25% reflects the definition of a deferred diagnosis. Traditional definitions of deferred and discordant FS diagnoses should be refined to reflect the increasing use of adjunct techniques, especially in tumor classification. These findings emphasize that, in children and adolescents, most FSs are performed for tumor classification, triage, detection, and specimen adequacy, and for possible Hirschsprung disease. In children and adolescents, FSs are used infrequently to identify normal or unknown tissue, to analyze a lesion in a radiographically directed specimen, or to detect lymph node metastases. The differences in pediatric and adolescent FS indications and use underscore the importance of focused education in pediatric surgical pathology.
Intraoperative Consultation in the Diagnosis of Pediatric Brain Tumors
Authors: Adesina Adekunle M.
Published: February 2021

Context.—The prevalence of brain tumors in the pediatric population differs from that in the adult population. Similarly, the frequency and location of the different histologic types of brain tumors vary significantly between the pediatric and adult populations.

Objective.—To familiarize the pathologist with the pediatric brain tumors encountered during intraoperative consultation and with the appropriate differential diagnoses in this setting.

Data Sources.—The medical literature and the author's experience and expertise.

Conclusion.—Compared with adult brain tumors, pediatric brain tumors present different challenges and distinct differential diagnoses that the pathologist should be aware of during intraoperative consultation.
Comparison of Fresh Frozen Serum to Traditional Proficiency Testing Material in a College of American Pathologists Survey for Ferritin, Folate, and Vitamin B12
Authors: Bock Jay L. , Endres David B. , Elin Ronald J. , Wang Edward , Rosenzweig Bruce , Klee George G.
Published: February 2021

Context.—Comparison of different analytical methods in proficiency surveys may be affected by the artificial nature of the survey material.

Objective.—To compare intermethod differences in proficiency survey results between 2 types of survey material, conventional proficiency testing material (PTM) and fresh frozen human serum (FFS), for 3 markers of anemia: ferritin, folate, and vitamin B12.

Design.—Data were gathered from a 2003 survey event in the College of American Pathologists Ligand (“K”) Series, in which the specimens to be tested by each participating laboratory included 1 vial of FFS and 2 vials of PTM with different analyte concentrations. The more than 1600 laboratories subscribing to the survey were not advised as to the nature of the specimens.

Main Outcome Measures.—The bias of each method relative to the median of method means for each analyte and each type of survey material, and the interlaboratory coefficient of variation for each method.

Results.—For each of the 3 analytes, moderate to large method biases were observed. For ferritin, method biases correlated strongly between comparable PTM and FFS specimens (Spearman r = 0.863, P < .001), whereas virtually no correlation was found for folate (r = −0.224, P = .48), and a marginally significant correlation existed for B12 (r = 0.55, P = .049).

Conclusions.—With ferritin, proficiency survey performance of PTM is similar to that of FFS, implying that method biases relate mainly to calibration. With folate and to a lesser extent with B12, PTM and FFS exhibit different method biases, implying that the biases reflect analyte heterogeneity and/or matrix effects.
Pulmonary Complications After Bone Marrow Transplantation: An Autopsy Study From a Large Transplantation Center
Authors: Roychowdhury Monika , Pambuccian Stefan E. , Aslan Deniz L. , Jessurun Jose , Rose Alan G. , Manivel J. Carlos , Gulbahce H. Evin
Published: February 2021

Context.—Bone marrow transplantation (BMT) is used to treat various malignant and nonmalignant disorders. Pulmonary complications are some of the most common causes of mortality in BMT recipients. Poor general health and bleeding tendency frequently preclude the use of definitive diagnostic tests, such as open lung biopsy, in these patients.

Objective.—To identify pulmonary complications after BMT and their role as the cause of death (COD).

Design.—The autopsy and bronchoalveolar lavage (BAL) slides and microbiology studies of BMT recipients from a 7-year period were reviewed.

Results.—Pulmonary complications were identified in 40 (80%) of the 50 cases. The most common complications were diffuse alveolar damage (DAD) and diffuse alveolar hemorrhage (DAH). Pulmonary complications were the sole or 1 of multiple CODs in 37 cases (74%). All complications were more common in allogeneic BMT recipients. In 19 (51%) of the 37 cases in which pulmonary complications contributed to the death, cultures were negative. Both DAD and DAH, complications commonly reported in the early post-BMT period, were seen more than 100 days after BMT in 33% and 12% of cases, respectively. Five (83%) of 6 cases of invasive pulmonary aspergillosis diagnosed at autopsy were negative for fungi ante mortem (by BAL and cultures).

Conclusions.—Pulmonary complications are a significant COD in BMT recipients, many of which, especially the fungal infections, are difficult to diagnose ante mortem. The etiology of DAD and DAH is likely to be multifactorial, and these complications are not limited to the early posttransplantation period. Autopsy examination is important in determining the COD in BMT recipients.
Patient Safety in Anatomic Pathology: Measuring Discrepancy Frequencies and Causes
Authors: Raab Stephen S. , Nakhleh Raouf E. , Ruby Stephen G.
Published: February 2021

Context.—Anatomic pathology discrepancy frequencies have not been rigorously studied.

Objective.—To determine the frequency of anatomic pathology discrepancies and the causes of these discrepancies.

Design.—Participants in the College of American Pathologists Q-Probes program self-reported the number of anatomic pathology discrepancies in their laboratories by prospectively performing secondary review (post–sign-out) of 100 surgical pathology or cytology specimens. Reasons for the secondary review included conferences, external review, internal quality assurance policy, and physician request.

Participants.—Seventy-four laboratories self-reported data.

Main Outcome Measures.—Frequency of anatomic pathology discrepancy; type of discrepancy (ie, change in margin status, change in diagnosis, change in patient information, or typographic error); effect of discrepancy on patient outcome (ie, no harm, near miss, or harm); and clarity of report.

Results.—The mean and median laboratory discrepancy frequencies were 6.7% and 5.1%, respectively. Forty-eight percent of all discrepancies were due to a change within the same category of interpretation (eg, 1 tumor type was changed to another tumor type). Twenty-one percent of all discrepancies were due to a change across categories of interpretation (eg, a benign diagnosis was changed to a malignant diagnosis). Although the majority of discrepancies had no effect on patient care, 5.3% had a moderate or marked effect on patient care.

Conclusions.—This study establishes a mean multi-institutional discrepancy frequency (related to secondary review) of 6.7%.
Fibrous Hamartoma of Infancy: A Case Report With Associated Cytogenetic Findings
Authors: Lakshminarayanan Renuka , Konia Thomas , Welborn Jeanna
Published: February 2021

A 2-month-old male infant presented with a subcutaneous mass on the left middle finger; the mass had been present since birth. This was treated with local excision, and there has been no recurrence. Histology revealed the typical features of a fibrous hamartoma. Cytogenetic studies revealed a reciprocal translocation, t(2;3)(q31;q21), as the sole abnormality. To our knowledge, this is the first report of the cytogenetic findings in fibrous hamartoma, and it suggests that this lesion represents a benign neoplasm.
Association Between the Implementation of a Laboratory Information System and the Revenue of a General Hospital
Authors: Park Woong-Sub , Yi Sang Yeop , Kim Sang-A. , Song Jae-Seok , Kwak Youn Hee
Published: February 2021

Context.—A laboratory information system (LIS) is a useful tool for the management of laboratory processes and data, as well as for improving quality.

Objective.—To examine the association between the implementation of a LIS with the outpatient and inpatient revenues of a general hospital.

Design.—This study analyzed the outpatient and inpatient revenue data of all 212 general hospitals in South Korea; data were obtained from the Korean National Health Insurance Corporation during the period from 1996 through 1999. The mixed model was used for the repeated measure data. The following listed variables were used in the analysis: LIS implementation status, the population size, the state of competition, average local income, the hospital location, the hospital size, whether or not the hospital was a teaching hospital, whether the hospital was private or public, and the effect of the implementation time.

Results.—The revenues from both the outpatient and inpatient departments were significantly higher 1 year after implementing a LIS, even after controlling for confounding variables.

Conclusions.—Although the causality needs to be clarified, the implementation of a LIS was found to be significantly associated with higher outpatient and inpatient revenues.
Carcinosarcoma of the Liver: A Case Report and Review of the Literature
Authors: She Rosemary , Szakacs Juliana
Published: February 2021

No more than 11 cases of carcinosarcoma of the liver have been reported in the past 40 years that fulfill the definition of hepatocellular carcinoma combined with differentiated sarcomatous elements. Most cases consist of hepatocellular carcinoma with 1 to 2 heterologous elements. We report a case of a 51-year-old woman with liver carcinosarcoma consisting of 3 carcinomatous components and 4 sarcomatous components. Hepatocellular carcinoma, fibrolamellar type, was accompanied by neuroendocrine carcinoma (neuron-specific enolase and synaptophysin positive) and adenocarcinoma (cytokeratin 7 and 20 positive). The sarcomatous elements consisted of poorly differentiated spindle cell neoplasm (vimentin positive), leiomyosarcoma (smooth muscle actin positive), rhabdomyosarcoma (desmin positive), and osteosarcoma. To our knowledge, this is the first case of liver carcinosarcoma with this many differentiated heterologous features. There are differing views on the pathogenesis of this tumor. Findings in this case support the view that metaplasia of carcinomatous cells gives rise to the sarcomatous elements.
Immunohistochemical Expression of Wilms Tumor Gene Protein in Different Histologic Subtypes of Ovarian Carcinomas
Authors: Waldstrøm Marianne , Grove Anni
Published: February 2021

Context.—Immunohistochemical expression of Wilms tumor gene protein (WT1) has previously been described in primary ovarian carcinomas.

Objective.—To evaluate differences in WT1 expression among different histologic subtypes of ovarian carcinomas and the correlation to the histologic grade.

Design.—Ninety-one primary ovarian carcinomas were reviewed, and 1 representative formalin-fixed and paraffin-embedded tissue block was selected. One slide from each case included in the study was immunostained using the WT1 clone 6F-D2. The immunoreactivity was graded according to the percentage of stained tumor cells. Only nuclear staining was considered a positive reaction. A tumor was regarded as negative if less than 1% of the tumor cells was stained.

Results.—All serous carcinomas (28/28) showed WT1 expression, whereas all mucinous (14/14) and all clear cell carcinomas (14/14) were negative. The lone malignant Brenner tumor and 3 (60%) of 5 undifferentiated carcinomas included in the study were also negative. The endometrioid carcinomas showed either no reaction for WT1 or were diffusely positive with more than 50% of the tumor cells stained. All the grade 1 tumors (10/10) were negative, whereas 5 (45%) of the 11 grade 2 tumors and 5 (63%) of the 8 grade 3 tumors showed a positive reaction.

Conclusion.—The present study demonstrates differences in immunohistochemical expression of WT1 among different histologic subtypes of primary ovarian carcinomas. Regarding the endometrioid subtype, the expression seems to be correlated to the histologic grade.