bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is There a Set of Histologic Changes That Are Invariably Reflux Associated?
Authors: Takubo Kaiyo , Honma Naoko , Aryal Gopi , Sawabe Motoji , Arai Tomio , Tanaka Yasuo , Mafune Ken-ichi , Iwakiri Katsuhiko 
Published: February 2021

Abstract
Many histologic changes have been described in the esophageal squamous mucosa in patients with gastroesophageal reflux disease (GERD), including dilated intercellular spaces, balloon cells, intrapapillary vessel dilation, elongated papillae, basal cell hyperplasia, acanthosis, intraepithelial eosinophils, Langerhans cells, and p53 protein overexpression. To define a set of histologic changes that are invariably reflux associated, we examined the histologic changes in esophageal specimens from normal controls, patients with GERD, patients without GERD but with a suspicion of other pathology, and patients with esophageal carcinoma. We also examined biopsy specimens from sites with differing endoscopic features, including cloudy white and reddened mucosa. A definitive set of reflux-associated histologic changes could not be defined from the small number of biopsy specimens examined in the present study. Histologic changes indicative of GERD are likely to be found somewhere in the esophagus in all patients with GERD, but these changes are nonspecific. A set of histologic changes that are invariably reflux associated may exist, but these changes are nonspecific. To develop a set of characteristic reflux-associated features, endoscopists may perform targeted biopsies from several sites with various endoscopic features and at different stages of disease.
Frozen Section Examination of Liver, Gallbladder, and Pancreas
Authors: Lechago Juan 
Published: February 2021

Abstract
Context.—Frozen section of the liver is a comparatively frequent request that most often applies to a relatively limited number of situations. The only indication for frozen tissue examination of a gallbladder with any frequency is the presence of a polypoid mucosal lesion or a suspicious thickening of the gallbladder wall. A variety of intraoperative consultations may be applicable during surgery of the pancreas.
Objective.—To examine the indications and pitfalls regarding the gross examination and frozen section performance for liver, gallbladder, and pancreas.
Data Sources.—Author experience and review of the pertinent literature.
Conclusions.—Although indications are relatively straightforward for frozen section of liver and gallbladder, handling of the pancreas specimens for frozen tissue examination is often a cause for a certain degree of anxiety. This situation is the result of a relative rarity of such specimens outside large tertiary referral medical centers coupled with a variety of confounding factors, including the presence of chronic pancreatitis with distortion of the normal structures and the frequent presence of variable degrees of dysplasia. The suboptimal preservation of the frozen tissue adds further angst to the scenario. In this article, the main issues are critically examined in light of the experience of the author and others.
Is There a Way for Pathologists to Decrease Interobserver Variability in the Diagnosis of Dysplasia?
Authors: Montgomery Elizabeth 
Published: February 2021

Abstract
Many obstacles interfere with our efforts to screen patients with Barrett esophagus. Probably the largest is choosing the appropriate patient group for screening. Beyond this problem, sampling error on the part of endoscopists is probably more serious a problem than observer variation among pathologists reviewing patient samples. Pathologists agree well on lesions that merit close follow-up or other intervention (high-grade dysplasia and invasive carcinoma), although interobserver agreement between pathologists interpreting lesser lesions is not good. This lack of agreement is not likely to improve substantially, and many adjunct markers are being sought in an attempt to identify patients with lesions of lower grades that are most likely to progress, allowing doctors to identify patients who would benefit from upgraded surveillance.
Cytologic Features of Low-Grade Squamous Intraepithelial Lesion in ThinPrep Papanicolaou Test Slides and Conventional Smears: Comparison of Cases That Performed Poorly With Those That Performed Well in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology
Authors: Renshaw Andrew A. , Dubray-Benstein Barbara , Haja Jennifer , Hughes Jonathan H. 
Published: February 2021

Abstract
Context.—Both conventional and ThinPrep Papanicolaou smears with high-grade squamous intraepithelial lesions that are frequently missed are known to have relatively few abnormal cells. Whether this is also true of cases of low-grade squamous intraepithelial lesion is not known.
Objective.—To compare the cytologic features of cases of low-grade squamous intraepithelial lesion that perform poorly with the features of cases that perform well.
Design.—The cytologic features of 10 ThinPrep Pap Test and conventional smear cases of low-grade squamous intraepithelial lesion that performed poorly in the College of American Pathologists Interlaboratory Comparison Program were compared with 46 ThinPrep Pap Test and conventional smear cases that performed extremely well. The numbers of abnormal cells were categorized into less than 50, 51 to 100, 101 to 250, 251 to 500, and more than 500.
Results.—The median number of abnormal cells for cases that performed poorly was less than 50, whereas the median number of abnormal cells for cases that performed well was between 101 and 250. Overall, cases that performed poorly were significantly more likely to have less than 50, less than 100, and less than 250 abnormal cells than cases that performed well (P &lt; .001, P &lt; .001, and P = .009, respectively). A minority of cases performed well even with very few abnormal cells and groups. The same findings were present when conventional smears and ThinPrep specimens were analyzed separately.
Conclusions.—ThinPrep Pap Test cases and conventional smears with a diagnosis of low-grade squamous intraepithelial lesion that perform poorly in this program have significantly fewer abnormal cells than those that perform well. The median number of abnormal cells in cases that performed well is lower than that of comparable high-grade cases in the program.
High-Grade Pelvic Osteosarcoma With Intravascular Extension to the Right Side of the Heart: A Case Report and Review of the Literature
Authors: Jani Jigna C. , Massad Malek , Kpodonu Jacques , Alagiozian-Angelova Victoria , Guzman Grace 
Published: February 2021

Abstract
We describe a rare case of high-grade osteosarcoma with intravascular extension to the right atrium and right ventricle in a 23-year-old woman. Osteosarcomas rarely metastasize to the heart, and only a few cases have been reported in the literature thus far. Diagnoses in some of these cases were made during investigation for severe cardiac failure and in most of these cases at autopsy. We describe a unique case of intravascular extension of the tumor embolus in a cordlike fashion from the left femoral vein to the right side of the heart that morphologically resembled a chondrosarcoma.
Creatinine Measurement: State of the Art in Accuracy and Interlaboratory Harmonization
Authors: Greg Miller W. , Myers Gary L. , Ashwood Edward R. , Killeen Anthony A. , Wang Edward , Thienpont Linda M. , Siekmann Lothar 
Published: February 2021

Abstract
Context.—The National Kidney Disease Education Program recommends calculating glomerular filtration rate from serum creatinine concentration. Accurate creatinine measurements are necessary for this calculation.
Objective.—To evaluate the state of the art in measuring serum creatinine, as well as the ability of a proficiency testing program to measure bias for individual laboratories and method peer groups.
Design.—A fresh-frozen, off-the-clot pooled serum specimen plus 4 conventional specimens were sent to participants in the College of American Pathologists Chemistry Survey for assay of creatinine. Creatinine concentrations were assigned by isotope dilution mass spectrometry reference measurement procedures.
Participants.—Clinical laboratories with an acceptable result for all 5 survey specimens (n = 5624).
Results.—The fresh frozen serum (FFS) specimen had a creatinine concentration of 0.902 mg/dL (79.7 μmol/L). Mean bias for 50 instrument-method peer groups varied from −0.06 to 0.31 mg/dL (−5.3 to 27.4 μmol/L), with 30 (60%) of 50 peer groups having significant bias (P &lt; .001). The bias variability was related to instrument manufacturer (P ≤ .001) rather than method type (P = .02) with 24 (63%) of 38 alkaline picric acid methods and with 6 (50%) of 12 enzymatic methods having significant biases. Two conventional specimens had creatinine concentrations of 0.795 and 2.205 mg/dL (70.3 and 194.9 μmol/L) and had apparent survey biases significantly different (P &lt; .001) from that of the FFS specimen for 34 (68%) and 35 (70%) of 50 peer groups, respectively.
Conclusions.—Thirty of 50 peer groups had significant bias for creatinine. Bias was primarily associated with instrument manufacturer, not with type of method used. Proficiency testing using a commutable specimen measured participant bias versus a reference measurement procedure and provided trueness surveillance of instrument-method peer groups.
Myeloid Sarcoma Involving the Breast
Authors: Valbuena Jose R. , Admirand Joan H. , Gualco Gabriela , Medeiros L. Jeffrey 
Published: February 2021

Abstract
Context.—Myeloid sarcoma is a neoplasm of myeloid cells that can arise before, concurrent with, or following acute myeloid leukemia. Rarely, it can also occur as an isolated mass.
Objective.—To describe the clinicopathologic features of 6 patients with myeloid sarcoma involving the breast.
Design.—Clinical information for all 6 patients was obtained from the medical record. Routine hematoxylin-eosin–stained slides; naphthol AS-D chloroacetate stain; and immunohistochemical stains for myeloid, B-cell, and T-cell antigens were prepared.
Results.—There were 6 women with a median age of 52 years (range, 31–73 years). Two patients presented with isolated tumors of the breast, with no history or subsequent development of acute myeloid leukemia. In 3 patients, the breast tumors represented relapse of acute myeloid leukemia. One patient who presented initially with myeloid sarcoma involving the breast, skin, and spleen was lost to follow-up. Histologically, these tumors were classified as well differentiated (n = 3), poorly differentiated (n = 2), and blastic (n = 1). Naphthol AS-D chloroacetate esterase was positive in all 3 cases assessed. Immunohistochemistry showed that myeloperoxidase (n = 5) and CD43 (n = 3) were positive, and CD3 (n = 5) and CD20 (n = 5) were negative in all cases assessed. Lysozyme was positive in 4 (80%) of 5; CD117 was positive in 2 (67%) of 3; and single cases were positive for CD45 (1/3), TdT (1/2), CD79a, and the PAX5 gene product.
Conclusions.—Myeloid sarcoma involving the breast is uncommon. In the literature, as in this study, these tumors most often represent relapse or the initial presentation of acute myeloid leukemia. However, 2 of the cases we report presented with isolated masses, without a history or subsequent development of acute myeloid leukemia at last follow-up. Immunohistochemical studies are extremely helpful for recognizing isolated myeloid sarcoma.
Malignant Deciduoid Mesothelioma: A Diagnostic Challenge
Authors: Mourra Najat , Chaisemartin Cecilede , Goubin-Versini Isabelle , Parc Rolland , Flejou Jean-Francois 
Published: February 2021

Abstract
Malignant deciduoid mesothelioma, a rare phenotype of epithelioid mesothelioma, arises more commonly from the peritoneum of young women, but it is also reported in the pleura of elderly people. We report a case of malignant deciduoid mesothelioma that occurred in a 41-year-old woman after cesarean section and was initially misdiagnosed as pseudotumoral deciduosis. Microscopically, the tumor was entirely composed of deciduoid areas, and only scattered tumor cells were positive for calretinin and keratin 5/6. The patient died 14 months after the first operation. This observation confirms the poor prognosis of this entity and the importance of the differential diagnosis of pseudotumoral deciduosis.
Association of Mild Transient Elevation of Troponin I Levels With Increased Mortality and Major Cardiovascular Events in the General Patient Population
Authors: Gudmundsson G. Steinar , Kahn Stephen E. , Moran John F. 
Published: February 2021

Abstract
Context.—The prognostic value of mild elevation of cardiac-specific troponin I (cTnI) levels is poorly defined, which can make interpretation of such an elevation difficult.
Objective.—To study the prognostic value of transient mild elevation of cTnI levels in the hospitalized patient population.
Design.—We performed a case-control study that compared the outcome of patients hospitalized for any cause with at least 2 subsequent transient cTnI measurements of 0.1 ng/mL or higher and less than 1.5 ng/mL with matched controls with cTnI levels less than 0.1 ng/mL. A cohort of 118 patients (mean ± SD age, 67.4 ± 14.0 years; 35.6% men) was followed up for an average ± SD of 11.9 ± 7.9 months. Seventy-one cases were matched with 37 controls in terms of demographics, coronary artery disease risk factors, and reason for admission. End points were all-cause mortality and major cardiovascular end points, including cardiovascular mortality, myocardial infarction, and revascularization.
Results.—The total event rate was significantly increased in the case group compared with the control group at 12, 6, and 3 months (62.0% vs 24.3%, 59.2% vs 16.2%, and 47.9% vs 5.4%, respectively; P &lt; .001). At 12, 6, and 3 months, the cases had a significant increase in all-cause mortality (43.7% vs 16.2%, 40.8% vs 8.1%, and 33.8% vs 0.0%, respectively; P = .005) and major cardiovascular end points (26.8% vs 8.1%, 26.8% vs 8.1%, and 21.1% vs 5.4%, respectively; P = .02) compared with controls.
Conclusion.—Transient mild elevation of cTnI levels in hospitalized patients is associated with an increase in all-cause mortality and major cardiovascular complications. Such elevations of cTnI levels can be considered a marker for both all-cause and cardiovascular morbidity and mortality.
Regulators of Apoptosis in Cholangiocarcinoma
Authors: Jhala Nirag C. , Vickers Selwyn M. , Argani Pedram , McDonald Jay M. 
Published: February 2021

Abstract
Context.—Dysregulation of mediators of apoptosis is associated with carcinogenesis. For biliary duct cancers, p53 gene mutation is an important contributor to carcinogenesis. Mutations in the p53 gene affect transcription of the Fas gene, resulting in lack of Fas expression on cell membrane. It has been previously shown that cloned Fas-negative but not Fas-positive human cholangiocarcinoma cells are resistant to anti–Fas-mediated apoptosis and develop tumors in nude mice. In addition, interferon gamma induces Fas expression in Fas-negative cholangiocarcinoma cells and makes them susceptible to apoptosis. Therefore, it becomes important to characterize immunophenotypic expression of p53 and Fas in normal and neoplastic human tissues of the biliary tract to further understand the pathogenesis of the disease. To date, human studies to characterize differences in immunophenotypic expression of the Fas protein between intrahepatic and extrahepatic biliary duct cancers and in their precursor lesions have not been performed.
Objective.—To report the immunophenotypic expression of p53 and Fas expression in various stages in the development of bile duct cancers (intrahepatic and extrahepatic tumor location) and their association with tumor differentiation.
Design.—Thirty bile duct cancer samples (13 intrahepatic and 17 extrahepatic) from 18 men and 12 women who ranged in age from 44 to 77 years (mean age, 65.6 years) were retrieved from the surgical pathology files. Hematoxylin-eosin–stained slides were evaluated for the type and grade of tumor and dysplastic changes in the biliary tract epithelium. Additional slides were immunohistochemically stained with p53 and anti–Fas mouse monoclonal antibody. The pattern of Fas distribution and percentage of cells positive for p53 and Fas expression were determined.
Results.—The percentage of Fas-expressing cells is significantly (P = .01) more frequently noted in extrahepatic tumors compared with intrahepatic tumors. Furthermore, Fas expression decreased from dysplastic epithelium to cholangiocarcinoma (P = .01), and this decreasing trend continued from well to poorly differentiated tumors. Nuclear p53 expression was not identified in normal and dysplastic epithelium but was noted in 30% of carcinomas (P = .02).
Conclusion.—Fas expression is an early event in pathogenesis of bile duct cancers. Immunophenotypic expression of Fas is associated with well to moderately differentiated tumors but not with poor tumor differentiation.
Renal Neoplasms in Younger Adults: Analysis of 112 Tumors From a Single Institution According to the New 2004 World Health Organization Classification and 2002 American Joint Committee on Cancer Staging System
Authors: Cao Ying , Paner Gladell P. , Perry Kent T. , Flanigan Robert C. , Campbell Steven C. , Picken Maria M. 
Published: February 2021

Abstract
Context.—Adult renal neoplasms have a predilection for older patients and are clinically and morphologically distinct from renal neoplasms found in pediatric age groups. Relatively rare tumors occur in younger adults (18–45 years of age). Whether these renal tumors are morphologically and clinically distinct from those of older adults has been the subject of controversy. Recent modification of the World Health Organization histologic classification and the American Joint Committee on Cancer staging system of adult renal tumors further highlighted the need for case analysis in this age group.
Objective.—To analyze renal tumors in younger adults based on a large surgical series from a single institution.
Design.—Of 780 renal mass nephrectomy (partial, total, or radical) specimens that were available for evaluation and had been obtained between 1986 and 2004 at Loyola University Medical Center, 112 specimens were from patients between 18 and 45 years of age. The tumors were reevaluated according to the 2004 World Health Organization classification and the 2002 American Joint Committee on Cancer staging system.
Results.—The likelihood of clear cell renal cell carcinoma was significantly reduced from 65% in older adults to 53% in younger adults (18–45 years, P = .04). The reduction trend was more significant when comparing an even younger age group. The majority (64%) of clear cell renal cell carcinoma in younger adults was low stage, T1a. Seventeen percent of these tumors had multilocular cystic features involving more than 50% of the tumor volume (55%–85%). The number of oncocytomas was also significantly lower in younger adults than in older adults (2% vs 11%, P &lt; .001), and this presumably age-related benign neoplasm was not identified in patients younger than 40 years in this study. In contrast, the miscellaneous tumor category showed a remarkable increase, from 4% in older adults to 26% in younger adults (P &lt; .001). The youngest patient group (18–35 years) had a higher incidence of miscellaneous tumors, 37%. Younger female adults tended to have more benign miscellaneous neoplasms than did their male counterparts (64% vs 36%, P &lt; .001). Clear cell and chromophobe renal cell carcinoma occurred more frequently in younger male adults than in female adults (2:1 and 8:1, respectively).
Conclusions.—Renal neoplasms are more heterogeneous in younger adults and have a different distribution pattern compared with that in older adults. Malignant and benign renal neoplasms tend to have a contrasting sex distribution in younger adults.
Comparison of Relative Value of Bone Marrow Aspirates and Bone Marrow Trephine Biopsies in the Diagnosis of Solid Tumor Metastasis and Hodgkin Lymphoma: Institutional Experience and Literature Review
Authors: Moid Farah , DePalma Louis 
Published: February 2021

Abstract
Context.—Bone marrow aspirates as well as bone marrow trephine biopsies are frequently performed to assess whether there is marrow involvement by a malignancy. Numerous reports differ in the relative value of these 2 procedures and fail to provide concise guidelines that can help choose the appropriate technique in this clinical situation.
Objective.—To compare the relative value of aspirates and trephine biopsies in the diagnosis of solid tumor metastasis and Hodgkin lymphoma. In addition, we correlate our findings with those of the literature to provide a concise practice guideline.
Design.—Sixty-six cases showing bone marrow involvement by solid tumor and Hodgkin lymphoma in bone marrow aspirates, bone marrow trephine biopsies, or both were included in the study. The diagnosis and findings made on aspirates were compared with those made on trephine biopsies in each case.
Results.—In those cases where both aspirate and trephine biopsy were available for evaluation, there was a 22% positive correlation in the findings on aspirates and trephine biopsies. The correlation between aspirates and trephine biopsies was highest in cases of small cell carcinoma of the lung (3/11, or 36.3%) followed by breast carcinoma (7/20, or 35%), prostate carcinoma (1/9, or 11.1%), and Hodgkin lymphoma (1/20, or 5%). Two of 5 cases from the miscellaneous category demonstrated simultaneous involvement of aspirate and trephine biopsy by a gastric carcinoma as well as an adrenal gland carcinoma.
Conclusions.—Bone marrow aspirate and bone marrow trephine biopsy should both be performed in patients with proven or suspected malignancies where staging may affect management. However, bone marrow aspirate has only a minimal role, if any, in detecting bone marrow involvement by Hodgkin lymphoma. In cases of breast carcinoma, small cell carcinoma of lung, and prostate carcinoma, aspirate evaluation may confirm trephine biopsy results or, more rarely, provide the sole confirmation of the malignancy.
Screening for Giardia/Cryptosporidium Infections Using an Enzyme Immunoassay in a Centralized Regional Microbiology Laboratory
Authors: Church Deirdre , Miller Karena , Lichtenfeld Angelika , Semeniuk Heather , Kirkham Brenda , Laupland Kevin , Elsayed Sameer 
Published: February 2021

Abstract
Context.—Stool parasitologic testing for Giardia and Cryptosporidium (G/C) previously relied on staining (ie, modified iron hematoxylin-kinyoun), ethyl acetate concentration procedures, and microscopy (the stool ova and parasite method). In April 1999, a microplate enzyme immunoassay (EIA) (ProSpecT G/C, Remel, Inc, Lenexa, Kan) for routine screening of all stool specimens was implemented.
Objective.—To determine the clinical and laboratory impact of this service change.
Design.—Changes were made to the regional microbiology requisition so that physicians could order either a G/ C EIA screen or stool ova and parasite examination. During a 3-year period (May 1999 through April 2002), changes in physician ordering practice, the rate of detection of G/ C infections, and test turnaround times were monitored. The economic outcomes have also been studied and compared annually since implementation and up to the current fiscal year (2004).
Results.—The following effects have been noted since G/ C EIA screening was implemented: (1) 70% of all stool parasite tests ordered were converted to G/C EIA screens versus stool ova and parasite tests, (2) stool parasitologic volumes decreased by up to 30% because of physicians ordering a single test per patient, (3) most stool parasite results (70%–80%) were reported within 24 hours of specimen receipt, and (4) the screening assay has improved detection of cryptosporidiosis cases. Although the G/C EIA tests cost more than stool ova and parasite examination, the equivalent of 1.8 full-time employees have been freed up to perform other duties.
Conclusions.—Routine stool G/C EIA screening in our region is not only clinically relevant but also improves the timeliness and efficiency of detection of these important enteric parasite infections.