bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prostatic Intraepithelial Neoplasia: Recent Advances
Authors: Ayala Alberto G. , Ro Jae Y. 
Published: February 2021

Abstract
Context.—There have been 2 putative prostatic cancer precursors, prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (adenosis), but PIN remains as a well-known precancerous condition.
Objective.—To describe recent advances in knowledge of PIN and to better define the diagnostic criteria and differential diagnosis of PIN.
Data Sources.—Review of the pertinent literature and our experience.
Conclusions.—The presence of ductal/acinar epithelial changes including nuclear enlargement, prominent nucleoli, chromatin alterations, and luminal complexity is an easy way to identify the disorder. Four main patterns of high-grade PIN (HGPIN) have been described: tufting, micropapillary, cribriform, and flat. In addition, variants of HGPIN have also been described. Both HGPIN and prostatic carcinoma share an increased incidence and severity with advancing age and with high rates of occurrence in the peripheral zone of the prostate. Furthermore, HGPIN and prostate cancer share genetic and molecular markers as well, with PIN representing an intermediate stage between benign epithelium and invasive carcinoma. The clinical significance of HGPIN is that it identifies patients at risk for prostatic carcinoma. With the increased use of extended biopsy protocols, clinicians are more likely to identify HGPIN and less likely to miss concurrent carcinoma.
An Overview of the Histology of Skeletal Substitute Materials
Authors: Bauer Thomas W. 
Published: February 2021

AbstractContext.—Orthopedic and spine surgeons are in frequent need of bone for skeletal reconstruction. The amount of autograft is limited, and conventional allograft has some disadvantages, so surgeons are now using increasing amounts of demineralized allograft and a variety of synthetic materials to replace or “extend” autograft.Objective.—To provide an overview of the composition and histology of the materials most likely to be seen by pathologists today.Data Sources.—The review is based on published literature and the author's experience with preclinical studies and human biopsies.Conclusions.—Pathologists are likely to find these skeletal substitute materials in biopsy and resection specimens from patients who have undergone prior treatment, and recognizing a synthetic bone substitute can help explain an otherwise confusing specimen. Pathologists also play an important role in helping define the safety and efficacy of new bioactive materials.
Goblet Cell Mimickers in Esophageal Biopsies Are Not Associated With an Increased Risk for Dysplasia
Authors: Younes Mamoun , Ertan Atilla , Ergun Gulchin , Verm Ray , Bridges Margaret , Woods Karen , Meriano Frank , Schmulen A. Carl , Colman Ronald , Johnson Craig , Barroso Alberto , Schwartz Jim , McKechnie John , Lechago Juan 
Published: February 2021

Abstract
Context.—Identification of intestinal-type goblet cells (ITGCs) in hematoxylin-eosin–stained sections of esophageal biopsies is essential for the diagnosis of Barrett metaplasia. However, we have seen cases diagnosed as Barrett metaplasia based solely on cells that pose morphologic similarity to ITGCs on hematoxylin-eosin staining or stain positive with Alcian blue.
Objective.—To determine the clinical significance of goblet cell mimickers.
Design.—Initial biopsies from 78 patients with original diagnosis of Barrett metaplasia negative for dysplasia and a mean follow-up of 72 months were reviewed and reclassified into 3 categories: (1) ITGCs, (2) goblet cell mimickers, or (3) neither. Sections from available paraffin blocks were stained with Alcian blue at pH 2.5. The presence of the different types of cells and positive Alcian blue staining were correlated with each other and evaluated for their significance as predictors of progression to dysplasia.
Results.—Goblet cell mimickers were present in 35 cases and were associated with ITGCs in the same biopsy in 23 (66%) of these cases. Intestinal-type goblet cells were present in 56 cases, and the remaining 10 cases, although called Barrett on the original report, did not show either ITGCs or goblet cell mimickers. Only the presence of ITGCs was associated with significant risk for dysplasia (P = .008). Positive Alcian blue staining was not associated with a significant risk for dysplasia.
Conclusions.—Our results indicate that the diagnosis of Barrett metaplasia should be rendered with confidence only when ITGCs are identified on routine hematoxylin-eosin–stained sections.
Primary Skull Lesions in the Pediatric Population: A 25-Year Experience
Authors: Gibson Sarah E. , Prayson Richard A. 
Published: February 2021

Abstract
Context.—Primary skull lesions are rare in the pediatric population. The differential diagnosis of these lesions is broad and includes both congenital and acquired lesions. Previous studies of skull lesions in the pediatric population suggest that dermoid/epidermoid tumors are the most common childhood skull tumors.
Objective.—To review the clinicopathologic features of primary skull lesions identified within the pediatric population of an academic tertiary medical center.
Design.—A retrospective review of surgical pathology reports during a 25-year period identified 19 primary skull lesions occurring in the pediatric population. Lesions were excluded if they were of known soft tissue or intracranial origin with secondary calvarial involvement, or if they represented a metastasis from a known primary malignancy.
Results.—Nineteen primary skull lesions were identified in 11 male (58%) and 8 female (42%) patients, with a median age at diagnosis of 9.5 years. These lesions were usually benign and most commonly presented as a painless mass (n = 8). The lesions were located in the occipital bone (n = 7), frontal bone (n = 5), parietal bone (n = 2), and temporal bone (n = 1). Diagnoses included epidermoid/ dermoid cyst (n = 8), Langerhans cell histiocytosis (n = 6), intraosseous hemangioma (n = 2), osteoblastoma (n = 1), infantile myofibroma (n = 1), and fibroma (n = 1). Intracranial extension was identified in 1 case, and recurrence was found in only 2 cases.
Conclusions.—Epidermoid/dermoid cysts and Langerhans cell histiocytosis are the most commonly encountered skull lesions in the pediatric population at our institution. Intracranial extension of these lesions is rare, and recurrence is uncommon following complete surgical resection.
Accuracy of ThinPrep Imaging System in Detecting Low-Grade Squamous Intraepithelial Lesions
Authors: Zhang Fred Fangyuan , Banks Helen Whitler , Langford Shanna Maria , Davey Diane Davis 
Published: February 2021

Abstract
Context.—The ThinPrep Imaging System (Imager) for cervical cytology is used in many US laboratories, but the ability of the system to identify classic changes of low-grade squamous intraepithelial lesion (LSIL) has not been independently reported.
Objective.—To evaluate the accuracy of this system in detecting classic LSIL cells.
Design.—A total of 114 imaged ThinPrep LSIL cases from April to June 2005 were reviewed to determine whether the most diagnostically relevant cells were present in the 22 fields selected by Imager. Those LSIL specimens from January to June 2005 that were initially screened by the Imager and classified as “negative” in the 22 fields were also reviewed. The average number of classic koilocytes per slide was compared among cases that had koilocytes within 22 fields with cases upgraded during full review.
Results.—Twelve (10.5%) of 114 LSIL cases from April to June 2005 did not show diagnostic LSIL cells within the initial 22 fields. Full manual rescreening was performed on 1025 cases from January to June (20.4% of negative cases). Nine cases that were initially negative in the 22 fields were revised to LSIL (2.4% of all 381 LSIL cases reported from January to June 2005). An average of 10 to 11 koilocytes were present in these 2 groups, which was significantly lower than the average of 75 koilocytes in cases in which the 22 Imager-selected fields showed LSIL.
Conclusions.—Although the ThinPrep Imager finds abnormal cells in most LSIL cases, the system may have limitations in detecting koilocytes in the 22 Imager-selected fields. When 10% quality control rescreening is performed as required by federal regulations, full manual rescreening will provide the most accurate results.
Activated Protein C Resistance and Factor V Leiden: A Review
Authors: Rosendorff Adam , Dorfman David M. 
Published: February 2021

Abstract
Context.—Factor V Leiden (FVL) is the most common heritable cause of venous thrombosis. It is caused by a single nucleotide substitution resulting in an R506Q missense mutation, resulting in factor V resistance to activated protein C (APC) inactivation. Carriers of FVL have an increased susceptibility to venous thrombosis, which is further increased in the presence of other genetic or environmental risk factors.
Objective.—To review the biology, clinical findings, laboratory detection methods, and screening recommendations for patients with the FVL mutation.
Data Sources.—PubMed review of published literature and online information.
Conclusions.—FVL remains an important heritable cause of hypercoagulability since its discovery more than 10 years ago. Clinical suspicion should be high in cases of unexplained venous thrombosis. APC resistance and FVL mutation can be diagnosed with high sensitivity and specificity with use of clotting time–based functional assays and genetic assays, respectively, allowing for evidence-guided clinical decision making regarding the benefit of long-term anticoagulation.
Reduced Annexin II Protein Expression in High-Grade Prostatic Intraepithelial Neoplasia and Prostate Cancer
Authors: Yee David S. , Narula Navneet , Ramzy Ibrahim , Boker John , Ahlering Thomas E. , Skarecky Douglas W. , Ornstein David K. 
Published: February 2021

Abstract
Context.—Annexin II is a calcium-dependent phospholipid-binding protein that plays a role in many cellular functions, including apoptosis, signal transduction, and cellular motility. The protein is strongly expressed in normal prostatic epithelial glands, but its expression in benign prostatic lesions has not been reported. Although commonly underexpressed in prostate cancer, the association of reduced expression with pathologic grade and stage is unknown.
Objective.—To compare annexin II expression in benign prostatic lesions with expression in high-grade prostatic intraepithelial neoplasia and prostate cancer, as well as to correlate expression levels with pathologic grade and stage.
Design.—A semi-quantitative assessment of annexin II expression was performed in radical prostatectomy specimens from 74 patients and prostate needle core biopsy specimens from 13 patients. Foci with normal prostatic glands, atrophic glands, basal cell hyperplasia, high-grade prostatic intraepithelial neoplasia, and prostatic adenocarcinoma were evaluated.
Results.—Annexin II expression was present in more than 50% of glands in most (&gt;85%) samples of benign prostatic epithelium, atrophic glands, and basal cell hyperplasia. In high-grade prostatic intraepithelial neoplasia, annexin II staining was markedly reduced in epithelial cells but not in basal cells. Annexin II was absent or focally present in moderately differentiated adenocarcinoma but was retained in poorly differentiated adenocarcinomas.
Conclusions.—Reduced annexin II expression may be a useful diagnostic biomarker to help identify small foci of moderately differentiated adenocarcinoma on needle core biopsy specimens since it is consistently expressed in benign prostatic glands. Re-expression of annexin II in poorly differentiated adenocarcinoma may provide prognostic information.
Sarcomas Arising in Paget Disease of Bone: A Clinicopathologic Analysis of 70 Cases
Authors: Deyrup Andrea T. , Montag Anthony G. , Inwards Carrie Y. , Xu Zhiheng , Swee Ronald G. , Krishnan Unni K. 
Published: February 2021

Abstract
Context.—Sarcomatous transformation is a rare complication of Paget disease of bone. Prognosis in patients with other types of sarcomas arising in bone has improved in the last several decades because of therapeutic advances. However, because of the rarity of Paget sarcoma, outcome studies in these patients are limited.
Objective.—To determine whether prognosis for Paget sarcoma has improved.
Design.—Seventy cases of sarcomas arising in the setting of Paget disease were collected, and the histologic and clinical findings were reviewed. Clinical follow-up was obtained in 67 cases.
Results.—Sarcoma arising in Paget disease tended to arise in older men (46 men, 24 women; age range, 31–88 years; mean age, 66 years) and predominated in the axial skeleton (n = 37), especially in the pelvis. Thirty-three patients had a clinical history of Paget disease ranging in duration from 16 months to 30 years (mean, 15 years). No significant difference in incidence between monostotic (n = 33) and polyostotic (n = 36) disease was noted. Most tumors were osteosarcomas (88%). All tumors were high grade. Follow-up information was obtained in 67 of 70 cases (range of follow-up, 1–252 months). Survival ranged from 1 month to 20 years, with a 5-year survival rate of 10%.
Conclusions.—Prognosis remains poor in patients with Paget sarcoma. There is no significant correlation between the number of bones involved with Paget disease or the duration of disease and development of Paget sarcoma. Poor prognosis in Paget sarcoma is unrelated to site or stage at presentation.
Sertoliform Endometrioid Carcinoma of the Ovary: A Potential Diagnostic Pitfall
Authors: Misir Anil , Sur Monalisa 
Published: February 2021

Abstract
Sertoliform endometrioid carcinoma of the ovary (SEC) is an uncommon variant that bears histologic similarity to Sertoli and Sertoli-Leydig cell tumors (SLTs). Clinically, SEC affects an older population (60–70 years), while patients with SLT have an average age of 25 years and may exhibit endocrine manifestations. A number of histologic features can be used to distinguish the 2 entities, the most important ones being (1) the presence of areas with the usual pattern of endometrioid carcinoma, and (2) the presence of mucin at the apical borders of the tumor cells. Cytokeratin stains positively, while inhibin and calretinin stain negatively in SEC; the converse is true for SLTs. Based on the clinicopathologic behavior of this entity, SEC should be considered a well-differentiated carcinoma with relatively good prognosis if limited to the ovary.
Practice of Forensic Medicine and Pathology in Sri Lanka
Authors: Balachandra A. Thambirajah , Vadysinghe Amal N. , William Anita L. 
Published: February 2021

Abstract
The practice of forensic medicine and pathology in Sri Lanka is based on the British model. Medical students during their third and fourth years receive approximately 50 hours of lectures and tutorials in forensic medicine and pathology and then undergo an examination. After completing an internship, these doctors are sent to various hospitals throughout Sri Lanka where they may be asked to perform medicolegal examinations on victims and suspects in rape cases, persons suspected of being under the influence of drugs and/or alcohol, and, injured live patients. As well, they may be asked to perform medicolegal autopsies. Depending upon their experience, some medical officers may be designated as judicial medical officers and appointed full time to do medicolegal work. Up until 1980, judicial medical officers with at least 2 years of work experience were allowed to obtain their postgraduate qualifications in the United Kingdom. However, since 1981 and the establishment of its own Postgraduate Institute of Medicine in Colombo, Sri Lanka, medical officers are offered 2 postgraduate programs in forensic medicine and pathology, a diploma in legal medicine and a doctorate in medicine (forensic medicine). After completing the doctorate in forensic medicine, doctors are allowed to train abroad for a further year in an approved center. Upon return they can then be appointed as consultant judicial medical officers. The practice of forensic medicine and pathology in Sri Lanka is unique and vibrant. However, due to the country's prevailing civil war, the practice of forensic medicine and pathology is suboptimal.
Expression of JL1 Is an Effective Adjunctive Marker of Leukemia Cutis
Authors: Park Young Soo , Park So Hyung , Park Seo-Jeong , Kim Youngji , Jang Kee-Taek , Ko Young Hyeh , Lee Mi-Woo , Huh Joo Ryung , Park Chan-Sik 
Published: February 2021

AbstractContext.Specific differentiation of leukemia cutis (LC) from nonleukemic dermatoses is crucial to ensure proper treatment for the disease. Because of the exceptionally variable histologic features of LC and the frequent nonleukemic dermatoses in leukemia patients, identification of leukemic cells that infiltrate skin lesions is important. Here, we introduce JL1, a novel leukemia-associated surface antigen, which is not expressed in mature human tissue but in cortical thymocytes and small subpopulations of bone marrow hematopoietic precursors.Objectives.To assess the expression pattern of JL1 in LC and compare it with other commonly used markers. Also, to evaluate the expression of JL1 in other cutaneous lesions that need differential diagnoses.Design.Immunohistochemical staining with anti-JL1 and other commonly used markers for LC was performed on paraffin-embedded skin biopsies from 32 cases of LC with acute lymphoblastic leukemia/lymphoma and acute myelogenous leukemia. Immunohistochemical staining score was evaluated in each case according to the proportion of positive tumor cells found. JL1 staining was also done on 96 reactive or neoplastic cutaneous lesions.Results.JL1 was detected in 7 of 11 acute lymphoblastic leukemia/lymphoma LC (63.6%) and 7 of 21 acute myelogenous leukemia LC (33.3%), with invariably high-staining scores. None of the other cutaneous lesions or normal tissues expressed JL1. The expression pattern of JL1 was not altered in 2 patients with follow-up biopsies.Conclusions.Our finding that JL1 is expressed exclusively and stably by leukemic cells suggests that it can be used as a useful adjunctive marker for initial diagnosis and follow-up biopsy of LC, particularly in cases of scarce infiltrates.
Malignant Fibrous Histiocytoma: Between the Past and the Present
Authors: Al-Agha Osama M. , Igbokwe Anne A. 
Published: February 2021

Abstract
The precise nature and diagnostic concept of malignant fibrous histiocytoma (MFH) has been debated for years. Currently, a histiocytic lineage of the tumor cells is no longer favored. The nomenclature and classification of MFH and its subtypes have also been changed. The MFH pattern, especially that of storiform-pleomorphic variant, is viewed as a morphologic pattern shared by a number of sarcomas as well as by other nonsarcomas. Therefore, a diagnosis of MFH based solely on morphology is no longer acceptable and identification of a line of differentiation should be sought. A diagnosis of MFH should be made only for pleomorphic sarcomas in which no specific line of differentiation is discerned. Precise categorization of MFH-like tumors may require thorough sampling of the tumor and judicious use of immunohistochemistry and/or electron microscopy. Familiarity with the current terminology and classification of MFH and its subtypes is of paramount significance in the modern practice of pathology.
Primary Peritoneal Anaplastic Giant Cell Carcinoma: Case Report of an Unusual and Highly Malignant Müllerian Neoplasm
Authors: Lu Xian , Zhang Cunxian , Liu Fang , Sung C. James , Steinhoff Margaret M. , Lawrence W. Dwayne 
Published: February 2021

Abstract
Virtually all primary peritoneal carcinomas (PPCs) are of serous papillary type. We report an unusual histologic type of PPC composed of anaplastic giant cells, which exhibited an aggressive clinical course. A 72-year-old woman presented with lower abdominal pain. Computed tomography showed a diffuse omental thickening. The patient underwent an exploratory laparotomy with omentectomy, total hysterectomy, bilateral salpingo-oophorectomy, and appendectomy. Pathologic examination revealed extensive omental replacement by tumor but only superficial surface cortical involvement of both ovaries, a disease distribution consistent with a typical müllerian-derived PPC. However, this neoplasm was composed of diffuse anaplastic tumor giant cells, rather than serous carcinoma, which is the usual histologic type encountered in PPC. The patient died within 1 month after surgery. We report this unusual histologic variant of PPC to raise awareness that anaplastic giant cell carcinoma may arise in the pelvic peritoneum as a primary tumor.
Physician Compliance With Platelet Usage Criteria
Authors: Ang Daphne Chua , Marinescu Luminita , Kuriyan Mercy 
Published: February 2021

AbstractContext.—Platelet transfusions are used in clinical practice as prophylaxis or to treat bleeding thrombocytopenic patients. This procedure also carries risks and costs and must be allocated appropriately.Objective.—To evaluate physician compliance with the platelet transfusion criteria in our tertiary care academic institution.Design.—We evaluated platelet unit releases from the transfusion service for 4 months, and we retrieved pretransfusion platelet counts. Reasons for transfusion were obtained by reviewing patient charts and talking to clinicians. Compliance with hospital criteria for platelet use was determined.Results.—Platelets were given to 113 patients in 282 transfusion episodes. Criteria were not met for 32 (11%) of 282 platelet transfusions. Justifiable reasons for transfusion at platelet counts of greater than 10 × 103/μL included bleeding risk from oral ulcers, other risks of bleeding in patients who were transfused before discharge, and antiplatelet drug use in cardiac surgery patients. Reasons for transfusion at platelet counts greater than 10 × 103/ μL that were not justified include transfusion at a platelet count of 110 × 103/μL to a lung cancer patient with no platelet dysfunction and transfusion to 4 septic patients with platelet counts of 70 to 90 × 103/μL.Conclusions.—This study showed 89% physician compliance with hospital platelet transfusion criteria. Transfusion-medicine specialists concurred that strict adherence to hospital blood usage criteria was not applicable for 9.2% of these patients; however, 5 (1.8%) of 282 platelet transfusions were not indicated and could have been prevented by transfusion medicine physician intervention.