bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of Send-Out Test Ordering: A College of American Pathologists Q-Probes Study of Ordering Accuracy in 97 Clinical Laboratories
Authors: Valenstein Paul N. , Walsh Molly K. , Stankovic Ana K. 
Published: February 2021

Abstract
Context.—Errors entering orders for send-out laboratory tests into computer systems waste health care resources and can delay patient evaluation and management.
Objectives.—To determine (1) the accuracy of send-out test order entry under “real world” conditions and (2) whether any of several practices are associated with improved order accuracy.
Design.—Representatives from 97 clinical laboratories provided information about the processes they use to send tests to reference facilities and their order entry and specimen routing error rates.
Results.—In aggregate, 98% of send-out tests were correctly ordered and 99.4% of send-out tests were routed to the proper reference laboratory. There was wide variation among laboratories in the rate of send-out test order entry errors. In the bottom fourth of laboratories, more than 5% of send-out tests were ordered incorrectly, while in the top fourth of laboratories fewer than 0.3% of tests were ordered incorrectly. Order entry errors were less frequent when a miscellaneous test code was used than when a specific test code was used (3.9% vs 5.6%; P = .003).
Conclusions.—Computer order entry errors for send-out tests occur approximately twice as frequently as order entry errors for other types of tests. Filing more specific test codes in a referring institution's information system is unlikely to reduce order entry errors and may make error rates worse.
Did Sir William Osler Perform an Autopsy at The Johns Hopkins Hospital?
Authors: Lucey Brendan P. , Hutchins Grover M. 
Published: February 2021

AbstractSir William Osler was the preeminent internist of his time, who also worked as a pathologist for a considerable period during his career. Between 1876 and 1889, he performed nearly 1000 autopsies in Montreal, Quebec, and Philadelphia, Pa. Many authors concluded that Osler stopped performing autopsies once he moved to Baltimore, Md, because the autopsy service was organized under William Welch, the professor of pathology. However, this assertion has been contradicted by a recent biography of Dr Osler. To reexamine this issue, the autopsy records of The Johns Hopkins Hospital and relevant publications were examined. The evidence suggests that Dr Osler was an enthusiastic, and sometimes engaged, observer of Hopkins autopsies but that he did not function as an autopsy prosector.
Undifferentiated Tumor: True Identity by Immunohistochemistry
Authors: Bahrami Armita , Truong Luan D. , Ro Jae Y. 
Published: February 2021

AbstractContext.—“Undifferentiated tumor” refers to a heterogeneous group of neoplasms with little or no evidence of differentiation on routine light microscopic morphology.Objective.—To identify the true identity of undifferentiated tumors by immunohistochemical analysis.Data Sources.—Review of the pertinent literature and the authors' experience.Conclusions.—For treatment and prognostic evaluation, it is crucial to delineate whether an undifferentiated neoplasm is epithelial, mesenchymal, melanocytic, or hematopoietic in nature. Application of a screening panel to demonstrate the expression of markers of major lineages is fundamental for determination of the broad category of neoplasia. Because poorly differentiated carcinomas and in particular sarcomatoid carcinomas are known to be heterogeneous in their antigen expression, several epithelial markers in combination may be required to establish the carcinomatous nature of tumor. A diagnostic misinterpretation as a consequence of occasional aberrant or unexpected antigen expression is best avoided by using a broad panel that includes both antibodies that are anticipated to be positive and those that are expected to be negative. In this treatise, the immunohistochemical dissection of undifferentiated tumors on the basis of their morphologic features is outlined, supplemented with algorithmic immunohistochemical analysis for each morphologic category of small round cell tumors, carcinomatous tumors, sarcomatous (or sarcoma-like) tumors, and tumors with histologically overlapping features, including hematolymphoid malignancies, melanoma, and sarcomas with epithelioid appearance. The utility of several organ- or tissue-specific markers in the context of undifferentiated tumors is reviewed.
Application of Immunohistochemistry to the Diagnosis of Primary and Metastatic Carcinoma to the Lung
Authors: Jagirdar Jaishree 
Published: February 2021

Abstract
Context.—Immunohistochemistry is a very valuable and often used tool in the differential diagnosis of lung carcinomas whether primary or secondary to the lung. The most useful application is in distinguishing primary lung tumors from metastatic tumors to the lung from common sites (colon, breast, prostate, pancreas, stomach, kidney, bladder, ovaries, and uterus). Immunohistochemistry also aids in the separation of small cell carcinoma from non–small cell carcinoma and carcinoids particularly in small biopsy specimens limited by artifact. Although there is no “lung-specific tumor marker,” with the help of a relatively restricted marker, thyroid transcription factor 1, it is possible to separate a lung primary from a metastasis with a reasonable degree of certainty. Another lung-specific marker on the horizon is napsin A, which appears to complement thyroid transcription factor 1 in defining a lung primary.
Objective.—To present a practical review and to critique commonly used markers in the differential diagnosis of lung neoplasms and to list valuable immunohistochemical prognostic markers that the pathologist is called on to perform and interpret.
Data Sources.—A comprehensive PubMed data search and personal practical experience.
Conclusions.—With a panel of immunohistochemical markers, it is possible to distinguish or narrow down most lung neoplasms and separate them into meaningful therapeutic categories. In the future as more proteomic and genomic data surface, immunohistochemical markers to newly discovered antigens may become a routine part of prognostication.
Extranodal Lymphoma
Authors: Ferry Judith A. 
Published: February 2021

Abstract
Lymphomas arising in extranodal sites are intriguing. The types of lymphomas encountered vary widely from one extranodal site to another. For many types of extranodal lymphomas, there are distinctive clinicopathologic features, sometimes including association with an underlying immunodeficiency syndrome, autoimmune disease, infection, or other immunologic disorder, or a predilection to affect patients of certain ethnic origins. Presented below is a review of lymphomas that are encountered most often in extranodal sites.
How Well Do We Communicate Autopsy Findings to Next of Kin?
Authors: Keys Elizabeth , Brownlee Carolyn , Ruff Monica , Baxter Cynthia , Steele Lisa , Green Francis H. Y. 
Published: February 2021

AbstractContext.—A failure of communication among families, physicians, and pathologists is recognized as a major cause of declining autopsy rates and may be involved in increased litigation.Objective.—To determine how effectively autopsy results are communicated to the next of kin and how satisfied families are with the process from consent to relaying of the results.Design.—A retrospective telephone survey of next of kin of 106 consecutive patients autopsied at a major teaching hospital. The family was asked questions on the process of obtaining consent and the information they received back from health care providers.Results.—Thirty-two percent of relatives indicated that they were not adequately informed as to the purpose of the autopsy. Eighty percent of respondents were notified of or obtained the results. The ways in which the autopsy findings were communicated varied, but 54% were involved in a discussion of the results with a medical professional. More than half of the families wished to have a copy of the results. Two-thirds felt they were satisfied with the explanation of the results, but an important cause of dissatisfaction was the use of unfamiliar medical terminology. When the family's understanding of the cause of death was compared with the diagnoses on the autopsy reports, 65% of families demonstrated an accurate knowledge of the autopsy findings, 28% had a general understanding, and for only 8% was their knowledge judged inaccurate. Overall, 92% of notified respondents felt the autopsy had served a useful purpose, mostly for personal reasons.Conclusions.—We conclude that the autopsy fulfills an important need for many families; however, the purpose of the autopsy and the findings need to be more effectively communicated.
Evaluation of the BiliChek Being Used on Hyperbilirubinemic Newborns Undergoing Home Phototherapy
Authors: Reyes Christine A. , Stednitz Donald R. , Hahn Carol , Mutchie Kelly D. , McCullough Steven R. , Kronberg Kent 
Published: February 2021

Abstract
Context.—Newborns are often screened prior to discharge for hyperbilirubinemia. Transcutaneous bilirubin analyzers, such as the BiliChek, are promoted as screening tools, but it is unclear whether they also function well as monitoring devices. Newborns on home phototherapy require frequent determinations of serum bilirubin levels to monitor therapy effects. A transcutaneous bilirubin analyzer would be helpful to limit blood draws and enhance staff efficiency. We evaluated the accuracy of the BiliChek analyzer in this setting.
Objective.—Is the BiliChek sufficiently accurate to monitor the effectiveness of home phototherapy and establish when to terminate therapy?
Design.—Paired serum bilirubin results and results from the BiliChek were obtained from newborns on home phototherapy during daily home health care visits.
Results.—The BiliChek demonstrates a negative bias (mean bias, −1.71 mg/dL; 95% confidence interval, −1.89 to −1.52 mg/dL) compared with serum bilirubin values. This bias worsens as the serum bilirubin level rises. If a value of 14 mg/dL or less obtained using the BiliChek had been used as the cutoff for termination of phototherapy, 45% of newborns would have had therapy terminated prematurely. If, knowing the negative bias of the BiliChek, the cutoff for termination of therapy was set at less than or equal to 11 mg/dL, then 29% of newborns would have had therapy terminated prematurely.
Conclusions.—The values obtained using the BiliChek, compared to serum bilirubin values, have a negative bias that worsens at the higher bilirubin levels expected in newborns at home on phototherapy. The BiliChek does not provide sufficient accuracy to be utilized to monitor newborns on home phototherapy or to ascertain when to discontinue such therapy.
Monophasic Synovial Sarcoma Arising in the Vulva: A Case Report and Review of the Literature
Authors: White Beverly E. , Kaplan Alan , Lopez-Terrada Dolores H. , Ro Jae Y. , Benjamin Robert S. , Ayala Alberto G. 
Published: February 2021

Abstract
Synovial sarcomas most commonly arise in the soft tissue of the extremities. Less commonly, these tumors present in the head and neck, abdominal wall, and other sites. However, synovial sarcoma occurring in the vulvar area is extremely rare. Only 2 previous cases of biphasic synovial sarcoma of the vulva have been reported, but no case of vulvar monophasic synovial sarcoma has been described in the English literature. We report the third case of synovial sarcoma and apparently the first case of monophasic synovial sarcoma arising in soft tissues of the vulva. The patient was a 33-year-old woman who presented for evaluation of a painless vulvar mass. The tumor was located in the deep fibroadipose tissue of the right vulva (6.5 × 4.2 × 3.5 cm). The histology of the lesion was that of a monophasic synovial sarcoma with a hemangiopericytic vascular pattern. A subsequent molecular analysis revealed SYT-SSX2 gene fusion, which confirmed the diagnosis of synovial sarcoma. After an initial wide local excision, the patient developed a recurrence in the right groin and received chemotherapy and additional surgery. The patient is currently disease free, on adjuvant chemotherapy, and being followed up closely.
Immunophenotypic Study of Basophils by Multiparameter Flow Cytometry
Authors: Han Xiaohong , Jorgensen Jeffrey L. , Brahmandam Archana , Schlette Ellen , Huh Yang O. , Shi Yuankai , Awagu Sylvester , Chen Weina 
Published: February 2021

Abstract
Context.—The immunophenotypic profile of basophils is not yet fully established, and the immunophenotypic changes in chronic myelogenous leukemia are not fully characterized.
Objective.—To establish a comprehensive immunophenotypic spectrum of normal basophils and to assess the range of immunophenotypic aberrations of basophils in chronic myelogenous leukemia.
Design.—Using 4-color flow cytometry, we compared the immunophenotypic profile of basophils in peripheral blood or bone marrow samples from 20 patients with no evidence of neoplasia to basophils from 15 patients with chronic myelogenous leukemia.
Results.—Basophils in control cases were all positive for CD9, CD13, CD22, CD25 (dim), CD33, CD36, CD38 (bright), CD45 (dimmer than lymphocytes and brighter than myeloblasts), and CD123 (bright), and were negative for CD19, CD34, CD64, CD117, and HLA-DR. Basophils in all chronic myelogenous leukemia patients possessed 1 to 5 immunophenotypic aberrancies. The most common aberrancies were underexpression of CD38, followed by aberrant expression of CD64 and underexpression of CD123. CD34 and CD117 were present in cases with basophilic precursors. Myeloblasts showed a distinct immunophenotypic profile, as they typically expressed CD34 and CD117, showed dimmer expression (compared with basophils) of CD38, CD45, and CD123, and lacked expression of CD22.
Conclusions.—Flow cytometric immunophenotyping can identify immunophenotypic aberrations of basophils in chronic myelogenous leukemia, and discriminate basophils from myeloblasts.
Evidence-Based Pathology and the Pathologic Evaluation of Thymomas: Transcapsular Invasion Is Not a Significant Prognostic Feature
Authors: Gupta Ruta , Marchevsky Alberto M. , McKenna Robert J. , Wick Mark , Moran Cesar , Zakowski Maureen F. , Suster Saul 
Published: February 2021

Abstract
Context.—Evaluation of transcapsular invasion is currently considered very important in the pathologic examination of thymomas. However, recent studies have questioned the prognostic value of stratifying thymoma patients into stage I and II disease. Evidence-based pathology promotes the use of systematic reviews of literature and meta-analysis of data to synthesize the results of multiple publications.
Objective.—To analyze the data in the literature regarding the prognostic importance of transcapsular invasion in thymoma stage I and II.
Design.—A systematic review of the English literature was carried out for “thymoma,” “stage,” and “prognoses.” Case reports, case series with fewer than 10 cases, and studies with follow-up periods shorter than 5 years were excluded. Twenty-one retrospective publications reporting the experience with 2451 thymomas were selected for review, including 1419 stage I and 1032 stage II patients. Meta-analysis was performed, and possible publication bias was studied with funnel plots of precision and various statistics.
Results.—Meta-analysis yielded no significant differences in disease-free or overall survival rates in stage I and II thymoma patients. Funnel plots of precision and statistical tests such as the Egger regression intercept test showed no significant publication bias.
Conclusions.—The lack of significant differences in the prognosis of patients with stages I and II thymoma suggests that evaluation of transcapsular invasion is of no clinical value in tumors that lack invasion of neighboring organs or the pleura. The data regarding the prognosis of stage II thymoma patients is somewhat heterogenous, with only some individuals having been treated with radiation therapy, suggesting the need for future randomized controlled trials.
Alveolar Airspace and Pulmonary Artery Involvement by Extramedullary Hematopoiesis: A Unique Manifestation of Myelofibrosis
Authors: Ozbudak Irem H. , Shilo Konstantin , Hale Sabine , Aguilera Nadine S. , Galvin Jeffrey R. , Franks Teri J. 
Published: February 2021

Abstract
Pulmonary extramedullary hematopoiesis is a rare manifestation of myelofibrosis. We encountered a unique case of pulmonary extramedullary hematopoiesis occurring in a 59-year-old white man, where in addition to the typical foci of interstitial hematopoietic cells, a surgical lung biopsy showed airspace and arterial wall involvement. Airspace foci were associated with acute and organizing alveolar hemorrhage, while within arteries the hematopoietic elements had a striking predilection for the vascular intima. The hematopoietic foci included erythroid precursors, myeloid precursors, and megakaryocytes, which were immunoreactive with hemoglobin, myeloperoxidase, and CD61, respectively. Whether extramedullary hematopoiesis represents in situ embryonic stem cell differentiation or a compensatory seeding of hematopoietic cells from the bone marrow remains to be elucidated. However, familiarity with these findings in the lung could be helpful in uncovering occult hematological disorders accompanied by extramedullary hematopoiesis. Extramedullary hematopoiesis should also be considered as a cause of pulmonary hemorrhage, especially in the setting of myelofibrosis.
Surgical Neuropathology Update: A Review of Changes Introduced by the WHO Classification of Tumours of the Central Nervous System, 4th Edition
Authors: Brat Daniel J. , Parisi Joseph E. , Kleinschmidt-DeMasters Bette K. , Yachnis Anthony T. , Montine Thomas J. , Boyer Philip J. , Powell Suzanne Z. , Prayson Richard A. , McLendon Roger E. 
Published: February 2021

Abstract
Context.—The World Health Organization (WHO) recently published its 4th edition of the classification of tumors of the central nervous system, incorporating a substantial number of important changes to the previous version (WHO 2000). The new WHO classification introduces 7 changes in the grading of central nervous system neoplasms, ranging in significance from minor to major, in categories of anaplastic oligoastrocytomas, meningiomas, choroid plexus tumors, pineal parenchymal tumors, ganglioglioma, cerebellar liponeurocytoma, and hemangiopericytomas. The 4th edition also introduces 10 newly codified entities, variants, and patterns, as well as 1 new genetic syndrome. A number of established brain tumors are reorganized, including medulloblastomas and primitive neuroectodermal tumors, in an attempt to more closely align classification with current understanding of central nervous system neoplasia.
Objective.—To summarize and discuss the most significant updates in the 4th edition for the practicing surgical pathologist, including (1) changes in grading among established entities; (2) newly codified tumor entities, variants, patterns, and syndromes; and (3) changes in the classification of existing brain tumors.
Data Sources.—The primary source for this review is the WHO Classification of Tumours of the Central Nervous System, 4th edition. Other important sources include the 3rd edition of this book and the primary literature that supported changes in the 4th edition.
Conclusions.—The new edition of the WHO blue book reflects advancements in the understanding of brain tumors in terms of classification, grading, and new entities. The changes introduced are substantial and will have an impact on the practice of general surgical pathologists and neuropathologists.
Podoplanin Expression in Cancerous Stroma Induces Lymphangiogenesis and Predicts Lymphatic Spread and Patient Survival
Authors: Kitano Haruhisa , Kageyama Shun-Ichiro , Hewitt Stephen M. , Hayashi Ryuji , Doki Yoshinori , Ozaki Yoshitomo , Fujino Shozo , Takikita Mikiko , Kubo Hajime , Fukuoka Junya 
Published: February 2021

Abstract
Context.—Podoplanin is a mucin-type glycoprotein and a lymphatic endothelial marker. Immunohistochemical staining for podoplanin is currently used as a routine pathologic diagnosis tool in Japan to identify lymphatic invasion of cancer cells. Recent reports suggest that podoplanin and other proangiogenic molecules are expressed in stromal fibroblasts and myofibroblasts.
Objective.—To analyze the distribution of podoplanin expression in tumor stroma and its clinical and biologic significance.
Design.—We performed immunohistochemistry for podoplanin on tissue microarrays from 1350 cases of 14 common cancer types.
Results.—Two hundred eighty-seven of 662 cases (43%) showed podoplanin expression in the stromal cells within cancer nests. Stromal podoplanin expression in 14 common cancer types was significantly associated with tumor stage (P &lt; .001), lymph node metastases (P &lt; .001), lymphatic invasion (P  =  .02), and venous invasion (P &lt; .001). The stromal cells positive for podoplanin were also positive for α-smooth muscle actin but negative for desmin, confirming a myofibroblasts phenotype. In contrast, myofibroblasts in inflammatory fibrotic lung diseases were podoplanin negative. Lymphatic vessel density was greater in the stromas with podoplanin expression than in the stroma lacking podoplanin-expressing stromal cells (P  =  .01). Survival data were available for non–small cell lung cancer. Stromal podoplanin expression was associated with poorer prognosis in adenocarcinoma (P &lt; .001) and remains statistically significant after adjustment for sex, age, and stage (P  =  .01).
Conclusion.—Our data indicate that podoplanin expression in stromal myofibroblasts may function as a proangiogenic biomarker and may serve as a predictive marker of lymphatic/vascular spread of cancer cells and a prognostic marker of patient survival.
A Practical Approach to Testicular Biopsy Interpretation for Male Infertility
Authors: Cerilli Lisa A. , Kuang Wayne , Rogers David 
Published: February 2021

Abstract
Context.—The combination of testicular biopsy and clinical evaluation for male infertility is becoming progressively more important because new technologies allow men previously considered infertile to father children. Although most general pathologists are experienced with normal, neoplastic, and cryptorchid testicular specimens, the testicular biopsy for infertility requires understanding of a different set of diagnostic categories not otherwise commonly encountered.
Objective.—To highlight a standardized nomenclature for germ cell abnormalities allowing for effective communication with the urologist and maximal clinical benefit from the biopsy.
Data Sources.—Previously published consensus statements, review articles, peer-reviewed research publications, and abstracts.
Conclusions.—A practical approach to evaluating testicular biopsies for fertility and the clinical implications for each abnormality are herein outlined.