bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPV 16/18/45 Are Not The Most Frequent Genotypes In Women Of African-American Descent: Analysis In Cervical Pap Smears Of Women In An Inner-City Hospital
Authors: Dababneh M , Birdsong G , Mosunjac M , Krishnamurti U 
Published: October 2020

Abstract

Introduction/Objective
HPV-driven cervical cancer is one of the leading causes of cancer-related deaths in women. More African American (AA) and Hispanic women are reported to get HPV-associated cervical cancer than women of other ethnicities, possibly because of decreased access to testing or treatment. High variation has been reported in the attribution of specific HPV genotypes among various ethnicities and races. Here we report the distribution of high- risk (HR) HPV genotypes in an inner-city hospital that primarily serves an AA population.

Methods
Genotyping of HR-HPV+ (encompassing 14 genotypes) cervical cytology specimens commenced in October 2018 at our institution. The presence of genotypes 16, and 18/45 (combined) are separately reported; 11 other high-risk genotypes are pooled in cases that were HR-HPV+. The HR-HPV and HPV genotyping assays were performed by the Aptima method (Hologic, Inc.) Distribution of HPV genotypes by the Bethesda diagnostic categories for the period October 2018 to March 31, 2020 was evaluated.

Results
A total of 13,160 cervical Pap smear cases were screened, and 10,060 cases were tested for HR-HPV. HR- HPV positive rate was 14% (1412/10060), of which 78% were in African Americans (AA), 14% in Hispanics, 4% in Caucasians, and 4% in others. HPV genotyping results were available for 1136 of the HR-HPV + cases. The cytology diagnoses (n) with their corresponding HPV genotyping results and distribution (HPV16, HPV18/45, and other HPVs), respectively, are as follows: NILM (270), 3.7%, 5.9%, and 90.4%; ASCUS (415), 8.2%, 6.8%, and 84.8%; LSIL (247), 8.1%, 13.0%, and 78.1%; ASCH (100), 18.0%, 13.0%, and 67.0%; HSIL (74), 20.3%, 14.9%, and 60.8%; AGC (30), 6.66%, 3.33%, and 90.0%, respectively. Co-infection with both HPV 16 and HPV 18/45 was seen in only 0.7% of all cases (4.0% of HSIL).

Conclusion
Overall, the HR-HPV positive rate was 14.0%. HPV 16/18/45 positivity accounts for ~18% of all HR-HPV positive cases. HPV 16/18/45 positivity is lowest in Pap-negative cases (9.6%) and highest in cases with HSIL (39.2%). Co-infection with HPV 16 as well as 18/45 is rare. This study highlights that in women of AA descent, it is not HPV genotypes 16/18/45 but other HPV genotypes that are more frequent.
Pancreatic/Peripancreatic Spindle Cell Lesions Cytology: A 15-Year Review
Authors: Aldrees R , Rosenblum F , Eltoum I 
Published: October 2020

Abstract

Introduction/Objective
Spindle cell lesions (SCL) are diagnostically challenging, especially on cytology specimens where entities have overlapping features. Neoplastic and non-neoplastic SCL are uncommonly encountered in the pancreas/peripancreatic tissue. The sensitivity and specificity of EUS-FNA of pancreatic lesions both approach 95%. In this study, we assess the frequency of SCL found in pancreas/peripancreatic tissue on cytology specimens, the frequency of performing IHC stains and the most useful IHC panels. We also evaluate histology-cytology discrepancies and pitfalls.

Methods
A retrospective analysis of all pancreas/peripancreatic cytology specimen results between January 2004 - August 2019 was conducted. A total of 5,132 cases were identified. The number of spindle cell lesions was 27 (0.52%), with surgical pathology results available for 15 cases (55%). IHC stains were performed on 18 cell blocks (66%) and 9 surgical pathology specimens (60%).

Results
Of the 27 SCL identified, 22 lesions were neoplastic (81%), and 5 lesions were non-neoplastic (19%). The Neoplastic cases were: 10 GISTs (37%), 4 spindle cell lesions, NOS (14.8%), 2 metastatic sarcomas (7.4%), 1 pheochromocytoma (3.7%), 1 leiomyoma (3.7%), 1 schwannoma (3.7%), 1 malignant fibrous histiocytoma (3.7%), 1 granular cell tumor (3.7%), and 1 neuroendocrine carcinoma (3.7%). Of the neoplastic cases, 10 were lesions originating in a different organ with direct extension/distant metastasis to the pancreas (71%), with the most common organ being the stomach, 6 cases (60%). The non-neoplastic cases were: 4 granulomas (14.8%), and 1 accessory spleen (3.7%). IHC stains were performed on 18 cell blocks (66%), and attempted unsuccessfully on 2 cell blocks.
The most commonly utilized stains were: CD117, 15 cases (83%), SMA, 11 cases (61%), S-100, 9 cases (50%), CD34, 5 cases (27%) and Cytokeratin, 5 cases (27%). IHC stains assisted with proper classification in 9 cytology cases (50%). There was one interpretation error*, and the histology-cytology discrepancy rate was 6%.

Conclusion
Pancreatic and peripancreatic spindle cell lesions are uncommon (520/100,000), and are particularly challenging on cytology specimens. If neoplastic, the majority originate in an organ other than the pancreas. If non- neoplastic, the majority are granulomas. Immunohistochemical staining is required for proper classification. And in this small series, cytology is highly accurate for diagnosis (96%).
A Case Series Describing The Cytomorphology And Clinical Features Of Follicular Dendritic Cell Sarcoma
Authors: Bailey C A , Weimholt R C 
Published: October 2020

Abstract

Introduction/Objective
Follicular dendritic cell sarcoma (FDCS) is the malignant counterpart of the germinal center follicular dendritic cell. Cytomorphological descriptions are few, with only 24 prior cytology reports from 22 publications. We present 4 cases with the aim of adding to this small body of literature.

Methods
Our database was searched for “dendritic cell.” Patients diagnosed with FDCS that had a cytology specimen were included. Clinical and cytologic features were tabulated.

Results
Case 1 was an 87-year-old man with a retroperitoneal mass. Aspiration rendered a new diagnosis of FDCS, supported cell block immunohistochemistry. Case 2 was an aspiration of metastatic FDCS to the lung in a 40 year-old- man with a known neck primary. Case 3 was a 46-year-old-man with a left neck mass. Aspiration rendered a misdiagnosis of “atypical epithelioid cells in a background of granulomatous inflammation”. Subsequent needle biopsy confirmed FDCS. Case 4 was an aspiration of metastatic FDCS to the liver in a 66 year-old-woman with a known splenic primary. Comparison of cytomorphology show identical features in all cases. Smears were hypercellular and composed of variably sized syncytial aggregates as well as individually dispersed cells. Tumor cells were variably epithelioid to spindled, had fine chromatin and small nucleoli, displayed frequent bi- and multinucleated forms, and had abundant pale cytoplasm with long, slender fibrillar processes. All cases demonstrated many small lymphocytes intermixed both within the syncytial aggregates and dispersed in the background.

Conclusion
Cytomorphological features of FDCS appear conserved from case to case. Knowledge of these features may aid in its recognition in aspiration material.
Efficacy of HLA-compatible Platelet Transfusion for Patients with Acute Myeloid Leukemia Refractory to Platelet Transfusion
Authors: Tsai T , Perez-Alvarez I , Woo J , Tran M 
Published: October 2020

Abstract

Introduction/Objective
Acute myeloid leukemia (AML) patients often require transfusion support during induction chemotherapy. Platelet transfusion refractoriness (PTR) may develop due to HLA alloimmunization. Management of immune-refractory patients with HLA-compatible platelet transfusions is labor intensive and associated with increased costs. The purpose of this study is to evaluate the efficacy of HLA-compatible platelet units in AML patients.

Methods
Newly diagnosed AML patients undergoing induction chemotherapy in our institute between 2015 and 2018 were identified. Platelet counts and platelet transfusion data from initiation of chemotherapy until platelet recovery (&gt; 20K/µL and increased consistently) were extracted. A 24-hour posttransfusion corrected count increment (CCI) was calculated to evaluate the efficacy of each platelet transfusion. PTR was declared if a patient had a 24-hour CCI &lt; 4K following two consecutive transfusions. Student’s t-test was used for statistical analysis. Results were presented as mean ± SE, * if p &lt; 0.05.

Results
We identified 39 patients with newly diagnosed AML. PTR developed in 22/39 (56%) patients during induction chemotherapy. The average CCI was higher among those without PTR compared to those with PTR (8,408 ± 585 vs. 2,923 ± 360*), and overall platelet transfusion burden (in number of units) was lower (7.29 ± 1.0 vs. 18.55 ± 1.71*). HLA antibodies were identified in 3/22 (14%) PTR patients, as 6/22 (27%) were tested. The average CCI during HLA matched transfusions for these 3 patients was higher than that with random units (2,059 ± 149 vs. -126 ± 306*). Compared to HLA-negative PTR patients receiving random units, the average CCI for HLA-compatible transfusions was still lower, though not significantly (2,059 ± 149 vs. 3,099 ± 390, p = 0.33), while the number of HLA- compatible units transfused was significantly higher (31.0 ± 3.0 vs. 16.6 ± 1.45*).

Conclusion
In a cohort of newly diagnosed AML patients undergoing induction chemotherapy whose PTR was associated with detectable HLA antibodies, transfusion support with HLA-matched products did not lead to reduced overall platelet transfusion rates and CCI remains in the refractory range. This suggests that use of HLA matched platelets among newly diagnosed AML patients with PTR, even in the setting of detectable HLA antibodies, does not appear to result in reduced overall product utilization.
The Rare First Manifestation Of Mantle Cell Lymphoma As Immune Complex Glomerulonephritis With Crescents And Membranoproliferative Features
Authors: Dehghani A , Wang D , Alshal M , Wieczorek R , Gosmanova E , Der Mesropian P 
Published: October 2020

Abstract

Introduction/Objective
Initial presentation of Non-Hodgkin Lymphoma (NHL) with immune complex glomerulonephritis (ICGN) is rare. Mantle cell lymphoma (MCL) is a rare aggressive lymphoma comprising 3–7 % of all NHL and ICGN as the first manifestation of MCL is very unusual.

Methods
We report a 73 year-old-man with increased serum creatinine (2.1 mg/dl) from normal baseline 3 months ago. Urinalysis showed the presence of dysmorphic RBCs, RBC casts and 300 mg/dl of protein. Physical examination revealed diffuse lymphadenopathy. Hepatitis C and B Ab, HIV screen, ANA, ANCA, Anti dsDNA Ab, Anti GBM Ab, and Serum protein electrophoresis were normal or negative.

Results
The renal biopsy showed Immune complex glomerulonephritis with (25%) fibrocellular/cellular crescents and focal membranoproliferative (MPGN) features. There were foci of dense monomorphic lymphoid aggregates of small lymphocytes and 30% interstitial fibrosis with corresponding tubular atrophy. No tubulitis was present. Direct Immunofluorescence showed 2+ to 4+ granular mesangial and capillary loop staining for Total Ig, IgG, IgA, IgM, C1q, C3 and C4. The lymphoid aggregate was monoclonal Kappa. Electron microscopy showed widespread podocyte foot process effacement, subendothelial and rare mesangial dense deposits. Excisional lymph node biopsy flow cytometry showed a monoclonal population of CD19+, CD20+, CD22+, CD5+, skappa-restricted, CD10-, CD11c-, CD23-, CD25- CD38-, CD103-, CD200- B- cells. Cyclin D1 was positive on immunostain, consistent with stage IV (renal) MCL. He received chemotherapy with steroids, bendamustine, and rituximab leading to resolution of lymphadenopathy and proteinuria and improvement in serum creatinine.

Conclusion
It is important to recognize that the first manifestation of MCL may present as renal involvement in the form of ICGN and, as in this case, with fibrocellular/cellular crescents and a focal MPGN pattern. This is an extremely rare, but important, cause of renal insufficiency that can be successfully treated with lymphoma chemotherapy.
Non-Acute Myeloid Neoplasms With CD34(-) Blasts: Immunophenotypic And Clinical Analysis Of 5 Cases
Authors: Shponka V , Kroft S , Harrington A M , Monahan K , Atallah E 
Published: October 2020

Abstract

Introduction/Objective
Non-acute myeloid neoplasms (NAMNs) comprise clonal hematopoietic disorders, characterized by ≤20% myeloblasts in the peripheral blood (PB) and/or bone marrow (BM). The blasts of NAMN are almost exclusively CD34(+), contrasting with blasts in some acute myeloid leukemias (AML). We detail the clinicopathologic features of NAMN with CD34(-) blasts.

Methods
We searched 981 NAMN pathology reports for CD34(-) blasts by flow cytometry (FC). 8-color FC data was analyzed using cluster analysis to identify all relevant cell populations with a comprehensive antibody panel. CD34(-) blast populations were defined as reproducible clusters with similar light scatter properties across antibody tubes, after exclusion of other cell populations (e.g. basophils, neutrophils, mast cells). Blast aberrancies were defined as differences from established normal antigen expression patterns. PB and BM morphology was reviewed and chart reviews were performed.

Results
We identified 5 NAMN patients with CD34(-) blasts (2M, 3F; 57-84y/o) including 3 myelodysplastic syndrome (MDSs) with excess blasts, 1 therapy-related MDS, and 1 chronic myelomonocytic leukemia-1 (CMML). Blasts ranged from 0-1.5% in PB and 2.8-8% in BM. CD34(-) blasts accounted for 0.85-8.2% of BM events by FC, with all showing other aberrancies. The CMML patient had CD34(-) blasts with monocytic differentiation; all other CD34(-) blast populations showed expression of CD13, CD33, and CD117 and aberrant under-expression of CD38. Aberrancies were also present in the CD34(+) blasts in all patients (1-4/patient), accounting for 0.01-0.55% of events; 3/5 pts had under-expression of CD33, CD38, CD45, and/or HLA-DR. No cases had adverse cytogenetics. Patient outcomes included: indolent disease (1); died from disease 3 years post-diagnosis and chemotherapy (1); transformed to AML (2; 1-alive in complete remission; 1-died); and alive following allogeneic stem cell transplant (1).

Conclusion
Our data confirm that CD34(-) blasts are rarely observed in NAMN, and these patients have variable outcomes. Interestingly, all cases showed a concomitant aberrant CD34(+) blast population.
Biological Factors Affecting Thrombocytopenia In Hepatitis C Infected Patients
Authors: Bhuyan R , Tiburcio J 
Published: October 2020

Abstract

Introduction/Objective
Thrombocytopenia is one of the major extra-hepatic manifestations of Hepatitis C virus (HCV) infection. There are numerous studies suggesting several pathophysiology mechanisms explaining the association of thrombocytopenia with HCV infection; however occasional presence of thrombocytopenia with normal liver function, or presence of significance hepatic damage with normal platelet count has not been well explained. Biological factors, such as ethnicity, age, smoking status and gender have been suggested as the probable causes, but not enough studies exist showing such predispositions. The goal of this study is to evaluate the association of degree of thrombocytopenia with liver function abnormalities in different ethnicity in HCV infected patients.

Methods
Forty -five patients with thrombocytopenia and HCV infection were included. Data was collected on ALT level, ethnicity, platelet count, and liner regression study was performed. Clinical predictors included in the analysis were age, gender, liver fibrosis stage, smoking status and ALT level. Results: Severe thrombocytopenia (&lt;80,000) is associated with severity of liver function. Moderate and mild thrombocytopenia does not depend on liver function abnormalities. Moreover, there is an increases incidence of moderate and severe thrombocytopenia among Hispanics Latinas. Also, the incidence of mild thrombocytopenia (&gt;110,000/ µL) is not significantly different among people of different ethnicity infected with HCV.

Results
Our study suggests that chronic HCV infection is associated with variable degree on thrombocytopenia., and only severe thrombocytopenia (platelet count &lt; 80,000/ µL) can be explained by liver function abnormalities.

Conclusion
As liver disease advances, platelet count decreases only in patients with platelet count is below 80,000 / µL and, it is more prominent in Hispanic/Latina population.
Improvement on the Use of 3-aminopropyltriethoxysilane and Poly-L-lysine Coated Slides for Immunohistochemical Staining of Lifting Tissue Sections
Authors: Iyiola S , Aremu O , Onifade J A 
Published: October 2020

Abstract

Introduction/Objective
Lifting of tissue section during antigen retrieval occasionally occur most especially with the brain tissue. therefore, this work seeks to provide solution on how to use locally charged 3-aminopropyltriethoxysilane (APES) and poly-l-lysine coated slides for brain immunohistochemistry (IHC).

Methods
This laboratory experimental control study was carried out in Obafemi Awolowo University Teaching Hospital Complex, Nigeria owing to section lifting associated with our brain tissue during IHC. Two tissue blocks of lifting brain section were cut at 5um. 30 sections were cut from each block. 10 sections from each block were floated onto APES coated slides, poly-l-lysine and superfrost plus. The sections were allowed to stand for two hours before putting them on hot plate at 370C overnight. The slides were arranged on 4 slide carrier containing 15 slides from each block, 5 slides from each group. The slides were dewaxed and hydrated to distilled water. Then, a set of 15 slides in a carrier from each block was allowed to air dry under ceiling fan on hot plates at 30OC until no traces of water was found on them. All the slides were then subjected to heat mediated antigen retrieval protocol using citrate buffer solution. Three slides from each block consisting of a non-post hydration air dried tissue section on superfrost plus as a control, post hydration air dried tissue section from APES and poly-l-lysine were stained with GFAP.

Results
All the sections on superfrost plus did not lift. All the post hydration air dried tissue sections on locally charged slides did not lift. Approximately one tissue section from non-air dried post hydration locally charged slides did not lift. There was no difference in the staining pattern of GFAP on all the tissue sections.

Conclusion
We propose that air dried tissue section after dewax and hydration could be used for GFAP study, most especially in a population that cannot afford commercially charged slides.
Innovating With the Times: Pathology Education in Context of Physician Burnout
Authors: Saxena R , Crum R , Moore N , Warha S 
Published: October 2020

Abstract

Introduction/Objective
Learning a boundless volume of information, preparing for multiple exams, and getting involved in several other academic activities are just a few things that the current medical students need to tackle in a finite duration. While these challenges encourage learners to be their best, and prepare them for their careers as future physicians, they can also result in a largely unnoticed issue — burnout. Curricular reform targeted at developing skills to mitigate burnout is the need of the hour. To combat this issue in the pathology classroom, we used our tried and tested strategy of algorithms in combination with fun activities, particularly keyword mnemonics, to evaluate the impact on reducing burnout in medical students.

Methods
Lectures were delivered and recorded for students of semester 4 and 5, and sample algorithms and mnemonics were included. We also used pathophysiology case sessions comprising clinical vignettes and questions. Students were divided into small groups to solve questions and had to frame their own algorithms and mnemonics to help them. The method’s effectiveness was assessed using performance in past and current exams. Feedback was performed to gauge students’ perceptions

Results
Feedback evaluation showed that 86% of students indicated that algorithms and mnemonics not only strengthened the rote memory but also helped lessen the stress during exam preparation. 59% of students expressed that teamwork made it easier and fun to work. Almost 11% felt that mnemonics should be included as part of new lectures but they found it difficult and ineffective to make their own. Further assessment will be performed to analyze the strategy’s impact on burnout.

Conclusion
Classroom traditions that encourage shared problem-solving and decision-making leads to reduced burnout rates among medical students, with the added benefit of enhanced retention of complicated material and improved clinical correlation capabilities. The relationship between stress and memory is well-documented, and feedback revealed that this technique helped alleviate negative stress on the students. Our project underlines the essence of research studies to minimize burnout in medical students, for design and development of future interventions to prevent burnout at the outset in the training of future physicians.
Nonconcordance of E, N, and RdRp Genes in SARS-Coronavirus-2 Nucleic Acid Amplification Test Among Patients Older than 60 Years
Authors: Caulkins H , Rand K , Harris N , Beal S 
Published: October 2020

Abstract

Introduction/Objective
During the COVID-19 pandemic, the FDA authorized emergency use of nucleic acid amplification (NAA) testing. Accurate and rapid testing identifies infected persons, especially among at-risk populations. In our institution, the InGenius platform detects three gene targets of SARS-Coronavirus-2: envelope (E), nucleocapsid (N), and RNA-dependent RNA polymerase (RdRp). Nonconcordance of these components present accuracy or precision errors or may correspond to varying expression of viral genes with disease progression.

Methods
We retrospectively analyzed the result components from 93 nasopharyngeal swabs from 50 patients older than 60 years and positive for SARS-Coronavirus-2 (SARS-CoV-2). The symptom onset date was determined by chart review.

Results
We found a significant 26% nonconcordance rate, with a predominant pattern demonstrating positive N with negative RdRp and E (χ2 = 27.25, P &lt; 0.0005). This nonconcordant pattern was more prevalent at longer symptom durations. In 7 patients with serial testing, the transition from concordant to nonconcordant results occurred 12 days (95% CI 3.5 – 20.3 days) after symptom onset.

Conclusion
This may be caused by several mechanisms. Possibilities include decreased expression of E and RdRp over time, inhibition of expression by treatments or host immune response, or lower viral titers by clearance or migration to the lower respiratory tract. Presence of a different viral strain or systematic processing errors are less likely causes of nonconcordance. Future directions of study would determine whether a similar decline in RdRp and E detection is seen in tracheal samples or if this correlates with changes in symptom severity.