bluuebunny/crossref_metadata_2025_split huggingface dataset:
Esophageal Pityriasis Lichenoides Chronica
Authors: Dasaraju S , Liu S , Elkadi O 
Published: October 2020

Abstract
Casestudy: Pityriasis Lichenoides is an uncommon inflammatory skin condition of unknown cause that ranges from mild chronic form to a more severe acute eruption. The mild form, pityriasis lichenoid chronica (PLC), is characterized by the gradual development of symptomless, small scaling papules that spontaneously flatten and regress over weeks. The acute form is characterized by the sudden eruption of small scaling papules that develops into blisters and crusted red brown spots. This acute form is called pityriasis lichenoides et varioliformis acuta (PLEVA). Both forms usually involve the skin of the trunk and proximal extremities. Visceral involvement is not a well described phenomenon. We report a case of a 69-year-old female with significant history of PLC controlled by immunosuppressive therapy. The patient presented with odynophagia and dysphagia that occurred after a period of discontinuation of her PLC treatment. She underwent endoscopy which showed distal esophageal narrowing and stricture. Biopsy revealed squamous esophageal mucosa with marked intraepithelial lymphocytosis along with basal cell hyperplasia, acanthosis, vacuolation and prominent apoptosis in the epithelial cells. PAS, CMV and HSV stains showed no fungal or viral organisms. The esophagus is commonly involved in a number of dermatologic conditions including pemphigus vulgaris, erythema multiforme, epidermolysis bullosa, lichen planus and lichen sclerosis. The pattern of involvement is often in the form of “lymphocytic esophagitis”. To our knowledge, there are no reported cases in the literature on PLC involving the esophagus. While the diagnosis heavily relies on clinical history of PLC, awareness of potential involvement of the esophagus and attention to certain endoscopic and morphological details may better help classify esophagitis biopsies.
A Case Of Pancreatic Hamartoma Mimicking Malignancy: An Uncommon Pitfall
Authors: Dasaraju S , Liu S , Kelly R , Mneimneh W 
Published: October 2020

Abstract

Casestudy
Hamartomas are benign, disordered, tumor-like growth of cellular constituents resembling the tissue of its origin. Hamartomas are usually seen in lung, heart, kidney and spleen. Pancreatic hamartomas (PH) are extremely rare, accounting for &lt;1% of all hamartomas. PH occurs at any age (median: 50 years) without gender predilection. PH presents as single or multiple, solid and/or cystic mass composed of exocrine tissues. Admixed neuroendocrine cells may be seen, but well-formed islets are unusual. PH stroma is typically positive for CD34 by immunohistochemistry. We present a case of a PH resected for the clinical suspicion of malignancy, with the final diagnosis established postoperatively.
The case is that of a 74-year-old male with an incidental 2.3 x 1.7 x 1.1 cm hyperenhancing solid mass of the pancreatic uncinate process, found during anemia workup. The radiologic appearance was suspicious for a neuroendocrine tumor. Biopsy of the mass showed benign-appearing pancreatic ductal and acinar tissue. Given the clinical suspicion of malignancy, the patient elected to undergo a pancreaticoduodenectomy. Macroscopically the mass was well-circumscribed with solid, tan-white, firm cut surface. Microscopic examination revealed well- circumscribed proliferation of disorderly-arranged, well-differentiated, bland exocrine pancreatic tissue. Chromogranin, synaptophysin and CD56 immunostains did not highlight significant neuroendocrine component. Ki-67 proliferation index was low (1%). CD34 and CD117 immunostains were negative in the stroma. The findings were consistent with PH.

Conclusion
PH may mimic a malignant process of the pancreas. The preoperative diagnosis of PH is extremely challenging due to the lack of characteristic clinical and radiological features, therefore, the diagnosis of PH is often made on resection specimen. CD34 immunostain is not always helpful for the diagnosis as it may be negative in PH stroma. Although extremely rare, pancreatic hamartoma should be considered in the differential diagnosis of a pancreatic tumor.
Acquired Cystic Disease-Associated Renal Cell Carcinoma: An Unusual Case in the Absence of Acquired Cystic Disease or Dialysis
Authors: Pandiri M , Freeman J 
Published: October 2020

Abstract
Casestudy: Acquired cystic disease-associated renal cell carcinoma (ACD-RCC) is a relatively recently recognized subtype of RCC. Although much less common than clear cell RCC and papillary RCC, it is the most common tumor occurring in patients with end-stage renal disease (ESRD) and acquired cystic disease (ACD). The tumor is said to occur exclusively in patients with acquired cystic disease, most commonly in patients undergoing long- term dialysis. We report a case of a 67-year-old male with stage IV chronic kidney disease due to membranous glomerulonephritis for 6 years with no history of dialysis and without a history of acquired cystic disease. The patient presented with left lower quadrant pain. On imaging, an enhancing exophytic mass was noted in the left kidney. Partial nephrectomy was performed, demonstrating a unifocal 2.2 cm nodular mass diagnosed as ACD-RCC.
Microscopically, the tumor revealed intracystic papillary growth, focal cytoplasmic vacuoles (sieve-like growth) with involvement of perinephric adipose tissue by the tumoral cysts. Immunohistochemical staining revealed tumor cells positive for CD10, MIT/113, MPAX8, AMACR, and negative for CK7 and CD117. This immunophenotype supports the diagnosis of ACD-RCC (although itis not specific). Although the patient lacks a clinical history of dialysis and no intratumoral oxalate crystals were noted, the morphological findings and immunohistochemistry support the diagnosis of ACD-RCC, with concurrence by outside expert opinion. In summary, we present this unusual case of ACD-RCC to emphasize the awareness of this entity when considering the differential diagnosis of RCC in adult patients with chronic kidney disease, and specifically distinguish it from the close differential of papillary renal cell carcinoma.
Epithelioid Variant of Angiosarcoma Associated with an Arteriovenous Fistula in the Setting of Post-Renal Transplant
Authors: Harrell M , Broehm C J 
Published: October 2020

Abstract

Introduction/Objective
Angiosarcomas are rare malignant tumors that mimic the function and morphologic features of endothelium. They are commonly associated with prior radiation exposure, but have rarely been reported arising in synthetic graft material, congenital syndromes, or in the vicinity of an ateriovenous fistula (AVF). Herein, we report the clinical and histologic features of an epithelioid angiosarcoma arising in an AFV in the setting of post-renal transplant.

Methods
A 67-year-old Native American man with a cadaveric kidney transplant twelve years earlier for end-stage renal disease presented with pain at the site of his wrist AVF. The initial clinical impression was of a thrombosed fistula, and a routine AVF revision was performed. Histologic sections demonstrated an infiltrative neoplasm comprised of round, moderately pleomorphic, epithelioid cells with centrally located nuclei and prominent nucleoli, which was associated with a large thrombosed vessel. By immunohistochemistry the neoplastic cells expressed CD31 and ERG, with patchy reactivity for CD34, pan-cytokeratin, and SMA. Desmin, caldesmon, calponin, EMA, and SOX10 were negative. INI-1 was retained. A re-excision was necessary for complete margination of the lesion, and demonstrated similar histologic findings to the initial specimen.

Conclusion
Angiosarcoma specimens in which epithelioid appearing cells predominate are classified as epithelioid angiosarcomas, a highly aggressive variant that conveys a comparatively worse prognosis than their non-epithelioid counterparts. These classically are positive for CD31, Fli-1, Factor VIII and vimentin, with variable staining for EMA, cytokeratins, and CD34. Epithelioid angiosarcoma arising from an AVF is a rare entity, with less than 30 cases reported in the literature. The diagnosis should be considered in patients presenting with an enlarging mass, pain, or bruising near a previously quiescent AVF site. Given the aggressive nature of this disease process, there may be consideration for routine submission of AVF revision specimens for histologic evaluation.
Pulmonary Cement Emboli After Kyphoplasty: A Case Of Bilateral Pulmonary Emboli And Exacerbation Of Interstitial Lung Disease
Authors: Balikani L , Chen F 
Published: October 2020

Abstract

Introduction/Objective
Osteoporosis often complicates the management of vertebral conditions, including spinal stenosis and vertebral fractures in the geriatric population. In addition to pharmacologic pain management; surgical interventions are employed if the pain is not adequately managed. The surgical interventions include vertebroplasty and kyphoplasty. These procedures involve the introduction of a cement polymer, Polymethylmethacrylate (PMMA), into the vertebral body. Cement leakage is a reported complication more commonly seen in vertebroplasty (30-75%) compared to kyphoplasty (8-33%). This occurs due to distant leakage of cement into the venous plexus or retrograde migration into the aorta which leads to pulmonary cement emboli (PCE). PCE are usually asymptomatic; few patients are symptomatic; seen in 0.9% for vertebroplasty and 0.4% for kyphoplasty. PMMA has a prothrombotic effect, contributing to the thrombosis of the pulmonary vessels. Symptoms typically arise weeks to months after the procedure. In addition, it has been reported that rarely PCE can present with ARDS especially in patients with interstitial lung abnormalities.

Methods
We present a case of an 80-year-old female with a history of hypertension, diabetes mellitus and osteoporosis who underwent a kyphoplasty procedure with use of PMMA for spinal stenosis. Her post-operative course was complicated by multiple surgical revisions. She was noted to have pulmonary cement emboli five months post kyphoplasty and developed significant shortness of breath eight months post procedure. She ultimately developed cardio-pulmonary failure and was found to have bilateral pulmonary emboli and cement emboli at autopsy. Microscopic examination of the cement emboli documented round to oval vacuole-like cavities within and around blood vessels consistent with PMMA.

Conclusion
The histo-pathologic findings of cement emboli are not well documented in human beings compared to animal models. We attempt to highlight the gross and microscopic findings of PMMA cement emboli which is essential in the clinical-histo-pathologic correlation and characterization of pulmonary emboli at autopsy.
Dediduosis: An Incidental Autopsy Finding Simulating Metastatic Disease
Authors: Quereda Bernabeu B , Strayer D 
Published: October 2020

Abstract

Casestudy
Deciduosis, defined as the presence of benign decidual cell clusters outside the endometrium, is an uncommonly reported entity described in pregnant women. It represents progesterone-induced metaplasia of stromal cells, and has been reported in ovary, cervix, uterine serosa and fallopian tubes. Deciduosis has been noted very rarely in peritoneum, omentum, appendix, diaphragm, abdominal organs and pelvic lymph nodes. As an incidental finding, it must be distinguished from more ominous entities which it may resemble.

Methods
A 30 year old female, 29w pregnant, died from an intracranial hemorrhage. Her history was significant for Crohn’s disease and multiple sclerosis, with no previous history of malignancy. At the time of autopsy, she had had an emergency C-section and delivered a healthy male newborn. She donated multiple organs which limited our examination. However, we examined her gynecologic and aerodigestive tract completely. Several enlarged abdominal lymph nodes were identified and sampled for histologic examination.

Results
Gross examination of the gynecologic tract was consistent with status post cesarean section, with no other significant findings. Microscopically, one abdominal lymph node showed multiple clusters of cells with abundant amphophilic cytoplasm, small round nuclei, inconspicuous nucleoli, and prominent myxoid change, obliterating the sinusoids. Similar cells were found in subserosal locations in both ovaries, the endocervical stroma and the mesoappendix. The cells were negative for cytokeratins and calretinin, ruling out metastatic carcinoma and mesothelioma, respectively. CD68 highlighted individual sinusoidal macrophages surrounding the clusters. The cells were positive for vimentin, CD10, and progesterone receptor. These findings are consistent with deciduosis. The absence of associated endometrial-type glands excluded a diagnosis of endometriosis with decidualized endometrial stroma.

Conclusion
Deciduosis is a rarely reported entity that is important to recognize when dealing with suspicious cell clusters simulating metastatic disease in a pregnant woman. There are few high quality photomicrographs in medical literature, particularly for unusual locations such as lymph nodes. We believe our findings will help illustrate the morphologic appearance and immunohistochemical characteristics of this entity, and help distinguish it from more serious diseases.
Primary Cutaneous Follicle Center Lymphoma (PCFCL) with Parotid Gland Involvement
Authors: Ayub S , Al-Duwal Z , Sellers D , Rosenberg A 
Published: October 2020

Abstract

Introduction/Objective
Primary cutaneous follicle center lymphoma (PCFCL) is the most common primary cutaneous B-cell lymphoma. It arises from mature germinal center B lymphocytes. Here we report two cases of PCFCL with parotid gland involvement.

Methods
First case is a 66-year-old male with an enlarging forehead mass for nine months and a painless nodule on the right pre-auricular skin. Second is a 39-year-old male with a history of a recurring scalp spindle cell B-cell lymphoma now presenting with an enlarging lesion on the scalp and “fullness” in the right neck. There was no nodal or other extranodal involvement found in either case. Skin and parotid gland biopsies were obtained in both cases.

Results
Case one: The skin and parotid gland demonstrated sheets of predominantly medium sized infiltrating lymphoma cells, positive for CD20, Bcl-6, CD5 (dim) and Bcl-2 (dim), and negative for CD10, Bcl-1, and MUM-1. The epidermis was spared.
Case two demonstrated medium sized, spindle shaped lymphoma cells. The skin showed a vague follicular growth pattern, sparing the epidermis. The parotid gland showed diffuse infiltration by lymphoma cells, positive for CD20 and Bcl-6, Bcl-2 (dim) and no definite positivity for CD10.
Fluorescent in situ hybridization for t(14;18) translocation was absent in both cases.

Conclusion
Dissemination of PCFCL to extracutaneous sites is uncommon (~10% of cases) and to our knowledge, has not been reported in the parotid gland. Here we present two unique cases, which in the absence of nodal disease, prove the diagnosis of PCFCL with parotid gland involvement.
When Patients Have Neuropathy: Frequency Of A Positive Immunofixation Electrophoresis (IFE) For Monoclonal Protein When The Serum Protein Electrophoresis (SPEP) Is Negative, The Veteran Affairs Medical Center (VAMC) Experience
Authors: Petersen J M , Litman M , Millili R , Jhala D 
Published: October 2020

Abstract

Introduction/Objective
Although serum protein electrophoresis (SPEP) is the backbone of testing to determine the presence of monoclonal proteins, immunofixation electrophoresis (IFE) is more sensitive with the ability to pick up fainter bands or bands comigrating with the normal beta protein peak. Given the costs of performing additional IFE and the known increased sensitivity, algorithms for reflex IFE published in the literature have stated that unexplained neuropathy would be an indication for reflex IFE even if the SPEP appears negative in a new patient. However, literature on exactly how many of these reflex IFE’s end up positive is sparse. Therefore, we present the Veteran Affairs Medical Center (VAMC) experience in a veteran population.

Methods
As part of a quality assurance/improvement project, retrospective Vista/Fileman search of all SPEPs with IFE performed from January 2017 to February 2019 was undertaken to identify all SPEPs/IFE with the standard comment language typically used in patients with neuropathy, namely a preliminary diagnosis of no monoclonal bands on SPEP with an IFE to confirm this diagnosis. All SPEPs and IFEs had undergone review by a pathologist prior to signout which includes a chart review in the computerized patient record system (CPRS) to rule out the documented presence of unexplained neuropathy in new patients who have not previously had IFE workup.

Results
There were 129 SPEP/IFE cases identified. Of these 129, the overwhelming majority or 123 specimens (95%) were negative on IFE. However, there were 6 specimens (5%) that demonstrated a band on IFE without a band being identified on the SPEP. These bands were in the beta region or very faintly located in the gamma region at or below the limit of detection of the SPEP

Conclusion
The performance of IFE for patients with unexplained neuropathy would, in the veteran population at the VAMC, identify a monoclonal band in about 1/20 cases. This provides support for the published algorithms advocating for performing IFE on negative SPEP specimens from patients with unexplained neuropathy, as this finding might be important and would otherwise have been missed if just the SPEP was performed alone.
Elevated Cardiac Troponin in the Setting of Periodic Symptomatology: A Case Report
Authors: Rohr J M , Pirruccello S , Sofronescu A 
Published: October 2020

Abstract

Introduction/Objective
Serial cardiac troponin measurement is a sensitive method to identify recent cardiac injury and is a necessary function of the clinical chemistry laboratory. We present a case of out-of-range cardiac troponin I (cTnI) elevation which remained spuriously elevated for at least 30 days.

Methods
Cardiac troponins were measured on a DxI (Beckman Coulter), Vitros 5600 (Ortho Clinical Diagnostics), iSTAT (Abbott), and Cobas e602 (Roche) according to the manufacturers’ instructions with appropriate controls.
Heterophile antibody blocking (Scantibodies Laboratories) was performed according to the package insert.

Results
A 58-year-old male with a medical history significant for chronic non-ischemic cardiomyopathy with open valvular repair (ejection fraction 15-20%), chronic atrial fibrillation, and Hodgkin’s lymphoma in remission presented to a rural clinic with chest pain and a cTnI of 0.8 ng/mL (reference &lt;0.04 ng/mL). He was transferred to our tertiary center for open revision. The patient’s cTnI (measured on a Beckman Coulter DxI) was above linearity threshold (&gt;71.00 ng/mL) starting day 1 after surgery. The patient self-discharged against medical advice on day 16. On day 21 he experienced new chest pain and dyspnea and was readmitted with a cardiac troponin T (cTnT) of &gt;35 ng/mL (iSTAT; reference &lt;0.08 ng/mL) and cTnI again above threshold. This value remained elevated for the next five days despite abated symptoms. To address the discordant laboratory and physical findings, dilutional cTnI measurements on serum from day 30 demonstrated linearity. Heterophile antibody testing was negative. cTnI on the DxI machine remained &gt;71.00 ng/mL but was separately measured as 3.4 ng/mL (Vitros 5600, reference &lt;0.08 ng/mL). cTnT was found to be 1.05 ng/mL (Cobas e602; reference 0.00 ng/mL). Comparative examination of all methodologies was unrevealing.

Conclusion
This case demonstrates a spurious elevation of cardiac troponins which remarkably demonstrated linearity on serial dilution. Multiple testing methodologies were necessary to prove fallacy. The cause of the result remains unclear. The clinical pathologist should be aware of possible false positives and investigate unlikely continuous cardiac troponin elevations.
Predictive value of ABO blood type with Carcinoembryonic antigen in a Nigerians population with preoperative Colorectal Cancer
Authors: Nwadike C N , Nnodim J , Anyagwa M K , Edward U , Ogbuokiri D K , Umeh O N , Duru M K 
Published: October 2020

Abstract

Introduction/Objective
Earlier studies speculated possible link between ABO blood type and risk of malignancies.
Given recent increase in Colorectal cancer (CRC) cases in Nigeria amidst poor facilities for early diagnosis, unraveling measures for prevention and prognosis become critical options. This study aims at assessing the predictive association of ABO blood types with preoperative Carcinoembryonic antigen (CEA) levels and some markers of gut immunostasis among southern Nigerian population with CRC.

Methods
The retrospective study evaluated 200 patients, scheduled for resection surgery for CRC between July, 2018 and September 2019 in Federal medical center Yenegoa, Nigeria. The relationship between the ABO blood types and CEA, interleukins, IL(6 and 8,) and Short chain fatty acids, SCFA (butyrate and propionate) were evaluated preoperatively using immunoturbidimetric assay, ELISA, and GC-MS respectively. The mean age of the patients was 51 years. The distribution of the ABO blood types in the patients were 60 (30.1%) for A, 50 (25%) for B, 79 (39.5%) for O, and 11 (5.5%) for AB. Patients with CEA levels &lt;5 ng/mL, 6-30 ng/mL, and &gt;30 ng/mL were classified as CEA Group 1, group 2 and group 3 respectively. Patient’s blood types, demographic characteristics and tumor locations, were recorded. SPSS, 22 was employed for data analysis.

Results
We determined a significant correlation between CEA levels and IL 6 in different blood types of CRC patients. No significant correlation was observed between CEA and gender. Blood type A showed significant increase in mean levels of CEA and IL 6 when compared to blood type B and O. No significant difference was observed in the mean SCFA levels among different blood types.

Conclusion
ABO blood type demonstrated significant prognostic value with CEA in colorectal cancer, with blood type A being most unfavorable.