bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autoimmune Pancreatitis: More Than Just a Pancreatic Disease?A Contemporary Review of Its Pathology
Authors: Deshpande Vikram , Mino-Kenudson Mari , Brugge William , Lauwers Gregory Y. 
Published: February 2021

Abstract
Context.—Autoimmune pancreatitis (AIP) is a chronic inflammatory condition of the pancreas constituting one quarter of Whipple resections performed for benign conditions in North America.
Objective.—We review the clinical, radiologic, and characteristic histopathologic patterns of this disease and discuss the extrapancreatic manifestations of AIP.
Design.—We searched the literature using MEDLINE and OVID, related conference abstracts, and bibliographies of selected studies.
Results.—Autoimmune pancreatitis predominantly affects elderly individuals, frequently presenting as obstructive jaundice and occasionally in association with other autoimmune diseases. The histology is characterized by a collar of periductal inflammation, obliterative phlebitis, and the absence of stigmata of alcoholic pancreatitis. A prepancreatectomy diagnosis can be rendered using a combination of clinical findings, radiologic features, elevated immunoglobulin G4 levels, endoscopic ultrasound-guided fine-needle aspiration biopsy, and response to steroids. The disease can involve the bile ducts (sclerosing cholangitis), gallbladder (lymphoplasmacytic sclerosing cholecystitis), and kidney (interstitial nephritis) and can form inflammatory masses in the lungs.
Conclusions.—Despite significant evolution in our understanding of AIP, a prepancreatectomy diagnosis remains a challenge in the North American and European population.
Max Brödel: Illustrating Healed Valve Ring Abscesses
Authors: Lucey Brendan P. , Thomas Caroline Bedell , Hutchins Grover M. 
Published: February 2021

Abstract
A 14-year-old adolescent girl presented with severe congestive heart failure, progressive throughout 3 months. A precordial thrill, machinery-like murmur, and right bundle branch block were noted. Death occurred despite digitalis and diuretic therapy and removal of pleural and ascitic fluid. The autopsy revealed 2 multilocular cystic structures in the interventricular septum consistent with being spontaneously drained valve ring abscesses. One of these lesions formed a fistulous communication that penetrated through the interventricular septum between the right aortic sinus of Valsalva and the crista supraventricularis that connected to the right ventricle. Another lesion, an adjacent separate but similar cystlike structure, communicated only with the left ventricular cavity. Although the cause of these lesions is uncertain, it seems probable that they are the residue of spontaneously drained and healed valve ring abscesses. Max Brödel, a medical illustrator and the first director of the Department of Art as Applied to Medicine at The Johns Hopkins University, drew previously unpublished figures of this patient's cardiac lesions. These illustrations exhibit Brö del's superb command of both art and medicine essential to his ability to make complex anatomic relationships demonstrable. We discuss Brödel's career and his influence on both the art and science of medicine.
An Indolent Case of T-Prolymphocytic Leukemia With t(3;22)(q21;q11.2) and Elevated Serum β2-Microglobulin
Authors: Moid Farah , Day Estella , Schneider Marta A. , Goldstein Kenneth , DePalma Louis 
Published: February 2021

Abstract
We report a novel case of T-prolymphocytic leukemia, small cell variant, associated with complex cytogenetic findings including t(3;22)(q21;11.2) and elevated serum β2-microglobulin. The diagnosis is based on morphologic, immunophenotypic, cytogenetic, and molecular analysis of peripheral blood and bone marrow. In contrast to most reported cases of T-prolymphocytic leukemia, this patient did not present with lymphadenopathy or organomegaly. Moreover, only a moderate leukocytosis (25.3 × 103/μL) was evident at presentation. In the absence of any specific treatment, the patient is doing well, with a stable white blood cell count 12 months following presentation. Further investigation may be warranted to determine whether the unusual cytogenetic findings and elevated serum β2-microglobulin are associated with the indolent clinical course in this patient.
Pathology of the NovaSure (Radio-Frequency) Impedance-Controlled Endometrial Ablation System
Authors: Fadare Oluwole , Qin Lihui , Martel Maritza , Tavassoli Fattaneh A. 
Published: February 2021

AbstractThe widespread use of increasingly novel diagnostic and neoadjuvant therapeutic modalities necessitates that contemporary pathologists familiarize themselves with the spectrum of tissue derangements that may be seen in the eventual surgical specimens. In the management of endometrial lesions, for example, a variety of endometrial ablation technologies, such as cryosurgery, balloon therapy, microwave, hot circulating saline, and bipolar impedance technology, have been introduced in the past decade and are being utilized with increasing frequency. We describe herein pathologic changes associated with one such technology, the NovaSure impedance-controlled endometrial ablation system. The US Food and Drug Administration approved NovaSure in 2001 for ablation of the endometrial lining in premenopausal women with menorrhagia. The ablation is accomplished by the delivery of radio-frequency energy for a period of approximately 90 seconds through a device inserted transcervically into the endometrial cavity. Our patient, a 54-year-old with menorrhagia, had undergone the NovaSure ablative treatment 38 days prior to her eventual hysterectomy. The resultant changes were quite distinctive: in a uterine wall that was 20 to 30 mm thick, a 3- to 6-mm-thick, hyalinized, subendometrial bandlike zone was apparent throughout the uterus even on macroscopic examination of the slides. This zone was sharply demarcated from the subjacent myometrium and from the endometrium; the latter displayed severe stromal fibrosis, some myxoid change, and sparse glands that were largely confined to the basalis. Paradoxically, scattered aggregates of stromal cells in the endometrium remained relatively viable. Adenomyotic aggregates and leiomyomata in the myometrium beneath the hyalinized zone were unaffected by this treatment. Practitioners evaluating hysterectomy specimens should be aware of changes such as those described herein, not only to better understand the specimens they evaluate but to avoid potentially misinterpreting grotesque alterations caused by benign processes.
Frozen Section of the Gastrointestinal Tract, Appendix, and Peritoneum
Authors: Younes Mamoun 
Published: February 2021

Abstract
Context.—Intraoperative consultation is frequently requested by surgeons operating on the gastrointestinal tract, appendix, and peritoneum. In this setting, the pathologist's diagnosis plays a central role in determining whether a resection is needed, and if so, how much to resect and whether it was adequate. There is no room for errors in the frozen section laboratory, because a small mistake can have serious consequences. To my knowledge, no recent books or publications in the literature have dealt with this important topic.
Objective.—To review the intraoperative consultation of the gastrointestinal tract, appendix, and peritoneum.
Data Sources.—The MEDLINE database was queried for keywords, including gastrointestinal, esophagus, stomach, esophageal, gastric, small intestine, and all other names of the gastrointestinal tract, peritoneum, and appendix in combination with frozen section. All suitable articles were retrieved and reviewed. This literature search and my personal experience formed the basis of this review.
Conclusions.—The role, value, and limitations of frozen section and gross consultation are different for different areas of the gastrointestinal tract, even for the same types of lesions. Close interaction with the surgeon and knowing what is intended from the frozen section, what will be done following a certain diagnosis, and what is the minimal information needed from the pathologist at the time of frozen section are essential for proper patient management.
Frozen Section of Lung Specimens
Authors: Sienko Anna , Allen Timothy Craig , Zander Dani S. , Cagle Philip T. 
Published: February 2021

Abstract
Context.—Frozen section of lung tissue is performed to guide the surgeon in subsequent therapy.
Design.—Practical experience in frozen section of the lung was reviewed in the medical literature and from the records of several academic hospitals.
Results.—Most frozen sections of the lung are performed for evaluation of a solitary nodule, a mass, or the surgical margins of a resection. Frozen section may also be used to assess the adequacy of a lung wedge biopsy taken for later diagnosis of a condition.
Conclusion.—The pathologic evaluation of intraoperative pulmonary lesions is indicated for the differential diagnosis of pulmonary nodules and masses, both neoplastic and nonneoplastic, surgical resection margins, and mediastinal lymph nodes. The most worrisome pitfalls involve differentiating benign reactive atypia from malignancy on frozen section.
Frozen Section Diagnosis and Indications in Ophthalmic Pathology
Authors: Chévez-Barrios Patricia 
Published: February 2021

Abstract
Context.—Frozen sections for ophthalmic tissues require very precise indications.
Objective.—To describe indications and procedures for frozen sections in ophthalmic pathology based on review of my experience and reports in the literature.
Design.—Frozen sections received by the ophthalmic pathology service at The Methodist Hospital from 1996 to 2004 were reviewed. A review of the literature also was performed.
Results.—Of the 277 specimens received, most were eyelid lesions (138, 49.8%), followed by orbital (106, 38.3%), temporal artery (17, 6.1%), optic nerve (9, 3.2%), and conjunctival (7, 2.5%) lesions. A review of appropriate indications for intraoperative diagnosis is presented and a description of tissue handling and procedures to obtain better results in ophthalmic pathologic lesion cases is discussed.
Conclusions.—The most frequent indications for frozen sections in ophthalmic abnormalities are for margin control in eyelid and orbital lesions. At my institution, the second most frequent indications for ophthalmic frozen sections are the evaluation of adequacy of tissue sampling and triaging for flow cytometry and molecular techniques, especially in childhood malignancies.
Fine-Needle Aspiration of Pulmonary Hamartoma: A Common Source of False-Positive Diagnoses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology
Authors: Hughes Jonathan H. , Young Nancy A. , Wilbur David C. , Renshaw Andrew A. , Mody Dina R. 
Published: February 2021

Abstract
Context.—We use data from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology to evaluate the accuracy of fine-needle aspiration (FNA) biopsy for diagnosing pulmonary hamartoma (PH).
Objective.—To use the performance characteristics of the PH cases in the Nongynecologic Cytology Program to determine the accuracy of FNA for identifying these lesions and to determine potential sources of interpretative errors.
Design.—A retrospective review of the College of American Pathologists Nongynecologic Cytology cumulative data from 1997 to 2003 was performed to identify the overall accuracy of FNA for diagnosing PH and to determine the most common interpretative pitfalls. The slides from each of the cases of PH in the Nongynecologic Cytology Program were then reviewed in an effort to identify the cytologic characteristics that contributed to the poor performance of these cases.
Results.—A total of 766 participant responses for 19 PH FNA specimens were reviewed. The specificity of FNA for making the correct general reference interpretation of benign was 78%. The false-positive rate was 22%, with the most common false-positive diagnoses being carcinoid tumor, adenocarcinoma, and small cell carcinoma. The overall accuracy for making the correct specific reference diagnosis of PH was 26%. Microscopic review of the individual cases revealed possible explanations for some of the interpretative errors and the most frequent false-positive interpretations.
Conclusions.—Cytologists should be aware of the potential false-positive interpretations that can occur in FNAs of PH and the potential reasons for these inaccuracies in order to minimize clinically significant diagnostic errors.
Comparison of Pooled Fresh Frozen Serum to Proficiency Testing Material in College of American Pathologists Surveys: Cortisol and Immunoglobulin E
Authors: Palmer-Toy Darryl Erik , Wang Edward , Winter William E. , Soldin Steven J. , Klee George G. , Howanitz Joan H. , Elin Ronald J. 
Published: February 2021

Abstract
Context.—The College of American Pathologists (CAP) provides proficiency testing (PT) surveys to laboratories around the world.
Objectives.—To compare diagnostic assay methods for serum/plasma cortisol and immunoglobulin (Ig) E in terms of their bias and precision, to determine how well CAP PT specimens simulate human serum, and to reassess proficiency test grading criteria in light of these findings.
Design.—A participant-blinded, prospective trial. One vial of pooled fresh frozen serum (FFS) and 4 different admixtures of PT material (PTM) were sent to laboratories participating in PT surveys.
Participants.—Laboratories providing cortisol (&gt;1000) or IgE (&gt;230) results among the subscribers to the CAP surveys, Ligand (General) 2003, set K/KN-A and Chemistry 2003, set C-C.
Main Outcome Measures.—The main outcome measures were (1) bias among laboratories using the same method (peer groups), defined relative to the median of method means (MedMM); (2) imprecision as measured by the SD and coefficient of variation (CV) about each method mean; and (3) total error across laboratories for the FFS cortisol results, defined as |Bias Relative to Reference Method| + 2 SD.
Results.—Cortisol method biases, relative to MedMM, ranged from −22% to 9% for the FFS challenge and from −24% to 36% for comparable PTM challenges. The method biases, relative to the reference method, ranged from −3% to 19% for the FFS challenge. The cortisol method CVs ranged from 4.2% to 13.6% for the FFS challenge and from 4.7% to 12.7% for comparable PTM challenges. Total error across laboratories ranged from 1.4 to 6.9 μg/dL (39 to 190 nmol/L) for the FFS challenge. Immunoglobulin E method biases, relative to MedMM, ranged from −8% to 9% for the FFS challenge and from −7% to 5% for comparable PTM challenges. The IgE method CVs ranged from 3.6% to 6.7% for the FFS challenge and from 3.4% to 9.8% for comparable PTM challenges.
Conclusions.—The bias for cortisol results was less with FFS than with PTM, but imprecision was comparable. The FFS MedMM was 8.5% higher than the reference value. Fresh frozen serum and PTM bias and imprecision for IgE methods were each less than 10%. Because some of the methods demonstrated greater bias when analyzing PTM than FFS, peer group grading of both these analytes is appropriate.
Giant Cell Tumors: Inquiry Into Immunohistochemical Expression of CD117 (c-Kit), Microphthalmia Transcription Factor, Tartrate-Resistant Acid Phosphatase, and HAM-56
Authors: Ramos Rolando Y. , Haupt Helen M. , Kanetsky Peter A. , Donthineni-Rao Rakesh , Arenas-Elliott Carmen , Lackman Richard D. , Martin Anne-Marie 
Published: February 2021

AbstractContext.—Osteoclast-like giant cells (GCs) in giant cell tumors (GCTs) are thought to derive from a monocyte-macrophage lineage. Microphthalmia transcription factor (MITF) is necessary for osteoclast gene expression and tartrate-resistant acid phosphatase (TRAP) activation; c-Kit plays a role in regulation of MITF.Objective.—To gain insight into the differentiation of GCTs of bone (GCTBs) and GCTs tendon sheath (GCTTSs) by investigating immunohistochemical staining for c-Kit, MITF, TRAP, and HAM-56 in the GCs and stroma.Design.—Immunoreactivity for CD117 (c-Kit), MITF, TRAP, and HAM-56 was studied in 35 GCTBs, 15 GCTTSs, and 5 foreign-body GC controls.Results.—Across tumors, MITF and TRAP but not c-Kit were generally expressed in GCs; TRAP was variably expressed in stromal cells. The MITF was expressed more consistently in stromal cells of GCTTSs than GCTBs (P &lt; .001). The GCTBs showed more intense MITF stromal (P &lt; .001) and TRAP GC staining (P = .04) than GCTTSs. HAM-56 staining by stromal cells was associated with MITF stromal staining (r2 = 0.6, P &lt; .001).Conclusions.—Results suggest that MITF and TRAP are expressed during osteoclast differentiation and that a proportion of mononuclear cells in GCTs express the macrophage marker HAM-56. Both GCTBs and GCTTSs show similar patterns of immunohistochemical expression.
Usefulness of Cutaneous T-Cell Clonality Analysis for the Diagnosis of Cutaneous T-Cell Lymphoma in Patients With Erythroderma
Authors: Cordel Nadege , Lenormand Bernard , Courville Philippe , France Helot Marie , Benichou Jacques , Joly Pascal 
Published: February 2021

Abstract
Context.—Demonstration of a dominant T-cell clone in skin biopsy specimens by a molecular assay constitutes an additional diagnostic criterion to differentiate cutaneous T-cell lymphomas (CTCLs) from inflammatory dermatoses.
Objective.—To determine which patients, depending on their clinical presentations, could most benefit from a cutaneous T-cell clonality analysis in addition to histopathologic analysis for the diagnosis of CTCL.
Design.—Comparison of sensitivity and specificity of histopathologic analysis and a combination of this method and the detection of a T-cell receptor γ chain gene rearrangement by polymerase chain reaction denaturing gradient gel electrophoresis performed on skin biopsy specimens obtained at initial presentation.
Patients.—One hundred forty consecutive patients were classified into 4 groups, depending on their clinical presentation: (1) eczematous patches suggestive of early-stage mycosis fungoides (MF) (IA and IB of the TNM classification) (n = 42); (2) plaques, nodules, or tumors that arise on or are associated with plaques suggestive of late-stage MF (IIB and III of the TNM classification) (n = 16); (3) erythroderma (n = 50); and (4) nodules or tumors that arise in normal skin, suggestive of non-MF CTCL (n = 32).
Results.—When compared with histopathologic examination, the addition of clonality analysis increased the sensitivity of CTCL diagnosis in all groups of patients except those with cutaneous lesions suggestive of late-stage MF, because the diagnosis was made based on histopathologic analysis alone in 100% of these cases. The main increase in sensitivity of CTCL diagnosis was observed in patients with erythroderma: 62% with histopathologic analysis alone to 87% with the combination of both methods (P = .04). Diagnostic specificity of molecular assays decreased from 100% to 76% (P = .01) in patients with patch lesions and from 100% to 70% (P = .04) in patients with nodules that occurred in normal skin due to the detection of a T-cell clone in 6 patients with follicular mucinosis without a histologic pattern of MF and in 5 of 20 cases of T-cell pseudolymphoma (25%), respectively. In contrast, a T-cell clone was not detected in the 34 patients with erythroderma of inflammatory origin.
Conclusion.—Polymerase chain reaction analysis of cutaneous T-cell clonality could be useful for the diagnosis of CTCL in patients who present with erythroderma.
Epstein-Barr Virus in Breast Carcinoma in Argentina
Authors: Preciado María Victoria , Chabay Paola Andrea , De Matteo Elena Noemí , Gonzalez Pedro , Grinstein Saúl , Actis Andrea , Daniel Gass Hugo 
Published: February 2021

AbstractContext.—Because the etiology and progression of breast carcinoma remain unclear, novel mechanisms of disease pathogenesis need to be considered. Recent interest has focused on Epstein-Barr virus (EBV), an oncogenic ubiquitous herpesvirus. Investigations of this association could not only broaden understanding of breast cancer etiology but also have implications regarding early detection, treatment, and prevention.Objective.—To assess EBV presence in breast carcinoma in an Argentine series.Design.—Breast biopsy specimens of 69 women with breast carcinoma and fresh tumor tissue of 39 of these women were collected. As controls, 17 biopsy specimens of fibroadenomas, 9 of benign epithelial proliferation, 4 of atypical ductal hyperplasia, and 10 of usual ductal hyperplasia and 8 normal breast tissues from women were studied. The EBV-infected cells were identified by means of immunohistochemical analysis, using a monoclonal antibody against Epstein-Barr virus–encoded nuclear antigen 1 (EBNA-1). Polymerase chain reaction (PCR) was used to amplify EBV DNA, with primers that cover the EBV encoded RNA (EBER) and BamHIW regions.Results.—Nuclear expression of EBNA-1 was observed in tumor epithelial cells in 24 (35%) of the 69 cases. We confirmed both positive and negative immunohistochemical results by PCR in those cases where good quality DNA was also available, detecting amplification fragments of 108 base pairs (bp) from the EBER region and 122 bp from the BamHIW region. Neither immunohistochemical analysis nor PCR detected any positive EBV results in the control samples.Conclusions.—Our results demonstrate the presence and expression of EBV restricted to epithelial tumor cells in a subset of breast carcinomas studied. However, no significant association was observed between EBV expression and worse clinical and pathologic patient characteristics.
Hairy Cell Leukemia Variant With Features of Intrasinusoidal Bone Marrow Involvement
Authors: Ya-In Charin , Brandwein Joseph , Pantalony Dominic , Chang Hong 
Published: February 2021

Abstract
Hairy cell leukemia variant (HCL-V) is a rare lymphoproliferative disorder. We report a case of HCL-V with an intrasinusoidal pattern of bone marrow involvement without interstitial or diffuse infiltration that is typical of HCL and its variant. The peripheral blood and bone marrow aspirates demonstrated abnormal lymphoid cells with cytoplasmic projections that were weakly positive for tartrate-resistant acid phosphatase cytochemical staining. Immunostaining of the bone marrow biopsy specimen showed that these cells were strongly positive for CD20, located within bone marrow sinusoids, and weakly positive for DBA44. By flow cytometry, these cells were positive for CD19, CD20, CD11c, and CD103, exhibited λ light chain restriction, and were negative for CD25. The patient was initially diagnosed as having splenic lymphoma with villous lymphocytes (SLVL) or splenic marginal zone lymphoma (SMZL) (World Health Organization designation) and treated with fludarabine followed by splenectomy with simultaneous liver biopsy. The pathologic analysis of the spleen revealed infiltration of red pulp by the critical cells without white pulp involvement, which is characteristic of HCL and HCL-V but not of SLVL (SMZL). This case illustrates an atypical marrow presentation of HCL-V and emphasizes the need to correlate all clinical and pathologic data, including tissue biopsy, in reaching a diagnosis.