bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epstein-Barr Virus–Associated Posttransplantation Lymphoproliferative Disorder Following Lung Transplantation Is More Commonly of Host Origin
Authors: Peterson Michael R. , Emery Shawn C. , Yung Gordon L. , Masliah Eliezer , Yi Eunhee S. 
Published: February 2021

Abstract
Context.—Posttransplantation lymphoproliferative disorder (PTLD) in patients who have undergone solid organ transplantation is thought to be mostly of host (ie, transplant recipient) origin, as opposed to being predominantly of donor origin, which is observed in patients who have undergone bone marrow transplantation. Donor-origin PTLDs reportedly follow a more indolent course than host-origin PTLDs.
Objective.—To determine the origin of PTLD and its clinical implications in patients who have undergone lung transplantation.
Design.—Patients' medical records were reviewed for clinical data. We performed a molecular study to determine the origin of abnormal lymphoid cells in 4 PTLD cases identified from our autopsy files. Each case underwent restriction fragment length polymorphism analysis using polymerase chain reaction–based genotyping for CYP2D6. Epstein-Barr virus (latent membrane protein 1) immunostaining and polymerase chain reaction analysis were performed on PTLD-involved tissues.
Results.—Three of 4 PTLD cases were of host origin, and the remaining case was of donor origin. Epstein-Barr virus was detected by immunohistochemical and polymerase chain reaction methods in all PTLD-involved tissues that were examined. There was no apparent difference in clinical manifestations between host-origin and donor-origin PTLD cases in our study.
Conclusions.—The PTLDs in our patients who had undergone lung transplantation were Epstein-Barr virus–positive and mostly of host origin, without any notable clinical difference from donor-origin PTLD.
Longitudinal Case-Based Evaluation of Diagnostic Competency Among Pathology Residents: A Statistical Approach
Authors: Ducatman Barbara S. , Ducatman Alan M. 
Published: February 2021

Abstract
Context.—Accreditation Council for Graduate Medical Education guidelines require the evaluation of residents in 6 competencies. Pathology residents demonstrate medical knowledge, patient care, communication, and practice-based learning competencies in their attainment of competency in surgical pathology diagnosis.
Objective.—To implement a prospective case-based approach to longitudinally evaluate the acquisition of competency in surgical pathology diagnosis by trainees.
Design.—Each resident made his or her surgical pathology diagnosis on cases before faculty review of the cases. Faculty members scored each resident diagnosis as to whether they agree, partially agree, or disagree with the diagnosis. Forty-three months of surgical pathology reports (August 2001 through January 2005) and 22 252 surgical pathology cases were analyzed.
Setting.—Pathology residency program.
Participants.—Thirteen faculty members and 21 trainees.
Main Outcome Measure.—Time and training year trends for the number of cases reviewed and the percent agreement between faculty and trainees on the diagnoses.
Results.—A mean of 146 cases (range, 12–327 cases) was reviewed during each month-long rotation. The number of cases reviewed increased through postgraduate year 4. The percent agreement on the diagnoses was 78% (range, 56%– 99%) for all trainees, with improvement by postgraduate year, although the improvement attenuated by postgraduate year 3. Residents were less likely to preview the most complex cases. Faculty rank and sex and resident sex did not significantly affect outcomes. The overall agreement on the diagnoses increased over time. Residents experiencing difficulty could be identified clearly and early.
Conclusions.—Individual resident performance was easily tracked over time. The review of hundreds of reports increases systems accountability and allows more objectivity than traditional evaluations. The use of case-based evaluation fosters earlier identification and remediation of deficiencies.
Utility of CD117 Immunoreactivity in Differentiating Metastatic Melanoma From Clear Cell Sarcoma
Authors: Garcia Joaquin J. , Kramer Miranda J. , Mackey Zachary B. , O'Donnell Richard J. , Horvai Andrew E. 
Published: February 2021

Abstract
Context.—Clear cell sarcoma is a malignant soft tissue tumor with melanocytic differentiation. Molecular methods are sometimes necessary to identify the unique t(12; 22)(q13;q12) translocation and differentiate clear cell sarcoma from melanoma.
Objective.—To determine whether CD117 immunoreactivity may be useful in separating melanoma from clear cell sarcoma.
Design.—We identified 20 tumors listed in our surgical pathology files that were diagnosed as clear cell sarcoma or in which clear cell sarcoma was strongly considered. These were tested for the presence of the t(12;22) translocation by reverse transcriptase/polymerase chain reaction and sequencing from paraffin-embedded tissue. Tumors with a t(12;22) translocation were immunostained with an antibody to CD117 and compared with 16 similarly stained metastatic melanomas.
Results.—Twelve tumors from 9 patients demonstrated t(12;22). No metastatic melanomas demonstrated t(12;22). None of the 12 clear cell sarcomas showed membrane or cytoplasmic staining for CD117. Conversely, 10 (63%) of 16 metastatic melanomas were, at least focally, positive for CD117; this difference was significant (P &lt; .001). Interestingly, 3 tumors in which clear cell sarcoma was initially considered as a diagnosis, but which lacked t(12;22), were also positive for CD117.
Conclusions.—Reverse transcriptase/polymerase chain reaction, performed on paraffin-embedded tissue, is a useful, rapid tool for identifying the presence of t(12;22) in clear cell sarcoma. The CD117 immunoreactivity may prove useful in the differential diagnosis of deep soft tissue or visceral lesions with melanocytic differentiation; positive staining results exclude clear cell sarcoma, but are compatible with metastatic melanoma.
Mastocytic Enterocolitis: Increased Mucosal Mast Cells in Chronic Intractable Diarrhea
Authors: Jakate Shriram , Demeo Mark , John Rohan , Tobin Mary , Keshavarzian Ali 
Published: February 2021

Abstract
Context.—In some adult patients with chronic intractable diarrhea, the diagnosis remains elusive even after detailed evaluations, and colonic or duodenal biopsy specimens may appear unremarkable on routine hematoxylin-eosin staining.
Objectives.—To assess the concentration of mast cells in colonic or duodenal biopsy specimens by immunohistochemical analysis for mast cell tryptase from patients with chronic intractable diarrhea and to evaluate their response to drugs affecting mast cell function.
Design.—Mast cells per high-power field were assessed in biopsy specimens from 47 patients with chronic intractable diarrhea, from 50 control subjects, and from 63 patients with other specific diseases that cause chronic diarrhea (inflammatory bowel disease, celiac disease, collagenous colitis, and lymphocytic colitis). Patients with chronic intractable diarrhea who had more than 20 mast cells per high-power field were administered drugs affecting mast cell mediator function and release.
Results.—The mean ± SD concentration of mast cells in the 50 control subjects was 13.3 ± 3.5 cells per high-power field; hence, patients with more than 20 mast cells per high-power field were considered to have increased mast cells. Thirty-three (70%) of 47 patients with chronic intractable diarrhea had increased mast cells, and symptoms were controlled by drug therapy in 22 (67%) of the 33 patients. No patient had systemic or cutaneous mastocytosis. No increase in mast cells was seen in patients with other common causes of chronic diarrhea.
Conclusions.—In chronic intractable diarrhea, colonic or duodenal biopsy specimens may appear unremarkable on routine hematoxylin-eosin staining, but increased mast cells may be demonstrated by immunohistochemistry for mast cell tryptase, with the novel term mastocytic enterocolitis describing this condition. Similar increases in mast cells are not apparent in control populations or in patients with other specific diseases that cause chronic diarrhea. The cause of the increased mast cells remains to be elucidated.
Cystic Panfolliculoma
Authors: Hoang Mai P. , Levenson Brian M. 
Published: February 2021

AbstractPanfolliculoma is a rare follicular neoplasm with differentiation toward both upper (infundibulum and isthmus) and lower (stem, hair matrix, and bulb) segments of a hair follicle. We present an unusual case of cystic panfolliculoma. A 33-year-old Hispanic woman presented with an 8-month history of a 3.0-cm cystic scalp mass. The lesion was excised, and the histologic sections showed a cystic follicular neoplasm that contained corneocytes in basket-woven and laminated array, trichohyalin granules of the inner root sheath, germinative cells, papillae, matrical cells, and “shadow” cells. Cytokeratin 903 and cytokeratin 5/6 immunostains uniformly highlight the tumor cells. Ber-EP4 strongly labels the germinative cells but not the follicular papillae. CD34 labels the surrounding fibrotic stroma and focally the epithelial component.
Communicating Critical Values in Anatomic Pathology
Authors: LiVolsi Virginia A. , Leung Stanley 
Published: February 2021

AbstractCritical values in anatomic pathology are usually information sensitive, whereas most such values in laboratory medicine are time sensitive. However, there is an important time element in anatomic pathology as well. Pathologists should be aware that many medicolegal actions against radiologists are based on failure to communicate “abnormal” results in a timely manner. Are pathologists the next group that will be targeted? Pathologists can spend much time trying to communicate important data that will affect patient care to someone who will accept the information. This is not an efficient use of pathologists' professional time. Most important, what are our obligations to patients to communicate “critical” abnormal results to the treating physician? What results need to be so communicated? Are pathologists obliged to contact the patient directly if there is a failure to communicate the critical results to a clinician? We explore these questions to promote discussion of these important issues as they relate to pathologists' liability and to patient care.
The Application of Molecular Techniques to the Study of Hospital Infection
Authors: Andrei Anca , Zervos Marcus J. 
Published: February 2021

Abstract
Context.—Nosocomial infections represent an important cause of morbidity and mortality in hospital settings, resulting in high health care costs. The roles of an epidemic investigation are to recognize that a problem exists, to compare characteristics of affected persons with those of similar but unaffected persons (case-control study), and to identify risk factors. Integrating typing methods as part of conventional epidemiologic surveillance is cost-effective and results in a reduction in rates of nosocomial infections. During the past 10 years, there has been unprecedented progress in molecular biology and in the application of nucleic acid technology to the study of the epidemiology of human infections.
Objectives.—To summarize the available molecular tests for determination of the relatedness of microorganisms causing nosocomial infections, emphasizing the most useful applications of the tests to the study of the epidemiology of hospital-acquired infection; and to discuss the appropriate use of these tests in the prevention and control of hospital-associated infection.
Data Source.—Published English-language literature from 1980 to the present.
Conclusions.—Pulsed-field gel electrophoresis is the method of choice for strain delineation. The newest techniques include polymerase chain reaction and multilocus sequence typing, in which various housekeeping genes that are stable markers of strain identity are sequenced. Molecular techniques are broadly applicable to the study of diverse pathogens. Typing data obtained by DNA analysis should always be considered together with epidemiologic information, because only this combination will enable the most accurate epidemiologic evaluation.
Iatrogenic Trichuris suis Infection in a Patient With Crohn Disease
Authors: Kradin Richard L. , Badizadegan Kamran , Auluck Pavan , Korzenik Joshua , Lauwers Gregory Y. 
Published: February 2021

Abstract
We report a case of biopsy-proven iatrogenic infection by the pig whipworm Trichuris suis in a patient with Crohn disease. The deliberate therapeutic ingestion of T suis ova has been adopted as an experimental approach to the treatment of Crohn disease in an effort to promote a switch from the T helper subtype 1 to T helper subtype 2 inflammatory phenotype in vivo. This report examines the morphology of the immature and adult T suis, the effects of this intervention on the immunophenotype of the bowel mucosa, and it also raises the possibility of persistent active infection in man.
Evaluation of Total Serum Calcium Critical Values
Authors: Howanitz Joan H. , Howanitz Peter J. 
Published: February 2021

Abstract
Context.—As a patient safety measure, laboratories are required by regulatory agencies to have a critical values policy. Total serum calcium commonly is included in critical results lists; however, a wide range of values are used and there is scant outcome data justifying inclusion of this analyte in these lists.
Objective.—To evaluate the appropriateness of the critical values for total serum calcium used in our institution.
Design.—We studied all critical total serum calcium results found during a 3-month period. The patients' medical records were evaluated for the presence of documented critical results call for calcium, clinician response, and patient outcome. The patients' outcomes were measured by time of clinical response, length of stay in the hospital, and mortality.
Results.—There were 722 (1.4%) critical results found in a total of 50 402 total serum calcium results. Using our criteria of 7 mg/dL or less as the low and 12 mg/dL or more as the high critical value, we found 171 patients with 608 critically low results and 47 patients with 114 critically high results. Eighty percent of patients with critically low results and 75% of patients with critically high results had length of stays greater than our average (5.58 days). Clinicians responded to 49% of the critical results calls within 4 hours. There was an overall mortality rate of greater than 25%, with more than half the mortality occurring in patients who had results within 0.5 mg/dL of the cutoff values used.
Conclusion.—Although broadening critical values limits would reduce required calls, this does not appear warranted. The disease severity of the patients as measured by length of stay and mortality, as well as the rapidity with which patients were treated, indicate that the current limits are appropriate and should not be widened.
Fatal Hemorrhage Secondary to Ulcerated Epiphrenic Pseudodiverticulum
Authors: Chen Lei , Walser Eric M. , Schnadig Vicki 
Published: February 2021

Abstract
A 47-year-old man was found unconscious after experiencing severe hematemesis. He had a history of alcohol abuse, hepatic cirrhosis, and previous episodes of gastrointestinal bleeding. Imaging studies indicated that the left gastric artery was the probable source of bleeding. A severe coagulopathy was also noted clinically. Angiographic embolization of the left gastric artery failed to staunch bleeding, and the patient died shortly after admission. Autopsy demonstrated a large, ulcerated epiphrenic esophageal pseudodiverticulum, the base of which was in close proximity to an esophageal branch of the left gastric artery. Cystic dilatation of adjacent esophageal submucosal glands was also seen. Gelatin embolic material, without associated thrombus formation, was found within the left gastric artery. Esophageal pseudodiverticulosis is an uncommon disorder that may be associated with dysphagia, stricture, and odynophagia. Bleeding and perforation are very rare complications. This case may be the first fatality proven by autopsy to be secondary to esophageal pseudodiverticulosis.
Prospective Step Sections for Small Skin Biopsies
Authors: Bruecks Andrea K. , Shupe Jill M. , Trotter Martin J. 
Published: February 2021

Abstract
Context.—In our laboratory, for small skin biopsies or curetted specimens, 3 slides are prepared before the case is reviewed by the dermatopathologist.
Objective.—To examine the utility of these “prospective” step sections in improving diagnostic accuracy and turnaround time.
Design.—Five hundred consecutive cases, in which step sections had been cut prior to slide review, were studied. For each specimen, 3 slides, each consisting of 1 ribbon of tissue containing 4 to 6 sections, were obtained at 50-μm intervals from the paraffin block.
Results.—Fifty-eight biopsies (12%) were nondiagnostic using slide 1 alone. Step sections provided a diagnosis in 19 of 58 cases. In an additional 15 cases (3%) in which a diagnosis was possible using slide 1, deeper levels resulted in a change in diagnosis. Thus, in 34 (7%) of 500 biopsies, deeper levels resulted in improved diagnostic accuracy. In addition, the pathologist would have ordered step sections in a further 117 cases (23%) to clarify the diagnosis rendered on level 1 or to exclude other lesions. Thus, 30% of small skin biopsies would have required deeper levels if step sections had not been obtained prior to slide review.
Conclusions.—In our laboratory, the use of prospective step sections is essentially cost-neutral and case turnaround time is improved by 9% to 45%. Step sections result in a changed diagnosis in 7% of small skin biopsy specimens.
Application of a Combined Protocol for Rational Request and Utilization of Antibody Assays Improves Clinical Diagnostic Efficacy in Autoimmune Rheumatic Disease
Authors: Tampoia Marilina , Brescia Vincenzo , Fontana Antonietta , Zucano Antonietta , Morrone Luigi Francesco , Pansini Nicola 
Published: February 2021

AbstractContext.—Because of a marked increase in the number of requests for antinuclear antibodies, anti–extractable nuclear antigen antibodies, and anti–double-stranded DNA antibodies for the diagnosis of autoimmune rheumatic disease, guidelines have been proposed for their appropriate use.Objective.—To evaluate in terms of clinical efficacy and cost-benefit ratio the outcome of applying a protocol for the diagnosis of autoimmune rheumatic disease.Design.—A diagnostic protocol for the rational utilization of second-level tests (anti–extractable nuclear antigen antibodies and anti–double-stranded DNA antibodies) was applied at Hospital Polyclinic beginning January 2004. The appropriateness of 685 consecutive requests received at the clinical pathology laboratory from January to June 2004 was assessed. Patients who underwent these laboratory tests were followed up for 12 months after blood sample drawing.Results.—Introduction of the protocol led to a significant reduction in the number of second-level tests prescribed (27.9% vs 49.5% for anti–extractable nuclear antigen antibodies; 27.5% vs 56.6% for anti–double-stranded DNA antibodies). After the period of observation, none of the 163 patients who had negative results on the first-level test and were asymptomatic, for whom second-level tests had not therefore been performed, were found to have autoimmune rheumatic disease. In 90.5% (77/85) of patients positive for the second-level tests, clinical confirmation of autoimmune rheumatic disease was obtained.Conclusions.—Not only did application of the diagnostic protocol reduce the number of second-level tests performed but it also increased their specificity. Our data thus indicate that the use of shared guidelines by clinical and laboratory specialists yields satisfactory results.
Best Practices in Diagnostic Immunohistochemistry: Pleomorphic Cutaneous Spindle Cell Tumors
Authors: Folpe Andrew L. , Cooper Kumarasen 
Published: February 2021

AbstractContext.—Pleomorphic cutaneous spindle cell tumors can be difficult to distinguish solely on histologic grounds. The use of ancillary immunohistochemical studies can greatly assist in this differential diagnosis.Objective.—To review histologic and immunohistochemical aspects of cutaneous spindle cell tumors and discuss a basic panel of markers to assist in the differential diagnosis.Data Sources.—English-language literature published between 1981 and 2005.Conclusions.—A basic immunohistochemistry panel for high-molecular-weight cytokeratin, melanocytic markers (S100 protein, HMB-45, Melan-A), smooth muscle actin, desmin, and endothelial markers (CD31, CD34) is effective in diagnosing most cutaneous spindle cell tumors.
The Value of Monitoring Human Papillomavirus DNA Results for Papanicolaou Tests Diagnosed as Atypical Squamous Cells of Undetermined Significance: A College of American Pathologists Q-Probes Study of 68 Institutions
Authors: Tworek Joseph A. , Jones Bruce A. , Raab Stephen , Clary Karen M. , Walsh Molly K. 
Published: February 2021

Abstract
Context.—Papanicolaou (Pap) tests are often diagnosed as atypical squamous cells of undetermined significance (ASC-US). Human papillomavirus (HPV) DNA testing has been proposed as a quality metric for this diagnosis.
Objective.—To measure the frequency of HPV positivity in Pap tests diagnosed as ASC-US and to examine laboratory variables that are associated with institutional deviation from the mean percent of HPV positivity.
Design.—As part of a College of American Pathologist Q-Probes program, 68 participating laboratories retrospectively identified approximately 50 consecutive ASC-US Pap tests that had HPV testing results.
Results.—The mean percentage of HPV positivity for ASC-US was 43.74% among institutions surveyed, but it had a broad distribution, with an SD of 17.77%. Associations were found for lower difference of the institutional mean from the surveyed interinstitutional mean percentage of positive HPV with (1) higher numbers of Pap tests in the past year that had HPV testing, (2) in-house HPV testing, and (3) teaching hospitals. All 3 factors correlated with a larger volume of Pap tests per institution. An association was found between patient age and the probability of a positive HPV result, indicating a dependence upon prevalence of HPV.
Conclusions.—Larger volumes of Pap tests may offer an opportunity to gain greater comfort in interpreting Pap tests. While there is significant variability in interinstitutional HPV-positive rates in ASC-US Pap tests, monitoring the HPV-positive rate in ASC-US Pap tests is a valuable broad measure of quality. Performance beyond 2 SDs of the mean should prompt reassessment of diagnostic criteria used in the evaluation of Pap tests and/or investigation of the prevalence of HPV positivity in the population from which the Pap tests are obtained.