bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heparin Monitoring and Patient Safety: A College of American Pathologists Q-Probes Study of 3431 Patients at 140 Institutions
Authors: Valenstein Paul N. , Walsh Molly K. , Meier Frederick 
Published: February 2021

Abstract
Context.—Appropriate laboratory monitoring of unfractionated heparin therapy promotes effective anticoagulation while minimizing hemorrhagic complications.
Objectives.—To measure heparin therapy monitoring in a “real-world” setting and to assess the degree of anticoagulation achieved.
Design.—One hundred forty institutions abstracted laboratory and pharmacy data from up to 30 inpatients receiving standard-dose unfractionated heparin therapy for 72 hours. Institutions also reported their therapeutic ranges and described heparin prescribing and monitoring policies.
Results.—Activated partial thromboplastin times or anti–factor Xa levels were measured at least once within the first 12 hours of administration for 95% of 3431 heparinized inpatients. Eighty-seven percent of patients had a platelet count performed within 72 hours of heparin administration. Seventy-eight percent of heparinized inpatients achieved therapeutic anticoagulation within 24 hours, but more than one third of patients entered the supratherapeutic range on at least 2 occasions during the first 72 hours. We found moderate variation in performance among the 140 institutions participating in the study, with more consistency in monitoring patients but less consistency in achieving therapeutic levels of anticoagulation. In one fourth of hospitals, more than half of the heparinized patients entered the supratherapeutic range on 2 or more occasions during the first 72 hours of therapy. None of 20 institutional practices we examined were meaningfully associated with more thorough monitoring of patients or with a higher percentage of patients achieving therapeutic anticoagulation. There was moderately wide variation in therapeutic ranges among the 140 sites.
Conclusions.—The prevention of heparin over-anticoagulation represents an important opportunity for improving patient safety in a significant number of institutions.
Giant Cell Tumor of Rib Masquerading as Thymoma: A Diagnostic Pitfall in Needle Core Biopsy of the Mediastinum
Authors: Volmar Keith E. , Sporn Thomas A. , Toloza Eric M. , Martinez Salutario , Dodd Leslie G. , Xie H. Bill 
Published: February 2021

Abstract
Giant cell tumor of bone is rarely seen in the rib, where it may present as a mediastinal mass. The diagnosis of giant cell tumor of bone is generally straightforward by fine-needle aspiration or needle core biopsy, but sampling problems may lead to confusion with other neoplasms or inflammatory processes. Here, we report a case of giant cell tumor of rib presenting as a mediastinal mass in a 36-year-old man. Because of inadequate sampling and inaccurate clinical information, the tumor was initially mistaken for thymoma. When the mass failed to respond to conventional chemotherapy, additional tissue was obtained and a giant cell tumor was diagnosed. Consequently, definitive therapy was delayed. The case illustrates an important diagnostic pitfall in the biopsy of mediastinal masses.
Three Cases of Massive Fetomaternal Hemorrhage Presenting Without Clinical Suspicion
Authors: Pourbabak Sam , Rund Chad R. , Crookston Kendall P. 
Published: February 2021

Abstract
Fetomaternal hemorrhage (FMH) is a common obstetrical occurrence most often associated with small volumes of blood transferred across the placenta. Fetomaternal hemorrhage leads to alloimmunization of Rh D-negative mothers, resulting in an increased risk of hemolytic disease of the newborn. Massive FMH involving volumes of blood greater than 30 mL can cause substantial fetal morbidity and mortality. Massive FMH may present with signs and symptoms such as decreased movement, sinusoidal heart rhythms, or fetal anomalies. We present 3 cases of clinically unexpected massive FMH of 206, 88, and 155 mL. The treating clinicians were unaware of any fetal or maternal signs or symptoms of FMH until contacted by the laboratory. These cases illustrate the necessity for FMH quantitation, even in the absence of clinical suspicion. Additional studies are needed to find better ways to identify these patients in advance. Development of criteria allowing identification of patients at risk would be of benefit to both mother and baby.
Balamuthia mandrillaris Meningoencephalitis in an Immunocompetent Patient: An Unusual Clinical Course and a Favorable Outcome
Authors: Jung Sungmi , Schelper Robert L. , Visvesvara Govinda S. , Chang Howard T. 
Published: February 2021

Abstract
Balamuthia mandrillaris meningoencephalitis is a rare but often fatal infection; only 2 survivors have been reported to date worldwide. We report the case of an apparently immunocompetent patient (72-year-old woman) who developed several episodes of seizures without prior history of respiratory or skin infections. Magnetic resonance imaging with contrast revealed 2 ring-enhancing lesions, one in the right precentral region and the other in the left posterotemporal region. Open biopsy revealed Balamuthia encephalitis. The patient was treated with combination antibiotics (pentamidine, 300 mg intravenously once a day; sulfadiazine, 1.5 g 4 times a day; fluconazole, 400 mg once a day; and clarithromycin, 500 mg 3 times a day) and was discharged home. There have been no significant neurological sequelae at this writing (6 months after biopsy). We present this case with unusual clinical course to raise awareness of this infectious disease, which may have a more favorable outcome if diagnosed and treated in its early states.
Human Papillomavirus Typing of Rare Cervical Carcinomas
Authors: Matthews-Greer Janice , Dominguez-Malagon Hugo , Herrera Guillermo A. , Unger James , Chanona-Vilchis José , Caldito Gloria , Turbat-Herrera Elba A. 
Published: February 2021

AbstractContext.—Most cervical tumors are classified as squamous cell carcinoma or adenocarcinoma, both of which are associated with persistent human papillomavirus (HPV) infection. Although other (rare) types represent less than 5% of all cervical carcinomas, it is necessary that these more unusual tumors be studied in the current era of papillomavirus vaccine development, especially in regions with high incidence of cervical cancer.Objective.—To compare papillomavirus types found in histologically rare cervical carcinomas (n = 29) with those types found in common cervical carcinomas (n = 14) archived at the Institute of Cancer in Mexico City, Mexico.Design.—Paraffin-embedded tissues were received and sectioned at the Louisiana State University Health Sciences Center at Shreveport. One section for each block was stained and examined by 2 pathologists. Specific histologies were categorized into 2 broad groups: common (squamous cell carcinoma or adenocarcinoma) or rare (adenosquamous, papillary, villoglandular, anaplastic, transitional, spindle, adenoid basal, colloid, neuroendocrine, and glassy cell carcinomas). Papillomavirus typing results were based on Roche Molecular Systems line-blot assay.Results.—No significant difference was found for dual HPV types (21% of both groups), positivity for HPV-16 (66% of rare tumors and 71% of common tumors), or absence of HPV types 16 or 18, although the rare cancers had a greater tendency toward more unusual HPV types (8/29 rare tumors and 1/14 common tumors had no HPV- 16 or HPV-18 DNA). Non–HPV-16/18 types found only in rare tumors included HPV types 52, 84, 26, 35, and 58.Conclusions.—Rare types of cervical carcinoma also are associated with papillomavirus, most with types similar to those found in common cervical neoplasias.
Plasmablastic Lymphoma of the Cervical Lymph Nodes in a Human Immunodeficiency Virus–Negative Patient: A Case Report and Review of the Literature
Authors: Lin Fan , Zhang Kai , Quiery Albert T. , Prichard Jeffrey , Schuerch Conrad 
Published: February 2021

Abstract
We report a case of plasmablastic lymphoma presenting in cervical lymph nodes in an 82-year-old, human immunodeficiency virus–negative man. Cytologic and histologic examinations demonstrated a large cell lymphoma with plasmacytic differentiation. The tumor cells were positive for CD138, CD38, epithelial membrane antigen, CD30, and lysozyme, but lacked expression of leukocyte common antigen, T-cell, and B-cell markers. Abundant Epstein-Barr virus–encoded RNA transcripts were identified by in situ hybridization. A monoclonal rearrangement of κ-light- chain gene was demonstrated. The cytologic, histologic, immunohistochemical, and molecular features of plasmablastic lymphoma are reviewed. The potential diagnostic pitfalls and differential diagnoses, especially in a fine-needle aspiration specimen, are addressed.
Continuous Monitoring of Stat and Routine Outlier Turnaround Times: Two College of American Pathologists Q-Tracks Monitors in 291 Hospitals
Authors: Novis David A. , Walsh Molly K. , Dale Jane C. , Howanitz Peter J. 
Published: February 2021

Abstract
Context.—The laboratory test turnaround times (TATs) that exceed the expectations of clinicians who order those tests, the so-called outlier test reporting rates, may be responsible for perceptions of inadequate laboratory service.
Objective.—To monitor outlier test reporting rates for emergency department stat potassium results and routine inpatient morning blood tests.
Design.—In 2 different monitors, each conducted for 2 years, laboratory personnel in institutions enrolled in the College of American Pathologists (CAP) Q-Tracks program tracked the percentages of emergency department stat potassium results and/or the percentages of morning rounds routine test results that were reported later than self-imposed reporting deadlines.
Setting.—A total of 291 hospitals participating in 2 CAP Q-Tracks monitors.
Results.—Participants monitored 225 140 stat emergency department potassium TATs, of which 33 402 (14.8%) were outliers, and 1 055 040 routine morning test reporting times, of which 123 554 (11.7%) were outliers. For both monitors, there was a significant (P &lt; .05) downward trend in the outlier rates as the number of quarters in which participants submitted data increased.
Conclusion.—Outlier reporting rates for emergency department stat potassium and routine morning test results decreased during the 2-year period of continuous monitoring. The CAP Q-Tracks program provides an effective vehicle by which providers of laboratory services may improve the timeliness with which they deliver the results of laboratory tests.
Expression of Cysteine Protease Protein 32 in Prostatic Adenocarcinoma Correlates With Tumor Grade
Authors: Anwar Shahgul , Ambros Robert A. , Jennings Timothy A. , Ross Jeffrey S. , Beza Anton , Mian Badar , Nazeer Tipu 
Published: February 2021

Abstract
Context.—Controlled cell death is mediated by apoptosis-specific genes, tumor suppressor genes, and oncogenes. The caspase family is a group of at least 15 known cysteine proteases that serve as initiator and effector molecules of the apoptosis pathway. On activation, caspases cause cell shrinkage, condensation of chromatin, fragmentation of DNA, and the formation of blebs in the cytoplasmic membrane.
Objectives.—The patterns of cysteine protease protein (CCP) 32 (caspase-3) expression have been determined in normal human tissues and a variety of tumors, and have been shown to correlate with the outcome in breast cancer and linked to resistance to chemotherapy in other tumors. This study was performed to determine whether CPP32 is expressed in prostatic adenocarcinoma and to define its relationship with outcome variables.
Design.—Formalin-fixed, paraffin-embedded radical prostatectomy specimens from 211 patients with prostatic adenocarcinoma were evaluated for CPP32 expression by immunohistochemistry. Hematoxylin-eosin–stained slides were reviewed, and tumors were graded based on the Gleason grading system. Tumors were scored for CPP32 expression semiquantitatively, based on the staining intensity and distribution patterns. These results were compared with Gleason grade and clinical and pathologic stages.
Results.—One hundred thirty-three (63%) of 211 cases showed high expression of CPP32, whereas expression was low in 78 (37%) cases. One hundred three (49%) of 211 cases had a high Gleason score (7 and above). Of 103 cases with a high Gleason score, 74 (72%) showed high CPP32 expression. Strong cytoplasmic staining for CPP32 in high-grade tumors was statistically significant (P = .01). Also, by linear regression analysis a significant correlation was seen between the Gleason score and the cytoplasmic CPP32 expression (P = .001). Expression of CPP32 did not correlate with either clinical stage (P = .28) or pathologic stage (P = .60); however, this study included very few patients with stage IV disease.
Conclusion.—The correlation between CPP32 and high tumor grade suggests a CPP32-related high turnover rate in high-grade prostatic adenocarcinoma. Moreover, strong correlation with Gleason grade, a powerful predictor of disease progression and overall survival, suggests potential usefulness of CPP32 as a prognostic factor, especially in limited biopsy samples.
Transforming Growth Factor α and Epidermal Growth Factor Receptor in Reactive and Malignant Mesothelial Proliferations
Authors: Cai Yun-Cai , Roggli Victor , Mark Eugene , Cagle Philip T. , Fraire Armando E. 
Published: February 2021

Abstract
Background.—Growth factors such as transforming growth factor α (TGF-α) and epidermal growth factor receptor (EGFR) play an important role in cell proliferation. The immunohistochemical expression of these factors has been extensively studied in malignant tumors including mesothelioma. However, the comparative expression of these growth factors in mesothelioma and reactive mesothelial proliferations has been less well studied.
Objective.—To evaluate the possible role of TGF-α and EGFR in the clinically important distinction between reactive mesothelial proliferations and malignant mesothelioma.
Methods.—The expression of TGF-α and EGFR was studied in 39 cases of mesothelioma and 30 cases of reactive mesothelial proliferations by means of immunohistochemistry.
Results.—Fourteen (70%) of 20 reactive mesothelial proliferations tested and 29 (76%) of 38 mesotheliomas tested expressed TGF-α. One (3%) of 30 reactive mesothelial proliferations and 17 (45%) of 39 mesotheliomas expressed EGFR.
Conclusions.—These results suggest an up-regulation of EGFR in mesothelioma as compared with reactive mesothelial proliferations. This up-regulation further suggests a possible use of EGFR as an adjunct immunohistochemical test in the differential diagnosis of mesothelioma and reactive mesothelial proliferations.
Differential Trends in the Intestinal and Diffuse Types of Gastric Carcinoma in the United States, 1973–2000: Increase in the Signet Ring Cell Type
Authors: Henson Donald Earl , Dittus Christopher , Younes Mamoun , Nguyen Hong , Albores-Saavedra Jorge 
Published: February 2021

Abstract
Context.—During the last 50 years, the incidence and mortality of gastric cancer has declined in many countries. This decline has primarily included the intestinal type (Lauren classification). However, there is an impression among pathologists that the diffuse type, especially the signet ring cell subtype, has become more prevalent.
Objectives.—Using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, we analyzed the trends of the 2 primary types (intestinal and diffuse) of gastric carcinomas from 1973 through 2000.
Design.—Trends in age-adjusted rates were determined for gastric carcinomas through the SEER statistical program (SEER*Stat), which is available on the Internet to the public.
Results.—During the period studied, the intestinal type continued to decline in males, females, African Americans, and whites. The intestinal type was more common in males than in females and more common in African Americans than in whites. In contrast, a consistent increase in the rate of the diffuse type of gastric carcinoma was seen during this period. The rate increased from 0.3 cases per 100 000 persons in 1973 to 1.8 cases per 100 000 persons in 2000. This increase was seen in males, females, African Americans, and whites. The predominant increase occurred in the signet ring type.
Conclusions.—The results indicate a progressive decrease in the incidence of the intestinal type of gastric cancer and an increase in the diffuse type of gastric carcinoma, especially the signet ring cell type. The clinical implications of the increase are considered.
Primary Basal Cell Carcinoma of the Nipple
Authors: Gupta Chakshu , Sheth Dharti , Snower Daniel P. 
Published: February 2021

Abstract
Basal cell carcinoma arising from the nipple of the breast is an uncommon malignancy, with only a handful of cases reported in the literature. The diagnosis is, however, important because basal cell carcinoma in this location can mimic breast cancer, may behave aggressively, and there is a relative lack of consensus in its treatment. A case of basal cell carcinoma of the nipple is described in a 67-year-old man with a brief review of the literature.
Intrascrotal Lipoblastoma With a Complex Karyotype: A Case Report and Review of the Literature
Authors: Somers Gino R. , Teshima Ikuko , Nasr Ahmed , Cook Anthony , Khoury Antoine E. , Taylor Glenn P. 
Published: February 2021

Abstract
Lipoblastoma is a tumor of adipose tissue that usually occurs in young children. Most lipoblastomas occur on the extremities, trunk, and head and neck, and most have rearrangements of the 8q region. We describe a lipoblastoma in a 12-month-old boy who presented with a rapidly enlarging scrotal mass. Electron microscopy revealed features consistent with immature adipocytes, and cytogenetic analysis revealed the following karyotype: 57,XY,+4,+6,+7,der(8)t(8;12) (q22;q13), +der(8)t(8;12) (q22;q13), +9,+10,+12,−16,+17,+der(18)t(8;18)(q22;q23),+19,+20. Interestingly, the breakpoint on chromosome 12 (q13) is the same as that seen in lipoblastomas. To our knowledge, this is the first reported case of such a complex karyotype in lipoblastoma and adds to the expanding list of karyotypic abnormalities seen in such tumors.
Small Intestinal Angiosarcoma Leading to Perforation and Acute Abdomen
Authors: Kelemen Katalin , Yu Qing Qing , Howard Lydia 
Published: February 2021

Abstract
A 76-year-old man presented to the emergency room with abdominal pain and fatigue. The patient had a history of gastrointestinal bleeding. An abdominal computed tomographic scan showed collections of free air in the abdomen with obstruction of the distal small intestine and multiple masses in the liver. Laparotomy revealed a widespread malignant neoplasm in the abdomen, with multiple tumor nodules in the ileal wall, mesentery, and liver. The ileal wall was perforated within the area of one of the tumors. Pathologic examination of the lesion showed a neoplasm composed of solid sheets of spindle and undifferentiated cells, forming interlacing delicate vascular channels with atypical endothelial cells. The tumor cells were positive for the endothelial marker CD31, whereas reactivity for a broad panel of epithelial and other endothelial markers was negative. This case demonstrates that although angiosarcomas of the gastrointestinal tract are rare, they should be considered in cases of intestinal perforation or severe bleeding, especially in the elderly. A broad panel of immunochemical markers might be necessary to establish the pathologic diagnosis.
Progression of Chronic Myeloid Leukemia to Blast Crisis During Treatment With Imatinib Mesylate
Authors: Xu Yin , Wahner Andrea E. , Nguyen Phuong L. 
Published: February 2021

Abstract
Context.—Previous investigators have reported discrepancies between hematologic, marrow morphologic, and cytogenetic responses to imatinib mesylate among patients with chronic myeloid leukemia (CML). In addition to disease refractoriness, rare instances of disease progression from chronic phase to blast crisis during imatinib therapy have recently been anecdotally reported.
Objectives.—To describe the clinicopathologic features of 3 patients with CML who rapidly progressed from chronic phase to blast crisis while taking imatinib and to perform a review of the literature.
Design.—Morphologic, immunophenotypic, and cytogenetic analyses were performed on the 3 patients at the time of initial diagnosis, during imatinib therapy, and at blast crisis.
Results.—The 3 patients were men, aged 39, 42, and 43 years. Two had been treated with hydroxyurea for 16 and 21 months before imatinib therapy, while 1 was started on a regimen of imatinib following diagnosis. Despite a hematologic response in all 3 patients, none of them achieved cytogenetic remission, and all progressed to blast crisis at 7 to 10 months of imatinib therapy. Blood findings during blast transformation were heterogeneous, including normal blood morphologic findings in 1 patient, leukocytosis with circulating blasts and basophilia in 1, and marked pancytopenia in 1. All 3 marrow specimens demonstrated moderate to marked diffuse reticulin fibrosis with more than 20% blasts. Clonal cytogenetic evolution was evident in 2 of the 3 patients and included an extra Philadelphia chromosome in both. All 3 patients underwent allogeneic bone marrow transplantation. One was alive with no evidence of disease at 14 month follow-up, while 2 had residual disease after bone marrow transplantation and died of complications at 4 and 5 months after transplantation.
Conclusions.—Blood data did not always reflect marrow status. Therefore, bone marrow follow-up is critical for monitoring of response. Our findings suggest that significant progression of marrow reticulin fibrosis during imatinib therapy can be an indicator for a return or progression of CML and, in some patients with CML, imatinib may promote cytogenetic clonal evolution, resulting in a poor response to treatment.
Angioimmunoblastic T-Cell Lymphoma With Cutaneous Involvement: A Case Report With Subtle Histologic Changes and Clonal T-Cell Proliferation
Authors: Huang Chien-Tai , Chuang Shih-Sung 
Published: February 2021

Abstract
Angioimmunoblastic T-cell lymphoma is a nodal peripheral T-cell lymphoma that rarely involves the skin. We describe a 62-year-old Taiwanese man who developed a second relapse of angioimmunoblastic T-cell lymphoma with generalized erythroderma and numerous plaquelike and nodular lesions. Biopsy of the erythematous skin lesion demonstrated mild infiltrate of atypical small lymphocytes, some with clear cytoplasm. The lymphoid infiltrate was located mainly around skin appendages and in the upper dermis without epidermotropism. Immunohistochemically, these atypical lymphocytes expressed CD3. Polymerase chain reaction analysis for T-cell receptor γ-chain gene rearrangement using paraffin section showed the same-sized monoclonal bands in the skin and 2 previous nodal biopsies. We conclude that the histologic features of angioimmunoblastic T-cell lymphoma involving skin may be very subtle, showing only mild lymphoid infiltrate. Awareness of the history of angioimmunoblastic T-cell lymphoma with ancillary studies, including clonality testing for T-cell receptor gene rearrangement, is crucial for reaching an accurate diagnosis.