bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myeloperoxidase-Positive Intravascular Large B-Cell Lymphoma
Authors: Conlin Phillip A. , Orden Mageline B. , Hough Tiffany R. , Morgan David L. 
Published: January 2021

Abstract
Intravascular large B-cell lymphoma (IVLBL) is an uncommon form of non-Hodgkin lymphoma that is also known as malignant angioendotheliosis, intravascular lymphomatosis, and angiotropic large-cell lymphoma. The disease is characterized by a bizarre population of neoplastic cells, which are found systemically within vascular lumina. Although originally thought to be a neoplastic process of the endothelial cells, it has since been demonstrated, by molecular techniques and immunohistochemistry, that the neoplastic cells are of lymphoid origin. The differential diagnosis of these lesions includes granulocytic sarcomas that can be distinguished from IVLBL or other lymphomas by the presence of immunohistochemical positivity for myeloperoxidase. We describe a patient with a history of a myelodysplastic syndrome who subsequently developed IVLBL, which demonstrated immunohistochemical positivity for myeloperoxidase. To our knowledge, this represents the first case of a malignant lymphoma to demonstrate such findings.
Diagnostic Utility of Intracytoplasmic Lumen and Transgressing Vessels in Evaluation of Hürthle Cell Lesions by Fine-Needle Aspiration
Authors: Yang Yi J. , Khurana Kamal K. 
Published: January 2021

Abstract
Introduction.—Recent abstracts have emphasized the importance of recognizing intracytoplasmic lumen and transgressing vessels as useful criteria enabling distinction between Hürthle cells encountered in neoplastic and nonneoplastic thyroid aspirates. The purpose of this retrospective study was to evaluate if application of these criteria improves specificity and sensitivity of cytologic diagnosis of true Hürthle cell neoplasms.
Materials and Methods.—We retrospectively reviewed 30 fine-needle aspirates of thyroid with cytologic diagnosis of Hürthle cell neoplasms (13 cases) and nonneoplastic thyroid with prominent Hürthle cells (17 cases). All cases were evaluated for the presence of intracytoplasmic lumen and transgressing vessels and were reclassified as neoplastic or nonneoplastic based on the presence or absence of 1 or both of these criteria. Surgical follow-up was available in all cases.
Results.—Surgical follow-up in 13 cases of Hürthle cell neoplasms revealed Hürthle cell carcinoma (3 cases), Hürthle cell adenoma (6 cases), and Hashimoto's thyroiditis (4 cases). Seventeen cases with nonneoplastic diagnosis revealed Hürthle cell carcinoma (1 case), Hashimoto's thyroiditis (12 cases), and nodular goiter (4 cases). After application of the previously mentioned cytologic criteria, the cytologic diagnoses were reclassified as Hürthle cell neoplasms (13 cases) and nonneoplastic thyroid (17 cases). The true sensitivity of the test before and after the application of the criteria was 90% and 100%, respectively. The true specificity before and after the application of the cytologic criteria was 65% and 85%, respectively.
Conclusions.—Intracytoplasmic lumen and transgressing vessels are helpful features in distinguishing neoplastic and nonneoplastic Hürthle cell thyroid lesions. Use of these criteria may improve the specificity and sensitivity of the cytologic diagnosis.
Cytokeratin Subset Immunostaining in Rectal Adenocarcinoma and Normal Anal Glands
Authors: Ramalingam Preetha , Hart William R. , Goldblum John R. 
Published: January 2021

Abstract
Context.—A large percentage of cases of perianal Paget disease are associated with an internal cancer, most commonly rectal adenocarcinoma. Immunostains for cytokeratin 7, cytokeratin 20, and gross cystic disease fluid protein 15 are useful in identifying cases associated with rectal adenocarcinoma. The Paget cells and rectal adenocarcinoma cells of these lesions typically have a cytokeratin 7+/cytokeratin 20+/gross cystic disease fluid protein 15− immunophenotype. It is not known whether rectal adenocarcinoma unassociated with perianal Paget disease has the same cytokeratin profile as rectal adenocarcinoma associated with perianal Paget disease.
Objective.—To evaluate the immunohistochemical cytokeratin 7 and 20 profile of resected rectal adenocarcinoma unassociated with perianal Paget disease as well as that of normal anal glands from hemorrhoidectomy specimens.
Design.—We performed immunohistochemistry for cytokeratins 7 and 20 on tissues from 30 cases of rectal adenocarcinoma unassociated with perianal Paget disease and 12 hemorrhoidectomy specimens from 12 cases with normal anal glands. We defined positive staining as any immunoreactivity within the neoplastic cells.
Results.—Twenty-six of 30 cases of rectal adenocarcinoma (87%) had a cytokeratin 7−/cytokeratin 20+ immunophenotype, similar to the immunophenotype of cases of nonrectal large intestine adenocarcinoma. In 4 cases (13%), neoplastic cells coexpressed cytokeratins 7 and 20. Anal glands stained strongly for cytokeratin 7 but were negative for cytokeratin 20 in all cases, and the anal transitional zone mucosa had a similar immunophenotype.
Conclusions.—Rectal adenocarcinoma unassociated with perianal Paget disease has a cytokeratin profile similar to that of nonrectal large intestine adenocarcinoma. These data suggest that rectal adenocarcinoma unassociated with perianal Paget disease has a different cytokeratin profile than rectal adenocarcinoma associated with perianal Paget disease.
Endometrial Stromal Sarcoma of the Rectosigmoid Colon Arising in Extragonadal Endometriosis and Revealed by Portal Vein Thrombosis
Authors: Mourra Najat , Tiret Emmanuel , Parc Yann , de Saint-Maur Paul , Parc Rolland , Flejou Jean-François 
Published: January 2021

Abstract
Malignant transformation is an infrequent complication of endometriosis. The ovary is the primary site in 76% of cases, and extragonadal sites are identified in 24%. Endometrioid carcinoma is the most common histologic type; sarcoma is very rare. We report a case of low-grade endometrial stromal sarcoma of the rectosigmoid colon presenting with epigastric pain due to portal vein thrombosis. This tumor arose from extragonadal endometriosis in a 61-year-old woman and was treated by surgical resection. The main differential diagnosis of this unusual colonic neoplasm includes primary mesenchymal tumors, such as gastrointestinal stromal tumors.
Colonic Lymphoid Hyperplasia in Melanosis Coli
Authors: Pearce Callum B. , Martin Hilary , Duncan Hamish D. , Goggin Patrick M. , Poller David N. 
Published: January 2021

Abstract
We describe the case of a patient with Rett syndrome, a syndrome characterized by progressive infant encephalopathy, developmental delay, dementia, autism, ataxia, microcephaly, spastic paraparesis, and autonomic neuropathy with constipation. At colonoscopy, multiple foci of tiny white, sessile, polypoid lesions were seen throughout the colon and rectum, mimicking the appearances of small hyperplastic or adenomatous polyps, associated with generalized melanosis coli. This is the first case to our knowledge describing melanosis coli in a patient with Rett syndrome. As melanosis pigment deposition is characteristically not seen in lymphoid tissue, the lymphoid tissue was identifiable at endoscopy as multiple white nodules mimicking generalized colonic polyposis throughout the colon. We discuss the likely mechanisms of lymphoid hyperplasia and coexistent melanosis coli in Rett syndrome.
Diagnosis of Chondroid Lipoma by Fine-Needle Aspiration Biopsy
Authors: Yang Yi Jun , Damron Timothy A. , Ambrose Joseph L. 
Published: January 2021

Abstract
Chondroid lipoma is a rare, recently described soft tissue tumor that mimics extraskeletal chondrosarcoma and myxoid liposarcoma. Reports regarding its cytologic and radiological features are sparse. In this report, we describe the cytologic features of this unusual tumor, which include mixed mature lipocytes and lipoblast-like cells embedded in chondromyxoid matrix. We also describe the “target sign appearance” of this tumor in magnetic resonance imaging studies, resembling a neurogenic tumor. More importantly, we demonstrate that a definitive diagnosis of this unusual tumor can be made by fine-needle aspiration biopsy. The usefulness of cell block in fine-needle aspiration biopsy diagnosis of soft tissue tumors is emphasized.
A High-Grade Primary Leiomyosarcoma of the Bladder in a Survivor of Retinoblastoma
Authors: Liang Sharon X. , Lakshmanan Yegappan , Woda Bruce A. , Jiang Zhong 
Published: January 2021

Abstract
Second nonocular malignancies develop with increased incidence in patients with hereditary retinoblastoma. Osteosarcoma is by far the most common type with an incidence of up to 50%, followed by soft tissue sarcomas. Visceral leiomyosarcoma is extremely rare and only 2 cases have been reported in the past 2 decades, one in the liver and another one in the urinary bladder, both of which developed after cyclophosphamide therapy. Here we report a case of vesical leiomyosarcoma that was diagnosed in a 49-year-old woman 47 years after the diagnosis of a hereditary retinoblastoma. The patient's retinoblastoma was treated with unilateral enucleation without adjuvant radiation or chemotherapy. We believe that this is the first report of vesical leiomyosarcoma occurring in a patient with retinoblastoma without a prior history of radiation or chemotherapy. This report is significant not only because of the rarity of vesical leiomyosarcoma as a second nonocular tumor in retinoblastoma patients, but also because of the infrequency of vesical leiomyosarcoma in general. We also investigated the potential molecular pathogenesis of the leiomyosarcoma.
Clear Cell Variant of Fibrolamellar Carcinoma of the Liver
Authors: Cheuk Wah , Chan John K. C. 
Published: January 2021

Abstract
Fibrolamellar carcinoma of the liver is a distinctive variant of hepatocellular carcinoma characterized histologically by trabeculae of oncocytic cells with intervening lamellae of collagen fibers. We describe a case with a prominent component of clear cells, a feature not previously recognized in this tumor type. The patient was a 59-year-old woman incidentally found to have a solitary liver tumor, measuring 5 cm. Pathologic examination revealed a circumscribed, firm, tan tumor with peculiar concentric streaks. Oncocytic cells and clear cells were arranged in trabeculae separated by lamellae of collagen or sinusoids. The clear cells possessed abundant finely reticulated clear cytoplasm, which was highlighted by trichrome stain and immunostaining with antimitochondria antibody. Ultrastructurally, the cytoplasm of the clear cells was packed with empty membrane-bound vesicles that occasionally contained short cristae. The features suggested that the clear cell change resulted from ballooning and rarefactive changes of mitochondria. Clear cell fibrolamellar carcinoma should not be confused with conventional clear cell hepatocellular carcinoma, since the former is associated with a more favorable prognosis.
Nongynecologic Cytology Turnaround Time
Authors: Jones Bruce A. , Novis David A. 
Published: January 2021

Abstract
Objectives.—To determine the turnaround time for nongynecologic cytology and to identify laboratory and specimen characteristics associated with variations in turnaround time.
Design and Setting.—Prospective evaluation of nongynecologic cytology turnaround times in 180 laboratories.
Main Outcome Measure.—Nongynecologic cytology case turnaround time.
Results.—Participants from 180 laboratories submitted turnaround times for 16 950 nongynecologic cytology cases and submitted information describing their laboratories' practice characteristics relating to the processing of nongynecologic cytology specimens. Half of the participating laboratories had mean receipt to report turnaround times of 1.6 calendar days or less and were able to complete 90% of their cases within 3.0 calendar days. Ten percent of participants had mean turnaround times greater than 3.2 days and required 6.0 or more days to report 90% of their cases. Longer turnaround times were associated with processing fluid and fine-needle aspiration specimens, issuing atypical/suspicious for malignancy and nondiagnostic diagnoses, having cytotechnologist students screen slides, having to contact the physician offices for additional information, having to retrieve prior case material for review, and having to perform cell blocks and/or special stains.
Conclusion.—There is an opportunity for laboratories to shorten nongynecologic turnaround time by altering certain laboratory practices.
Method Preferences and Test Accuracy of Antimicrobial Susceptibility Testing
Authors: Jones Ronald N. 
Published: January 2021

Abstract
Objective.—To summarize the antimicrobial susceptibility testing results from the College of American Pathologists (CAP) Microbiology Surveys Program for 2000. Specifically, the frequency of tests used and the quantitative and qualitative (susceptibility category) accuracy were assessed.
Design.—The CAP Microbiology Surveys challenged subscribers in 2000 with 3 well-characterized organisms for antimicrobial susceptibility testing in pure culture. Each laboratory was to use the test method and reporting procedures routinely applied to patient samples. The strains were National Committee for Clinical Laboratory Standards (NCCLS) quality control organisms with precisely defined antimicrobial susceptibility patterns and reproducibility. Results reported by participants (2685–2979/sample) were graded for categorical accuracy and quantitative performance by comparing reported minimal inhibitory concentrations (μg/mL) or zone diameters (mm) against quality control ranges published by the NCCLS. The appropriateness of reported drugs was determined in the context of the type and anatomic location of the infection.
Results.—The tests most often used varied by the species of the organism and growth characteristics of the isolated strains. Nonfastidious, rapid-growing Surveys unknowns (Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853) were most often tested with commercial systems (MicroScan, 42.0%–42.4%; Vitek, 41.5%–43.0%) or with the standardized disk diffusion method (12.8%–13.9%). In contrast, fastidious species, such as Streptococcus pneumoniae (ATCC 49619), were predominantly tested by Etest (40.3%), followed by disk diffusion (27.6%) and MicroScan (23.2%). Categorical accuracy was essentially equal between dilution (98.9%) and diffusion (99.0%) methods. Among the minimal inhibitory concentration methods used to test penicillin against S pneumoniae, Etest method quantitative accuracy (96.3%) was greater than that of MicroScan (92.4%). Quantitative accuracy was greatest for dilution minimal inhibitory concentration methods, with more than 90% of results within NCCLS quality control ranges for nearly all reported antimicrobials. Reevaluations of quality control ranges may be needed for 4 to 7 agents, depending on method. Reporting errors were also detected in 2 areas: (1) reporting results for drugs not active at the site of infection and (2) reporting results for drugs tested with suboptimal methods without published NCCLS interpretive criteria.
Conclusions.—Antimicrobial susceptibility testing methods used in US laboratories were dominated by commercial products with relatively high accuracy (qualitative and quantitative). As available methods have become better suited to both fastidious and rapid-growing species, reporting errors have assumed a higher level of concern to the CAP Surveys in an effort to minimize prescription errors.
Nesidioblastosis Coexisting With Islet Cell Tumor and Intraductal Papillary Mucinous Hyperplasia
Authors: Zhao Xiaohui , Stabile Bruce E. , Mo Junqin , Wang Jun , French Samuel W. 
Published: January 2021

Abstract
A coexisting of intraductal papillary mucinous hyperplasia (IPMH) and islet cell tumor with nesidioblastosis of the pancreas in a 51-year-old man is reported. All of the clinical data indicated an insulinoma. A distal pancreatectomy was performed. A discrete mass measuring 1.9 × 2.0 cm was grossly identified in the tail of the pancreas. There were no other gross lesions. An islet cell tumor with nesidioblastosis was confirmed by immunostains and ultrastructural study. In addition, an IPMH was found that involved mainly branches of the pancreatic duct. The islet cell tumor and IPMH were topographically separated; however, there was a histologically intimate relationship between the nesidioblastosis and the IPMH. These findings indicate that the IPMH may have derived from autocrine and paracrine influences on the existing duct epithelial cells. To the best of our knowledge, this is the first report of nesidioblastosis coexisting with islet cell tumor and IPMH.
Extraskeletal Ewing Sarcoma in a 77-Year-Old Woman
Authors: Cheung Carol C. , Kandel Rita A. , Bell Robert S. , Mathews Raymond E. , Ghazarian Danny M. D. 
Published: January 2021

Abstract
Extraskeletal Ewing sarcoma (EES) is a rare soft tissue tumor that is morphologically indistinguishable from Ewing sarcoma of bone. It is usually found in young people, but several cases have occurred in patients older than 50 years. The differential diagnoses include other small, blue round cell tumors (SBRCTs) and other members of the Ewing family of tumors such as the primitive neuroectodermal tumor. We present a case of EES in the left inguinal region of a 77-year-old woman. The tumor was distinguished from other SBRCTs by lack of immunoreactivity for epithelial, lymphoid, vascular, neuroendocrine, neural, histiocytic, and muscle markers. Primitive neuroectodermal tumor was excluded because of the lack of neural differentiation by histologic analysis, immunohistochemistry, and electron microscopy. Extraskeletal Ewing sarcoma was confirmed by characteristic features on histologic analysis, histochemistry, immunohistochemistry, and electron microscopy and by the presence of the t(11;22)(q24;q12) fusion transcript detected by reverse transcriptase–polymerase chain reaction. This case serves to remind the reader that EES is not a tumor that occurs exclusively in young patients.
p53 Mutation in Adenocarcinoma Arising in Retrorectal Cyst Hamartoma (Tailgut Cyst)
Authors: Moreira Andre L. , Scholes John V. , Boppana Sushma , Melamed Jonathan 
Published: January 2021

Abstract
Retrorectal cyst hamartoma (RCH) is a rare benign cystic lesion located in the retrorectal space. Malignancy arising in such lesions is very uncommon. In this study, 2 cases of mucinous adenocarcinoma arising in RCH are presented. In one case, dysplastic epithelium lined the cyst wall, surrounding the area of carcinoma and suggesting a dysplasia-carcinoma progression in RCH. Adenocarcinoma and the dysplastic epithelium were strongly positive for p53 and Ki-67 and showed negative staining for p21 by immunohistochemistry. These findings are suggestive of a mutation in the p53 gene in the adenocarcinoma and in dysplastic epithelium lining the cysts, similar to the dysplasia-carcinoma sequence described for the development of colonic adenocarcinoma.
Digital Image Documentation for Quality Assessment
Authors: Cruz Domingos , Valentí Carla , Dias Aureliano , Seixas Mário , Schmitt Fernando 
Published: January 2021

Abstract
Objective.—To demonstrate the feasibility of the use of digital images to document routine cases and to perform diagnostic quality assessment.
Methods.—Pathologists documented cases by acquiring up to 12 digital images per case. The images were sampled at 25:1, 50:1, 100:1, 200:1, or 400:1 magnifications, according to adequacy in aiding diagnosis. After each acquisition, the referral pathologist marked a region of interest within each acquired image in order to evaluate intrinsic redundancy. The extrinsic redundancy was determined by counting the unnecessary images. Cases were randomly selected and reviewed by one pathologist. The quality of each image, the possibility of accomplishing a diagnosis based on images, and the degree of agreement was evaluated.
Results.—During routine practice, 1469 cases were documented using 3902 images. Most of the images were acquired at higher power magnifications. From all acquired cases, 143 cases and their 373 related images were randomly selected for review. In 88.1% (126/143) of reviewed cases, it was possible to accomplish the diagnosis based on images. In 30.2% (38/126) of these cases, the reviewer considered that the diagnosis could be accomplished with fewer images. The referral pathologist and the reviewer found intrinsic redundancy in 57.8% and 54.5% of images, respectively.
Conclusions.—Our results showed that digital image documentation to perform diagnostic quality assessment is a feasible solution. However, owing to the impact on routine practice, guidelines for acquisition and documentation of cases may be needed.
Computed Tomographic–Pathologic Correlation of Gross Tumor Volume and Clinical Target Volume in Non–Small Cell Lung Cancer
Authors: Chan Roscoe , He Yu , Haque Abida , Zwischenberger Joseph 
Published: January 2021

Abstract
Context.—Computed tomographic (CT) scan data are used regularly in radiation treatment planning for patients with lung cancer. To our knowledge, the relationship of the CT images of tumors and their corresponding microscopic extent has not yet been studied in detail.
Objective.—To correlate tumor sizes on CT with tumor sizes measured microscopically (ie, the gross tumor volume [GTV]-clinical target volume margin) in non–small cell lung cancers.
Design.—Prospective pilot study.
Setting.—Single institution.
Patients.—Patients with operable non–small cell lung cancer were identified preoperatively.
Interventions.—Once the surgical specimen was available, it was oriented with the surgeon and the pathologist. Seven whole-mount, cross-sectional histologic glass slides were made from 5 tumors using formalin fixation and hematoxylin-eosin staining. The pathologist then outlined the cancer-containing area under the microscope (Micro-GTV) and the area of surrounding inflammatory response (Micro-GTV + inflammation). Preoperative CT scans were used for outlining tumor on the corresponding slice (CT-GTV).
Main Outcome Measures.—Correlation of the areas of Micro-GTV, Micro-GTV + inflammation, and CT-GTV was performed.
Results.—There was an obvious trend that the CT-GTV was bigger than the Micro-GTV, except in specimen 1, in which the 2 areas were about equal. However, on comparing the values for the CT-GTV and the Micro-GTV + inflammation, the difference between the 2 areas became smaller.
Conclusions.—Modern CT scans might overestimate the GTV in non–small cell lung cancer. The GTV–clinical target volume margin could actually be zero or even a negative value. The findings in this small study are interesting and provoking. Further study with a larger number of patients and more rigid quality control is warranted to confirm our findings.
Peculiar Artifacts Mimicking Carcinoma
Authors: Wu Mark Li-cheng , Natarajan Sathima , Lewin Klaus J. 
Published: January 2021

Abstract
Artifacts that mimic malignancy may lead to diagnostic difficulty and can cause serious consequences. We present 2 cases received in consultation which demonstrated peculiar artifacts that closely mimicked carcinoma. In case 1, contaminating products of conception were confused with squamous cell carcinoma. In case 2, artifactual signet ring cells induced by procedural trauma were suspicious for signet ring cell carcinoma. In both cases, clinical correlation failed to completely exclude carcinoma, and limited tissue prevented use of ancillary studies. Our final resolution of these artifacts required lengthy and detailed morphologic analysis.