bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of CD200 in the Detection of Nonhematologic Neoplasms by Routine Flow Cytometry Analysis
Authors: Laakman Joseph , Holman Carol 
Published: October 2021

Abstract

Objectives
While flow cytometry is routinely used in the diagnostic work-up of hematolymphoid malignancies, its role in identifying non-hematolymphoid neoplasms is controversial. While a diagnosis of “non-hematolymphoid process” may be suggested by flow cytometry, typically, CD45-negative entities are not further characterized by their immunophenotypic profile. Some markers, such as CD56, have been well documented in non-hematolymphoid malignancies, such as high-grade neuroendocrine carcinomas (Stacchini, et al, 2018; Bryson et al, 2002). Other cell surface markers that are routinely studied with flow cytometry panels, such as CD200, are less well-described in the literature with regards to their presence/absence in non-hematolymphoid processes. We examined all flow cytometry cases from our institution over a 5-year period to identify trends in the immunophenotypes of non-hematolymphoid malignancies that were known to be CD45-negative and CD56-positive by flow cytometry.

Methods
We examined 3634 flow cytometry cases (2015-2020) and identified non-hematolymphoid cases based upon lack of CD45 expression. After excluding multiple myeloma cases from the CD45-negative entities, we were left with 19 CD45-negative cases. Chart review of these cases confirmed them as non-hematolymphoid by concurrent surgical pathology/cytopathology studies. Of these 19 cases, 2 were excluded because CD56 was not evaluated.

Results
Of the 17 CD45-negative/CD56-positive cases, 16 showed CD200 positivity (94%). Of these CD200-positive cases, 10 were ultimately diagnosed as small cell carcinoma (59%), 1 was diagnosed as Merkel cell carcinoma (6%), 1 was diagnosed as melanoma (6%), 1 was diagnosed as poorly-differentiated carcinoma (6%), 1 was diagnosed as Ewing-like sarcoma (6%), and 2 were unclassified further (12%). The single CD200-negative case was diagnosed as poorly-differentiated acinar cell carcinoma (6%). All cases of small cell carcinoma that were evaluated by flow cytometry showed expression of CD200 and CD56.

Conclusions
Our findings suggest that in CD45-negative/CD56-positive non-hematolymphoid malignancies, particularly small cell carcinoma, CD200 is frequently positive. CD200 was also found to be positive in rare cases of other non-hematolymphoid malignancies within the differential diagnosis of small round blue cell tumors. These findings indicate that CD200 may be a useful marker in suggesting the possibility of small cell carcinoma in non-hematolymphoid specimens that are evaluated by flow cytometry.
Limited diagnostic utility of SARS-CoV-2 serologic testing in symptomatic PCR negative patients
Authors: Tawiah Kwaku , Hock Karl , Farnsworth Christopher 
Published: October 2021

Abstract

Background
Guidelines from the CDC and the IDSA suggest the use of serologic testing to support the diagnosis of COVID-19 in individuals with high clinical suspicion that repeatedly test negative by diagnostic methods. Given that variability in specimen type, collection technique, and time from symptoms all reduce the sensitivity of molecular methods for SARS-CoV-2. The routine use of serology to diagnose and manage patients with symptoms concerning COVID-19 is tempting, despite limited studies in the literature supporting this approach. Here, we assessed the utility of serology testing for diagnosing SARs-CoV-2 in symptomatic, PCR-negative patients.

Methods
Remnant EDTA plasma specimens were obtained from 393 patients with clinical suspicion for COVID-19 and a negative SARs-COV-2 RNA test by the nasopharyngeal swab. The specimens were analyzed for SARs-CoV-2 IgG on an Abbott Architect i2000 (Abbott diagnostic). Patient information and symptoms adjudication were obtained from patient electronic health records.

Results
14 of 393 patients were positive for antibodies to SARS-CoV-2 (seropositivity rate of 3.6%), 6 of which were from patients with previous RT-PCR-confirmed COVID-19 infection. Among patients without previously diagnosed COVID-19, the seropositivity rate in symptomatic patients was 1.2% (2/171), in patients with altered mental status was 4.3% (2/46), and in asymptomatic patients with no known previous COVID-19 diagnoses was 2.6% (4/170). The seropositivity rate among symptomatic patients presenting ≥ 14 days after symptom onset was 0% (0/67), 7-13 days was 5% (1/20), and for patients &lt; 7 days, was 2.1% (1/47). Among the 4 patients with AMS that were serologically positive, 2 were previously diagnosed by PCR.

Conclusion
There is a low diagnostic utility of SARS-COV-2 serological testing for identifying novel cases of acute SARS-CoV-2 infections in the ED after a negative PCR test.
Frequency and Clinical Significance of Negative Anion Gap Values in an Academic Medical Center Population
Authors: Laakman Joseph , Krasowski Matthew 
Published: October 2021

Abstract
Anion gap is a value calculated by determining the difference between major plasma cations (sodium, sometimes additionally potassium) and anions (namely bicarbonate and chloride), with “normal” levels falling somewhere between 8 and 16 mEq/L. Elevations in anion gap are classically described in a variety of different clinical disease states, including but not limited to uremia, ketoacidoses, lactic acidosis, and a number of drug toxicities. Comparatively little is understood about the etiology of low and negative (&lt;0) anion gap measurements; however, certain patient populations and pathologic states have been associated with negative anion gap measurements, such as multiple myeloma and hypertriglyceridemia (Kraut, 2007). We reviewed laboratory chemistries for 340,354 pediatric and adult patients over a ten-year period (2009-2018). Laboratory testing included values from basic and comprehensive metabolic panels and blood gas analyses. Chart review was performed on adult patients with anion gaps measuring less than 0 mEq/L to assess for medical trends or other explanations such as analytical interference or data errors. Additionally, blood gas analyses from patients being cared for in the neonatal intensive care unit (NICU) over the same ten-year period were also reviewed. Of the adult patients, 0.046% (157 samples) had an anion gap measuring below 0 mEq/L. Samples obtained as part of a blood gas analysis made up 52% of all negative gaps. While no definitive trends were noted, 23 samples were noted to be from patients with history of malignancy (solid tumor and hematopoietic), including multiple myeloma (4 patients).[mkrasows1] In addition to malignancy, 17 patients with hypertriglyceridemia were also found to have negative anion gaps. Negative anion gaps were rare in outpatient populations. Negative anion gaps as a result of a laboratory error were also rare, constituting only 1.3% of cases (2 patients). Negative anion gaps were comparatively more common in the NICU population, with 983 patients having a negative anion gap[mkrasows2] (0.289 %). NICU patients constituted 91% of all blood gas analyses with a negative anion gap, demonstrating that negative anion gaps are much more prevalent in this patient population than they are in other pediatric and adult populations. Negative anion gaps are relatively rare occurrences in the adult outpatient population; however, they can be seen in association with certain underlying disease states such as malignancy. By comparison, negative anion gaps are much more common in critically-ill populations, most notably NICU patients.
Unusual, non-anaphylactic transfusion reactions associated with severe IgA and IgM deficiencies and anti-IgA
Authors: Noubouossie Denis , Marques Marisa B , Siniard R Chad , Lima Jose L O 
Published: October 2021

Abstract
A few individuals with undetectable IgA develop anti-IgA, which is theorized to promote anaphylactic or anaphylactoid reactions to blood products. Here, we describe a recurrent, unusual reaction in a patient with no IgA or IgM, and anti-IgA present. The patient is a 49-year-old male with cirrhosis secondary to hepatitis C, who presented to the emergency department in January of 2014 with abdominal distension, leg swelling and dyspnea. He was severely anemic with a hemoglobin of 4.5 g/dL. Several minutes into a transfusion, he complained of chills, dyspnea and back pain. The transfusion was discontinued after &lt;10mL, and his symptoms resolved rapidly without further intervention. The patient’s blood pressure, heart rate and temperature before and after the reaction were 134/63 mmHg and 180/64 mmHg, 98 beats/minute (bpm) and 102 bpm, and 98.6⁰ F and 98.7⁰ F, respectively. A laboratory workup for hemolysis was negative pre- and post-transfusion and an “OK to transfuse” order was given if future blood products were indicated. The following day, another transfusion of PRBCs was stopped after &lt;75 mL due to similar symptoms, which again resolved rapidly; no vital signs changes or signs of hemolysis were noted. Because he was receiving other fluids concurrently with the PRBCs, it was recommended to transfuse future products slowly and to premedicate with furosemide. Although he tolerated three subsequent PRBC transfusions during the same admission, he developed the same clinical picture as soon as &lt;75mL of a platelet unit was started. At that time, unbeknownst to Transfusion Medicine, the primary care team ordered immunoglobulin levels and anti-IgA, and the results of these tests were entered into his electronic medical record (EMR) after discharge.
Approximately six years later, the patient was readmitted following a fall and was found to be thrombocytopenic. After receiving &lt;30 mL of platelets, he developed back pain and headache and the transfusion was aborted. His wife informed the primary provider that her husband was IgA-deficient. When Transfusion Medicine was notified, a review of his EMR showed undetectable IgA (&lt;6 mg/dL: reference: 46-236 mg/dL) and IgM (&lt;25 mg/dL; reference 43-279 mg/dL) and mildly increased IgG (1787 mg/dL; reference 650-1643 mg/dL) from 2014. Additionally, a high-titer IgG anti-IgA (&gt;1000 U/mL; reference &lt;99 U/mL), had been reported. In lieu of these findings, we changed his transfusion requirements to issue only washed PRBCs and IgA-deficient platelets and plasma, but he has not required any blood products since the last reaction. While a definitive cause and effect has not been established, this case suggests that severe IgA- and IgM-deficiency with IgG anti-IgA may be associated with nonspecific symptoms even with the transfusion of small volumes (&lt;75 mL). To our knowledge, similar reactions have not been previously reported.
Patterns and Utility of Calprotectin in Patients with Microscopic Colitis
Authors: Abukhiran Ibrahim , Krasowski Matthew , Bellizzi Andrew , Boukhar Sarag , Merrill Anna 
Published: October 2021

Abstract

Context
Calprotectin is a cytoplasmic-protein that is released upon neutrophilic activation. Measuring fecal-calprotectin (FC) is used for monitoring inflammatory bowel disease activity and distinguishing it from irritable bowel syndrome. However, its utility in other types of colitis has not been well-investigated.

Design
Cases of collagenous-colitis (CC) and lymphocytic-colitis (LC) between 2015 and 2020 were retrieved from our institution surgical pathology database. Endoscopy and histopathologic examination findings were reviewed to confirm the diagnosis. 15 CC and 13 LC cases were included as FC was done at the time of initial diagnosis (before therapy). 62 cases of normal endoscopy and histopathologic examination were selected as a control group. One-way analysis of the variance (ANOVA) and receiver operating curve (ROC) analysis of FC were performed.

Results
Abnormally elevated FC (&gt; 50 ug/g) was identified in 77% and 64% of CC and LC cases, respectively. Only 1.6% of control cases had mildly elevated FC of 54 ug/g. The mean FC of CC and LC groups (246 and 214, respectively) were significantly higher than the control group (22.4); p= &lt;0.05. LC and CC groups had no statistically significant difference in the mean FC (p = 0.8). The area under the curve was 0.93 with ROC analysis. At the suggested cut-off of 50 ug/g, the sensitivity was 78.6%, specificity was 98.4% with a likelihood ratio of 48.7.

Conclusions
Fecal calprotectin can be elevated in patients with lymphocytic or collagenous colitis, however with no statistically significant difference between the two types. Therefore, it has the potential to be used as a marker for screening, diagnosis, and monitoring response to therapy in patients with microscopic colitis.
The surge in fatal diabetic ketoacidosis in the years of the COVID-19 pandemic: a forensic autopsy study
Authors: Geller R L , Aungst J , Lee C 
Published: October 2021

Abstract

Introduction/Objective
Although many deaths resulting from diabetic ketoacidosis (DKA) fall outside the legal jurisdiction of the medical examiner, a forensic pathologist may identify this cause of death through ancillary testing multiple times per year. We recognized a sharp increase in deaths due to DKA at a busy metropolitan medical examiner’s office in 2020 and 2021, coinciding with the COVID-19 pandemic. We hypothesize that in the majority of these cases, fatal DKA was the presenting symptom of previously undiagnosed diabetes mellitus (DM).

Methods/Case Report
We performed a retrospective autopsy review of all cases with a cause of death listed as “diabetic ketoacidosis” from January 1, 2018 through June 18, 2021. We compared the number of DKA deaths to all reported deaths from the same time period.

Results (if a Case Study enter NA)
We identified a total 34 cases of fatal DKA. In 2018, 5 cases of DKA were identified and all decedents had a known diagnosis of DM; the average age at death was 50.6 years (range: 40- 60 years) and 2 decedents were male (40%). In 2019, 5 cases of DKA were identified and 4 decedents had a known diagnosis of DM (80%); the average age at death was 51.4 years (range: 37- 61 years), and all decedents were male (100%). In 2021, 18 cases of DKA were identified and 9 decedents had a previous diagnosis of DM (50%); the average age at death was 43.5 years (range: 22- 64 years), 13 decedents were male (72%), and 1 decedent was COVID-19 positive (5.5%). In the first 6 months of 2021, 6 cases of DKA were identified and none of these decedents had a previous diagnosis of DM (0%); the average at death was 51.8 years (range: 35- 73 years), 4 decedents were male (66%), and 1 decedent was COVID-19 positive (16.6%). Reported deaths per year to our office are as follows: 2018 = 2585 deaths, 2019 = 2658 deaths, 2020 = 3091 deaths, and 2021 to date = 1482 deaths.

Conclusion
Coinciding with the COVID-19 pandemic, our office experienced a 16.2% increase in all reported deaths from 2019 to 2020, and a 260% increase in fatal DKA. In 2018 and 2019, 9 of the 10 decedents who died from DKA had a known diagnosis of DM (90%). However, in 2020 and the first half of 2021, DKA was the presenting symptom of previously undiagnosed DM in 15 of 24 cases of fatal DKA (62.5%). Further investigation must be done to examine the factors driving the recent surge in fatal DKA.
Fatal Moans and Bones in Crohn’s
Authors: Opara J C , Jackson N R 
Published: October 2021

Abstract

Introduction/Objective
Heterotopic mesenteric ossification (HMO) is a rare, reactive condition involving abnormal bone formation within the mesentery. While its etiology is uncertain, reports suggest two possible inciting events - either metaplasia from trauma and/or inflammation or dislodgment of bone fragments from other sites during abdominal surgery. With less than 50 reported cases, there is much unknown about this disease process. Herein, we present a rare, fatal case.

Methods/Case Report
A 43-year-old man with a history significant for Crohn’s disease status-post multiple abdominal surgeries and with resultant chronic abdominal pain was found unresponsive at home by family with an unknown downtime. He was taken to the local hospital where he was admitted to the Intensive Care Unit. Given a poor prognosis, family transitioned him to comfort care measures and he died shortly thereafter. Autopsy examination revealed a thin man with an ostomy and severe abdominal scarring. Internally, there were multiple aberrant bone fragments within the mesentery which neither perforated the bowel nor caused obstruction and which microscopically appeared to be mature and benign. Ancillary studies were significant severe dehydration. Follow-up conversation with his family revealed that due to debilitating abdominal pain, the decedent had significantly decreased his oral intake and had stopped taking medications to control his high output ostomy. Given the autopsy and investigative findings his death was certified as a natural death caused by dehydration due to complications of Crohn’s disease.

Conclusion
This is the first reported case of HMO occurring in inflammatory bowel disease. Awareness of this condition is important for clinicians as it can alter management of these patients. Early review and recognition from radiologists and pathologists can potentially improve the morbidity and mortality of this group.
A Case Report of Autopsy: Large Mass of Pulmonary Metastatic Calcification in a Patient with End-Stage Renal Disease
Authors: Mahalingam V D , Zhang P 
Published: October 2021

Abstract

Introduction/Objective
Metastatic calcifications are reported in patients with end-stage renal disease (ESRD) in radiology literature but there are no pathologic reports regarding this clinical scenario in autopsy.

Methods/Case Report
We report the case of a 27-year-old African American man with nephrotoxic injury secondary to gentamicin treatment at a young age leading to ESRD requiring dialysis who then later developed congestive heart disease and arrhythmia. Prior to the patient’s last hospitalization, he had normal breath sounds with no signs of respiratory distress, rales, or wheezing. Imaging of the chest showed a patchy density in the right lung and a large parenchymal calcification. During autopsy, the patient was found to have bilateral markedly small and atrophic kidneys (left kidney weight: 27.5 g, size: 5.7 x 4.4 x 3.0 cm and right kidney weight: 30.6 g, size: 5.9 x 4.4 x 3.1 cm). Microscopically, the kidneys showed diffuse global glomerulosclerosis, atrophy of cortex, severe interstitial fibrosis, and tubular atrophy with thickened arteries as well as many foci of calcifications. A large mass measuring 3.5 x 2.4 x 1.9 cm was identified in the right middle lobe of the lung. Sections of the mass revealed large calcifications which were confirmed microscopically. In addition, concentric heart hypertrophy was identified with heart weight of 925 g and left ventricle measuring up to 2.2 cm. Calcifications (ranging from 0.2 – 0.5 mm) were also identified on the left atrial wall as well as a 1.2 x 0.8 x 0.6 cm mitral valve nodule along with additional microcalcifications within the myocardium.

Results (if a Case Study enter NA)
NA

Conclusion
In conclusion, our autopsy case supports previous radiologic reports that metastatic calcification can be dramatically present in the lung in patients with ESRD.
Echogenic Intestine: a Case of Intrauterine Fetal Demise at Term
Authors: Panah E , Zelman B , Gvozdjan K 
Published: October 2021

Abstract

Introduction/Objective
Parvovirus B19 is a non-enveloped, single-stranded DNA virus that preferentially infects early erythroids, and is commonly associated with second trimester hydrops fetalis. Third trimester non-hydropic intrauterine fetal demise due to parvovirus B19 infection with associated pathologic changes has rarely been described, particularly in the context of IgG seroconverted mother.

Methods/Case Report
We present a case of a 37 weeks’ gestation stillborn female fetus born to a 29 year-old mother who presented with lack of fetal movement for one day. Fetal ultrasound demonstrated diffuse intestinal echogenicity. Maternal parvovirus B19 IgG level was high (5.48, reference: &lt;=0.90 Index). Postmortem examination revealed a non-dysmorphic fetus. Gross examination was unremarkable. Microscopic examination of small intestine revealed mucosal inflammation and multifocal calcifications. Prominent extramedullary hematopoiesis was present in the liver. Viral cytopathic effect was noted microscopically within nucleated red blood cells present intravascularly within chorionic villi, small intestine, liver, and spleen. Parvovirus B19 infection was confirmed by immunohistochemistry.

Results (if a Case Study enter NA)
NA

Conclusion
The cause of clinically puzzling intrauterine fetal demise at term with prominent intestinal echogenicity on ultrasound was determined to be parvovirus B19 infection on postmortem examination. We emphasize the possibility of this diagnostic differential in non-hydropic, third trimester fetal demise in presence of maternal IgG seroconversion and lack of signs of active infection.
Extraskeletal mesenchymal chondrosarcoma mimicking a thrombosed venous aneurysm with femoral vein involvement: A case report
Authors: Muldoon J , Warmke L 
Published: October 2021

Abstract

Introduction/Objective
Mesenchymal chondrosarcoma is a high-grade primitive mesenchymal tumor, which accounts for &lt;5% of all chondrosarcomas and commonly affects young adults (peak incidence in second to third decade of life). The tumor has a widespread anatomic distribution, frequently involving the craniofacial bones as well as extraskeletal sites. The clinical presentation of an inguinal mass mimicking a thrombosed venous aneurysm is unusual and represents a potential diagnostic pitfall.

Methods/Case Report
A 42-year-old female with hypertension and obesity initially presented with a two-week history of left lower leg swelling. Venous doppler revealed presumed venous thrombosis, and she was prescribed apixaban while no history of coagulopathy, immobility, or recent surgery was noted. Two months later, she had residual swelling. Follow-up CT scan favored a large, peripherally thrombosed venous aneurysm arising from the left common femoral vein, while MRI showed a lobulated, inguinal soft tissue mass abutting the vein. Biopsy of the mass demonstrated a spindle cell mesenchymal neoplasm; subsequent resection revealed a pink-to-tan, well-circumscribed, and encapsulated mass (5.2 cm) with focal left common femoral vein invasion. Microscopically, the lesion demonstrated poorly-differentiated, oval-to-spindle cells with prominent staghorn vasculature interspersed were focal areas of well-differentiated hyaline cartilage. Immunohistochemical stains showed that the lesional cells were negative for cytokeratin cocktail, EMA, SMA, desmin, S100 protein, SOX10, STAT6, MUC4, MDM2, and ER. Next-generation sequencing (NGS) revealed a HEY1-NCOA2 gene fusion, confirming the diagnosis of extraskeletal mesenchymal chondrosarcoma.

Results (if a Case Study enter NA)
N/A

Conclusion
Extraskeletal mesenchymal chondrosarcoma can rarely present as an inguinal soft tissue mass with vascular invasion, mimicking a thrombosed venous aneurysm. Molecular confirmation of HEY1-NCOA2 gene fusion can help confirm the diagnosis in unusual clinical presentations.