bluuebunny/crossref_metadata_2025_split huggingface dataset:
Higher Prevalence of Multi-Drug Resistant Gonococcal Infections Among Patients with Prior Gonococcal and Chlamydia Infections
Authors: Mendoza R P , Gabutan E , Connelly C , Gupta R , Alejandro N 
Published: October 2021

Abstract

Introduction/Objective
Neisseria gonorrhoeae (NG) is the 2nd most common cause of sexually transmitted infection worldwide. WHO data from 2009-14 showed widespread resistance to ciprofloxacin (97%), azithromycin (81%), and oral cefixime and injectable ceftriaxone (66%). We have investigated local epidemiology of antimicrobial resistance in PCR-confirmed NG by chromosomal multi-locus sequence typing and analysis.

Methods/Case Report
Clinical specimens of 85 patients who tested positive for NG using automated PCR (COBAS 4800; Roche Diagnostics) were used in this study. The samples were amplified by PCR using 10 primers (Integrated DNA Technologies, USA) targeting seven antibiotic resistance-associated loci in the bacterial chromosome (penA, mtrR, ponA, porB, gyr, parC and 23s rRNA) and sequenced on a 48-channel ABI 3730 Sanger sequencer (Thermo Fisher). The resulting sequences were analyzed using the NG Sequence Typing for Antibiotic Resistance (NG-STAR) database for matching alleles, correlating to clinical resistance. Results were analyzed by Chi-square or Fisher’s exact tests.

Results (if a Case Study enter NA)
Most patients positive for NG were non-Hispanic Black males (60%), with mean age of 25 years (range: 14-53 years). 23.5% had Chlamydia trachomatis (CT) co-infection, and 29.4% had other sexually transmitted infections, such as syphilis, HIV and HPV. 15.0% had previous NG infection, and 12% had previous CT infection. Sixty-five samples (76.5%) yielded at least one gene locus with a DNA sequence with &gt;95% similarity in the NG-STAR database. About half (50.6%) of these sample had confirmed resistance mutations, 5 of which indicated resistance to multiple antibiotics. All specimens with porB and gyr mutations were resistant to penicillins, ceftriaxone, cefixime, erythromycin, tetracycline and ciprofloxacin. Most of those with mtrR mutations were resistant to ciprofloxacin. Most of those with mutations (with or without resistance) had previous NG infection. Significant correlation was observed between those with at least 1 mutated gene locus and CT co-infection (p=0.0001).

Conclusion
A significant proportion of our patients tested positive for resistance mutations, a majority of whom had previous NG infection. There was significant correlation between the presence of mutations and CT co-infection. These findings warrant utilization of culture and sensitivity testing in patients with previous NG and CT co-infection.
Preferential HER2 Expression in Lymphovascular Invasion of a Uterine Carcinosarcoma, a Case Report
Authors: Gillam J 
Published: October 2021

Abstract

Introduction/Objective
Uterine carcinosarcoma (UCS) is a rare, highly aggressive cancer accounting for &lt;5% of reported uterine cancer cases. Commonly, myometrial invasion and lymphovascular invasion (LVI) are found at diagnosis, and recurrence rates of &gt;40% are seen after therapy accounting for poor prognosis and high rate (16%) of death. Histologically, it is composed of both carcinoma and sarcoma components. HER2-targeted therapy without adjunctive chemotherapy for the treatment of UCS has generally not shown beneficial clinical responses, but a more recent phase II clinical trial revealed that the addition of Trastuzumab, a HER2-targeted monoclonal antibody, to carboplatin-paclitaxel chemotherapy showed an increase in progression free survival.

Methods/Case Report
Immunohistochemical (IHC) staining for HER2 was performed on histologic sections of UCS, areas of LVI, and lymph node metastasis (LNM). Confirmatory HER2 fluorescent in situ hybridization (FISH) studies were performed on the primary UCS and the LVI portion. A 67-year-old female presented with postmenopausal uterine bleeding. CT showed an enlarged uterus, widened endometrial canal, and enlarged lymph nodes. Initial endometrial biopsy showed UCS. Exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-ophorectomy, omentectomy, and lymph node dissection was performed with pathology confirming UCS with 86% myometrial invasion and LVI.

Results (if a Case Study enter NA)
NA

Conclusion
HER2 expression in this patient was solely seen in foci of LVI and within LNM. This finding suggests inclusion of histologic sections with LVI and LNM when evaluating for the presence of HER2 expression in uterine carcinosarcoma with reflex FISH testing when indicated may be helpful to provide additional treatment opportunities for patients. Further studies need to be performed to determine if this finding in generalizable to carcinosarcoma and endometrial serous carcinoma samples.
Unexpected endometrial malakoplakia in a 74-year-old-female: A case report
Authors: Abdelwahed M , Chavarria Bernal H , Truskinovsky A 
Published: October 2021

Abstract

Introduction/Objective
Malakoplakia is a chronic inflammatory disease, usually associated with bacterial infection. The urinary system is the most commonly involved site. Involvement of the female genital tract is extremely rare. Histopathologically, the disease is manifested by solid sheets of histiocytes with abundant granular eosionophilic cytoplasm, and intra- and extracellular basophilic bodies. It should be differentiated from other types of granulomatous inflammation and from signet ring cell carcinoma. Treatment consists of antibiotics, but surgery is sometimes necessary.

Methods/Case Report
A 74-year-old woman experienced postmenopausal bleeding for several years. A previous endometrial biopsy showed a mucinous glandular proliferation of uncertain etiology. She also had coronary heart disease, hypertension, diabetes mellitus and hyperlipidemia. A prior urinalysis showed abundant bacteria, and she had been hospitalized recently for urinary tract infection (UTI). She underwent laparoscopic total hysterectomy. Grossly, the endometrium was mostly uniform, 0.1 cm in thickness, with one 0.4-cm polyp. Microscopically, the endometrium showed simple hyperplasia without atypia, benign endometrial polyp, and multifocal malakoplakia, manifested by sheets of histiocytes with granular eosinophilic cytoplasm, many of them containing variably-sized basophilic spherules imparting to them a targetoid, or bull’s eye, appearance. Multiple endometrial plasma cells were also seen.

Results (if a Case Study enter NA)
NA

Conclusion
Very few cases of endometrial malakoplakia have been reported in the medical literature. Here we present unexpected malakoplakia coexisting with endometrial simple hyperplasia without atypia. Reports from the electron microscopy literature suggest that the basophilic spherules, named Michaelis-Gutmann inclusion bodies, are electron-dense granules that result from coalescence of phagolysosomes, reflecting failed digestion of bacteria. In our patient, longstanding chronic endometritis, confirmed by the presence of endometrial plasma cells, possibly coexisting with chronic UTI, culminated in malakoplakia, which clinically and pathologically mimicked endometrial hyperplasia or even carcinoma, given her old age, chronic bleeding, and the mucinous epithelium in the endometrial biopsy. The finding of endometrial malakoplakia should remind us of the bacterial etiology of chronic endometritis and the need for timely treatment of urogenital infections with antibiotics.
Anti-NMDA-Receptor Encephalitis in a Patient with Ovarian Teratoma, Harboring Brain Histology of Varying Developmental Stages and Regions with Chronic Inflammation
Authors: Fatemi S , Qu E , Fullmer J 
Published: October 2021

Abstract

Introduction/Objective
Anti-NMDA-receptor encephalitis is a subacute, autoimmune disorder thought to be caused by autoantibodies directed against the N-methyl-D-aspartate (NMDA) receptor. Clinical symptoms of anti-NMDAR encephalitis may mimic schizophrenia and psychotic spectrum disorders or substance-induced psychosis. Although initially described in association with ovarian teratomas in women, anti-NMDAR encephalitis has been reported in individuals without paraneoplastic association, as well as in males. Herein, we report a case of a 29-year-old woman with suicidal ideation and other neuropsychiatric manifestations who was found to have a right ovarian cystic mass by imaging study. Microscopically, the resected ovarian mass is composed of mature skin, fat, cartilage and neural tissues. Nerve, ganglions and multiple brain tissues are present. Cerebellum including external granular cell layer (normally only seen in infants), cerebrum-like, choroid plexus and other neural elements are present. There is peripheral lymphoplasmacytic infiltrates around and within the neuroglial matrix. Cerebral spinal fluid was concurrently tested positive for Anti-NMDAR. The combined clinical, histological, and laboratory findings confirmed the above diagnosis. Although Anti-NMDAR encephalitis is a familiar entity to many clinical psychiatrist and neurologists, it is less commonly reported in the pathology literature. Its resultant relationship to cystic teratoma warrants awareness of this condition by pathologists.

Methods/Case Report
Case Report

Results (if a Case Study enter NA)
NA

Conclusion
Anti-NMDA-receptor encephalitis is related to cystic teratoma, therefore pathologists need to be aware of this condition.
Rhabdomyosarcoma in Ovary- Pathologist’s Diagnostic Dilemma
Authors: Srivastava A C , Hussain F , Patel T 
Published: October 2021

Abstract

Introduction/Objective
Rhabdomyosarcoma is the most common pediatric soft tissue sarcoma. However, rhabdomyosarcoma in the ovary is exceptionally unusual and presents a diagnostic challenge. We report one such case and its clinical and pathological perspective.

Methods/Case Report
16-year-old female presented with an enlarging pelvic mass, abdominal distension, and pain. Imaging revealed a heterogeneous left ovarian mass, right axillary lymphadenopathy, and right-hand soft tissue mass. CA-125 was 1833.0 U/ml. Patient underwent left salphingo-oophorectomy, omentectomy, peritoneal and mesenteric biopsy for ovarian staging, incidental appendectomy, and right axillary lymph node excision with suspicion of ovarian epithelial tumor. Pathological evaluation revealed a 16-cm intact ovary with multiple solid and cystic nodules with areas of hemorrhage and necrosis. Microscopic examination of ovarian tumor showed a high-grade malignant tumor consisting of sheets of small round blue cells with severe cytologic atypia, increased mitoses, and features suggestive of rhabdoid morphology. The other specimens were positive for metastases. The tumor cells were immunopositive for Myogenin and MyoD1 while immunonegative for Cytokeratin AE1/AE3, SF-1, PLAP, SALL4, MelanA, and S-100. INI-1 and BRG-1 demonstrated intact nuclear expression. FISH testing identified rearrangement of the FOX01 gene at 13q14. Based on these findings, diagnosis of alveolar rhabdomyosarcoma was rendered. Currently, the patient is receiving rhabdomyosarcoma chemotherapy treatment and has responded well.

Results (if a Case Study enter NA)
NA

Conclusion
In cases with complex and urgent clinical presentation, where the existence of a primary tumor is unknown and where symptoms attributable to primary ovarian tumor dominate the clinical picture, rhabdomyosarcoma is rarely proposed in the differential diagnoses of small round blue cell tumors of the ovary. At present, the right-hand mass is under evaluation; thus, the true nature of the ovarian mass, primary or metastatic is unknown. Our case illustrates the importance of exact diagnoses, as treatment of rhabdomyosarcoma, is different from other ovarian tumors.
Invasive Fungal Sinusitis: Clinical Pathologic Characteristics of Acute vs. Chronic Infections
Authors: Kitagawa Y , Mesa H , Lavik J 
Published: October 2021

Abstract

Introduction/Objective
Invasive fungal sinusitis is a serious condition requiring early diagnosis and treatment. It has been classified into acute, chronic and granulomatous forms. This study aims to investigate clinical pathologic aspects such as a) Frequency of mass forming lesions, b) Frequency of granulomatous reaction, c) Frequency of acute inflammatory reaction and d) Frequency of angioinvasion, perineural invasion and necrosis, to determine if these factors allow a more meaningful clinical-pathologic classification.

Methods/Case Report
Cases of invasive fungal sinusitis with surgical pathology specimens available in our laboratory since January 1, 2006 to date were gathered. Electronic medical records, histopathologic diagnostic material and laboratory fungal identification results were reviewed.

Results (if a Case Study enter NA)
Thirty-one cases of invasive fungal sinusitis were found: Twenty-two were acute (&lt; 4wk duration) and 9 chronic. Patient comorbidities in acute cases were malignancies: 45%, diabetes mellitus: 26% and solid organ transplant: 10%.
Among patients with malignancies, 5 cases had relapsed/refractory acute myeloid leukemia with neutropenia &lt; 1000/uL. Patients with diabetes mellitus exhibited an average HbA1c of 10.0%. Two out of 3 transplant patients had graft versus host disease.
The most common causative fungi were species of Aspergillus, Candida and mucormycetes. By contrast, a third of the chronic cases had a history of recreational drug use and six presented with space occupying lesions seen on imaging studies. Upon histologic review, four of these showed granulomas and the majority of cases exhibited extensive necrosis. Among necrotic cases, perineural and vascular invasion by fungal organisms was identified.

Conclusion
We report the contrasting clinical pathologic characteristics of acute and chronic invasive fungal sinusitis in a series of cases treated at University affiliated tertiary/quaternary-care Hospitals. Acute invasive sinusitis is usually a complication of severe systemic diseases. Chronic cases are caused by various medical conditions including the use of recreational drug and may mimic neoplasms on imaging.
Mass-forming chronic invasive fungal sinusitis; an uncommon mimicker of head & neck malignancy
Authors: Muldoon J , Hou T 
Published: October 2021

Abstract

Introduction/Objective
Invasive fungal sinusitis is a progressive infection affecting the nasal cavity and associated sinus spaces. Acute forms affect immunocompromised patients with debilitating systemic diseases while chronic forms usually occur in immunocompetent individuals.

Methods/Case Report
A 26-year-old immunocompetent male with daily Marijuana smoking consulted for acute swelling of the right eye with dull pain, photophobia, loss of vision and pressure of 4 day duration. He reported nasal congestion for approximately one year and over the previous 2 months developed exophthalmos. Imaging demonstrated a 4.9 x 4.3 x 4.1 cm invasive soft tissue mass in the right lamina papyracea with involvement of the paranasal sinus, right orbit, and intracranial space. The mass was presumed to represent a high-grade malignancy.
Biopsy was performed and demonstrated granulomatous invasive fungal sinusitis. The patient underwent right orbitotomy and right extranasal ethmoidectomy. He was begun on empiric amphotericin B. After culture and sequencing identification of Curvularia species, voriconazole was added. Follow up imaging studies after two month of treatment still demonstrated residual mass forming lesion with 10-20% decrease in size. The patient has regained his vision after 4 month of treatment and he is expected to complete a six months course. If the mass forming lesion persists, a second round of surgical debridement will be performed.

Results (if a Case Study enter NA)
N/A

Conclusion
Curvularia is a dematiaceous fungus most commonly associated with allergic sinusitis, but can rarely become invasive in immunocompetent individuals. Histopathologically large fungal elements are easily recognizable but specific identification requires culture or ribosomal DNA sequencing by PCR. Mass-forming chronic fungal sinusitis overlaps clinically and radiologically with head and neck malignancies. Our report brings attention to this uncommon clinical variant of invasive fungal sinusitis that affects immunocompetent individuals.
Pediatric Epithelioid Angiosarcoma of the Maxillary Sinus: Clinicopathologic, Immunophenotypic and Molecular Study of a Rare Entity
Authors: Rastegar S , Suster D 
Published: October 2021

Abstract

Introduction/Objective
Angiosarcomas are aggressive neoplasms of the vascular endothelium and comprise approximately 2% of all soft tissue sarcomas. The occurrence in the sinonasal cavity is rare. A case of epithelioid angiosarcoma of the maxillary sinus in a 19-year-old patient is presented and its clinical presentation, histologic, immunohistochemical, and molecular features are discussed.

Methods/Case Report
A 19-year-old male evaluated at Rutgers University Hospital for 3 months of left-sided epistaxis. He reports left side nasal obstruction, facial pain, and epiphoria. Computed tomography revealed a heterogeneous soft tissue mass within the left maxillary sinus; with dehiscent segments extending into the premaxillary space, infratemporal fossa, and the left orbital floor. Bilateral rigid nasal endoscopy showed bowing of the left maxillary sinus medial wall, exposing a mucosalized mass. He underwent left maxillary antrostomy and left subtotal maxillectomy. Positron emission tomography scan showed no metastasis.
The tumor was within the submucosa of the respiratory epithelium and focally demonstrated anastomosing vascular spaces lined by atypical endothelial cells. The neoplastic cells showed epithelioid morphology with increased nuclear size, prominent nucleoli, and atypical mitotic figures up to 22 mitoses per 10 high power fields. The tumor cells were strongly and diffusely positive for CD31, CD34, FLI1, ERG, vimentin, and cytokeratin AE1/AE3. The tumor was negative for HMB45, desmin, HHV8, CAMTA1, FOSB, and S-100 and retained the expression of INI-1. The proliferation index was 60-70%.
A next generation sequencing disclosed stable tumors microsatellite status and a mutational burden of 1 mutation/Mb. Numerous variants of uncertain significance were identified including amplification of BRIP1, GNA13, and PRKAR1A as well as various point mutations including FLT4 G1296S and G71R, MET R359Q, ROS1 R442Q, DOT1L R757W, PDCD11 R1610L, TLL2 R849C, FANCD2 D400E, LEF1 D177V, PRDM1 A408P, FLT1 F989L, and MAP3K1 S939C.

Results (if a Case Study enter NA)
NA

Conclusion
Sinonasal angiosarcoma is incredibly rare with a poor overall prognosis. Few lesions have been reported in the pediatric population. Angiosarcoma may be confused with other types of malignant neoplasms when epithelioid morphology is present. The use of multiple vascular and epithelial markers with clinical correlation will be helpful in the diagnosis.
Myoepithelial Carcinoma ex Pleomorphic Adenoma: Rare Case Report with Clinicopathologic and Immunohistochemical Features
Authors: Khazaeli M , Kamaluddin Z , Taherian M 
Published: October 2021

Abstract

Introduction/Objective
Myoepithelial carcinoma is identified by nearly exclusive myoepithelial differentiation and evidence of malignancy. It may arise de novo or in preexisting benign tumors including pleomorphic adenoma and benign myoepithelioma. It occurs most commonly in the parotid gland followed by submandibular glands, minor salivary glands, and occasionally in the sublingual gland. Nasopharyngeal origin has been rarely reported.

Methods/Case Report
An afebrile 19-year-old female presented to the emergency department with persistent facial pressure, otalgia (right side greater than left side), rhinorrhea, and several episodes of epistaxis. One month before, she has been treated with Amoxicillin for three days with no relief, where Augmentin started for her for five days. About four days prior presentation, she was placed on Prednisone and Cefdinir. Over the next several days, she began having throat pain with difficulty swallowing. Routine blood work revealed a leukocytosis of 14.2 with normal differentiation. CT of the neck showed a large soft tissue mass centered at the right nasopharynx. Flexible nasal endoscopy performed bilaterally to reveal the nasopharynx is entirely obstructed with a lobulated mass filling the nasopharynx. On the right side, it extends into the posterior nasal passage filling the sphenoethmoid recess and the posterior floor of the nasal passage. Outpatient biopsy from nasopharynx mass is also performed.

Results (if a Case Study enter NA)
Mass biopsy reveals a mucinous and chondromyxoid background with mixed epithelial and myoepithelial differentiation. The is squamous metaplasia of myoepithelial cells and prominent mitotic activity and apoptotic activity. Immunohistochemistry was positive for CK5/6, calponin, BCL2, SMA, BerEp4, Sox10, and a proliferative index up to 40%. Based on this information Myoepithelial Carcinoma ex-pleomorphic adenoma of the nasopharynx is the diagnosis.

Conclusion
Carcinoma ex pleomorphic adenoma is usually a high-grade malignancy. It occurs most commonly in the parotid gland, followed by submandibular glands, minor salivary glands, and occasionally in the sublingual gland. Our case is one of the few cases of myoepithelial carcinoma arising in nasopharyngeal pleomorphic adenoma.
Lipid droplets are dysregulated in the adult dentate gyrus during seizure
Authors: Ahamad A , Ge S 
Published: October 2021

Abstract

Introduction/Objective
Dentate gyrus (DG), a neurogenic niche, is a metabolically dense subregion of the hippocampus. Continuous production and integration of new neurons in the existing circuit and harmonious relationship between excitatory and inhibitory neurons accompanied by neuron-glia coupling is essential to maintain hippocampal homeostasis throughout adulthood. Imbalance in the neuronal activity generates seizures and can result in mesial temporal lobe epilepsy (MTLE). MTLE affects 50 million people across the globe and impairs the overall hippocampal network and its associated functions such as memory and cognition. Although altered lipid metabolism has been associated with status epilepticus, the role of lipid droplets (LDs), the minuscule metabolically active organelle known to provide a substrate for cellular energy, has not been explored in DG during seizure. LDs are composed of neutral lipids and surrounded by phospholipid monolayer, which is studded with a structural Perilipin family of proteins 1-5, reported to be involved in lipid metabolism.

Methods/Case Report
To study LDs in the brain, we used a novel approach by injecting Bodipy, a lipid dye in the tail vein of mice, and successfully labeled LDs in the DG. We used the pilocarpine-induced seizure model. After Bodipy injection followed by seizure induction, mice were sacrificed at four time-points 0.5, 1-, 3- and 18 hours.

Results (if a Case Study enter NA)
We found a significant increase in Bodipy signal and Perilipin 4, LDs specific marker expression at four time-points post-seizure than in the control cohort. To elucidate the role of neuron-glia metabolic coupling in DG, we measured LDs in microglia and astrocytes and found a significant increase in LDs in seizure mice than control groups suggesting the role of glia in lipid regulation in DG.

Conclusion
Overall, this novel study will highlight the undiscovered role of LDs in dentate gyrus during seizure and, in the future, can be used as a therapeutic target to alleviate the MTLE phenotype.