bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serology Curriculum for Residents Using Online, Case-Based Simulation Modules
Authors: Dent Edward , Guarner Jeannette 
Published: October 2020

Abstract

Background
Although serology concepts are a frequent topic of examination for Pathology trainees, serology education is challenging, in part, because the performance of serologic tests may occur in different laboratories (immunology, microbiology, or chemistry.) Serology educational topics and curriculums may be eclipsed by topics concerning the larger laboratory in which serology resides. We developed a one-week standalone curriculum in which residents were given four case-based vignettes to solve and discuss with a faculty member, eight online case-based simulation modules, and bench time in the laboratory with medical laboratory scientists performing serological tests (RPR, VDRL, hepatitis, and HIV).

Objectives
To evaluate the advantages and educational utility of online modules as adjuncts to other modalities used during a standalone serology rotation.

Methods
The online modules are housed within an e-learning Portal. Residents were asked to print the certificate of completion for the eight modules assigned at the end of the week. A survey of the week-long rotation was given to the residents one week and up to 2 months after the rotation. Residents could complete the survey anonymously.

Results
Twenty-three first-year residents (representing a 3-year period) presented completion certificates for the online modules, but only 10 (43.5%) responded to the survey. The average percentage of correct answers for online modules ranged from 73% for the HIV module to 88% for the hepatitis B module. The number of residents with scores below 80% was highest for the Epstein-Barr virus (EBV) and Cryptococcus modules (8 and 9 residents scoring &lt;80% respectively) and lowest for hepatitis B and toxoplasmosis modules (2 and 3 respectively). On the survey, residents stated that they had repeated the online modules between 1 and 4 times, with an average of 1 to 2 attempts. Although there was not a specific module rated as the most enjoyable, the toxoplasmosis and EBV modules were picked by 3 out of 10 residents as his or her favorite. There was no consensus on which module was subjectively easiest or most difficult, nor which was the least enjoyed. The majority of the residents (7/10) found the online modules helpful and all ten residents stated that they learned more after completion of the online modules as the modules reinforced (6/10) concepts important to serologic testing.

Conclusions
The online, case-based simulation modules are an effective addition to a serology curriculum that includes case-based discussions and time spent in the laboratory participating in test performance. The online modules are an effective educational tool because they reinforce learning and provide additional structure to the serology curriculum.
CD26 Role in Early-Stage Mycosis Fungoides Diagnosis
Authors: Azimpouran M , Esmaeili H 
Published: October 2020

Abstract

Introduction/Objective
The diagnosis of Mycosis Fungoides(MF) at its early stage is challenging because of its similarity to Large Plaque Parapsoriasis(LPP). Although the ISCL criteria were introduced for diagnosis of early MF, there have been false positives for some of the immunopathologic and molecular biological criteria. Thus, this criterion may not be as specific as it was thought to be.

Methods
During the present descriptive-analytical study from 2013 to 2018, 27 MF and 21 LPP cases were included and IHC staining for CD26 marker was performed.

Results
Of 18 patients with MF diagnosis with a mean age of 55.55, 11 were female and 7 were male. Also, 14 patients with a diagnosis of LPP with a mean age of 51.22, 9 were female and 5 were male. There was no significant difference between patients’ age and gender (P&gt;0.05). According to this test, there were statistically significant differences in CD5, CD7, and CD26 expressions between two groups (P=0.005, P=0.009, and P=0.005 respectively). According to the results for the expression of CD26, there is a significant discrepancy between MF and LPP (P=0.019).

Conclusion
IHC staining for CD26 marker can be successfully used in combination with other known criteria to discriminate patchy MF than LPP with significant precision.
Solitary Cardiac Low-Grade Neuroendocrine Tumor: A Case Report and Review of the Literature
Authors: Kavesh M , Drew P , Stewart B 
Published: October 2020

Abstract

Introduction/Objective
Primary tumors of the heart are uncommon; even rarer are primary cardiac neuroendocrine tumors. To our knowledge, only two cases have been described to date, both being high-grade tumors. We report a solitary low-grade neuroendocrine tumor of the heart, unexpectedly discovered on the wall of the right ventricle in a 44-year-old man during aortic valve repair for infectious bacterial endocarditis.

Results
Frozen section was sent intraoperatively and showed a plasmacytoid neoplasm. Final pathology of the biopsies showed a tumor composed of both cohesive and discohesive plasmacytoid cells separated by a vascular network and strands of fibrosis. Neither necrosis nor a mitotic rate greater than 2 mitoses per 2 mm2 were seen. The tumor showed strong reactivity for AE1/3, synaptophysin and CDX2 with focal reactivity for chromogranin-A and CD56, confirming the diagnosis of a low-grade neuroendocrine tumor. Both an esophagogastroduodenoscopy and colonoscopy were performed and showed no evidence of a primary gastrointestinal tumor. PET-CT DOTATATE performed after complete resection of the tumor showed no abnormal radiotracer uptake. The possibility of an intestinal neuroendocrine tumor undetected by DOTATATE PET-CT with a single known metastasis to the heart was considered. This too, on the basis of the literature, was considered exceedingly rare. Complete resection of this patient’s tumor was considered sufficient treatment; the patient was advised to follow up annually with medical oncology.

Conclusion
The presentation and management of a solitary cardiac low-grade neuroendocrine tumor has not previously been described in the literature.
Gastric Adenocarcinoma with Enteroblastic Differentiation: A Rare Find
Authors: Kumar S , Jabbar K 
Published: October 2020

Abstract
Casestudy: Gastric adenocarcinoma with enteroblastic differentiation (GAED), also called clear cell gastric carcinoma, is a subtype of alpha-fetoprotein (AFP) producing adenocarcinoma. GAED is not a well-documented malignancy. Due to rarity, it is often skipped from the list of gastric adenocarcinoma subtypes. We report a case of Gastric adenocarcinoma with enteroblastic differentiation in a 69-year-old male, who had an endoscopy that revealed an ulcerated, circumferential, malignant-appearing mass at the distal esophagus. The patient then underwent proximal gastrectomy with distal esophagectomy. Received was a portion of the proximal stomach and distal esophagus. On gross examination, a 2.6 cm ulcerated mass was present at the gastroesophageal junction with white, friable, and focally necrotic cut surface. H&E stained slides demonstrated a malignant tumor composed of cuboidal to columnar neoplastic cells with clear cytoplasm and prominent nucleoli. The neoplastic cells were arranged in tubular, solid, and trabecular growth patterns. There were also areas of admixed conventional moderately differentiated adenocarcinoma with overlying glandular dysplasia and focal intestinal metaplasia. Immunohistochemical stains demonstrated tumor positivity for CDX2 (strong) and AFP (focal). Neuroendocrine markers were negative within the tumor. In Conclusion, GAED is a rare malignancy with distinctive clinicopathologic features and associated aggressive behavior. Morphology and immunohistochemical stains are helpful in making the diagnosis of this rare malignancy.
Primary Appendiceal Gastrointestinal Stromal Tumor: A Case of an Incidental Tumor
Authors: Balikani L 
Published: October 2020

Abstract

Introduction/Objective
Gastrointestinal stromal tumors (GISTs) are rare with an approximate prevalence of 2%. Though rare, they are the most common mesenchymal neoplasm of the gastrointestinal tract. They commonly occur in the stomach (50-60%), small intestine (20-30%), large intestine and esophagus (&lt;10%). GISTs arising in the appendix are very rare, with less than 20 cases reported in the English literature to date. The clinical presentation varies from appendicitis-like symptoms to incidental findings on imaging, during surgery for other diseases or at autopsy. The differential diagnosis of GIST from other stromal tumors is often difficult on hematoxylin and eosin (H&E) examination alone. The use of immunohistochemistry (IHC) plays a key role in confirming the diagnosis. GISTs can be graded based on a four-tier risk stratification system, including high, intermediate, low and very low risk, taking size tumor and mitotic activity into consideration. Most of the previously reported cases of primary appendiceal GIST were low or very low risk but one case of malignant GIST arising in the appendix has been reported.

Methods
We present the case of a 65-year-old male with a slightly thickened appendix and fluid in the distal aspect incidentally found on computer tomography (CT) scan for diverticulitis workup. An appendectomy with adequate was performed. The gross specimen revealed a 0.2-0.4 cm thick wall with no gross perforations or masses. Histologically, the tumor measured 0.8 cm and was composed of spindle cells with no nuclear atypia and absent to low mitotic activity. The IHC profile of the tumor was positive for CD117, DOG1 and CD34. A diagnosis of Gastrointestinal stromal tumor, low grade was rendered.

Conclusion
We endeavor to highlight the importance of considering GIST in the differential diagnosis in patients with nonspecific symptoms and/or atypical image findings of the appendix especially in ruling out a possible malignant GIST.
EBV+ Inflammatory Pseudotumor-like Follicular/Fibroblastic Dendritic Cell Sarcoma: An Uncommon and Challenging Tumor
Authors: Bharadwaj H , Freeman J 
Published: October 2020

Abstract
Casestudy: Inflammatory pseudotumor-like follicular/fibroblastic dendritic cell sarcoma (IP-L FDC/FRC) is a rare dendritic cell neoplasm recognized as a specific entity in the WHO classification of tumors of the hematopoietic and lymphoid tissues. The tumor has specific clinical features, including a predominance in young to middle-aged women typically involving the liver or spleen, with neoplastic cells typically positive for Epstein-Barr virus.
Morphologically, the tumor poses a diagnostic challenge to distinguish it from inflammatory pseudotumor and inflammatory myofibroblastic tumor, with which it shares considerable morphologic and immunohistochemical overlap. We present a case report of a 35-year-old female who presented with weight loss, malaise, and intraabdominal mass. MRI revealed a 14 cm large ovoid solid mass with central hemorrhage and necrosis. Biopsy and subsequent resection of the tumor confirmed IP-L FDC/FRC sarcoma. Histologically, the tumor was composed of spindle cells admixed with many lymphocytes and prominent plasma cells. Immunohistochemical stains showed neoplastic spindle cells focally positive for dendritic cell markers CD21, CD23, and CD35, diffuse positivity for SMA, and striking in situ hybridization for Epstein-Barr virus (EBER). Due to its rarity, biologic behavior and outcomes are not well established. The tumors are generally regarded as indolent with a risk of repeated intraabdominal recurrence, although recurrences may be related to the ease and completeness of surgical resection. It is essential to distinguish this tumor from other high- grade sarcomas with greater metastatic potential and overall worse prognosis.
Primary Amyloidosis
Authors: Bhuyan R , Tran T T , Mc Phaul L , Liu Y 
Published: October 2020

Abstract

Introduction/Objective
Amyloid light chain (AL) results from the deposition of immunoglobulin light chain fragments, and can lead to dysfunction in multiple organs. Our patient was being investigated for unknown malignancy with high differential for plasma cell neoplasm for severe amyloidosis leading to renal failure, uncontrolled ascites and thickening of the skin. The patient died of progressive liver and renal failure. Our autopsy findings show severe amyloidosis deposition in spleen, heart, kidney and liver with no significant plasma cells in the bone marrow, the findings correlate with a rare condition of primary AL amyloidosis.

Methods
63 years old man with no past medical history presenting with progressive leg swelling with 15 pounds weight loss. He was admitted to another hospital a month ago. Patient was a smoker with a pack in 2-3 days for 38 years, occasional alcohol intake with no history of heavy alcohol use and no drug use. The patient worked as a chef and lived with his wife. Physical examination shows temporal wasting with cachecxia, had difficulty in staying upright and wanting to sleep when presented to the emergency department. Physical examination was significant for decreased breath sound bilaterally, more on left side, central weakness noted given difficultly sitting upright from laying down flat. Also, there were some lymphadenopathy in the jugular digastric region. Laboratory showed an increase elevation in alkaline phosphatase to the 1000s along with elevated LDL to 300s, nephrotic range proteinuria. Chest X-ray showed left pleural effusion and CT chest and abdomen showed slight hepatosplenomegaly with hypoattenuation and focal calcification. Autopsy finding indicated heavy spleen (260 grams) with a stiff and hard texture. Liver weighs in upper limit of normal (1660 grams) with a yellow firm surface. There is significant amyloid deposition in spleen. Also, moderate amyloid deposition was seen in all the organs including liver, kidney, heart and, also in the skin. No definite lesion was seen in the gross, nor cancer cells found in the microscopy examination. Bone marrow examination did not reveal plasma cells, ruling out the possibility of multiple myeloma or plasma cell dyscrasia.

Conclusion
This is a rare case of AL primary amyloidosis with aggressive progression and poor prognosis not associated with plasma cell neoplasm.
Simple And Cost-Effective Classics Are Back- Revisiting The Role Of Urine Microscopic Analysis For Assessing Severity Of Renal Involvement In Lupus Nephritis
Authors: Venkataraman S , Murari M , Agrawal V , Pandey R , Aggarwal A 
Published: October 2020

Abstract

Casestudy
Urinalysis is important to assess disease activity in Lupus nephritis (LN). Hematuria, pyuria, cellular/granular casts and proteinuria are scored separately for assessing renal activity in SLEDAI. However, pyuria is not specific, and could indicate infection. We studied the correlation of microscopic urinalysis and degree of lymphocyturia with histological ISN/RPS 2018 class of LN.

Methods
Pre-biopsy urine was collected in 76 LN patients. The urine sediment was analyzed using light and phase- contrast microscope. Smear stained with supravital stain Sternheimer Malbin, was assessed semi-quantitatively for lymphocytes (per HPF). Renal biopsy was classified into proliferative (Class III/IV ± V)[N=64] and non-proliferative LN (Class I, II, V, VI) [N=12].

Results
48 patients had active urinary sediment. Cellular and/or granular casts were identified only in proliferativeLN (n=15/64; 23.4%). Hematuria (Range 0-65/HPF) was seen in 45 patients. Dysmorphic RBCs were identified in proliferative (n=17/41; mean 9.9 RBCs/HPF) and were absent in non-proliferative LN (mean 1.4 RBCs/HPF). 20 of the 34 patients with pyuria showed predominant lymphocytes. Lymphocyturia (Range 0-20/HPF) was significantly higher in proliferative LN (Mean 4.6/HPF) as compared to non-proliferative LN (Mean 1.5/HPF). Degree of pyuria or proteinuria had no correlation with biopsy class or activity. Lymphocyturia and hematuria showed correlation with biopsy activity index (r=0.30 and 0.39; p&lt;0.05 and &lt;0.001 respectively). A cut-off of average 6 RBCs/HPF or 5 lymphocytes/HPF could correctly identify proliferative LN with 100% specificity (p&lt;0.001; AUC 0.72 and 0.74 respectively, combined AUC 0.81) and sensitivity of 0.42 and 0.36 respectively.

Conclusion
Although renal biopsy is the gold standard for assessment of renal lesions in LN, urine lymphocytes ≥5 and RBCs ≥6/HPF have a high specificity to differentiate proliferative and non-proliferative LN. This may be especially important in patients having comorbidities contraindicating a renal biopsy. Defining urine sediments using lymphocytes can increase the specificity of clinical activity indices.
Qualification of a 17β-estradiol (E2) Assay in Sprague Dawley Rat Serum
Authors: Martin J A , Figueiredo J , Wang L 
Published: October 2020

Abstract

Introduction/Objective
Significant technical issues are associated with methods used for the measurement of estradiol.The objective of this study was to qualify an electrochemiluminescent (ECL) assay for the quantification of 17β-estradiol (E2) in rat serum. Hemolysis has been identified as a factor that interferes with accurate measurement.The impact of hemolysis was also assessed.

Methods
Approximately 1.0 mL of whole blood was collected from male and female rats into separate red top tubes and processed to serum.
The LoQ for E2 was evaluated by analyzing the low calibrator or at least 6 serum samples diluted to produce a value at the low end of the reportable range 8 times in the same run.The mean, standard deviation, and %CV were calculated for each sample.The data set was analyzed by plotting the data and determining the concentration at the intersection of the precision profile curve.
Linearity of dilution was performed using commercially available calibration verification material and E2 stripped rat serum.The correlation coefficient, the slope, and the % Nominal were calculated.
Intra assay precision was evaluated by analyzing 8 consecutive times in a single run one rat serum sample that was not diluted or spiked. This analysis was performed during the evaluation of the LoQ.The mean, SD and %CV were calculated.
The interference of hemolysis with the E2 assay was tested by analyzing at least 5 rat serum samples/pools spiked with hemolyzed rat serum at different hemoglobin concentrations.The %RE was calculated.

Results
The LoQ assays were acceptable. For all samples tested, the % CV was less than or equal to 25%.The LoQ was verified to be 8.50 pg/mL. The %CV was 15.6%. For samples with estradiol concentrations below the LoQ, a value of 4.25 pg/ml was reported.
Linearity of dilution for E2 was acceptable.The correlation coefficients were greater than or equal to 0.9000, the slopes were between 0.7500 and 1.2500, and the % nominals for each level were between 75-125%.
The intra-assay precision was considered acceptable with a %CV of 8.6%.
There was no hemolysis interference in the assay when samples were spiked with hemoglobin concentrations of up to 70 mg/dL, based on the %RE of less than or equal to 25% of non-hemolyzed samples.

Conclusion
Qualification of the ECL method, demonstrates the assay is suitable for the determination of E2 in serum samples from rats and absence of hemolysis interference up to 70 mg/dL of hemoglobin concentration.
Serum Folate of Less than 7.0 ng/mL is a Marker of Malnutrition
Authors: Mattox S N , Kozman D , Singh G 
Published: October 2020

Abstract

Introduction/Objective
To identify clinical/laboratory factors associated with folate deficiency in tertiary care patients.

Methods
We reviewed the medical records of 1019 patients with serum folate &lt;7.0 ng/mL, 301 patients with serum folate of 15 ng/mL, and 300 patients with serum folate &gt; 23 ng/mL.

Results
Serum prealbumin levels were subnormal in 54.8% of patients with serum folate &lt;7.0 ng/mL. Vitamin B12, hemoglobin, and serum albumin levels were significantly lower in the &lt;7.0 ng/mL folate group. In 62.4% of patients with serum folate &lt;7.0 ng/mL, 1 or more markers of malnutrition were present. The low-folate group had a significantly higher prevalence of gastrointestinal (GI) disorders, sepsis, and abnormal serum creatinine level. There were no significant differences in the 2 groups regarding diabetes; behavioral/neurological disorders, including drug and alcohol abuse; bariatric surgery; or a diagnosis of malnutrition. The average body mass index (BMI) for the &lt;7.0 ng/mL and 15 ng/mL folate groups was significantly different (28.89 and 28.31, respectively), although the difference does not appear to be clinically meaningful.

Conclusion
The prevalence of folate deficiency depends on what is considered a normal serum folate level. Approximately 10% of tertiary care patients have levels &lt;7.0 ng/mL and exhibit other markers of malnutrition. It is recommended that patients with GI disorders, chronic kidney disease, and sepsis be routinely tested for serum folate levels, before administration of vitamin supplements. Patients with serum folate levels &lt;7.0 ng/mL should be evaluated for malnutrition, despite BMI &gt; 25. Folate supplementation should be administered only after excluding coexisting vitamin B12 deficiency.
Changes In Prothrombin And Activated Partial Thromboplastin Time During Replacement Therapy With Human Recombinant Growth Hormone In Growth Hormone Deficient Adults
Authors: Kamel Y S 
Published: October 2020

Abstract

Introduction/Objective
The aim of this study was to investigate the effects of GH administration on basic coagulation parameters: PT, aPTT and fibrinogen concentrations in adult GHD patients before and during one year of GH replacement.

Methods
Twenty-one adult patients with severe GHD (mean age +/- SE: 38.6 +/- 2.8 years) were included in this hospital based, prospective, interventional study. All patients were treated with rhGH for 12 months (GH dose: 0.4 mg/day for male and 0.6 mg/day for female patients). IGF-1 concentrations were determined using RIA-INEP kits. Basic coagulation tests, i.e. aPTT and fibrinogen concentrations, were measured before and after 3, 6 and 12 months of treatment with rhGH. Control values were obtained from fourteen “healthy” subjects matched by age, sex and body mass index (BMI).

Results
At baseline, we observed no significant differences in PT, aPTT and fibrinogen values between GHD and healthy subjects. IGF-1 concentrations increased significantly within 3 months of GH therapy (8.2 +/- 1.5 vs. 24.2 +/- 2.9 nmol/l, p &lt;0.05) and remained stable thereafter. A significant increase in PT values, which was more pronounced in female subjects, was noted after 6 and 12 months of treatment with GH. aPTT values increased significantly after 12 months of treatment only in male patients (28.8 +/- 4.6 vs. 39.7 +/- 2.1 s.; p &lt;0.05). No significant changes in fibrinogen concentrations were found during the study.

Conclusion
Twelve months of GH replacement therapy led to a significant increase in PT and aPTT values in adult GHD patients, while fibrinogen concentrations did not change. Changes in PT were more pronounced in female GHD patients, while an increase in aPTT values was observed only in male patients with GHD. The clinical significance of these changes needs further evaluation.