bluuebunny/crossref_metadata_2025_split huggingface dataset:
Waldenstrom Macroglobulinemia Presenting as a Pleural Effusion
Authors: Mansoor Adnan , Wagner Randall P. , DePalma Louis 
Published: February 2021

Abstract
We describe a patient with Waldenstrom macroglobulinemia who presented with a lymphocytic pleural effusion. Pleural involvement in Waldenstrom macroglobulinemia is very rare. In addition, to our knowledge, there are no reports in the literature in which a primary diagnosis was made on the basis of pleural fluid analysis. The presence of small lymphocytes in serous cavity fluid can pose great difficulty in the differentiation between a low-grade lymphoproliferative disorder and reactive lymphocytosis. The diagnosis of malignancy in this case was established on the basis of morphologic testing, flow cytometry, and the detection of B-cell immunoglobulin gene rearrangement.
Composite Prolymphocytoid and Hodgkin Transformation of Chronic Lymphocytic Leukemia
Authors: O'Sullivan Maureen J. , Kaleem Zahid , Bolger Michael J. , Swanson Paul E. , Zutter Mary M. 
Published: February 2021

Abstract
The indolent course of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is occasionally altered by transformation to a histologically distinct, rapidly progressive, and clinically unresponsive hematologic malignant neoplasm. We report a case of CLL that, after 3 years of slowly progressive disease and treatment with single-agent chemotherapy (fludarabine phosphate), underwent a composite prolymphocytoid and classic Hodgkin lymphoma transformation. The diagnosis of classic Hodgkin lymphoma was based on the presence of Reed-Sternberg cells with typical morphologic structure and immunophenotype (CD15+, CD30+, CD45−, CD20−) associated with the characteristic polymorphous inflammatory background consisting of numerous eosinophils, plasma cells, and reactive T lymphocytes. The remainder of the lymph node and the peripheral blood showed increased numbers of prolymphocytes admixed with typical small CLL cells. Recognition of such a transformation is of the utmost importance, since histologically similar Reed-Sternberg–like cells may be seen in Richter transformation. In contrast to prolymphocytoid transformation of CLL, Richter syndrome is rapidly fatal, with a median survival of 4 to 5 months. The patient pursued a clinical course similar to pure prolymphocytoid transformation and died with disease after 30 months following treatment with combination chemotherapy.
Histiocytic Sarcoma Associated With Idiopathic Myelofibrosis
Authors: Fukunaga Masaharu , Kato Hiroyuki 
Published: February 2021

Abstract
We describe the case of a 39-year-old man with idiopathic myelofibrosis, who developed histiocytic sarcoma (true histiocytic lymphoma) 6 months after diagnosis. The patient developed generalized lymphadenopathy. A lymph node biopsy showed pronounced distension of the sinuses in the medulla and periphery, caused by the accumulation of large tumor cells. The tumor cells had abundant clear or eosinophilic cytoplasm. The nuclei were of various sizes and shapes, with condensed chromatin and prominent nucleoli. Some tumor cells displayed erythrophagocytosis. Immunohistochemically, the tumor cells were positive for CD68, α1-antitrypsin, CD45, CD45RO, and S100 protein, and were negative for B- and T-cell markers, CD30, CD1a, lysozyme, myeloperoxidase, factor VIII–related antigen, CAM 5.2, and HMB-45. Despite multiagent chemotherapy, the patient died of disease 25 months after diagnosis. Although histiocytic sarcomas are very rare, their recognition may be important for clinical and prognostic reasons.
Combining Human Papillomavirus Testing or Cervicography With Cytology to Detect Cervical Neoplasia
Authors: Howard Michelle , Sellors John W. , Lytwyn Alice , Roth Paula , Mahony James B. 
Published: February 2021

Abstract
Context.—Cervicography and oncogenic human papillomavirus (HPV) testing have been proposed for improving the accuracy of cervical cancer screening.
Objective.—To examine whether cervicography and HPV testing can improve beyond chance the detection of cervical intraepithelial neoplasia (CIN) 2 or 3 in women with atypical cells of undetermined significance or low-grade squamous intraepithelial lesions on cytology.
Design.—Cross-sectional analysis. Oncogenic HPV testing by Hybrid Capture II assay or cervicography combined with cytology was compared with the reference standard of colposcopy with directed biopsy.
Setting.—Community family practices.
Participants.—Three hundred four women with low-grade cytologic abnormality.
Main Outcome Measures.—The gain in accuracy for detecting histologic CIN 2 or 3 or carcinoma. Because an adjunct test may improve sensitivity by chance alone, the sensitivity or specificity if the second test performed randomly was estimated.
Results.—Cervical intraepithelial neoplasia 2 or 3 was found in 11.8% (36/304) of the women and invasive squamous cell carcinoma in 0.3% (1/304). The sensitivity of cytology for detecting CIN 2 or 3 was 73.0% and increased by 21.6% to 94.6% with the addition of a cervigram showing a low-grade lesion or higher or a positive HPV test result. These gains were reduced to 8.1% and 10.8% above the sensitivities expected if the additional tests performed randomly. The corresponding specificities decreased from 49.1% to 32.2% and 33.0%. There was insufficient power to determine whether observed sensitivities were statistically significantly higher than the expected sensitivities.
Conclusion.—Adjunctive HPV testing or cervicography may provide similar gains in sensitivity, but they can appear misleadingly large if chance increases are not taken into account.
Analysis of Deaths During the Severe Acute Respiratory Syndrome (SARS) Epidemic in Singapore: Challenges in Determining a SARS Diagnosis
Authors: Chong Pek Yoon , Chui Paul , Ling Ai E. , Franks Teri J. , Tai Dessmon Y. H. , Leo Yee Sin , Kaw Gregory J. L. , Wansaicheong Gervais , Chan Kwai Peng , Ean Oon Lynette Lin , Teo Eng Swee , Tan Kong Bing , Nakajima Noriko , Sata Tetsutaro , Travis William D. 
Published: February 2021

AbstractContext.—An outbreak of severe acute respiratory syndrome (SARS), an infectious disease attributed to a novel coronavirus, occurred in Singapore during the first quarter of 2003 and led to 204 patients with diagnosed illnesses and 26 deaths by May 2, 2003. Twenty-one percent of these patients required admission to the medical intensive care unit. During this period, the Center for Forensic Medicine, Health Sciences Authority, Singapore, performed a total of 14 postmortem examinations for probable and suspected SARS. Of these, a total of 8 were later confirmed as SARS infections.Objective.—Our series documents the difficulties encountered at autopsy during the initial phases of the SARS epidemic, when the pattern of infection and definitive diagnostic laboratory criteria were yet to be established.Design.—Autopsies were performed by pathologists affiliated with the Center for Forensic Medicine, Health Sciences Authority, Singapore. Tissue was accessed and read at the Tan Tock Seng Hospital, Singapore, and at the Armed Forces Institute of Pathology, Washington, DC. Autopsy tissue was submitted to the Virology Department, Singapore General Hospital, for analysis, and in situ hybridization for the SARS coronavirus was carried out at the National Institute of Infectious Diseases, Tokyo, Japan.Results.—Thirteen of 14 patients showed features of diffuse alveolar damage. In 8 patients, no precipitating etiology was identified, and in all of these patients, we now have laboratory confirmation of coronavirus infection. Two of the 8 patients presented at autopsy as sudden unexpected deaths, while the remaining 6 patients had been hospitalized with varying lengths of stay in the intensive care unit. In 3 patients, including the 2 sudden unexpected deaths, in situ hybridization showed the presence of virally infected cells within the lung. In 4 of the 8 SARS patients, pulmonary thromboemboli were also recognized on gross examination, while one patient had marantic cardiac valvular vegetations.Conclusions.—It is unfortunate that the term atypical pneumonia has been used in conjunction with SARS. Although nonspecific by itself, the term does not accurately reflect the underlying dangers of viral pneumonia, which may progress rapidly to acute respiratory distress syndrome. We observed that the clinical spectrum of disease as seen in our autopsy series included sudden deaths. This is a worrisome finding that illustrates that viral diseases will have a spectrum of clinical presentations and that the diagnoses made for such patients must incorporate laboratory as well as clinical data.
Multilocular Thymic Cyst Associated With Mature Mediastinal Teratoma: A Report of 2 Cases
Authors: Rakheja Dinesh , Weinberg Arthur G. 
Published: February 2021

Abstract
Acquired thymic cysts are multilocular and show florid xanthomatous and myofibroblastic inflammation. They usually occur in association with mediastinal neoplasms, systemic autoimmune diseases, or trauma. We describe 2 cases (in a 12-year-old girl and an 11-year-old boy) of acquired thymic cysts occurring in association with cystic teratomas, an association that to our knowledge has not been described previously in the literature.
Collision Metastasis of Prostatic and Colonic Adenocarcinoma: Report of 2 Cases
Authors: Wade Zane K. , Shippey John E. , Hamon Gregory A. , Smoak Robert L. , Argani Pedram , Allsbrook William C. 
Published: February 2021

Abstract
Collision metastases of carcinomas in lymph nodes are rare. Carcinoma metastasizing to lymph nodes containing malignant lymphoma has also been reported. The literature contains 3 cases of collision metastasis of prostatic and urothelial carcinoma. To our knowledge, we report the first 2 cases of collision metastasis of prostatic and colonic adenocarcinoma, one involving a mesenteric lymph node and the other involving a perirectal lymph node, both from resections for colonic adenocarcinoma in patients with known metastatic prostatic carcinoma.
Early Nodular Hyperplasia of the Liver Occurring With Inflammatory Bowel Diseases in Association With Thioguanine Therapy
Authors: Shastri Sunita , Dubinsky Marla C. , Fred Poordad F. , Vasiliauskas Eric A. , Geller Stephen A. 
Published: February 2021

Abstract
Context.—Nodular hyperplasia (also referred to as nodular regenerative hyperplasia and nodular regenerative hyperplasia of the liver) is a sequel to therapy with thioguanine in patients with hematologic malignancies. Recently, 6-thioguanine has been used to treat patients with inflammatory bowel disease who have been resistant to other forms of therapy.
Objective.—To study liver biopsies from 3 patients with inflammatory bowel disease who had received thioguanine for more than a year, and who had elevated serum liver enzyme values and underwent percutaneous liver biopsy.
Design.—Percutaneous liver biopsies and histologic examinations were performed, including staining with the reticulin silver impregnation method.
Results.—All 3 patients had foci of nodular regenerative hyperplasia, which was best seen with the reticulin silver impregnation method.
Conclusions.—Thioguanine-treated inflammatory bowel disease patients are at risk for the development of nodular hyperplasia. Reticulin-stained histologic sections are necessary to recognize this change. Further studies are needed to determine the frequency and significance of this change.
Spinal Cord Neuropathology in Human West NileVirus Infection
Authors: Fratkin Jonathan D. , Leis A. Arturo , Stokic Dobrivoje S. , Slavinski Sally A. , Geiss Roger W. 
Published: February 2021

Abstract
Context.—During the 1999 New York City West Nile virus (WNV) outbreak, 4 patients with profound muscle weakness, attributed to Guillain-Barré syndrome, were autopsied. These cases were the first deaths caused by WNV, a flavivirus, to be reported in the United States. The patients' brains had signs of mild viral encephalitis; spinal cords were not examined. During the 2002 national epidemic, several patients in Mississippi had acute flaccid paralysis. Electrophysiologic studies localized the lesions to the anterior horn cells in the spinal gray matter. Four of 193 infected patients in Mississippi died and were autopsied. All 4 experienced muscular weakness and respiratory failure that required intubation. Postmortem examinations focused on the spinal cord.
Objective.—To emphasize apparent tropism of WNV for the ventral gray matter of the spinal cord.
Design.—Cerebral hemispheres, basal ganglia, diencephalon, brainstem, cerebellum, and spinal cord sections were stained with hematoxylin-eosin and incubated with antibodies to T cells, B cells, and macrophages/microglial cells.
Results.—We identified neuronophagia, neuronal disappearance, perivascular chronic inflammation, and microglial proliferation in the ventral horns of the spinal cord, especially in the cervical and lumbar segments. Loss of ganglionic neurons, nodules of Nageotte, and perivascular lymphocyte aggregates were found in dorsal root and sympathetic ganglia. Severity of cellular reaction was proportional to the interval length between patient presentation and death.
Conclusion.—West Nile virus caused poliomyelitis. Injury to spinal and sympathetic ganglia mirrored the damage to the spinal gray matter. The disappearance of sympathetic neurons could lead to the autonomic instability observed in some WNV patients, including labile vital signs, hypotension, and potentially lethal cardiac arrhythmias.
Perivascular Fibrosis in the Bone Marrow in Sickle Cell Disease
Authors: Manci Elizabeth A. , Culberson Donald E. , Gardner Julia M. , Brogdon Byron G. , Shah Arvind K. , Elyse Holladay; J. , Powell Randall W. , Mankad Vipul N. 
Published: February 2021

AbstractContext.—Magnetic resonance imaging of bone marrow in homozygous sickle cell disease (hemoglobin [Hb] SS) shows nonhomogeneous, mottled signals that increase with age and number of crises. The pattern of these signals is reminiscent of the underlying vascular architecture, but histopathology of this tissue has not been adequately studied.Objective.—To elucidate the histopathology of blood vessels in the bone marrow in sickle cell disease.Design.—Retrospective histochemical morphometric study of bone marrow arteries by point counting in HbSS (13 cases) and sickle cell Hb C (HbSC) (8 cases) compared to nonanemic normal controls (HbAA) (10 cases). All patients were nondiabetic, normotensive, younger than 37 years, and matched for age group.Results.—The mean point count for perivascular fibrous tissue was significantly greater in the HbSS group (P &lt; .001) in both small (P &lt; .001) and medium-sized (P = .002) vessels, and in both age groups (pediatric, P &lt; .001; adult, P = .005) compared with the HbAA group. Additional analysis showed the difference was significant in HbSS pediatric small vessels (P &lt; .001) and in pediatric and adult medium vessels (P = .045 and P = .03, respectively). Ratios of fibrous tissue to muscle showed proportionately greater fibrous tissue in HbSS pediatric small (P &lt; .001) and medium-sized vessels (P = .02), and in adult large vessels (P = .03). Mean point counts for muscle were significantly decreased in HbSS small vessels when all ages were compared as a group (P = .02), but when compared by age groups, counts were significantly increased in adult HbSS medium-sized vessels (P = .01). Overall mean point counts for muscle and fibrous tissue in the HbSC group were intermediate between those of the HbSS and HbAA groups, but were not significantly different from counts in the HbAA group (P = .78 and P = .35, respectively).Conclusion.—In sickle cell disease, arterial vessels in the bone marrow show significantly increased fibrous connective tissue and changes in muscle that vary with age and vessel size.
Fatal Hemorrhagic Pneumonia Concomitant With Chlamydia pneumoniae and ParainfluenzaVirus 4 Infection
Authors: Rubinas Tara C. , Carey Roberta B. , Kampert Mitchell C. , Alkan Serhan , Lednicky John A. 
Published: February 2021

Abstract
Context.—Cases of fatal hemorrhagic pneumonia need to be investigated for highly contagious viral causes. While not all hemorrhagic pneumonias are caused by very contagious agents, the etiology must be correctly determined in order to administer appropriate patient care.
Objective.—To determine whether chlamydia, paramyxovirus, or mycoplasma was the causative agent in a case of fatal hemorrhagic pneumonia, and to evaluate the possibility that this was the first case of hantavirus pulmonary syndrome in Illinois.
Design.—Nonroutine virological and molecular analyses were performed on lung tissue taken during an unrestricted autopsy of a patient who died in 2002.
Setting and Patient.—An elderly, male, Chicago-area resident with a 3-week history of nonspecific, mild upper respiratory tract infection was admitted for hospital treatment of the respiratory infection and viral myositis without cardiac involvement. The patient became febrile, hypoxic, developed hemorrhagic pneumonia, and died. Because he had proven exposure to mice and had developed hemorrhagic pneumonia, hantavirus pulmonary syndrome was suspected as the cause of death. Mice known to carry hantaviruses live in Illinois, including the Chicago area.
Interventions.—Gatifloxacin and heparin anticoagulation were initiated because community-acquired pneumonia and pulmonary embolism were considered likely etiologies for an acute exacerbation of hypoxemia.
Results.—Two respiratory pathogens were isolated and identified: Chlamydia pneumoniae and human parainfluenza virus 4a.
Conclusions.—A mixed (polymicrobial) infection contributed to the patient's death. Hemorrhage was likely a result of anticoagulation therapy superimposed on lung tissues damaged by pneumonia. The uncommon nature of this case and the pathogens involved underscore the challenges in infection control and clinical evaluation that hospitals will face when confronted with possibly new and potentially deadly communicable diseases.
An Improved Failure Mode Effects Analysis for Hospitals
Authors: Krouwer Jan S. 
Published: February 2021

Abstract
Objective.—To review the Failure Mode Effects Analysis (FMEA) process recommended by the Joint Commission on Accreditation of Health Organizations and to review alternatives. This reliability engineering tool may be unfamiliar to hospital personnel.
Data Sources.—Joint Commission on Accreditation of Health Organizations recommendations, Mil-Std-1629A, and other articles about FMEA were used.
Study Selection.—The articles were selected by a literature search that included Web site–accessible material.
Data Extraction.—All articles found were used.
Data Synthesis.—The results are based on the articles cited and the author's experience in conducting FMEAs in the medical diagnostics industry.
Conclusions.—Fault trees and a list of quality system essentials are recommended additions to the FMEA process to help identify failure mode effects and causes. Neglecting mitigations for failure modes that have never occurred is a possible danger when too much emphasis is placed on improving risk priority numbers. A modified Pareto, not based on the risk priority number, is recommended when there are qualitatively different failure mode effects with different severities. Performing a FMEA that both meets accreditation requirements and reduces the risk of medical errors is an attainable goal, but it may require a different focus.
Pathology Informatics Questions and Answers From the University of Pittsburgh Pathology Residency Informatics Rotation
Authors: Harrison James H. 
Published: February 2021

Abstract
Context.—Effective pathology practice increasingly requires familiarity with concepts in medical informatics that may cover a broad range of topics, for example, traditional clinical information systems, desktop and Internet computer applications, and effective protocols for computer security. To address this need, the University of Pittsburgh (Pittsburgh, Pa) includes a full-time, 3-week rotation in pathology informatics as a required component of pathology residency training.
Objective.—To teach pathology residents general informatics concepts important in pathology practice.
Design.—We assess the efficacy of the rotation in communicating these concepts using a short-answer examination administered at the end of the rotation. Because the increasing use of computers and the Internet in education and general communications prior to residency training has the potential to communicate key concepts that might not need additional coverage in the rotation, we have also evaluated incoming residents' informatics knowledge using a similar pretest.
Data Sources.—This article lists 128 questions that cover a range of topics in pathology informatics at a level appropriate for residency training. These questions were used for pretests and posttests in the pathology informatics rotation in the Pathology Residency Program at the University of Pittsburgh for the years 2000 through 2002. With slight modification, the questions are organized here into 15 topic categories within pathology informatics. The answers provided are brief and are meant to orient the reader to the question and suggest the level of detail appropriate in an answer from a pathology resident.
Results.—A previously published evaluation of the test results revealed that pretest scores did not increase during the 3-year evaluation period, and self-assessed computer skill level correlated with pretest scores, but all pretest scores were low. Posttest scores increased substantially, and posttest scores did not correlate with the self-assessed computer skill level recorded at pretest time.
Conclusions.—Even residents who rated themselves high in computer skills lacked many concepts important in pathology informatics, and posttest scores showed that residents with both high and low self-assessed skill levels learned pathology informatics concepts effectively.