bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interobserver and Intraobserver Variability Using the Fuhrman Grading System for Renal Cell Carcinoma
Authors: Al-Aynati Maamoun , Chen Vicky , Salama Samih , Shuhaibar Hafez , Treleaven Darin , Vincic Lydia 
Published: January 2021

Abstract
Context.—Histologic grading of renal cell carcinoma has been shown to be second to staging in prognostic significance. A 4-tier grading scheme proposed by Fuhrman et al and based on nuclear features is the system used most frequently in North America. There are, however, very few studies in the literature assessing the interobserver variability for this system, and to our knowledge, none addressing intraobserver variability.
Objective.—To assess the interobserver and intraobserver agreement among 4 pathologists using the Fuhrman nuclear grading scheme for renal cell carcinoma.
Design.—Representative hematoxylin-eosin–stained slides of 99 consecutive primary renal cell carcinoma cases diagnosed between 1994 and 1999 at St Joseph's Hospital, Hamilton, Ontario, were independently graded by 4 pathologists on 2 occasions with a minimum period of 3 months separating the 2 readings.
Results.—Intraobserver κ values ranged from 0.29 to 0.62 (mean = 0.45), and interobserver κ values ranged from 0.19 to 0.38 and from 0.09 to 0.44 for the first and second rounds, respectively (combined mean κ value = 0.29). When combining Fuhrman grades 1 and 2 as low-grade tumors and grades 3 and 4 as high-grade tumors, the intraobserver κ values ranged from 0.4 to 0.64 (mean = 0.53) and interobserver κ values ranged from 0.28 to 0.59 and from 0.26 to 0.58 for the first and second rounds, respectively (combined mean κ value = 0.45). The admixture of 2 grades in the same tumor was observed in 53% of cases.
Conclusions.—We found only moderate intraobserver and interobserver agreement using the 4-grade Fuhrman scheme. After collapsing the diagnostic grades to 2, the intraobserver agreement changed from moderate to substantial. The collapsing of the 4-category Fuhrman grades into 2 categories is useful in improving intraobserver agreement.
Lack of Association of Lipoprotein Lipase Gene Polymorphisms With Coronary Artery Disease in the Saudi Arab Population
Authors: Abu-Amero Khaled K. , Wyngaard Carol A. , Al-Boudari Olyan M. , Kambouris Marios , Dzimiri Nduna 
Published: January 2021

AbstractContext.—Previous studies reported an association of certain polymorphisms in the lipoprotein lipase (LPL) gene with the risk of coronary artery disease (CAD); however, these studies were small and inconsistent. In addition, none of these studies attempted to establish such an association in the Arab population.Objective.—To determine whether 2 LPL polymorphisms (LPL-HindIII and LPL-PvuII located on introns 8 and 6, respectively, of the LPL gene) can be considered as independent risk factors or as predictors for CAD in Arabs.Design.—We used polymerase chain reaction and restriction enzyme digestion to determine the distribution of the LPL-HindIII and LPL-PvuII polymorphisms among healthy blood donors of Arabic origin (BD group) and angiographically confirmed CAD patients (CAD group) with identical ethnic backgrounds.Results.—For the HindIII genotypes, within the BD group (n = 410), the +/+ genotype was found in 206 individuals (50.2%), 173 (42.2%) carried the +/− genotype, and 31 (7.6%) carried the −/− genotype. Within the CAD group (n = 352), the +/+ genotype was found in 189 individuals (53.7%), 138 (39.2%) carried the +/− genotype, and 25 (7.1%) carried the −/− genotype. P values of .38, .45, and .92 were obtained for the +/+, +/−, and −/− genotypes, respectively. For the PvuII genotypes, within the BD group (n = 511), the +/+ genotype was found in 182 individuals (35.6%), 248 (48.5%) carried the +/− genotype, and 81 (15.9%) carried the −/− genotype. Within the CAD group (n = 431), the +/+ genotype was found in 138 individuals (32%), 225 (52.2%) carried the +/− genotype, and 68 (15.8%) carried the −/− genotype. P values of .28, .29, and .98 were obtained for the +/+, +/−, and −/− genotypes, respectively. The distribution and the allele frequency of these 2 LPL variants were similar in CAD and BD study groups and followed the Hardy-Weinberg equilibrium.Conclusion.—There was no difference in the distribution of both LPL polymorphisms between the healthy group and the CAD group. Therefore, these 2 LPL polymorphisms cannot be considered as independent risk factors or as predictors for CAD in this population.
Age and Laboratory Costs for Hospitalized Medical Patients
Authors: Brimhall Bradley B. , Dean Troy , Hunt Edgar L. , Siegrist Richard B. , Reiquam William 
Published: January 2021

Abstract
Objective.—To examine the hypothesis that older hospitalized patients have higher laboratory costs than younger patients in the same severity-adjusted diagnosis-related group (DRG).
Design.—We obtained hospital case mix data sets (1995–1997) from the Massachusetts Division of Health Care Finance and Policy. We selected discharge abstracts from 4 medical DRGs, at 5 large academic hospitals (n = 15 265) and 5 midsized community hospitals (n = 10 540), for analysis. We converted laboratory and blood product charges to direct costs using the department-specific ratio of cost to charges. We adjusted diagnostic groups for severity of comorbid conditions and complications using the refined DRG method.
Main Outcome Measures.—Hospital length of stay (LOS), laboratory direct cost (LDC) per hospitalization, LDC per hospital day, and ratio of LDC to total direct cost.
Results.—Hospital LOS was longer for older patients in all comparisons. Laboratory direct cost per hospitalization was higher for older patients in some DRGs, but lower in other DRGs. Laboratory direct cost per hospital day was almost always less for older patients than for younger patients, both at academic and community hospitals. Data stratification by gender, admission status, and principal diagnosis yielded substantially the same pattern of cost differences observed within the larger data set.
Conclusions.—Older medical patients have longer hospital stays and generally higher costs. These patients also have a significantly decreased rate of laboratory resource consumption over the course of hospitalization (LDC per hospital day), as well as lower laboratory costs as a proportion of total costs. Age-specific differences in LOS and cost parameters were essentially unchanged after controlling for several potential sources of bias.
Clinical-Histopathologic Concordance of Tumors of the Nervous System at the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery in Mexico City
Authors: Velásquez-Pérez Leora , Jiménez-Marcial María Esther 
Published: January 2021

Abstract
Context.—When making a diagnosis, the main purpose of clinicians should not be to achieve certainty, but to decrease diagnostic uncertainty in order to make optimal therapeutic decisions. Diagnostic concordance is an essential characteristic if a measurement is to be considered scientific. In the case of tumors of the nervous system (TNS), one of the most accurate diagnostic tests is magnetic resonance imaging. However, histopathologic analyses are essential, because they refine the diagnosis, benefit the patient, and improve our understanding of the disease. By determining the clinical-histopathologic correlation of TNS in one of the main neurologic centers in Mexico, we sought to project reliable morbidity and/or mortality statistics.
Objective.—To assess clinical and histopathologic diagnostic agreement in cases involving TNS admitted to the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery between 1990 and 1999.
Design.—Cross-sectional diagnostic concordance study, including all clinical hospital records of patients with histopathologically diagnosed TNS, classified according to World Health Organization criteria.
Results.—Among 2041 TNS cases, the 3 most frequent types were those affecting the neuroepithelial tissue (32.9%), tumors of the sellar region (29.2%), and tumors of the meninges (25.6%). We found that, overall, clinical-histopathologic concordance for these 3 categories was substantial and statistically significant.
Conclusions.—Tumors of the nervous system constitute a heterogeneous group of neoplasms. In the present study, clinical diagnoses substantially agreed with pathologic diagnoses. The a priori clinical diagnosis allowed prompt treatment even before diagnostic confirmation by histopathologic analysis, which is the best way to confirm, clarify, and correct a diagnosis.
Conformity to Guidelines for Pathologic Examination of the Placenta
Authors: Spencer Michael K. , Khong T. Yee 
Published: January 2021

Abstract
Context.—The College of American Pathologists developed a consensual guideline for placental examination that included indications for the submission of placentas for pathologic examination. The adherence to this guideline is not known.
Objectives.—To identify the number of placentas that were and that should have been examined by a tertiary-care hospital according to the College of American Pathologists' practice guideline and to compare the indications listed by medical staff on their pathology request forms with the clinical events recorded on the hospital's databases.
Design.—Data from the hospital computer databases and from pathology request forms were collected for all 987 deliveries occurring at a tertiary-level maternity hospital from April through June 2000.
Results.—Fewer than 20% of placentas were examined, but about 50% should have been. Maternal fever and suspected neonatal infection were the indications with the lowest examination rates. Neonatal indications were infrequently listed.
Conclusions.—This hospital examined approximately one third of the placentas that should have been examined. When the placentas were examined, the medical staff often failed to appropriately list the indications on their pathology request forms.
Multiple Langerhans Cell Nodules in an Incidental Thymectomy
Authors: Novak Lea , Castro Claudia Y. , Listinsky Catherine M. 
Published: January 2021

Abstract
The isolated appearance of Langerhans cell histiocytosis in the thymus is quite rare. We report the finding of multiple small Langerhans cell nodules in the thymus of an 11-month-old infant who had undergone thymectomy in the course of surgical correction of tetralogy of Fallot. The subtle appearance of some of these nodules and aggregates was unlike the pattern of massive thymic infiltration seen in 7 previously reported cases of thymic Langerhans cell histiocytosis in childhood. This difference led us to consider whether these aggregates might be common in the thymus but overlooked in thymus glands removed incidental to cardiac surgery. We examined histologic material from 22 sequential thymectomy specimens removed during cardiac surgery from infants and children. None (0/22) had cohesive aggregates of Langerhans cells, as were seen in the index patient's thymus. Our patient's small thymic nodules resemble more closely a pattern found in adult patients with myasthenia gravis who have been incidentally shown to have Langerhans cell histiocytosis.
Nocardiosis With Brain Abscess Due to an Unusual Species, Nocardia transvalensis
Authors: Yorke Rebecca F. , Rouah Emilie 
Published: January 2021

Abstract
The identification of Nocardia transvalensis, an unusual and probably underrecognized cause of nocardial infection, is clinically significant because of this species' resistance to aminoglycosides, a standard antinocardial therapy. Diagnosis requires analytic methods available predominately in reference laboratories. We report a case of disseminated infection with N transvalensis with primary pulmonary involvement and subsequent development of brain abscesses, and review the literature to date. Familiarity with the epidemiology, pathologic findings, and clinical significance of this and other unusual Nocardia species may increase early identification and antibiotic susceptibility testing in cases of nocardial infection.
Pathology Resident Attitudes and Opinions About Pathologists' Assistants
Authors: Grzybicki Dana Marie , Vrbin Colleen M. 
Published: January 2021

Abstract
Context.—Changes in health care economics and organization have resulted in increased use of nonphysician providers in most health care settings. Attitudinal acceptance of nonphysician providers is important in the current health care environment.
Objectives.—To obtain descriptive information regarding pathology resident attitudes and opinions about pathologists' assistants in anatomic pathology practice and to assess the implications of resident attitudes and opinions for pathology practice and training.
Design.—A self-administered, mailed, voluntary, anonymous questionnaire was distributed to a cross-sectional sample of pathology residents in the United States (2531 pathology residents registered as resident members of one of the national pathology professional organizations). The questionnaire contained (1) items relating to resident demographics and program characteristics, (2) Likert-scale response items containing positive and negative statements about pathologists' assistants, (3) a multiple-choice item related to pathologists' assistants scope of practice, and (4) an open-ended item inviting additional comments. Both quantitative and qualitative analysis of responses was performed.
Results.—The overall response rate was 19.4% (n = 490); 50% of the respondents were women, and 77% reported use of pathologists' assistants in their program. Most respondents were 25 to 35 years old and in postgraduate years 3 through 5 of their training, and most were located in the Midwestern United States. The majority of residents expressed overall positive attitudes and opinions about pathologists' assistants and felt that pathologists' assistants enhanced resident training by optimizing resident workload. A minority (10%–20%) of residents expressed negative attitudes or opinions about pathologists' assistants. Additionally, some residents reported a lack of knowledge about pathologists' assistants' training or roles.
Conclusions.—Increased resident education and open discussion concerning pathologists' assistants may be beneficial for optimizing resident attitudes about and training experiences with pathologists' assistants.
Misdiagnosis of High-Grade Vulvar Intraepithelial Neoplasia (VIN III) as Mild Cervical Intraepithelial Neoplasia (CIN I) on Papanicolaou Tests
Authors: August Carey Z. , Ganji Masoud , Froula Evelyn 
Published: January 2021

Abstract
Context.—Although high-grade vulvar intraepithelial neoplasia (VIN III) is a clinically significant lesion, it can be overlooked because of nonspecific clinical findings and the fact that its cytomorphologic features mimic those of mild cervical intraepithelial neoplasia (CIN I).
Objective.—To determine if there are cytomorphologic features on Papanicolaou tests that can reliably distinguish between VIN III and CIN I.
Design.—Papanicolaou tests diagnosed as CIN I from patients with biopsy-proven CIN I were compared with Papanicolaou tests diagnosed as CIN I from patients with biopsy-proven VIN III but with no biopsy-proven CIN I.
Results.—None of the cytomorphologic features evaluated could reliably distinguish CIN I from VIN III.
Conclusion.—Since the Papanicolaou test cannot be used to distinguish between CIN I and VIN III, the clinician must pay careful attention to the clinical and colposcopic findings. Further research evaluating the use of ancillary studies, such as human papillomavirus typing, may be useful.
Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome Are Distinct Pathologic Entities
Authors: Hosler Gregory A. , Cusumano Ana M. , Hutchins Grover M. 
Published: January 2021

Abstract
Context.—Thrombotic thrombocytopenic purpura (TTP) and the hemolytic uremic syndrome (HUS) share many clinical features and have been difficult to separate into distinct entities. Histologic examination of organs from autopsied patients suggested that TTP and HUS have dissimilar lesions of different severity and distribution.
Objective.—To perform a retrospective observational review of autopsied patients with TTP or HUS to compare the nature and severity of the lesions found.
Design.—To examine the pathologic features of these conditions, we reviewed all cases among 51 350 indexed autopsies at The Johns Hopkins Hospital (Baltimore, Md) diagnosed with TTP or HUS, and included those showing multiple arteriolar thrombi or their sequela.
Results.—The 56 cases that met the inclusion criteria fell into 2 distinct groups, based on distribution and severity of arteriolar lesions. In 25 patients classified as having TTP, platelet-rich thrombi were present—in decreasing severity—in heart, pancreas, kidney, adrenal gland, and brain. In 31 patients with HUS, fibrin/red cell–rich thrombi were present, largely confined to the kidney and often severe, and only 6 cases showed pancreas involvement, 4 adrenal gland involvement, 2 brain involvement, and 1 heart involvement.
Conclusion.—Despite similar clinical features and therapeutic approaches, TTP and HUS each have a characteristic constellation of histopathologic findings. This observation suggests that TTP and HUS are 2 distinct disease entities with different pathophysiologies, and that they do not represent a spectrum of the same disease process.
Primary Pleural Synovial Sarcoma
Authors: Ng Siok Bian , Ahmed Qasim , Tien Sim Leng , Sivaswaren Christina , Lau Lai Ching 
Published: January 2021

Abstract
Synovial sarcoma (SS) is an uncommon soft tissue tumor that occurs primarily in the extremities of young adults, especially in the periarticular region. In this report, we describe the rare occurrence of primary SS of the pleura in a 15-year-old boy. Histologically, the tumor demonstrated monophasic morphologic findings and showed positive staining with vimentin and Bcl-2 and focally for cytokeratin CK7. Fluorescent in situ hybridization identified t(X;18) translocation. The patient developed recurrences 20 months following resection of the tumor. The literature on this uncommon entity is reviewed, and its histogenesis, differential diagnoses, and cytologic features are also discussed.
Primary Duodenal Carcinoma Showing Divergent Growth Patterns as Determined by Microdissection-Based Mutational Genotyping
Authors: Cheung Onki , Kandil Hossam , Moser Arthur J. , Swalsky Patricia A. , Sasatomi Eizaburo , Finkelstein Sydney D. 
Published: January 2021

Abstract
Primary duodenal adenocarcinoma accounts for less than 0.5% of all gastrointestinal cancers. We report a case of duodenal adenocarcinoma with highly divergent growth patterns consisting of poorly differentiated adenocarcinoma and neuroendocrine carcinoma proven to arise as a single neoplasm of monoclonal origin, as demonstrated by microdissection-based mutational profiling. Multicomponent growth patterns, as seen in this case, can occasionally be encountered in gastrointestinal malignancies and have led to speculation about the pathogenesis. The methods used to clearly establish monoclonal origin based on the unique profiling of mutational damage can address fundamental issues related to tumor development and progression, while providing cogent clinical information. Our findings confirm the great potential for intestinal epithelial cells to differentiate along different histogenetic lines during tumor progression.
Inflammatory Myofibroblastic Tumor With Bone Marrow Involvement
Authors: Hagenstad Christopher T. , Kilpatrick Scott E. , Pettenati Mark J. , Savage Paul D. 
Published: January 2021

Abstract
Inflammatory myofibroblastic tumor, also referred to as inflammatory fibrosarcoma, is a rare tumor composed of myofibroblastic spindle cells of uncertain etiology and disputed nosology. We report a case of inflammatory myofibroblastic tumor of the omentum with involvement of the bone marrow in an 18-year-old man. Histologic and immunohistochemical studies of the abdominal mass and bone marrow were consistent with inflammatory myofibroblastic tumor. Additionally, fluorescence in situ hybridization using a probe specific for the ALK gene showed disruption of the gene. The literature is reviewed with emphasis on the ability of inflammatory myofibroblastic tumor to recur, metastasize, and cause mortality.
CD83+ Dendritic Cells in Inflammatory Infiltrates of Churg-Strauss Myocarditis
Authors: Schoppet Michael , Pankuweit Sabine , Maisch Bernhard 
Published: January 2021

AbstractChurg-Strauss syndrome (CSS) is characterized by a granulomatous vasculitis of multiple organs with the cardiovascular system being commonly affected. The initiation of the disease is not well understood, but immunologic phenomena are thought to contribute at least partially to the syndrome. We have studied endomyocardial biopsy specimens from a patient with CSS and eosinophilic myocarditis for characterization of infiltrating immune cells by immunofluorescence staining techniques and found a major population to be composed of CD83+CD14−CD19−CD56−HLA-DR+ dendritic cells (DCs). Further phenotypic characterization of infiltrating CD83+ cells in CSS myocarditis showed a surface profile reminiscent of immature DCs. In the same patient, the cytokine expression pattern of mitogen-stimulated peripheral blood mononuclear cells revealed a TH0 response as evidenced by multiplex polymerase chain reaction, and interleukin-5 levels were elevated in plasma analyzed by enzyme-linked immunosorbent assay. Thus, in this case of CSS myocarditis, we found DC-like cells in myocardial lesions, which may suggest that DCs are involved in the inflammatory process possibly triggered or sustained by an imbalance of DCs and their failure to confer tolerance to self-antigens.
Hepatosplenic αβ T-Cell Lymphoma: A Report of an S100-Positive Case
Authors: Dong Jingyu , Chong Yap-Yee , Meyerson Howard J. 
Published: January 2021

AbstractHepatosplenic T-cell lymphoma is an uncommon neoplasm characterized by a lymphoid infiltrate within the sinusoids of the liver, spleen, and bone marrow, without significant nodal involvement. The majority of cases express the γδ T-cell receptor and are associated with an isochromosome 7q cytogenetic abnormality. Recently, a small number of cases have been reported that express the αβ T-cell receptor. Here, we report our findings of a case of an S100-positive hepatosplenic αβ T-cell lymphoma in a 20-year-old woman who presented with pancytopenia and hepatosplenomegaly. The case adds to the growing literature of hepatosplenic αβ T-cell lymphomas.
Inflammatory Pseudotumor of the Spleen in a 6-Year-Old Child: A Clinicopathologic Study
Authors: Sarker Ashit , An Caroline , Davis Mary , Praprotnik Darja , McCarthy Leo J. , Orazi Attilio 
Published: January 2021

Abstract
Inflammatory pseudotumors of the spleen are extremely rare in children. To our knowledge, only 3 cases of splenic inflammatory pseudotumors have been reported. An inflammatory pseudotumor of the spleen was found incidentally during the workup of vesicoureteral reflux disease in a 6-year-old girl. The clinical, pathologic, immunophenotypic, and molecular features and the differential diagnostic features are discussed here. Splenic inflammatory pseudotumors, although rare, should be considered in the differential diagnosis of a mass lesion of the spleen in children.
Renal Medullary Carcinoma: A Report of 2 Cases and Review of the Literature
Authors: Dimashkieh Haytham , Choe Jong , Mutema George 
Published: January 2021

Abstract
Renal medullary carcinoma is a recently described aggressive neoplasm of the kidney. With the exception of 2 patients, all other reported cases have been associated with sickle cell hemoglobinopathies, mainly sickle cell trait and hemoglobin SC disease. Renal medullary carcinoma is a highly malignant tumor with evidence of angiolymphatic and distant metastasis at the time of diagnosis. No specific genetic abnormality has been identified in this neoplasm despite its close association with a genetic disease. We describe 2 cases of renal medullary carcinoma, one associated with hemoglobin SC disease, and the other with what we believe to be the first reported case associated with sickle cell disease.