bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Safety in Anatomic Pathology: Measuring Discrepancy Frequencies and Causes
Authors: Raab Stephen S. , Nakhleh Raouf E. , Ruby Stephen G. 
Published: February 2021

Abstract
Context.—Anatomic pathology discrepancy frequencies have not been rigorously studied.
Objective.—To determine the frequency of anatomic pathology discrepancies and the causes of these discrepancies.
Design.—Participants in the College of American Pathologists Q-Probes program self-reported the number of anatomic pathology discrepancies in their laboratories by prospectively performing secondary review (post–sign-out) of 100 surgical pathology or cytology specimens. Reasons for the secondary review included conferences, external review, internal quality assurance policy, and physician request.
Participants.—Seventy-four laboratories self-reported data.
Main Outcome Measures.—Frequency of anatomic pathology discrepancy; type of discrepancy (ie, change in margin status, change in diagnosis, change in patient information, or typographic error); effect of discrepancy on patient outcome (ie, no harm, near miss, or harm); and clarity of report.
Results.—The mean and median laboratory discrepancy frequencies were 6.7% and 5.1%, respectively. Forty-eight percent of all discrepancies were due to a change within the same category of interpretation (eg, 1 tumor type was changed to another tumor type). Twenty-one percent of all discrepancies were due to a change across categories of interpretation (eg, a benign diagnosis was changed to a malignant diagnosis). Although the majority of discrepancies had no effect on patient care, 5.3% had a moderate or marked effect on patient care.
Conclusions.—This study establishes a mean multi-institutional discrepancy frequency (related to secondary review) of 6.7%.
Fibrous Hamartoma of Infancy: A Case Report With Associated Cytogenetic Findings
Authors: Lakshminarayanan Renuka , Konia Thomas , Welborn Jeanna 
Published: February 2021

Abstract
A 2-month-old male infant presented with a subcutaneous mass on the left middle finger; the mass had been present since birth. This was treated with local excision, and there has been no recurrence. Histology revealed the typical features of a fibrous hamartoma. Cytogenetic studies revealed a reciprocal translocation, t(2;3)(q31;q21), as the sole abnormality. To our knowledge, this is the first report of the cytogenetic findings in fibrous hamartoma, and it suggests that this lesion represents a benign neoplasm.
Association Between the Implementation of a Laboratory Information System and the Revenue of a General Hospital
Authors: Park Woong-Sub , Yi Sang Yeop , Kim Sang-A. , Song Jae-Seok , Kwak Youn Hee 
Published: February 2021

Abstract
Context.—A laboratory information system (LIS) is a useful tool for the management of laboratory processes and data, as well as for improving quality.
Objective.—To examine the association between the implementation of a LIS with the outpatient and inpatient revenues of a general hospital.
Design.—This study analyzed the outpatient and inpatient revenue data of all 212 general hospitals in South Korea; data were obtained from the Korean National Health Insurance Corporation during the period from 1996 through 1999. The mixed model was used for the repeated measure data. The following listed variables were used in the analysis: LIS implementation status, the population size, the state of competition, average local income, the hospital location, the hospital size, whether or not the hospital was a teaching hospital, whether the hospital was private or public, and the effect of the implementation time.
Results.—The revenues from both the outpatient and inpatient departments were significantly higher 1 year after implementing a LIS, even after controlling for confounding variables.
Conclusions.—Although the causality needs to be clarified, the implementation of a LIS was found to be significantly associated with higher outpatient and inpatient revenues.
Carcinosarcoma of the Liver: A Case Report and Review of the Literature
Authors: She Rosemary , Szakacs Juliana 
Published: February 2021

Abstract
No more than 11 cases of carcinosarcoma of the liver have been reported in the past 40 years that fulfill the definition of hepatocellular carcinoma combined with differentiated sarcomatous elements. Most cases consist of hepatocellular carcinoma with 1 to 2 heterologous elements. We report a case of a 51-year-old woman with liver carcinosarcoma consisting of 3 carcinomatous components and 4 sarcomatous components. Hepatocellular carcinoma, fibrolamellar type, was accompanied by neuroendocrine carcinoma (neuron-specific enolase and synaptophysin positive) and adenocarcinoma (cytokeratin 7 and 20 positive). The sarcomatous elements consisted of poorly differentiated spindle cell neoplasm (vimentin positive), leiomyosarcoma (smooth muscle actin positive), rhabdomyosarcoma (desmin positive), and osteosarcoma. To our knowledge, this is the first case of liver carcinosarcoma with this many differentiated heterologous features. There are differing views on the pathogenesis of this tumor. Findings in this case support the view that metaplasia of carcinomatous cells gives rise to the sarcomatous elements.
Immunohistochemical Expression of Wilms Tumor Gene Protein in Different Histologic Subtypes of Ovarian Carcinomas
Authors: Waldstrøm Marianne , Grove Anni 
Published: February 2021

Abstract
Context.—Immunohistochemical expression of Wilms tumor gene protein (WT1) has previously been described in primary ovarian carcinomas.
Objective.—To evaluate differences in WT1 expression among different histologic subtypes of ovarian carcinomas and the correlation to the histologic grade.
Design.—Ninety-one primary ovarian carcinomas were reviewed, and 1 representative formalin-fixed and paraffin-embedded tissue block was selected. One slide from each case included in the study was immunostained using the WT1 clone 6F-D2. The immunoreactivity was graded according to the percentage of stained tumor cells. Only nuclear staining was considered a positive reaction. A tumor was regarded as negative if less than 1% of the tumor cells was stained.
Results.—All serous carcinomas (28/28) showed WT1 expression, whereas all mucinous (14/14) and all clear cell carcinomas (14/14) were negative. The lone malignant Brenner tumor and 3 (60%) of 5 undifferentiated carcinomas included in the study were also negative. The endometrioid carcinomas showed either no reaction for WT1 or were diffusely positive with more than 50% of the tumor cells stained. All the grade 1 tumors (10/10) were negative, whereas 5 (45%) of the 11 grade 2 tumors and 5 (63%) of the 8 grade 3 tumors showed a positive reaction.
Conclusion.—The present study demonstrates differences in immunohistochemical expression of WT1 among different histologic subtypes of primary ovarian carcinomas. Regarding the endometrioid subtype, the expression seems to be correlated to the histologic grade.
Papillary Carcinomas of the Gallbladder: Analysis of Noninvasive and Invasive Types
Authors: Albores-Saavedra Jorge , Tuck Matthew , McLaren Bernadette K. , Carrick Kelley S. , Henson Donald Earl 
Published: February 2021

Abstract
Context.—Although papillary carcinomas have been recognized as distinct morphologic variants of gallbladder neoplasms, they have been lumped together in a single group despite the recognition of noninvasive and invasive types. As a result, the biologic behavior of each type remains undescribed.
Objective.—To compare the biologic behavior of noninvasive and invasive papillary carcinomas of the gallbladder.
Design.—The clinical and morphologic features of 16 noninvasive papillary carcinomas (&gt;1 cm) of the gallbladder were analyzed, and their clinical behavior was compared with that of 370 invasive papillary carcinomas recorded in the Survey Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1973 through 2001. The biologic behavior of invasive papillary carcinomas was compared with that of invasive nonpapillary carcinomas of the gallbladder recorded in SEER. Hematoxylin-eosin–stained sections were available for review in the 16 noninvasive papillary carcinomas. The number of slides examined per case varied from 3 to 16, with an average of 7.
Results.—The 16 patients with noninvasive papillary carcinomas included 11 women and 5 men, aged 34 to 83 years (mean age, 61 years). Thirteen patients had cholelithiasis. Laparoscopic cholecystectomy was performed on 12 patients and open cholecystectomy on 4. The tumors measured from 1.3 to 8.6 cm and were well to moderately differentiated. Fourteen noninvasive papillary carcinomas showed biliary phenotype, and 2 showed intestinal phenotype. Follow-up was obtained in 11 patients; 6 were asymptomatic 5 to 11 years after surgery, 2 were symptom free 9 months to 4 years following cholecystectomy, and 3 died of unrelated causes 2 to 3 years after surgery. Three hundred seventy cases of invasive papillary carcinomas were recorded in SEER. The 10-year relative survival rate for 225 patients with invasive papillary carcinomas confined to the gallbladder wall was 52%, while the 10-year relative survival rate for 83 patients with papillary carcinomas that had spread to the lymph nodes was less than 10%. Of the remaining 62 invasive papillary carcinomas, 58 had distant metastases and 4 were not staged. The 10-year relative survival rate for invasive nonpapillary carcinomas confined to the gallbladder wall was 30%.
Conclusion.—Noninvasive papillary carcinomas of the gallbladder—regardless of size, cell phenotype, and degree of differentiation—do not metastasize, and a simple cholecystectomy appears to be a curative procedure. In contrast, invasive papillary carcinomas do metastasize and are associated with a poor prognosis (10-year relative survival rate for tumors confined to the gallbladder wall was 52%, while the 10-year relative survival rate for tumors with lymph node metastasis was &lt;10%). The separation of papillary carcinomas into noninvasive and invasive types is clinically relevant and therefore fully justified.
Expression Patterns of Markers for Type II Pneumocytes in Pulmonary Sclerosing Hemangiomas and Fetal Lung Tissues
Authors: Yoo Seong Ho , Jung Kyeong Cheon , Kim Joo Hyun , Sung Sook Whan , Chung Jin-Haeng , Shim Young Soo , Lee Soong Deok , Chung Doo Hyun 
Published: February 2021

AbstractContext.—Although the histogenesis of sclerosing hemangioma is currently not well understood, the tumor has been characterized by its 2 histologically different types of cells, namely, surface and polygonal cells.Objective.—To elucidate the origin of these cells, we analyzed samples from 15 cases of sclerosing hemangioma and 15 specimens of fetal lung tissue.Design.—We immunostained specimens from 15 cases of sclerosing hemangioma and 15 samples of fetal lung tissue using antibodies against thyroid transcription factor 1, MUC1, Thomsen-Friedenreich antigen, and CD44v6, known as markers for type II pneumocytes, and a panel of antibodies against cytokeratin, epithelial membrane antigen, synaptophysin, CD56, estrogen receptor, and progesterone receptor.Results.—In fetal lung tissue, MUC1 and thyroid transcription factor 1 were expressed throughout all developmental stages of airway epithelium, whereas Thomsen-Friedenreich antigen and CD44v6 were expressed by type II pneumocytes of saccular and alveolar origin. Thomsen-Friedenreich antigen was expressed in the bronchial bud of the pseudoglandular stage. MUC1, thyroid transcription factor 1, and epithelial membrane antigen were observed in both surface and polygonal cells of sclerosing hemangioma. Only the surface cells in all cases of sclerosing hemangioma showed positivity for cytokeratin and CD44v6. Thomsen-Friedenreich antigen was expressed in the surface cells of 11 of 15 cases of sclerosing hemangioma. Epithelial membrane antigen was expressed in both types of tumor cells, whereas cytokeratin was not detected on polygonal cells, but was reactive with surface cells.Conclusions.—Our results suggest that the 2 types of cells in sclerosing hemangioma may derive from a common precursor cell through divergent differentiation toward the type II pneumocyte during tumorigenesis.
Acute Lymphoblastic Leukemic Transformation in a Patient With Chronic Idiopathic Myelofibrosis and Paroxysmal Nocturnal Hemoglobinuria: A Case Report and Review of the Literature
Authors: Shaheen Saad Paul , Talwalkar Sameer S. , Simons Ruth , Yam Lung 
Published: February 2021

Abstract
Leukemic transformation of chronic idiopathic myelofibrosis (CIMF) to acute lymphoblastic leukemia (ALL) is rare. We report a case of a patient with CIMF who developed paroxysmal nocturnal hemoglobinuria (PNH) 2 years after initial presentation. His disease eventually transformed to ALL of precursor B-cell type. In that CIMF and PNH are clonal stem cell disorders with different pathogeneses, there may be an association between them. However, leukemic transformation is a rare sequel of both disorders. Coexistence of CIMF and PNH and subsequent transformation to ALL have, to our knowledge, never been previously reported in the world literature. The simultaneous presentation of CIMF and PNH, complicated by the rare sequela of leukemic transformation, raises important issues with regard to diagnosis and treatment.
Storage and Transfusion of Infected Autologous Blood or Components: A Survey of North American Laboratories
Authors: Shulman Ira A. , Osby Melanie 
Published: February 2021

Abstract
Context.—Many patients request that autologous blood or components be collected and available for use during scheduled surgical or invasive medical procedures to avoid exposure to human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) from allogeneic transfusions. Some patients from whom autologous blood is collected are themselves infected with HIV, HBV, or HCV. However, unlike HIV-, HBV-, or HCV-infected allogeneic blood and components, which must be excluded from the community blood supply, infected autologous blood and components are allowed to be stored in hospitals and transfused back to the patients (autologous donors) from whom the blood was collected. Although the transfusion of HIV-, HBV-, or HCV-infected autologous blood or components does not present a risk to the autologous donor, such a transfusion presents a risk to other patients, considering that at least 1 in every 25 000 transfusions are administered to the wrong individual.
Objective.—To determine if hospital transfusion services store and/or transfuse autologous blood or components infected with HIV, HBV, and/or HCV.
Design.—An educational enhancement subsection of a College of American Pathologists Proficiency Testing Survey (J-C 2003) assessed transfusion service practices for storing and/or transfusing HIV-, HBV-, and HCV-infected autologous blood and components.
Setting and Participants.—A total of 4251 participants were asked whether they stored and/or transfused autologous blood or components and whether these stored blood products included those that were infected with HIV, HBV, or HCV.
Results.—Of the 4251 survey respondents, 3561 provided data regarding their autologous blood and component storage and/or transfusion practices. A total of 2988 participants reported that they store and/or transfuse autologous blood or components. A total of 2390 respondents reported that they do not test autologous donations collected in their own institution for evidence of infection with HIV, HBV, or HCV. Most survey participants reported that even if an autologous donation is tested and found to be infected they would still be willing to store and transfuse the blood component, according to which agent was causing the infection: HIV (n = 1867), HBV (n = 2158), or HCV (n = 2233).
Conclusion.—Most North American hospitals do not test autologous blood donations that they collect in their own institution for evidence of infection with HIV, HBV, or HCV, leading to the conclusion that infected autologous blood components are being stored and transfused. Even when autologous donations are tested and found to be infected with HIV, HBV, or HCV, most North American hospitals would be willing to store and/or transfuse the infected autologous blood components.
Performance Characteristics of Several Rules for Self-interpretation of Proficiency Testing Data
Authors: Carey R. Neill , Cembrowski George S. , Garber Carl C. , Zaki Zohreh 
Published: February 2021

Abstract
Context.—Proficiency testing (PT) participants can interpret their results to detect errors even when their performance is acceptable according to the limits set by the PT provider.
Objective.—To determine which rules for interpreting PT data provide optimal performance for PT with 5 samples per event.
Design.—We used Monte Carlo computer simulation techniques to study the performance of several rules, relating their error detection capabilities to (1) the analytic quality of the method, (2) the probability of failing PT, and (3) the ratio of the peer group SD to the mean intralaboratory SD. Analytic quality is indicated by the ratio of the PT allowable error to the intralaboratory SD. Failure of PT was defined (Clinical Laboratory Improvement Amendments of 1988) as an event when 2 or more results out of 5 exceeded acceptable limits. We investigated rules with limits based on the SD index, the mean SD index, and percentages of allowable error.
Results.—No single rule performs optimally across the range of method quality.
Conclusions.—We recommend further investigation when PT data cause rejection by any of the following 3 rules: any result exceeds 75% of allowable error, the difference between any 2 results exceeds 4 times the peer group SD, or the mean SD index of all 5 results exceeds 1.5. As method quality increases from marginal to high, false rejections range from 16% to nearly zero, and the probability of detecting a shift equal to 2 times the intralaboratory SD ranges from 94% to 69%.
Current Management of the Myeloproliferative Disorders: A Case-Based Review
Authors: Rice Lawrence , Baker Kelty R. 
Published: February 2021

Abstract
Context.—Properly managed, the myeloproliferative disorders are generally compatible with prolonged survival. Challenges to the hematologist include knowing when and how best to intervene to prevent and manage complications. The cytoreductive agent of choice for these disorders is currently hydroxyurea, emerging from randomized trials beginning with those of the Polycythemia Vera Study Group.
Objective.—To examine the roles and shortcomings of interventions (including hydroxyurea, antiplatelet agents, anagrelide, interferon, thalidomide, alkylating agents, cell cytopheresis, erythropoietins, splenectomy, bone marrow transplantation, and imatinib) for myeloproliferative disorders.
Data Sources.—This report uses actual case histories to illustrate the roles and shortcomings of these interventions.
Conclusions.—Beyond phlebotomy for polycythemia vera, patients with polycythemia vera and essential thrombocythemia can be stratified by their risk for thrombosis, which guides the institution of cytoreductive therapies. High-risk patients generally benefit from cytoreductive therapy, and hydroxyurea has emerged as the agent of choice, because alkylating agents (and P32) have high leukemogenic potentials. Anagrelide and interferon are second-line agents. The addition of low-dose aspirin is beneficial for most, helping to prevent arterial thrombotic complications. Therapy in any of these disorders should be tailored to the unique characteristics of the individual patient. With myelofibrosis, therapeutic options run the gamut from observation, erythropoietic stimulators, cytotoxic agents, splenectomy, and bone marrow transplantation. Thalidomide and imatinib have shown some utility. Future challenges are the refinement of individualized treatment strategies and the development of targeted therapies based on rapidly expanding understanding of the molecular perturbations in these disorders.
Quality Improvement to Decrease Specimen Mislabeling in Transfusion Medicine
Authors: Quillen Karen , Murphy Kate 
Published: February 2021

Abstract
Context.—Proper specimen identification and labeling is a critical preanalytic step in pretransfusion compatibility testing.
Objective.—To gather baseline data for specimen mislabeling, specifically targeting major mislabeling events, and to design and implement a plan of corrective action.
Design.—All mislabeled specimens received by the transfusion service for a type and screen were recorded and classified into minor and major mislabeling categories. Major mislabeling events were tracked by origin of the specimen. Locations with a high proportion of major mislabeling were given timely feedback (within 1 week) of the events as they arose.
Setting.—A university hospital.
Main Outcome Measures.—The incidence of major mislabeling.
Results.—The incidence of mislabeling in the transfusion service was 0.5% (243/49 955) during 21 months of data collection. Of these mislabeling events, 47% were classified as major events (unlabeled, mismatched specimen/ requisition, ABO/Rh result on current specimen not matching historical record on file). The emergency department accounted for a high proportion of these major mislabeling events. After the intervention of providing weekly feedback to emergency department staff, their contribution to major mislabeling fell from 47% in 1 year (23/49) to 14% (4/29) in the subsequent 3 quarters.
Conclusions.—Collecting and trending data on mislabeled samples with timely feedback to patient care areas can change phlebotomy practice and reduce specimen mislabeling.
Malignant Neoplasm of Perivascular Epithelioid Cells of the Liver
Authors: Parfitt Jeremy R. , Bella Anthony J. , Izawa Jonathan I. , Wehrli Bret M. 
Published: February 2021

Abstract
Neoplasms of perivascular epithelioid cells (PEComas) have in common the coexpression of muscle and melanocytic immunohistochemical markers. Although this group includes entities with distinct clinical features, such as angiomyolipoma, clear cell sugar tumor of the lung, and lymphangioleiomyomatosis, similar tumors have been documented in an increasing diversity of locations. The term PEComa is now generally used in reference to these lesions that are not angiomyolipomas, clear cell sugar tumors, or lymphangioleiomyomatoses. While most reported PEComas have behaved in a benign fashion, malignant PEComas have occasionally been documented. We present a case of hepatic PEComa with benign histologic features, which nonetheless presented with metastases to multiple sites nearly 9 years later. This case represents the second documented malignant PEComa of the liver, as well as the longest follow-up of a surviving patient with a malignant PEComa, emphasizing both the need for criteria that more accurately predict the behavior of PEComas and the necessity of long-term follow-up of patients with PEComas.
Meckel-Gruber Syndrome: Pathologic Manifestations, Minimal Diagnostic Criteria, and Differential Diagnosis
Authors: Alexiev Borislav A. , Lin Xiaoqing , Sun Chen-Chih , Brenner David S. 
Published: February 2021

Abstract
This article provides an overview of the major pathologic manifestations of Meckel-Gruber syndrome, current knowledge about its pathogenesis, minimal diagnostic criteria, and differential diagnosis. Typical sonographic findings (occipital encephalocele, postaxial polydactyly, and cystic enlargement of the kidneys) allow for diagnosis of most cases before the 14th week of gestation, but the pathologist may encounter clinically unsuspected or atypical cases that require morphologic confirmation. In these cases, a meticulous autopsy is necessary to establish the diagnosis of Meckel-Gruber syndrome.