bluuebunny/crossref_metadata_2025_split huggingface dataset:
Taalbarrières en tolken in de zorg: wie betaalt de prijs?
Authors: Koopmans M.A.H. 
Published: February 2021

Taalbarrières en tolken in de zorg: wie betaalt de prijs?
In 2012 is de tolkenvergoeding voor zorgaanbieders afgeschaft. Tegelijkertijd wordt er steeds meer verwacht dat zorgverleners en patiënten samen beslissen over medische behandelingen. Dit artikel gaat in op de informatieplicht van de zorgverlener, wanneer er een tolk moet worden ingeschakeld en hoe het afschaffen van de tolkenvergoeding zich verhoudt tot deze informatieplicht.
The Amyloid Deposit in Calcifying Epithelial Odontogenic Tumor Is Immunoreactive for Cytokeratins
Authors: Aviel-Ronen Sarit , Liokumovich Pavel , Rahima David , Polak-Charcon Sylvie , Goldberg Iris , Horowitz Ada 
Published: February 2021

Abstract
Calcifying epithelial odontogenic tumor, also known as Pindborg tumor, is a rare benign tumor with locally aggressive behavior. It is characterized by squamous epithelial cells, calcifications, and eosinophilic deposits that have been identified as amyloid. We report a case of calcifying epithelial odontogenic tumor and investigate the nature of the amyloid, using histologic, immunohistochemical, and ultrastructural studies. The amyloid was immunohistochemically negative for basement membrane components and positive for all cytokeratin stains performed (cocktail of cytokeratins 1, 5, 6, 8, 13, and 16, and cytokeratins AE1 and AE3). The amyloid stained focally in a glandular-like pattern, reminiscent of the epithelial glandlike structures of the tumor. We conclude that the amyloid is derived from filamentous degeneration of keratin filaments that originate from the tumor squamous epithelium. The keratin degeneration is part of a developmental or aging process that the tumor undergoes.
Spindle Cell Tumor of Urinary Bladder Serosa With Phenotypic and Genotypic Features of Gastrointestinal Stromal Tumor
Authors: Lasota Jerzy , Carlson John A. , Miettinen Markku 
Published: February 2021

AbstractMost mesenchymal tumors of the gastrointestinal tract are now referred to as gastrointestinal stromal tumors (GISTs). The tumors differ from ordinary leiomyomas and schwannomas in several respects: the GISTs typically express c-kit protein (CD117) and CD34, 30% to 50% of them are (often focally) positive for α-smooth muscle actin, and all are negative for desmin and S100 protein. Recently, mutations in the exon 11 of the c-kit gene have been identified and confirmed as a molecular genetic marker for the subset of GISTs. In this report, we describe a mesenchymal tumor removed from the pelvic cavity of a 52-year-old woman, who is alive without disease 36 months after the surgery. The 5-cm tumor was densely attached to the external aspect of the urinary bladder but was attached to small intestine by only filmy adhesions. The tumor grossly resembled a leiomyoma and was histologically composed of sheets of spindle cells with a dense collagenous background. The mitotic activity was low, less then 1 per 50 high-power fields. Immunohistochemically, the tumor cells were negative for α-smooth muscle actin and desmin and positive for CD117 and CD34. Molecular genetic analysis of the exon 11 of the c-kit gene revealed a point mutation in the region commonly mutated in GISTs. This mutation substituted T for A in the codon 557, leading to the change of amino acid sequence (tryptophan for arginine) of the KIT protein. This case illustrates that tumors phenotypically and genotypically similar to GISTs may present in sites other than the tubular gastrointestinal tract.
Persistent Tuberculosis or Specimen Contamination?
Authors: Trakas Kathy , Stosor Valentina , Dietrich Stephen , Mosher Laura , Warren John R. 
Published: February 2021

Abstract
Cross-contamination during sequential processing of sputum specimens from different patients causes false-positive growth of Mycobacterium tuberculosis in culture. We describe an unusual case of cross-contamination in a 36-year-old man with acquired immunodeficiency syndrome and possible persistent tuberculosis. Culture with 1 of 3 sputum specimens was positive for rifampin-susceptible M tuberculosis. Review of processing revealed that his single culture-positive sputum specimen had followed a sputum specimen from another patient with active pulmonary tuberculosis that was positive in culture for M tuberculosis resistant to rifampin. Molecular strain typing by restriction fragment length polymorphism demonstrated the 2 isolates to be an identical strain of M tuberculosis. Agar proportion susceptibility testing of the rifampin-resistant isolate revealed low numbers of resistant organisms in a range of 1.5% to 3.3%. It was concluded that rifampin-susceptible organisms that constituted approximately 98% of the resistant isolate contaminated sputum from the patient with possible persistent tuberculosis. His culture result was, therefore, considered false positive, not an indication of tuberculosis.
Accuracy of Fine-Needle Aspiration of Thyroid
Authors: Amrikachi Mojghan , Ramzy Ibrahim , Rubenfeld Sheldon , Wheeler Thomas M. 
Published: February 2021

Abstract
Context.—Fine-needle aspiration has become an accepted and cost-effective procedure for rapid diagnosis of thyroid lesions. The routine use of fine-needle aspiration has reduced the rate of unnecessary surgery for thyroid nodules.
Objectives.—To determine the accuracy of fine-needle aspiration biopsy diagnosis and to discuss the possible pitfalls.
Design, Setting, and Participants.—Reports of 6226 fine-needle aspiration biopsies of the thyroid performed during a period of 16 years (1982–1998) were reviewed. Computerized reports of the fine-needle aspiration biopsies were sent to the physicians who performed the procedures, and clinical follow-up information regarding the patients was requested. Twenty-four clinicians participated in the study. Histologic diagnoses were available for 354 cases. The cytopathologic diagnoses were correlated with the histologic findings or clinical outcomes.
Results.—The cytologic diagnoses were as follows: 210 (3.4%) malignant, 450 (7.2%) suspicious, 3731 (60%) benign, and 1845 (29.5%) unsatisfactory. Most of the cases with negative or unsatisfactory aspirates were followed clinically or by repeat fine-needle aspiration. We identified 11 false-negative and 7 false-positive diagnoses. For aspirates considered sufficient for diagnosis, the sensitivity and specificity levels were 93% and 96%, respectively.
Conclusions.—Fine-needle aspiration of the thyroid gland is highly accurate and has a low rate of false-negative and false-positive diagnoses. The major diagnostic problems are caused by diagnosis using a marginally adequate specimen, diagnosis of malignancy based on just 1 or 2 atypical cytologic features, or overlapping cytologic features of follicular neoplasm with those of follicular variant of papillary carcinoma.
Intraneuronal Aβ-Amyloid Precedes Development of Amyloid Plaques in Down Syndrome
Authors: Gyure Kymberly A. , Durham Robert , Stewart Walter F. , Smialek John E. , Troncoso Juan C. 
Published: February 2021

Abstract
Context.—Down syndrome patients who live to middle age invariably develop the neuropathologic features of Alzheimer disease, providing a unique situation in which to study the early and sequential development of these changes.
Objective.—To study the development of amyloid deposits, senile plaques, astrocytic and microglial reactions, and neurofibrillary tangles in the brains of young individuals (&lt;30 years of age) with Down syndrome.
Methods.—Histologic and immunocytochemical study of a series of autopsy brains (n = 14, from subjects aged 11 months to 56 years, with 9 subjects &lt;30 years) examined at the Office of the Chief Medical Examiner of the State of Maryland and The Johns Hopkins Hospital.
Results.—The principal observations included the presence of intraneuronal Aβ immunostaining in the hippocampus and cerebral cortex of very young Down syndrome patients (preceding the extracellular deposition of Aβ) and the formation of senile plaques and neurofibrillary tangles.
Conclusions.—We propose the following sequence of events in the development of neuropathologic changes of Alzheimer disease in Down syndrome: (1) intracellular accumulation of Aβ in neurons and astrocytes, (2) deposition of extracellular Aβ and formation of diffuse plaques, and (3) development of neuritic plaques and neurofibrillary tangles with activation of microglial cells.
Cerebrospinal Fluid Aβ42, Tau, and F2-Isoprostane Concentrations in Patients With Alzheimer Disease, Other Dementias, and in Age-Matched Controls
Authors: Montine Thomas J. , Kaye Jeffery A. , Montine Kathleen S. , McFarland Lynne , Morrow Jason D. , Quinn Joseph F. 
Published: February 2021

Abstract
Objective.—To test the hypothesis that quantification of cerebrospinal fluid (CSF) F2-isoprostanes (F2-IsoPs), in vivo biomarkers of free radical damage, along with CSF Aβ42 and tau levels improves laboratory diagnostic accuracy for Alzheimer disease (AD).
Participants.—Patients with probable AD (n = 19), dementias other than AD (n = 8), and age-matched controls (n = 10).
Main Outcome Measures.—Cerebrospinal fluid concentrations of Aβ42 and tau were determined by a commercially available test (Athena Diagnostics, Worcester, Mass). Cerebrospinal fluid F2-IsoP levels were quantified by gas chromatography/mass spectrometry.
Results.—Individuals were classified as AD or non-AD by a published method using CSF Aβ42 and tau levels (95% sensitivity, 50% specificity), by CSF F2-IsoP levels greater than 25 pg/mL and Aβ42 concentrations less than 1125 pg/mL (90% sensitivity, 83% specificity), and by combined analysis using CSF F2-IsoP, Aβ42, and tau levels (84% sensitivity, 89% specificity).
Conclusion.—Cerebrospinal fluid F2-IsoP quantification may enhance the accuracy of the laboratory diagnosis of AD.
Large Cell Variants of CD5+, CD23− B-Cell Lymphoma/Leukemia
Authors: Dunphy Cherie H. , Perkins Sherrie L. 
Published: February 2021

Abstract
Context.—Mantle cell lymphoma (MCL), and its leukemic phase, constitute a well-studied hematologic malignancy with known overall survival, prognostic indicators, morphologic findings at diagnosis and in bone marrow, and known incidence of the bcl-1 immunoglobulin gene rearrangement. Large cell variants of B-cell lymphoma/leukemia with a mantle cell immunophenotype (CD5+, CD23−), including but not limited to blastic MCL, prolymphocytoid MCL, blastic mantle cell leukemia, and prolymphocytic mantle cell leukemia, are not as well characterized. Although blastic MCL is known to be associated with a shorter overall survival than conventional MCL, the large cell variants of B-cell lymphoma/leukemia with a mantle cell immunophenotype have not been described as fully as conventional MCL.
Objective.—The purpose of the present study was to describe the large cell variants of B-cell lymphoma/leukemia with a mantle cell immunophenotype.
Design.—Nineteen cases of large cell variants of CD5+, CD23− B-cell lymphoma/leukemia are reviewed and described in regard to morphology, bone marrow morphological findings, Cyclin D1 immunostaining, and bcl-1 analysis. Clinical data were not available owing to the varied clinical sources of the specimens.
Setting.—Tertiary-care academic institution.
Results.—Lymph node involvement in blastic CD5+, CD23− B-cell lymphoma was diffuse (100%) with a nodular component (33%) or focal mantle zone pattern (10%). Bone marrow involvement in blastic CD5+, CD23− B-cell lymphoma was seen in only 27% of cases and was composed predominantly of small, slightly irregular lymphocytes. Cyclin D1 was demonstrated in 60% of the 15 cases analyzed and more sensitive in B5–fixed tissue. Bcl-1 (performed in 5 cases) was not detected in the 4 cases of blastic CD5+, CD23− B-cell lymphoma analyzed and was detected in the case of the prolymphocytoid MCL. Cyclin D1 was demonstrated in all 4 bcl-1 negative cases and was negative in the bcl-1 positive prolymphocytoid MCL.
Conclusion.—Careful analysis of clinical data, morphology, immunophenotype, Cyclin D1 expression, and molecular analysis are required to differentiate the unusual large cell variants of MCL from other processes.
One Patient, Two Lymphomas
Authors: Tang Zuoqin , Jing Wen , Lindeman Neal , Harris Nancy Lee , Ferry Judith A. 
Published: February 2021

Abstract
We report the case of a 73-year-old man who presented with a 2- to 3-month history of epigastric discomfort and guaiac-positive stool. An upper gastrointestinal endoscopy revealed a diffuse erythematous nodular mucosa and submucosal thickening in the stomach. Diffuse mucosal nodularity was also found in the second portion of the duodenum. A complete workup with histologic, immunohistochemical, and molecular studies revealed 2 distinct, apparently unrelated lymphomas, namely, a gastric marginal zone B-cell lymphoma (mucosa-associated lymphoid tissue type) in a background of Helicobacter pylori gastritis and a grade 1/3 duodenal follicular lymphoma. The patient was then treated with an H pylori eradication regimen. No therapy was given for his duodenal follicular lymphoma because his symptoms were thought to be due to the gastric disease and because the duodenal lesion was small. A 6-month follow-up with upper gastrointestinal endoscopy revealed only focal biopsy scarring in the stomach and an apparently normal duodenum. The follow-up biopsies revealed significant regression of his mucosa-associated lymphoid tissue lymphoma, but persistence of his duodenal follicular lymphoma. The combination of these 2 lymphomas in the same patient and the different clinical responses to antibiotic treatment make this case unique.
Microdissection Genotyping of Mixed Glial and Primitive Neuroectodermal Central Nervous System Neoplasm
Authors: Mohan Deepak , Rao Gutti R. , Swalsky Patricia A. , Bakker Anke , Martinez A. Julio , Finkelstein Sydney D. 
Published: February 2021

Abstract
A 22-year-old man with previous radiation treatment for childhood astrocytoma underwent resection of a right parietooccipital lesion. Histopathology revealed a malignant neoplasm with areas of astrocytic and primitive neuroectodermal components. To resolve the relationship and cellular origin, representative tissue was microdissected from several targets, obtaining a balanced mixture of each element. Nonneoplastic brain parenchyma was separately microdissected to determine polymorphic marker informativeness and to serve as an internal negative control. Despite the relatively small quantity of tissue removed for each microdissection target, sufficient material was available for reliable, balanced, polymerase chain reaction–format genotyping encompassing a panel of tumor suppressor genes and genetic loci associated with these forms of neoplasia. The findings revealed distinct discordant genotypic profiles for each of the neoplastic components. The efficacy of the approach used for molecular analysis of this complex neoplasm and the implication of the genotypic findings are discussed.
What Is a Picture Worth?: Digital Imaging Applications in Autopsy Reports
Authors: Pritt Bobbi , Gibson Pamela , Cooper Kumarasen , Hardin Nicolas 
Published: February 2021

Abstract
Context.—An image-enhanced report (IER) containing color digital images can serve as an educational tool and document important gross and microscopic findings in anatomic pathology.
Objective.—To determine the clinical impression of IERs on an academic autopsy service.
Design.—Autopsy IERs were initiated at this institution in December 2001. From January 2002 to July 2003, 261 hospital-service autopsies were performed; color images were produced for 39 (15%) of these autopsies. Of these IERs, 29 were distributed to 74 hospital-employed physicians. Each hospital physician recipient was sent a 6-question e-mail survey to evaluate his or her impression of image quality and added value.
Results.—Of the 74 hospital-employed physicians sent an IER, 41 responded to the survey (response rate, 55%). Twenty-one respondents recalled receiving a report with color images. Image quality was uniformly rated as good or excellent. Ninety-five percent thought the images increased their understanding of the report, and 76% thought that the images increased the utility of the report. All respondents stated they would (or did) use the images for educational purposes. Twenty-one percent of all respondents thought the presence of color images would increase their likelihood of requesting a future autopsy.
Conclusions.—Color digital images are perceived as a valuable addition to the autopsy report. Although clinicians did not consider color images a strong motivator to request a future autopsy, most thought that the images enhanced their understanding and the utility of the report. All respondents stated they would use the images to educate themselves, medical students, residents, and/or the patient's family.
False-Positive D-Dimer Result in a Patient With Castleman Disease
Authors: Mugler Kimberly , Lefkowitz Jerry B. 
Published: February 2021

Abstract
In suspected cases of disseminated intravascular coagulation, concurrent elevation of both fibrin(ogen) degradation products (FDPs) and D-dimer levels aids in confirming the diagnosis. This pattern of results reflects the action of plasmin proteolysis of cross-linked fibrin polymers as well as fibrinogen. We report the case of a patient with human immunodeficiency virus (HIV) and Castleman disease who presented with a high-positive D-dimer level and a negative FDP level in the course of a workup for disseminated intravascular coagulation. This finding suggested the possibility of either a false-positive D-dimer or a false-negative FDP level. To investigate the former, a Western blot was performed on the patient's serum to determine the presence of the D-dimer. No D-dimer band was visualized on the Western blot, confirming the false-positive nature of the D-dimer result. Insufficient quantity of patient serum, however, prevented further investigation into the etiology of this result. The false-positive D-dimer result is likely attributable to interference caused by the patient's Castleman disease–associated monoclonal gammopathy, a phenomenon that has been reported in other immunoassays. As the development of lymphoproliferative disorders is especially common within the HIV population, and hypergammaglobulinemia in Castleman disease is particularly common, clinicians should be aware of this phenomenon when the laboratory findings do not fit the clinical picture. Although it is rare, recognition of potential paraprotein interference in immunoassays will help avoid undertreatment or overtreatment of patients based on erroneous laboratory results.
How Sensitive Is a Prostate-Specific Antigen Measurement?: How Sensitive Does It Need to Be?
Authors: Bock Jay L. , Klee George G. 
Published: February 2021

Abstract
Assays are now available that can measure very low concentrations of prostate-specific antigen (PSA), but their analytic performance and clinical utility are not well defined. This brief article highlights some of the clinical issues related to the limited prognostic significance of small changes in PSA concentrations in men with prostate cancer who have been treated with prostate ablation therapy. College of American Pathologists proficiency survey data are presented, illustrating the performance of commercial PSA assays with low PSA concentration survey samples tested between 1998 and 2002. The performance of the assays appears to be improving, but many of the currently used assays have intralaboratory coefficients of variation greater than 20% for PSA concentrations less than 0.4 ng/mL. Also, there are major differences in the level of PSA reported by various assays in these low concentration samples. These level differences (if they are also seen in clinical samples) may cause clinical problems when fixed serum PSA thresholds (eg, 0.2 ng/mL) are used to make clinical decisions related to prostate tumor recurrence.
Zero-Check: A Zero-Knowledge Protocol for Reconciling Patient Identities Across Institutions
Authors: Berman Jules J. 
Published: February 2021

Abstract
Context.—Large, multi-institutional studies often involve merging data records that have been de-identified to protect patient privacy. Unless patient identities can be reconciled across institutions, individuals with records held in different institutions will be falsely “counted” as multiple persons when databases are merged.
Objective.—The purpose of this article is to describe a protocol that can reconcile individuals with records in multiple institutions.
Design.—Institution A and Institution B each create a random character string and send it to the other institution. Each institution receives the random string from the other institution and sums it with their own random string, producing a random string common to both institutions (RandA+B). Each institution takes a unique patient identifier and sums it with RandA+B. The product is a random character string that is identical across institutions when the patient is identical in both institutions. A comparison protocol can be implemented as a zero-knowledge transaction, ensuring that neither institution obtains any knowledge of its own patient or of the patient compared at another institution.
Results.—The protocol can be executed at high computational speed. No encryption algorithm or 1-way hash algorithm is employed, and there is no need to protect the protocol from discovery.
Conclusion.—A zero-knowledge protocol for reconciling patients across institutions is described. This protocol is one of many computational tools that permit pathologists to safely share clinical and research data.
Evaluation of Linearity in the Clinical Laboratory
Authors: Jhang Jeffrey S. , Chang Chung-Che , Fink Daniel J. , Kroll Martin H. 
Published: February 2021

Abstract
Context.—Clinical laboratory assessment of test linearity is often limited to satisfying regulatory requirements rather than integrating this tool into the laboratory quality assurance program. Although an important part of quality control and method validation for clinical laboratories, linearity of clinical tests does not get the attention it deserves.
Objective.—This article evaluates the concepts and importance of linearity evaluations for clinical tests.
Design.—We describe the theory and procedural steps of each linearity evaluation. We then evaluate the statistical methods for each procedure.
Results.—Visual assessment, although simple, is subjective. The lack-of-fit error and the 1986 NCCLS EP6-P G test are sensitive to imprecision and assume that the data are first order. Regression analysis, as developed as the polynomial method, is partly based on the experiences of the College of American Pathologists Instrumentation Resource Committee and has proved to be a robust statistical method.
Conclusions.—We provide general guidelines for handling non-linear results from a linearity evaluation. Handling linearity data in an objective manner will aid clinical laboratorians whose goal is to improve the quality of the tests they perform.