bluuebunny/crossref_metadata_2025_split huggingface dataset:
Declining Clinical Autopsy Rates Versus Increasing Medicolegal Autopsy Rates in Halifax, Nova Scotia
Authors: Wood Marnie J. , Guha Ashim K. 
Published: January 2021

Abstract
The downward trend in the rate of clinical autopsies has been extensively documented in the literature. This decline is of concern when the benefits of the clinical autopsy are considered. In contrast, the rate of medicolegal autopsies has not been studied in such detail. What little reference there is to medicolegal autopsy rates suggests an absence of the same downward trend. A retrospective review of autopsy data over a 13-year period from the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, and from the Office of the Chief Medical Examiner of Nova Scotia was conducted. This review showed a difference between the rates of clinical and medicolegal autopsies for the metro Halifax area. The clinical autopsy rate was consistently less than 30% and declined to 15% in 1999, while the medicolegal autopsy rate was consistently greater than 40% and rose to 62% in 1999. The literature proposes many reasons for the decline in the clinical autopsy rate, but none for this difference between rates. The explanation proposed here is the changing and currently uncertain purpose of the clinical autopsy versus the clear, and consistent over time, purpose of the medicolegal autopsy.
Pulmonary Valve Papillary Fibroelastoma
Authors: Saad Reda S. , Galvis Colleen O. , Bshara Wiam , Liddicoat John , Dabbs David J. 
Published: January 2021

AbstractPapillary fibroelastomas are rare and benign cardiac tumors that typically affect the cardiac valves. To the best of our knowledge, the English literature contains only 1 case report of pulmonary valve fibroelastoma diagnosed by echocardiogram and confirmed by surgical resection. There is a paucity of pathology literature on this subject. We describe an additional case of pulmonary valve fibroelastoma diagnosed by transesophageal echocardiography and magnetic resonance imaging confirmed by pathologic examination in a patient who also had a thymoma.
Papillary Carcinoma of Thyroid Metastatic to the Pituitary Gland
Authors: Bell C. David , Kovacs Kalman , Horvath Eva , Smythe Harley , Asa Sylvia 
Published: January 2021

Abstract
We describe a 35-year-old woman who presented with diabetes insipidus caused by metastatic papillary carcinoma of the thyroid involving the pituitary gland, 25 years after treatment for a papillary carcinoma of thyroid and 17 years after treatment for multiple pulmonary metastases. The literature contains 10 previously described cases of metastatic thyroid carcinoma involving the sella, but only 2 of these cases had unequivocal metastases to the pituitary gland, making the present case, to our knowledge, the third reported case of unequivocal hematogenous metastasis of thyroid carcinoma to the pituitary gland. The pituitary tumor was removed by transsphenoidal surgery, and the tissue was examined by conventional histology, extensive immunohistochemistry, and electron microscopy. The findings confirmed the tumor to be papillary thyroid carcinoma. To our knowledge, this is the first report citing use of thyroid transcription factor-1 to establish a thyroid source of a pituitary metastasis.
Vertebral Metastases From Pineoblastoma
Authors: Charafe-Jauffret Emmanuelle , Lehmann Gilbert , Fauchon François , Michiels Jean-François , Paquis Philippe , Maraninchi Dominique , Hassoun Jacques 
Published: January 2021

AbstractTwo male patients aged 26 and 18 years presented with vertebral metastases originating from pineoblastomas on which surgery had been performed 8 years and 5 months earlier, respectively. In the first case in which the metastasis developed in the T8 corpus, the disease is presently under control after high-dose chemotherapy and autologous blood stem cell transplantation. The second patient (sacral metastasis), despite aggressive adjuvant therapy, died 2 years after the last operation because of spinal seeding. These uncommon cases are discussed with reference to the literature on extraneural metastases that originate from neuroepithelial tumors of the central nervous system.
Allergic Granulomatosis Secondary to a Limited Form of Churg-Strauss Syndrome
Authors: Cualing Hernani , Schroder Louis , Perme Charles 
Published: January 2021

Abstract
Allergic granulomatosis is a disorder of obscure etiology characterized by infiltration of lymph nodes with histiocytic granulomas and eosinophils. In this report, we describe a case of allergic granulomatosis that is consistent with Churg-Strauss disease limited to lymph nodes. The histologic findings of this patient's lymph nodes demonstrated eosinophilic abscesses and ring-shaped necrotizing and nonnecrotizing granulomas surrounding hyperplastic germinal centers. We report herein a rare type of reactive lymphadenopathy and present its histologic, immunohistochemical, and flow cytometric findings, which may allow its distinction from other lymphadenopathies.
Adequate Histologic Sampling of Breast Core Needle Biopsies
Authors: Renshaw Andrew A. 
Published: January 2021

Abstract
Objective.—To determine the degree of histologic sampling necessary for adequate examination of breast core needle biopsy specimens.
Design.—The results of all breast core needle biopsies (11 and 14 gauge) with a diagnosis of atypical small acinar proliferation or atypical ductal hyperplasia and subsequent excisional biopsies, for a 50-month period were reviewed. Blocks of all cores were sectioned entirely in 8 slides to determine the amount of sectioning needed to detect these foci, and the results were correlated with those from the excision specimen.
Setting.—Large community hospital practice.
Results.—Of 3026 cases, 216 (7.1%) were diagnosed as atypical ductal hyperplasia or atypia not otherwise specified. Subsequent resections were available in 105 (49%) cases, and after review, 95 (92%) qualified as atypical ductal hyperplasia and 2 were determined to be atypical small acinar proliferations. The 2 small acinar proliferations were first detected on the second and fourth slides. Of the atypical ductal hyperplasia cases, 43% were detected on the first slide, 17% on the second, 23% on the third, 8% on the fourth, and 8% on the fifth. No lesions were initially detected after this level. Ductal carcinoma in situ was detected in the excision specimens from 1 case each of those detected initially on the fourth and fifth slides.
Conclusion.—Five sections of breast core needle biopsy specimens are necessary to ensure that all atypical small acinar proliferations and atypical ductal hyperplasia lesions are sampled.
Inflammatory Pseudotumor of the Submandibular Gland
Authors: Kojima Masaru , Nakamura Shigeo , Itoh Hideaki , Suchi Taizan , Masawa Nobuhide 
Published: January 2021

Abstract
We report a rare case of inflammatory pseudotumor arising in the submandibular gland, which presented with autoimmune disease–like clinical manifestations. A 70-year-old Japanese man developed masses in both submandibular regions. Laboratory tests revealed polyclonal hypergammaglobulinemia, high titers of antinuclear antibody, and a positive thyroid test. Histologically, the lesion was composed of multiple nodules separated by thick fibrous bands and contained a few atrophic lymphoid follicles and residual ductal structures. At higher magnification, the nodules contained numerous mature plasma cells mixed with myofibroblasts, lymphocytes, and histiocytes. Occasionally, the myofibroblasts were arranged in poorly formed fascicles and in a storiform pattern. Polymerase chain reaction analysis failed to demonstrated the rearrangement of the immunoglobulin heavy-chain gene. The patient was free of disease after 72 months follow-up. Marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type arising from salivary glands occasionally showed prominent plasma cell differentiation. The present case indicates that inflammatory pseudotumor should be added to the list of different diagnoses for mucosa-associated lymphoid tissue–type lymphoma of the salivary glands.
Confidentiality of Health Information Postmortem
Authors: Maixner Andrew H. , Morin Karine 
Published: January 2021

Abstract
Context.—Recent discussions of health care privacy have prompted new concerns over the control of private health information after a patient's death. The importance of confidentiality protections postmortem is compounded as genetic technologies and research capabilities advance and public interest in this information increases.
Objective.—The Council on Ethical and Judicial Affairs of the American Medical Association developed this report to guide physicians in the management of patients' health information postmortem.
Participants.—This report was developed by the 9 physician members of the Council on Ethical and Judicial Affairs with the assistance of staff from the Ethics Standards Group at the American Medical Association.
Evidence.—Literature searches in the MEDLINE and BIOETHICSLINE databases using the search terms postmortem and health information qualified with confidentiality or privacy yielded a combined total of 129 references. Additional references were culled from policies of a number of health care organizations.
Consensus Process.—The Council on Ethical and Judicial Affairs solicited suggestions from the federation of state medical and specialty societies before drafting this report. A copy of the report was sent to the College of American Pathologists for comment. It was then adopted by a majority vote of the House of Delegates of the American Medical Association.
Conclusions.—The report emphasizes the importance of maintaining confidentiality for information held within a deceased patient's medical record. However, these protections are subject to certain exceptions. Confidentiality can be upheld when such information is used for educational or research purposes by removing individual identifiers. For disclosures in which the identity of the deceased patient is known, a number of considerations are provided to assess when disclosure would be ethically permissible.
Unexpected Autopsy Findings Arising From Postmortem Ocular Examination
Authors: Butnor Kelly J. , Proia Alan D. 
Published: January 2021

Abstract
Background.—A full autopsy at our institution includes removal of the eyes for pathologic examination. To our knowledge, the rate of ophthalmic findings at autopsy has not been documented previously.
Design.—We retrospectively reviewed 277 consecutive autopsies conducted between 1995 and 1999 in which the eyes were removed for examination. Ophthalmic findings were placed in the following categories: I, major findings included those that contributed to the patient's death, would have changed patient management, and/or may have important medical implications for close relatives; II, expected findings after ophthalmologic surgery and minor findings that may have eventually required treatment; and III, incidental findings.
Results.—Major findings (category I) were found in 32% of autopsies. Minor findings (category II) and incidental findings (category III) were documented in 62% and 34% of autopsies, respectively. Only 14% of autopsies revealed no ophthalmologic diagnoses.
Conclusion.—In our series, postmortem ocular examination revealed a number of important findings, including several heritable and rare conditions. Eighty-six percent of autopsies disclosed at least one pathologic ophthalmologic finding, approximately one third of which demonstrated findings significant enough to have likely required management. Diabetic retinopathy was the most frequent major finding. Malignant melanoma of the choroid was the most commonly found intraocular neoplasm. Chronic uveitis was the most common minor finding. We conclude that important, often unexpected ophthalmic findings are frequently encountered at autopsy, underscoring the relevance of routine postmortem examination of the eyes.
Aberrant Expression of Tumor Suppressor Proteins in the Ewing Family of Tumors
Authors: Maitra Anirban , Roberts Helen , Weinberg Arthur G. , Geradts Joseph 
Published: January 2021

Abstract
Background.—Deregulation of tumor suppressor gene function and abrogation of cell cycle control are common features of malignant neoplasms, but corresponding data on Ewing sarcomas and primitive neuroectodermal tumors are relatively scarce. We studied the expression of 4 tumor suppressor proteins in the Ewing family of tumors (EFTs).
Design.—We examined a series of 20 pediatric EFTs for abnormal expression of p16INK4a, p14ARF, p21WAF1, and pRB by immunohistochemical analysis of pretreatment, nondecalcified archival specimens. Clinical follow up was available in all cases (median, 21 months; range, 5–103 months). Five patients presented with metastatic disease, 8 had no evidence of disease at last follow up, and 12 had an adverse outcome (death or progressive tumor posttherapy).
Results.—Twelve cases (60%) demonstrated abnormal expression of at least one tumor suppressor protein. There were 11 cases (55%) with loss of p21WAF1 expression, 4 (20%) with down-regulation of p16INK4a, 2 (10%) with absence of pRB, and one case (5%) with loss of p14ARF expression. Loss of p16INK4a expression correlated with metastatic disease at presentation (P = .026), and showed a trend toward shortened survival (P = .20). The p21WAF1, p14ARF, and pRB status was not significantly correlated with either metastatic disease at presentation or outcome.
Conclusion.—Abrogation of the G1 checkpoint was common in this series of EFTs, and down-regulation of p21WAF1 and p16INK4a were the most frequent findings. Loss of p16INK4a expression may identify a subset of cases with a more aggressive phenotype.
The Effect of Changes in Laboratory Practices on the Rate of False-Positive Cultures for Mycobacterium tuberculosis
Authors: Breese Peter E. , Burman William J. , Hildred Mary , Stone Barbara , Wilson Michael L. , Yang Zhenhua , Cave M. Donald 
Published: January 2021

Abstract
Context.—False-positive cultures for Mycobacterium tuberculosis have been found in nearly all DNA fingerprinting studies, but the effectiveness of interventions to reduce cross-contamination has not been evaluated.
Objective.—To evaluate whether changes in laboratory policies and procedures reduced the rate of false-positive cultures.
Design.—Retrospective study of isolates with matching DNA fingerprints.
Setting.—A mycobacteriology laboratory serving an urban tuberculosis control program and public hospital system.
Patients.—All M tuberculosis isolates processed from July 1994 to December 1999.
Methods.—Isolates were fingerprinted using IS6110; pTBN12 was used to fingerprint isolates having fewer than 6 copies of IS6110. We further evaluated all patients having only one positive culture whose DNA fingerprint matched that of another isolate processed in the laboratory within 42 days.
Interventions.—We changed laboratory policy to reduce the number of smear-positive specimens processed and changed laboratory procedures to minimize the risk of cross-contamination during batch processing.
Main Outcome Measure.—The rate of false-positive cultures.
Results.—Of 13 940 specimens processed during the study period, 630 (4.5%) from 184 patients and 48 laboratory proficiency specimens grew M tuberculosis. There were no cases (0/184) of probable or definite cross-contamination, compared with the 4% rate (8/199) identified in our previous study (P = .008). We also fingerprinted a convenience sample of isolates from other laboratories in Denver; 13.6% (3/22) of these were false-positive, a rate similar to the 11.9% rate (5/42) identified for other laboratories in our previous study (P = .84).
Conclusions.—Laboratory cross-contamination decreased significantly after relatively simple, inexpensive changes in laboratory policies and practices. Cross-contamination continued to occur in other laboratories in Denver.
Ganglioneuroma of Parapharyngeal Region
Authors: Albonico Giuseppe , Pellegrino Giovanna , Maisano Maurizio , Kardon David E. 
Published: January 2021

Abstract
In this article, we describe a case of ganglioneuroma observed in a 27-year-old woman. The tumor was found in an unusual location, the parapharyngeal space. The lesion was asymptomatic and was surgically excised after a fine-needle aspiration biopsy that was considered inadequate. The lesion measured 4 × 3 cm and was capsulated. Two distinct cells groups were identified: ganglion cells and Schwann cells placed in a loose myxoid stroma. Immunohistochemical stains (performed with the following monoclonal antibodies: high-molecular-weight cytokeratins, vimentin, neuron-specific enolase, neurofilaments, and S100) confirmed the diagnosis of ganglioneuroma. The pathologic findings and a review of recent literature are discussed.
CD15+ Acute Lymphoblastic Leukemia and Subsequent Monoblastic Leukemia
Authors: Dunphy Cherie H. , Gardner Laura J. , Evans H. Lance , Javadi Nader 
Published: January 2021

Abstract
The abnormality in the translocation of chromosomes 4 and 11 (t[4;11]) has been characteristically associated with calla-negative CD15+ acute lymphoblastic leukemia (ALL) of early pre–B-cell origin. Transformation of a lymphoblastoid to a monoblastoid morphologic structure has rarely been described at relapse in these cases; however, these cases have lacked flow cytometric immunophenotyping (FCI) and genotypic studies (GS) to define the immunophenotype of and the presence of a B-cell gene rearrangement in the monoblastoid component. We report a case of CD15+, CD10− ALL of early pre–B-cell origin defined by morphologic testing and FCI with the t(4;11) abnormality. At relapse, the morphologic testing, enzyme cytochemistry, and FCI data were characteristic of monoblastic leukemia. The t(4;11) abnormality persisted with associated additional chromosomal abnormalities, and the monoblasts contained a B-cell gene rearrangement by GS. These findings support the concept that both processes arose from a multipotential progenitor cell.
Solitary Blood Cultures
Authors: Novis David A. , Dale Jane C. , Schifman Ron B. , Ruby Stephen G. , Walsh Molly K. 
Published: January 2021

Abstract
Objective.—To determine the frequency with which solitary blood culture samples were submitted to laboratories serving small hospitals and to ascertain whether certain hospital practices relating to the performance of blood cultures were associated with lower solitary blood culture rates (SBCRs).
Design.—Participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data prospectively on the numbers of solitary blood culture sets from adult patients submitted to their laboratories and answered questions about their institutions' practice characteristics relating to the collection of blood culture specimens.
Setting and Participants.—Three hundred thirty-three public and private institutions with a median occupied bed size of 57. Participants were located in the United States (n = 329), Canada (n = 3), and Australia (n = 1).
Main Outcome Measure.—The solitary blood culture rate was defined as the number of instances in which only 1 blood culture venipuncture was performed on an individual patient during a 24-hour period divided by the total number of blood culture venipunctures that were performed during the study period.
Results.—Participants submitted data on 132 778 adult patient blood culture sets. The SBCRs were 3.4% or less in the top-performing 10% of participating institutions (90th percentile and above), 12.7% in the midrange of participating institutions (50th percentile), and 42.5% or more in the bottom-performing 10% of participating institutions (10th percentile and below). In half the participating institutions, the SBCRs for inpatients were 8.3% or less and for outpatients, 22% or less. Solitary blood culture rates were lower for institutions in which phlebotomists rather than nonphlebotomists routinely collected blood culture specimens, in which internal policies required drawing at least 2 blood culture sets, in which hospital personnel contacted clinicians when their laboratories received requests for solitary blood culture sets, and in which quality control programs monitored SBCRs routinely.
Conclusions.—Hospitals can achieve SBCRs under 5%. Those hospitals with particularly high SBCRs may lower their rates by altering certain institutional practices.
Preventing Medical Errors in Point-of-Care Testing
Authors: Kost Gerald J. 
Published: January 2021

AbstractObjective.—To prevent medical errors, improve user performance, and enhance the quality, safety, and connectivity (bidirectional communication) of point-of-care testing.Participants.—Group A included 37 multidisciplinary experts in point-of-care testing programs in critical care and other hospital disciplines. Group B included 175 professional point-of-care managers, specialists, clinicians, and researchers. The total number of participants equaled 212.Evidence.—This study followed a systems approach. Expert specifications for prevention of medical errors were incorporated into the designs of security, validation, performance, and emergency systems. Additional safeguards need to be implemented through instrument software options and point-of-care coordinators. Connectivity will be facilitated by standards that eliminate deficiencies in instrument communication and device compatibility. Assessment of control features on handheld, portable, and transportable point-of-care instruments shows that current error reduction features lag behind needs.Consensus Process.—Step 1: United States national survey and collation of group A expert requirements for security, validation, and performance. Step 2: Design of parallel systems for these functions. Step 3: Written critique and improvement of the error-prevention systems during 4 successive presentations to group B participants over 9 months until system designs stabilized into final consensus form.Conclusions.—The consensus process produced 6 conclusions for preventing medical errors in point-of-care testing: (1) adopt operator certification and validation in point-of-care testing programs; (2) implement security, validation, performance, and emergency systems on existing and new devices; (3) require flexible, user-defined error-prevention system options on instruments as a prerequisite to federal licensing of new diagnostic tests and devices; (4) integrate connectivity standards for bidirectional information exchange; (5) preserve fast therapeutic turnaround time of point-of-care test results; and (6) monitor invalid use, operator competence, quality compliance, and other performance improvement indices to reduce errors, thereby focusing on patient outcomes.(Arch Pathol Lab Med. 2001;1307–1315)