bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Stage of Epstein-Barr Virus Lytic Infection Leading to the “Starry Sky” Pattern Formation in Endemic Burkitt Lymphoma
Authors: Fujita Shuichi , Buziba Nathan , Kumatori Atsushi , Senba Masachika , Yamaguchi Akira , Toriyama Kan 
Published: February 2021

Abstract
Context.—Burkitt lymphoma (BL) is histologically characterized by a “starry sky” appearance, representing scattered macrophages that have phagocytosed cell debris among proliferating lymphoma cells. As is well known, almost all the neoplastic cells of endemic BL are infected with Epstein-Barr virus (EBV). Previous studies have indicated that most of the EBV in B cells is latent, and few virus particles enter the lytic cycle.
Objective.—To examine the histologic relationship between EBV infection stages and the formation of the starry sky pattern in African endemic BL tissues.
Design.—Tissue samples from 44 patients with African endemic BL were examined with immunohistochemistry and in situ hybridization. We used EBV-encoded small RNA (EBER) as a marker of latent infection, and BamHI H left frame 1 (BHLF1) and BamHI Z EBV replication activator (ZEBRA) as lytic cycle markers.
Results.—In all cases, signals for EBER were found in most neoplastic lymphocytes, and in 73% of cases, signals for BHLF1 and/or ZEBRA were recognized in the lymphoma cells within and around the lacunae in starry sky figures. The mean number of lacunae per unit area in cases positive for lytic cycle markers was significantly higher than that in negative cases (P &lt; .001).
Conclusions.—Our findings suggest that EBV-infected lymphoma cells in the lytic cycle, which eventually lapse into cell death, are phagocytosed prior to their rupture by macrophages that have migrated into the parenchyma. We emphasize that transition of EBV-infected lymphoma cells to the lytic cycle is one of the histomorphogenetic factors influencing the formation of starry sky pattern in endemic BL.
Gastric Myeloid Metaplasia: A Case Report and Review of the Literature
Authors: Chatelain Denis , Devendeville Agnès , Rudelli Alain , Bruniau Alexis , Geslin Guillaume , Sevestre Henri 
Published: February 2021

Abstract
We report a case of gastric myeloid metaplasia in an 89- year-old woman with agnogenic myeloid metaplasia. The lesions were fortuitously discovered on upper endoscopy. The antral mucosa was thickened and polypoid, and on histologic examination contained immature granulocytes, megakaryocytes, and a few erythroblasts without desmoplastic stromal reaction. The granulocytes were positive for CD15, CD68, and myeloperoxidase on immunohistochemistry, and the megakaryocytes showed positive reactivity for factor VIII. Gastric myeloid metaplasia is a very rare event, and to our knowledge only 6 cases have been reported in the literature to date. It usually occurs in patients with advanced myeloproliferative syndrome. Gastric myeloid metaplasia often has a pseudotumoral appearance, leading to digestive symptoms. Histologic diagnosis is straightforward when trilinear hematopoietic elements are identified in gastric biopsies. Immunohistochemistry with anti–factor VIII antibody can be useful to confirm the presence of megakaryocytes.
Primitive Neuroectodermal Tumor of the Gallbladder
Authors: Song Dong Eun , Choi Ga Won , Jun Sun-Young , Ro Jae Y. 
Published: February 2021

Abstract
Ewing sarcoma/primitive neuroectodermal tumor (ES/ PNET) most commonly occurs in the soft tissues of the extremities and the paravertebral areas. To our knowledge, no case of PNET has been reported in the gallbladder to date. We report a case of PNET of the gallbladder occurring in a 53-year-old woman. Microscopically, the monotonous small round cells with a formation of Homer-Wright rosettes showed intense membranous positive immunoreactivity for MIC2/CD99, as well as for neuron-specific enolase and synaptophysin. Other small round cell tumors, such as lymphoma, rhabdomyosarcoma, or melanoma, were excluded in light of negative immunoreactivity for leukocyte common antigen, desmin, and S100. The diagnosis of PNET was rendered based on the characteristic morphology and immunohistochemical findings, despite an absence of chromosomal translocations, such as t(11; 22)(q24;q12) and t(21;22)(q22;q12).
Comparison of Needle Core Biopsy and Fine-Needle Aspiration for Diagnostic Accuracy in Musculoskeletal Lesions
Authors: Yang Yi Jun , Damron Timothy A. 
Published: February 2021

Abstract
Context.—Needle core biopsy has been reported to be the choice of biopsy for musculoskeletal tumors. Fine-needle aspiration, on the other hand, has been widely accepted for nonmusculoskeletal tumors, but is only used in selected medical centers for musculoskeletal tumors. While fine-needle aspiration appears to have advantages to needle core biopsy in the aspects of simplicity and cost, the diagnostic accuracy should be the most critical parameter in determining the choice of biopsy. However, few studies comparing the diagnostic accuracy of these 2 biopsy methods have been performed.
Objective.—This study was designed to compare the diagnostic accuracy of fine-needle aspiration and needle core biopsy in musculoskeletal tumors.
Design.—Prospective study was performed in patients aged 10 years or older. Diagnostic accuracy was compared in 50 consecutive concurrent needle core biopsies and fine-needle aspirations of musculoskeletal lesions.
Results.—For primary musculoskeletal lesions, fine-needle aspiration achieved a diagnostic accuracy rate of 88% for nature of lesion, 64% for specific diagnosis, 78% for histologic grading, and 74% for histologic typing. Needle core biopsy achieved an accuracy rate of 93% for nature of lesions, 83% for specific diagnosis, 83% for histologic grading, and 90% for histologic typing. Both biopsy methods have a higher diagnostic accuracy rate for high-grade tumors than for low-grade or benign lesions in determining the nature, specific diagnosis, and histologic grading.
Conclusions.—The needle core biopsy has a higher diagnostic accuracy than fine-needle aspiration in all aspects, including determining the nature of the tumor, establishing the histologic type and grade, and achieving a specific diagnosis.
Quality Control Analysis of the Potential for Asbestos Contamination During Tissue Processing inPathology Laboratories
Authors: Dodson Ronald F. , O'Sullivan Michael , Hammar Samuel P. 
Published: February 2021

Abstract
Context.—Various quality assurance procedures are applied in pathology and analytical microscopy laboratories to ensure accurate results.
Objective.—To assess the potential of cross-contamination of tissue with asbestos fibers and asbestos bodies during the fixation and washing process.
Design.—Lung tissue from 10 patients with potential asbestos-related disease was evaluated. Samples of fixative, water, and lung tissue from each case were evaluated by light and analytical transmission electron microscopy for asbestos bodies and uncoated asbestos fibers.
Results.—The lung samples tested contained a range of asbestos bodies and uncoated asbestos fibers. One wash water sample contained one asbestos body. No asbestos bodies or uncoated asbestos fibers were found in any other water or fixative samples.
Conclusions.—The absence of uncoated asbestos fibers in wash water or fixative samples argues that the fixation process stabilizes asbestos fibers within tissue and the protocol used in this pathology laboratory protects against cross-contamination of tissue. The finding of one asbestos body in one water sample further supports the efficiency of the protective controls used in the testing methods, since this asbestos body was in the external solution that was being discarded before tissue sampling occurred.
Massive Thyroid Tumoral Embolism From a Breast Carcinoma Presenting as Acute Thyroiditis
Authors: Jiménez-Heffernan Jose A. , Perez Francisco , Hornedo Javier , Perna Cristian , Lapuente Fernando 
Published: February 2021

Abstract
We describe an unusual case of metastatic disease to the thyroid, characterized by massive intra-arterial embolization and clinical presentation as acute thyroiditis. The patient, a 37-year-old woman with a history of breast carcinoma, presented clinically with acute thyroiditis. No nodules were palpable, and fine-needle aspiration cytology of the left lobe was performed. It showed a pleomorphic carcinoma and was followed by total thyroidectomy. Histology disclosed a pleomorphic carcinoma diffusely affecting the thyroid gland. It was characterized by an extensive intra-arterial tumoral embolization. Immunohistochemistry confirmed the metastatic nature of the neoplasm. This is a very uncommon form of metastatic disease to the thyroid. The ischemia and necrosis associated with the embolic process were most probably responsible for this clinical presentation. This atypical clinical and cytologic presentation may induce confusion with a primary neoplasm, mainly anaplastic thyroid carcinoma.
Amiodarone-Induced Thyrotoxicosis and Thyroid Cancer: Clinical, Immunohistochemical, and Molecular Genetic Studies of a Case and Review of the Literature
Authors: Saad Aly , Falciglia Mercedes , Steward David L. , Nikiforov Yuri E. 
Published: February 2021

Abstract
Amiodarone-induced thyrotoxicosis (AIT) is a well-known complication of amiodarone treatment found in 3% to 12% of patients. Two types of AIT have been described, each associated with a distinct histologic pattern of thyroid involvement. Type 1, which typically develops in the background of pre-existing thyroid disease, is due to iodine-induced excess thyroid hormone synthesis, whereas type 2 is due to destructive thyroiditis. The prevalence of thyroid cancer in patients with AIT is unknown. We report a case of papillary thyroid carcinoma associated with type 2 AIT.
Spindle Cell Transformation of Papillary Carcinoma
Authors: Brandwein-Gensler Margaret S. , Wang Beverly Y. , Urken Mark L. 
Published: February 2021

Abstract
Spindle cells are not routinely encountered in the context of thyroid pathology and are most often present in anaplastic thyroid carcinoma, medullary thyroid carcinoma, and benign conditions such as Riedel struma or de Quervain granulomatous thyroiditis. Only a few publications have reported papillary thyroid carcinoma admixed with a prominent spindle cell component. While these tumors are clearly distinct from anaplastic thyroid carcinoma, prognostication as to their oncologic potential is not yet established. We describe a unique case of spindle cell transformation of papillary thyroid carcinoma. The blandness of the spindle cells was so impressive as to dissuade us from a malignant diagnosis on preoperative biopsies. However, this patient unfortunately died shortly after transformation of this papillary thyroid carcinoma. We conclude that this peculiar and rare spindle cell transformation should be regarded as a potentially lethal variant of papillary thyroid carcinoma.
A Unique Collision Tumor in Breast
Authors: Susnik Barbara , Jordi Rowe J. , Redlich Philip N. , Chitambar Christopher , Chang Chung-Che , Kampalath Bal 
Published: February 2021

Abstract
We report an extraordinary case of a collision tumor consisting of invasive ductal carcinoma with adjacent malignant lymphoma presenting as a single mass in the breast. A 79-year-old woman presented with a breast mass. A core biopsy performed at an outside hospital was interpreted as medullary carcinoma. On review of the breast core biopsy, a diagnosis of a synchronous malignant lymphoma and invasive ductal carcinoma was rendered. The patient underwent lumpectomy and axillary dissection. The excised specimen revealed a 2.1-cm, moderately differentiated invasive ductal carcinoma, partially surrounded by malignant lymphoma with areas where both tumors were intermixed. All 27 axillary lymph nodes were extensively involved by lymphoma, and 1 lymph node demonstrated metastatic carcinoma. The morphology and results of immunohistochemistry, flow cytometry, and cytogenetic analysis were consistent with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue.
Oncocytic Biliary Cystadenocarcinoma: A Case Report and Review of the Literature
Authors: Bardin Richard L. , Trupiano Jacqueline K. , Howerton Russell M. , Geisinger Kim R. 
Published: February 2021

Abstract
We report an unusual case of biliary cystadenocarcinoma with oncocytic differentiation. The patient was a 43-year-old woman who presented with right upper quadrant pain. Imaging revealed a 16 × 10 × 10-cm, heterogenous, right hepatic mass with extension into the right atrium. Surgical resection revealed a papillary neoplasm of malignant cells with atypical hyperchromatic nuclei and prominent nucleoli lining fibrovascular cores. Mesenchymal stroma was not present. The majority of the epithelial cells had abundant eosinophilic granular cytoplasm, consistent with oncocytic differentiation. There was extensive stromal and hepatic parenchymal invasion. Immunohistochemical staining revealed a “biliary pattern” of cytokeratin subset immunoreactivity, with positivity for cytokeratin 7 and an absence of staining with cytokeratin 20. The tumor was negative for mucin, carcinoembryonic antigen, α-fetoprotein, calretinin, CD31, and chromogranin. There was granular cytoplasmic staining with phosphotungstic acid hematoxylin, consistent with the presence of abundant mitochondria. Electron microscopy revealed abundant mitochondria within the neoplastic cells. This case is quite unusual because female patients only rarely lack the characteristic ovarian-like mesenchymal stroma of biliary cystadenomas/cystadenocarcinomas. Furthermore, to our knowledge, oncocytic differentiation in this neoplasm has been reported previously on only 2 occasions. The biologic behavior and prognostic significance, if any, of the lack of mesenchymal stroma in female patients or the presence of oncocytic differentiation remains to be further elucidated as more of these cases are described.
College of American Pathologists Special Topic Symposium on Error in Pathology and Laboratory Medicine—Practical Lessons for the Pathologist: Introduction
Authors: Zarbo Richard J. , Sirota Ronald L. 
Published: February 2021

Abstract
This article is an overview to the all-day special topic symposium on patient safety and error reduction, entitled “Error in Pathology and Laboratory Medicine: Practical Lessons for the Pathologist,” which was held at the College of American Pathologists annual meeting in Scottsdale, Ariz, on September 20, 2004. The intent of the symposium was to provide pathologists with useful take-home lessons related to error identification, reduction, and risk avoidance for adoption in practice. Error reduction in the laboratory has always been an implied, if not directly stated goal of laboratory quality management programs, but given the nature of humans to err, the call for redesign of the health care system, and the impending threat of national patient safety legislation calling for medical error reporting and disclosure, we believe that this topic of error will be one of continued interest to practicing pathologists for many years.
Immunohistochemical and Clinicopathologic Characteristics of Invasive Ductal Carcinoma of Breast With Micropapillary Carcinoma Component
Authors: Kim Mi-Jung , Gong Gyungyub , Joo Hee Jae , Ahn Se-Hyun , Ro Jae Y. 
Published: February 2021

Abstract
Context.—A micropapillary carcinoma (MC) component is generally considered to behave aggressively. Although several reports have described the prognostic significance of MC in breast carcinomas, immunohistochemical findings of MC, especially as compared to non-MC, are rarely described.
Objective.—We compared clinicopathologic and immunohistochemical findings between 38 cases of invasive breast carcinoma with an MC component (IMC) and 217 cases of invasive breast carcinoma without an MC component (NIMC).
Design.—We constructed a tissue microarray from 38 cases of IMC and performed immunohistochemical stainings for cytokeratin (CK) 7, CK20, estrogen receptor, progesterone receptor, p53, c-Erb-B2, CD34, CK5, epidermal growth factor receptor, and c-Kit in both MC and non-MC components.
Results.—Cases with IMC were associated with greater tumor size, more frequent lymphovascular invasion, nodal metastases, greater mean numbers of positive lymph nodes, and higher stage than those with NIMC, but were not associated with poorer survival rates. On immunohistochemistry, only p53 reactivity was statistically different between MC and non-MC components in IMC cases. Estrogen receptor positivity tended to be lower in MC than non-MC, but the difference was not significant. Most of the MCs and non-MCs in IMC cases were positive for CK7, but none of them were positive for CK20, CK5, epidermal growth factor receptor, or c-Kit.
Conclusions.—Based on the frequent nodal metastases and association with higher stage found in IMC as compared with NIMC cases, as well as higher p53 positivity and lower frequency of estrogen receptor expression, MC could be considered an aggressive histologic type of breast carcinoma. In both MC and non-MC components in IMC cases, no basallike immunostaining pattern was detected.
Myelodysplastic Syndromes: Clinicopathologic Features, Pathobiology, and Molecular Pathogenesis
Authors: Nishino Ha Thanh , Chang Chung-Che 
Published: February 2021

AbstractContext.—Myelodysplastic syndromes (MDSs) are clonal stem cell diseases characterized by ineffective hematopoiesis, multilineage dysplasia, and peripheral cytopenias with normocellular or hypercellular marrow. They represent a heterogeneous group of disorders with a varied spectrum of clinical, morphologic, biologic, and genetic characteristics. This heterogeneity in disease characterization has led to evolving classification systems, developing prognostic models, and continuing research efforts to elucidate its pathobiology and pathogenesis.Objective.—To summarize updated information and provide a general overview of the clinicopathologic features, pathobiology, and cytogenetic and molecular pathogenesis of MDSs.Data Sources.—Relevant articles indexed in PubMed (National Library of Medicine) between 1982 and 2005 and reference medical texts.Conclusions.—Although MDSs remain a relatively poorly defined disease entity, recent advancements in cytogenetic and molecular studies have significantly contributed to our present knowledge of MDSs. Novel strategies for studying the pathogenesis and evolution of MDSs continue to shape our understanding of this disease and guide our approaches to diagnosis and treatment.
Recognition of Histopathologic Patterns of Diffuse Malignant Mesothelioma in Differential Diagnosis of Pleural Biopsies
Authors: Allen Timothy Craig 
Published: February 2021

AbstractContext.—Diffuse malignant mesothelioma is generally divided into 3 basic histologic types—epithelial, biphasic, or sarcomatous. However, a great diversity of histologic patterns exists within these 3 basic histologic types.Design.—The diverse histologic patterns of diffuse malignant mesothelioma are briefly described, including infrequently encountered patterns.Results. The histologic patterns of diffuse malignant mesothelioma provide a wide variation of features for the pathologist to consider in the differential diagnosis of a pleural biopsy.Conclusion.—Pathologists should be aware of the varied histologic patterns of diffuse malignant mesothelioma when evaluating pleural biopsies.
The Italian Quality Control Scheme for Crossmatching Procedures and HLA Sera Screening: The 2002 Pilot Study
Authors: Conca Raffaele , Praticò-Barbato Loredana , Dall'Omo Anna Maria , Amoroso Antonio 
Published: February 2021

Abstract
Context.—The first national quality control (QC) program of histocompatibility serum testing was performed in Italy in 2002.
Objective.—To monitor the performance of HLA typing laboratories while meeting the accreditation requirements of the European Federation for Immunogenetics (EFI), which require HLA typing laboratories to participate in external QC of their crossmatch and antibody analyses.
Design.—The Turin Transplant Immunology Service was asked to organize a QC survey of 17 HLA typing laboratories in Italy. Each laboratory received 12 serum specimens and 6 blood samples and was required to perform 36 crossmatches and 12 serum antibody specificity determinations.
Settings.—Data of participating centers were compared to establish whether EFI requirements were satisfied.
Results.—In crossmatch analysis, the results of 32 of 36 crossmatches reached the 75% consensus target, with all the participating laboratories meeting the standards of the EFI. In antibody analysis, only 7 of 17 laboratories met the EFI standards.
Conclusion.—The first Italian QC program shows that the participating laboratories obtained consistent results in crossmatching, whereas the results were less satisfactory in the determination of serum antibody specificity, where consensus was reached only with monospecific sera and antibody-negative samples.
Clear Cell Myomelanocytic Tumor (PEComa) of the Duodenum in a Child With a History of Neuroblastoma
Authors: Mhanna Tony , Ranchere-Vince Dominique , Hervieu Valérie , Tardieu Dominique , Scoazec Jean-Yves , Partensky Christian 
Published: February 2021

Abstract
We report herein a case of digestive clear cell myomelanocytic tumor (PEComa) that is unique in its location and presentation. The lesion, located in the duodenal wall, was diagnosed in a child with a history of cervical neuroblastoma that was in remission after surgical resection and chemotherapy. The diagnosis was obtained by examination of a biopsy specimen taken during laparoscopy. The decision was made to perform surgical resection. Examination of the surgical specimen confirmed the diagnosis of PEComa. No metastasis was found. After 2 years of follow-up, the patient is alive, without evidence of metastasis or recurrence. This case highlights the distinctive characteristics of the cells in PEComa, recognizable even on limited biopsy material. It also suggests a possible association between PEComa and neuroblastoma, 2 unusual tumors that belong to the spectrum of lesions known to occur in patients with tuberous sclerosis and that may share a possible common pathogenetic mechanism.
Detection and Correction of Systematic Laboratory Problems by Analysis of Clustered Proficiency Testing Failures
Authors: Hoeltge Gerald A. , Phillips Mari Gina , Styer Patricia E. , Mockridge Peter 
Published: February 2021

Abstract
Context.—The Laboratory Accreditation Program of the College of American Pathologists monitors the performance of its subscribers in proficiency testing (PT). Failure to perform as expected prompts the program to query the laboratory.
Objective.—To determine whether laboratories are correcting apparent problems when contacted by the program about repeatedly unacceptable performance in a diagnostic test.
Design.—Retrospective analysis of 1 year's records (2002–2003) from the College's Proficiency Testing Exception Summary correspondence, which identifies clusters of PT failures. The analysis focused on those laboratories in which the Proficiency Testing Exception Summary algorithm identified repeated failures over 3 or 4 testing events; PT performance is monitored as a condition of accreditation. During 1 survey year, approximately 6300 accredited laboratories collectively tested approximately 1 205 000 analytes and submitted results to their PT providers on more than 3 500 000 PT challenges. During the period of observation, 14 085 Proficiency Testing Exception Summary reports were mailed to participants. Educational materials were included to help laboratories identify and correct each PT failure.
Results.—There were only 1304 cases of repeated PT failures after the initial correspondence from the accreditation program (9.3%). Of these, there were only 119 cases of unsatisfactory results on the subsequent PT event (9.1%). All systematic problems were resolved by the conclusion of the third round of correspondence.
Conclusions.—Accredited laboratories generally perform well in proficiency testing. Identification of clusters of PT failures by the accreditation provider can help those laboratories having analytic difficulties to investigate and correct the problems.