bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Analysis of Size Estimation by Mapping and Counting Number of Blocks With Ductal Carcinoma In Situ in Breast Excision Specimens
Authors: Dadmanesh Farnaz , Fan Xuemo , Dastane Aditi , Amin Mahul B. , Bose Shikha 
Published: February 2021

Abstract
Context.—The size of ductal carcinoma in situ (DCIS) is a significant predictor of local tumor recurrence and is used for selection of patients for conservative versus aggressive therapy. A standardized method for size assessment is lacking.
Objective.—To evaluate 2 commonly used methods for measurement of DCIS extent: one based on the distribution of the lesion in sequential series of sections (mapping method) and the other on the number of sections with DCIS (block method).
Design.—Ninety-eight consecutive cases of DCIS, measuring at least 1.0 cm, were retrieved from our files. All specimens were serially sectioned along the long axis. The size of DCIS was calculated for each case by 2 different methods: (1) mapping method (average thickness of each slice × number of consecutive slices with DCIS) and (2) block method (number of blocks with DCIS × 0.3 cm). Additional calculations were performed by using 0.35, 0.4, and 0.5 cm as multiplication factors for the block method in order to improve concordance.
Results.—The block method underestimated the size in 71 cases (72%) by 4.5% to 81.3% (mean, 33%). Using 0.4 cm as the multiplication factor improved concordance, while multiplying by 0.5 cm led to an overestimation of size.
Conclusions.—Assessment of DCIS size by the block method is inaccurate and underestimates size in most cases (72%), with an average reduction of 33%. Using 0.4 cm as the multiplication factor improves concordance. A standardized method for size estimation is necessary for effective patient management.
The Autopsy: Knowledge, Attitude, and Perceptions of Doctors and Relatives of the Deceased
Authors: Oluwasola Olayiwola Abideen , Fawole Olufunmilayo I. , Otegbayo Abiodun Jesse , Ogun Gabriel Olabiyi , Adebamowo Clement A. , Bamigboye Afolabi Elijah 
Published: February 2021

Abstract
Context.—Despite the crucial role that autopsy plays in the development of the science and practice of medicine, autopsy rates have been declining throughout the world in recent decades.
Objective.—To identify factors influencing the acceptance of autopsies in Nigeria.
Design.—Cross-sectional survey of the knowledge, attitude, and perceptions of doctors and relatives of deceased patients on factors influencing acceptance of autopsy at the University College Hospital, Ibadan, Nigeria.
Results.—Only 38% of relatives had satisfactory knowledge about autopsy and about 50% of doctors knew that physicians' desire for autopsy should not override patients' consent. Doctors identified difficulty in obtaining consent from relatives of deceased patients, administrative problems in requesting autopsy, and delay in obtaining autopsy report as major reasons responsible for the decline in autopsy requests, whereas relatives of the deceased cited fear of mutilation, concerns about delaying the funeral, and objection by the patient before death as reasons for refusal to grant permission for an autopsy. Sociodemographic factors such as age, occupation, religion, ethnicity, and level of education significantly influenced willingness to give consent for autopsy.
Conclusions.—There is need for concerted effort on the part of clinicians, pathologists, the public, and the government to resuscitate and sustain the practice of autopsy in Nigeria.
Standards to Support Information Systems Integration in Anatomic Pathology
Authors: Daniel Christel , García Rojo Marcial , Bourquard Karima , Henin Dominique , Schrader Thomas , Mea Vincenzo Della , Gilbertson John , Beckwith Bruce A. 
Published: February 2021

Abstract
Context.—Integrating anatomic pathology information— text and images—into electronic health care records is a key challenge for enhancing clinical information exchange between anatomic pathologists and clinicians. The aim of the Integrating the Healthcare Enterprise (IHE) international initiative is precisely to ensure interoperability of clinical information systems by using existing widespread industry standards such as Digital Imaging and Communication in Medicine (DICOM) and Health Level Seven (HL7).
Objective.—To define standard-based informatics transactions to integrate anatomic pathology information to the Healthcare Enterprise.
Design.—We used the methodology of the IHE initiative. Working groups from IHE, HL7, and DICOM, with special interest in anatomic pathology, defined consensual technical solutions to provide end-users with improved access to consistent information across multiple information systems.
Results.—The IHE anatomic pathology technical framework describes a first integration profile, “Anatomic Pathology Workflow,” dedicated to the diagnostic process including basic image acquisition and reporting solutions. This integration profile relies on 10 transactions based on HL7 or DICOM standards. A common specimen model was defined to consistently identify and describe specimens in both HL7 and DICOM transactions.
Conclusion.—The IHE anatomic pathology working group has defined standard-based informatics transactions to support the basic diagnostic workflow in anatomic pathology laboratories. In further stages, the technical framework will be completed to manage whole-slide images and semantically rich structured reports in the diagnostic workflow and to integrate systems used for patient care and those used for research activities (such as tissue bank databases or tissue microarrayers).
Primary Bone Lymphoma
Authors: Bhagavathi Sharathkumar , Fu Kai 
Published: February 2021

AbstractPrimary bone lymphomas are rare, even though secondary involvement of the bone marrow is a common event in systemic lymphomas. Most primary bone lymphomas are primary bone diffuse large B-cell lymphomas (PBDLBCLs) with a rare occurrence of follicular, marginal zone, anaplastic large cell, Hodgkin, and T-cell lymphomas. The PBDLBCL affects the middle-aged to elderly population, with a slight predominance in men. The patients present with bone pain, palpable mass, fractures, or neurologic symptoms. The metaphysis of bones is a common location of PBDLBCL. Morphologically, the lymphoma consists of a polymorphous mixture of small to large cells with multilobated nuclei, fine chromatin, and inconspicuous to prominent nucleoli. Differential diagnoses for PBDLBCL include chronic osteomyelitis, primary bone sarcoma, leukemic infiltrate, Ewing sarcoma, metastatic sarcomas, and carcinoma. Most PBDLBCLs are treated with combined radiotherapy and chemotherapy with good prognosis.
Unsatisfactory Reporting Rates: 2006 Practices of Participants in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology
Authors: Moriarty Ann T. , Clayton Amy C. , Zaleski Sue , Henry Michael R. , Schwartz Mary R. , Eversole Galen M. , Tench William D. , Fatheree Lisa A. , Souers Rhona J. , Wilbur David C. 
Published: February 2021

AbstractContext.—Minimum cellular criteria for satisfactory Papanicolaou tests were established with the Bethesda System in 2001, and unsatisfactory rates are used as a quality-reporting measure.Objective.—To evaluate practices and unsatisfactory rates from laboratories responding to the 2007 College of American Pathologists supplemental questionnaire survey.Design.—In 2007, a supplemental questionnaire was mailed to 1621 laboratories enrolled in the 2006 College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology (PAP Education), requesting data from the 2006 calendar year. Unsatisfactory rates, reasons for unsatisfactory specimens, laboratory size, and specimen preparation type were analyzed.Results.—A total of 42% of the laboratories responded to the survey. Most of those laboratories (637 of 674; 94.5%) used the Bethesda System minimum cellularity criteria. Of those laboratories responding, 79% (527 of 667) used the Bethesda System criteria for atrophic or postirradiation specimens. Unsatisfactory rates have increased since 1996. SurePath preparations were associated with the lowest unsatisfactory rate (50th percentile, 0.30; 95th percentile, 1.3), conventional Papanicolaou tests had the highest 95th percentile rates (50th percentile, 1.0; 95th percentile, 5.90), and ThinPrep specimens had the highest median percentile (50th percentile, 1.1; 95th percentile, 3.4). The most-common reason for unsatisfactory Papanicolaou tests was too few squamous cells. Air-drying artifact was the least-common reason for unsatisfactory reporting for liquid-based preparations.Conclusions.—Use of the Bethesda System criteria for unsatisfactory specimens is widespread. Unsatisfactory rates have increased since 1996; however, the median rates are 1.1% or less for all preparations. Results from the College of American Pathologists PAP Education supplemental questionnaire continue to provide valuable benchmarking data for cytologic quality-improvement programs in laboratories.
Hepatocellular Carcinoma Metastases to the Epidural Space
Authors: Somerset Hilary , Witt J. Peter , Kleinschmidt-DeMasters Bette K. 
Published: February 2021

Abstract
Hepatocellular carcinoma (HCC) is relatively uncommon in the United States, although hepatitis C, one of the known risk factors for disease, is currently showing burgeoning growth in the country. Hence, it is possible that the incidence of HCC also will increase. Clinicians and pathologists in the United States are relatively unfamiliar with the patterns of metastatic spread for HCC. We report 2 US-native patients with cirrhosis and HCC who developed epidural space metastasis, a pattern of disease spread seen infrequently, even in endemic areas. Diagnostic testing was delayed in both patients because of the lowered suspicion for metastasis and the fact that neither patient had recognized metastatic spread to more common sites, such as lung or lymph nodes. New-onset neck or back pain—especially with symptoms of paresthesia, radiculopathy, or cord compression—in the setting of HCC warrants prompt investigation for metastases to the spine and epidural space.
Solid-Pseudopapillary Neoplasm: A Pancreatic Enigma
Authors: Chakhachiro Zaher I. , Zaatari Ghazi 
Published: February 2021

AbstractSolid-pseudopapillary neoplasm of the pancreas is a relatively uncommon tumor. It typically affects young women, has nonspecific clinical and radiologic manifestations, and can be readily diagnosed by ultrasound-guided fine-needle aspiration and histopathologic evaluation. Histologic features characteristically show loosely cohesive, relatively uniform polygonal cells surrounding delicate capillary-sized blood vessels. Other features include cytoplasmic vacuolization, finely stippled chromatin, nuclear grooving, eosinophilic hyaline globules, and degenerative changes. Almost all solid-pseudopapillary neoplasms harbor mutations in the β-catenin gene. They stain with β-catenin, CD10, and focally with neuroendocrine markers. Although previously considered benign, this tumor is currently considered a low-grade malignant epithelial neoplasm with low metastatic rate and high overall survival. Most patients are cured by complete surgical excision. Despite the characterization of the morphologic and molecular features of this enigmatic neoplasm, more work is needed to uncover its cell of origin and true histogenesis.
Focal Glomerular Immune Complex Deposition: Possible Role of Periglomerular Fibrosis/Atubular Glomeruli
Authors: Satoskar Anjali A. , Calomeni Edward , Bott Cherri , Nadasdy Gyongyi M. , Nadasdy Tibor 
Published: February 2021

Abstract
Context.—Consensus exists among renal pathologists that, in biopsies with immune complex glomerulonephritis, even a single glomerulus with open capillary loops may be sufficient for immunofluorescence and/or electron microscopy evaluation because immune complex deposition is a diffuse phenomenon. However, we have encountered renal biopsies with focal absence of immune complexes in glomeruli on either immunofluorescence or electron microscopy examination despite presence of open glomerular capillary loops.
Objective.—To evaluate renal biopsies with focal immune complex deposition and look for any subtle or unusual morphologic changes in the glomeruli (and in the biopsy in general).
Design.—Native and transplant renal biopsies were reviewed. All biopsies had been triaged and processed according to our routine protocol for light microscopy, immunofluorescence, and electron microscopy examination.
Results.—Of 2018 renal biopsies from December 2005 to December 2007, we found 10 such biopsies; 5 native and 5 transplant kidney biopsies. We found that the glomeruli with absent immune complex deposits had periglomerular fibrosis with open, albeit, wrinkled appearing capillary loops but no glomerular sclerosis.
Conclusions.—We hypothesize that these histologic features are indicative of nonfunctional glomeruli and may be associated with disconnection between the Bowman capsule and proximal tubule (atubular glomeruli). These glomeruli may not have effective filtration, despite some degree of circulation through the open capillary loops, and therefore are unable to accumulate immune complex deposits. If biopsies are small and only such glomeruli are available for immunofluorescence or electron microscopy examination, the absence of immune complex deposition in them should be evaluated carefully.
An Algorithmic Approach to the Diagnosis of Pancreatic Neoplasms
Authors: Klimstra David S. , Pitman Martha B. , Hruban Ralph H. 
Published: February 2021

AbstractContext.—The pancreas gives rise to an array of distinct neoplasms that can be solid, cystic, or intraductal and can recapitulate the various lines of differentiation present in the normal gland.Objective.—To develop an algorithmic approach to the diagnosis of pancreatic neoplasms that simplifies their pathologic evaluation.Data Sources.—We reviewed literature related to the classification of pancreatic neoplasms on the basis of their gross, histologic, and immunohistochemical features.Conclusions.—By using a series of dichotomous decisions, the differential diagnosis of a pancreatic neoplasm can be narrowed, and in cases of the more common neoplasms, accurate classification can be achieved. Uncommon neoplasms not accounted for by this approach are also discussed, and the additional diagnostic information needed for complete pathologic reporting is presented.
Inaccurate Doses of Rh Immune Globulin After Rh-Incompatible Fetomaternal Hemorrhage: Survey of Laboratory Practice
Authors: Ramsey Glenn 
Published: February 2021

Abstract
Context.—Rh(D)-negative women with a large fetomaternal hemorrhage (FMH) from an Rh(D)-positive fetus are at risk for anti-D alloimmunization if they do not receive adequate Rh immune globulin (RhIG). Determination of the adequate RhIG dose for these women is a critical laboratory procedure for protecting their future Rh(D)-positive children.
Objective.—To determine how often laboratories recommended an inaccurate dose of RhIG for excess FMH.
Design.—Nearly 1600 laboratories using the College of American Pathologists' proficiency testing for fetal red blood cell detection were surveyed to determine (1) their calculation method and (2) the number of RhIG doses recommended for a survey specimen, based on their measured percentage of fetal red blood cells. We surveyed nearly 1450 laboratories for their accuracy in determining RhIG dose, using 2 common calculation methods we provided.
Results.—The AABB Technical Manual method was used by 67% of responding laboratories. However, 20.7% of laboratories using this method would have recommended an inaccurate dose of RhIG—11.5% too much and 9.2% too little—for the level of FMH reported in the survey specimen. If all laboratories had used the common recommendation of 300 μg/30 mL of fetal blood present, 2% would have recommended RhIG doses too low for the volume of FMH they measured. In 3 of the 4 calculation exercises we provided, 20% to 30% of laboratories underestimated the necessary dose of RhIG.
Conclusions.—Based on our surveys, some mothers with excess FMH may be receiving inaccurate doses of RhIG. Laboratories performing quantification of FMH should review their procedures and training for calculating RhIG dosage.
Implementation of American Society of Clinical Oncology/College of American Pathologists HER2 Guideline Recommendations in a Tertiary Care Facility Increases HER2 Immunohistochemistry and Fluorescence In Situ Hybridization Concordance and Decreases the Number of Inconclusive Cases
Authors: Middleton Lavinia P. , Price Kathy M. , Puig Pamela , Heydon Lori J. , Tarco Emily , Sneige Nour , Barr Kaye , Deavers Michael T. 
Published: February 2021

Abstract
Context.—The American Society of Clinical Oncology/ College of American Pathologists (ASCO/CAP) guideline recommendations from January 2007 identified many sources of immunohistochemistry (IHC) testing variation.
Objective.—In this current study, we implemented the guidelines and addressed our institution's preanalytic, analytic, and postanalytic variables relating to HER2 testing to improve clinical outcomes.
Design.—We evaluated core biopsies performed on breast lesions from 2006 through 2007. Prognostic/predictive markers obtained by IHC were correlated with HER2 fluorescence in situ hybridization (FISH). Preanalytic sources of biopsy testing variation were studied by collecting data on the number of biopsies that needed repeat testing because of inconclusive FISH results.
Results.—In the year preceding implementation of the guidelines, the HER2 IHC and FISH concordance was 98%. In an additional 10.8% of cases, the FISH results were inconclusive. When additional material became available to retest the inconclusive cases, the results were informative. Further evaluation of the inconclusive cases revealed that the core needle biopsies received, on average, 4 hours of formalin fixation. After implementation of a minimum 6 hours of fixation and the ASCO/CAP guideline recommendations, the HER2 IHC and FISH concordance was 98.5%. The number of FISH inconclusive cases decreased from 10.8% to 3.4% (a 64% reduction). Repeat estrogen-receptor IHC requests decreased by 40% from 38 in 2006 to 23 in 2007.
Conclusions.—We have shown that standardized fixation and adherence to the ASCO/CAP guidelines for HER2 testing has resulted in a greater HER2 IHC and HER2 FISH correlation, decreased numbers of inconclusive FISH cases, decreased repeat estrogen-receptor requests, and financial savings to the Department of Pathology.
Clinical Outcomes for “Suspicious” Category in Thyroid Fine-Needle Aspiration Biopsy: Patient's Sex and Nodule Size Are Possible Predictors of Malignancy
Authors: Raparia Kirtee , Min Soo Kee , Mody Dina R. , Anton Rose , Amrikachi Mojgan 
Published: February 2021

Abstract
Context.—Fine-needle aspiration (FNA) is recommended as an initial screening tool for the diagnosis of thyroid nodules. Approximately 10% of thyroid FNA diagnoses are “suspicious for neoplasm,” warranting surgical resection.
Objectives.—To examine the role of a patient's age, sex, size of nodule, and morphologic features as possible predictors of malignancy in patients with cytologic diagnosis of “suspicious for neoplasm.”
Design.—Cytopathology slides and reports of 402 consecutive thyroid FNAs from 2000–2005 interpreted as “suspicious” were reviewed. Of these, 180 cases that had subsequent surgical resection were selected.
Results.—Of the 108 cases suspicious for follicular neoplasm on cytologic evaluation, histologic follow-up showed malignancy in 26 (24%). Of the 37 cases suspicious for Hürthle cell neoplasm, 15 (41%) had malignancy. Of the 35 cases suspicious for malignancy, 29 had malignant histologic diagnoses. Among cases with cytologic diagnoses of “suspicious for follicular or Hürthle cell neoplasm,” the rate of malignancy in female patients was 22% as compared to 43% in male patients (P = .02). The rate of malignancy in nodules less than 2 cm was 19% compared to 47% in nodules measuring 2 cm or larger (P &lt; .001). These differences were statistically significant. No statistically significant difference was noted between the age of the patient and the rate of benign versus malignant diagnosis.
Conclusions.—Malignant tumors were more frequent in male patients with a cytologic diagnosis of “suspicious for follicular or Hürthle cell neoplasm” than in female patients. Risk of malignancy was higher in nodules measuring 2 cm or larger. Age of the patient was not a predictor of malignancy.
Paratesticular Paraganglioma: A Rare Cause of an Intrascrotal Mass
Authors: Gupta Ruta , Howell R. Spencer , Amin Mahul B. 
Published: February 2021

Abstract
We describe a case of a paratesticular paraganglioma in a 33-year-old man who presented with a scrotal mass and underwent a right testicular exploration. Metastasis is the only definite criterion for diagnosis of a malignant paraganglioma; however, lymphovascular invasion was noted in this case, which warranted a close clinical surveillance. The patient is currently well with no evidence of disease 18 months after radical orchiectomy. Paratesticular paragangliomas are extremely rare tumors with 6 cases reported in English literature. The histogenesis of these tumors is unknown. Though the histology and immunohistochemistry resemble those of paragangliomas at any other location, these tumors raise a plethora of differential diagnoses especially with the more commonly occurring tumors. Herein the relevant histopathologic differential diagnoses are discussed along with a brief review of literature.
Challenges of the “Omics” Future and Pathology Informatics Systems: Are We—Pathologists, Clinicians, and Consumers—Ready?
Authors: Yee Kwang Chien 
Published: February 2021

Abstract
The health care system is extremely complex and it is currently undergoing a massive transformation with rapid advances in technology. Pathology services have been leading the technology adaptation process and will continue to evolve rapidly with the introduction of “omics” technology. Future pathology informatics systems (PIS) will need to meet the needs of pathologists, clinicians, organizations, community services as well as the expectations of patients, especially given the complexity of “omics” technology. Technology advances, however, often progress at a pace faster than socio-cultural adaptation. A major question therefore arises, “Are we ready?” This article explores the socio-cultural-technical issues and provides a conceptual framework for future discussion about socio-cultural integration in the use of technology to provide a seamless delivery of patient-centered care. It discusses system requirements of future PIS in the context of rapid evolution of medical care. Finally, this article proposes some strategies for the design and implementation of future PIS to achieve socio-cultural-technical harmony in the “omics” era.
Aortotracheal Fistula Secondary to Bacterial Aortitis
Authors: Allende Daniela S. , Rodriguez E. Rene , Tan Carmela D. 
Published: February 2021

Abstract
Fistulas between the aorta and tracheobronchial tree are rare fatal complications that occur in patients treated with external and endobronchial radiation for carcinomas of the upper and lower respiratory tract. The etiopathogenesis can be multifactorial. We report the case of a patient with irradiated tracheal carcinoma who died of massive hemoptysis 25 months after completing therapy. Autopsy revealed a fistula between the trachea and arch of the aorta. Multiple colonies of cocci and bacilli were demonstrated within the media at the site of rupture and were absent in other areas of the aorta. The development of an aortotracheal fistula in this patient was most probably related to infection in an area of tracheal and vascular wall previously damaged by exposure to high doses of radiation.