bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Different Hematocrit Levels on Glucose Measurements With Handheld Meters for Point-of-Care Testing
Authors: Tang Zuping , Lee Judith H. , Louie Richard F. , Kost Gerald J. 
Published: January 2021

AbstractObjectives.—To determine the effects of low, normal, and high hematocrit levels on glucose meter measurements and to assess the clinical risks of hematocrit errors.Design.—Changes in glucose measurements between low and high hematocrit levels were calculated to determine hematocrit effects. The differences between glucose measured with meters and with a plasma glucose method (YSI 2300) also were compared.Setting.—Six handheld glucose meters were assessed in vitro at low (19.1%), normal (38.5%), and high (58.3%) hematocrit levels, and at 6 glucose concentrations ranging from 2.06 mmol/L (37.1 mg/dL) to 30.24 mmol/L (544.7 mg/dL).Results.—Most systems, regardless of the reference to which they were calibrated, demonstrated positive bias at lower hematocrit levels and negative bias at higher hematocrit levels. Low, normal, and high hematocrit levels progressively lowered Precision G and Precision QID glucose measurements. Hematocrit effects on the other systems were more dependent on the glucose concentration. Overall, Accu-Chek Comfort Curve showed the least sensitivity to hematocrit changes, except at the lowest glucose concentration.Conclusions.—We strongly recommend that clinical professionals choose glucose systems carefully and interpret glucose measurements with extreme caution when the patient's hematocrit value changes, particularly if there is a simultaneous change in glucose level.
Expression of Cytokeratins 7 and 20 in Carcinomas of the Extrahepatic Biliary Tract, Pancreas, and Gallbladder
Authors: Duval Jennie V. , Savas Louis , Banner Barbara F. 
Published: January 2021

Abstract
Background.—Expression of cytokeratins 7 (CK7) and 20 (CK20) may help distinguish the site of origin for metastatic carcinomas. Little is known regarding their expression in biliary tract and pancreatic carcinomas. Our aim was to study the expression of CK7 and CK20 in these tumors.
Design.—Fifty-three carcinomas of the extrahepatic bile ducts (n = 8), ampulla of Vater (n = 7), gallbladder (n = 11), and pancreas (n = 27), were retrieved from the surgical pathology files of the University of Massachusetts Medical Center. Formalin-fixed, paraffin-embedded sections were immunostained with mouse monoclonal antibodies to CK7 and CK20 using an avidin-biotin immunoperoxidase technique with microwave antigen retrieval. The percentage of cells positive for each antibody was assessed on a scale of 0 to 3 (0, &lt;10%; 1+, 10% to 50%; 2+, 51% to 90%; 3+, &gt;90%).
Results.—The majority of carcinomas in all groups were positive for CK7 (CK7+) and negative for CK20 (CK20−). Of the CK7+ tumors, the majority of tumors in each group were 3+ positive.
Conclusions.—(1) Carcinomas of the extrahepatic biliary tract and pancreas are strongly positive for CK7 and negative for CK20 and can be included in the differential diagnosis of other carcinomas with this profile in metastatic sites. (2) The CK7/CK20 immunostaining profile will not identify the site of origin for tumors with extensive growth in the porta hepatis region.
Myelophthisis as a Solitary Manifestation of Failure From Rectal Carcinoma
Authors: Mathew Paul , Fleming Declan , Adegboyega Patrick A. 
Published: January 2021

Abstract
Rectal carcinoma is uncommonly associated with systemic metastases in the absence of liver metastases, reflecting the predilection for spread via the portal system. Occasionally, isolated lung metastases are seen, which are usually attributed to spread via the portosystemic anastomoses in the distal rectum. However, myelophthisis is an unreported complication of rectal cancer as an isolated form of systemic failure. We present a case of fatal myelophthisis associated with otherwise localized rectal carcinoma secondary to metastatic rectal cancer. This observation led to the hypothesis that spread to the bone marrow occurred via a “third circulation,” the Batson plexus, a network of deep pelvic veins with rich anastomoses to the vertebral plexus.
Tenascin Expression in Intraepithelial Neoplasia and Invasive Carcinoma of the Uterine Cervix
Authors: Iskaros Basem F. , Koss Leopold G. 
Published: January 2021

AbstractObjective.—To determine whether the expression of the matrix protein tenascin (TN) is of diagnostic or prognostic value in cervical intraepithelial neoplasia (CIN).Design.—Tenascin expression was evaluated in 75 formalin-fixed, paraffin-embedded biopsy and surgical specimens of the uterine cervix. Specimens included 15 low-grade squamous neoplastic lesions (CIN I), 30 high-grade squamous neoplastic lesions (CIN II and CIN III), 5 microinvasive carcinomas, and 15 invasive squamous carcinomas. Five normal cervices and 5 examples of cervicitis were used as controls. Expression of TN was studied by immunohistochemistry with a monoclonal mouse anti-human tenascin antibody. Tenascin expression in the basement membrane and in the stroma was arbitrarily graded as normal or slightly, moderately, or markedly increased.Results.—In the normal cervix, TN formed a thin band along the basement membrane of the squamous epithelium, except for the transformation zone, where the bands splintered and delicate TN fibers were present in the adjacent stroma. In cervicitis, TN bands were splintered in the basement membrane and the protein was weakly expressed in the stroma infiltrated by inflammatory cells. In the 45 CIN lesions, regardless of grade, the TN bands in the basement membrane were slightly (25 cases) or moderately (20 cases) increased. In CIN lesions with chronic stromal inflammation, a slight increase in stromal staining was observed, similar to the findings in cervicitis. In microinvasive and frankly invasive squamous cell carcinomas, TN expression was markedly increased in the basement membrane and in the stroma surrounding the invasive nests of cancer cells.Conclusion.—Tenascin expression may be of value in the assessment of early stromal invasion in cancer of the uterine cervix. Tenascin expression is of no value in distinguishing various grades of CIN and, therefore, is not a predictor of future behavior.
Malignant Craniopharyngioma
Authors: Kristopaitis Theresa , Thomas Chinnamma , Petruzzelli Guy J. , Lee John M. 
Published: January 2021

Abstract
Craniopharyngiomas are histologically and cytologically benign epithelial tumors of the central nervous system that may be locally aggressive and tend to recur after excision. Malignant change in craniopharyngiomas is extremely rare; we found only 4 such reports in the literature. In this report, we describe a case of squamous cell carcinoma arising in a previously benign craniopharyngioma in a 42-year-old woman. The patient was diagnosed with craniopharyngioma in 1982; during the subsequent 15 years she experienced 7 tumor recurrences, for which surgical resections and 3 courses of radiotherapy were performed. In 1998, the tumor recurred with involvement of the nasal cavity and sphenoid and ethmoid sinuses. Histologic evaluation revealed foci of typical adamantinomatous craniopharyngioma associated with a moderately differentiated squamous cell carcinoma. The transition of typical craniopharyngioma to squamous cell carcinoma was well demonstrated, suggesting that carcinoma arose from the underlying craniopharyngioma. Radiation may have been a contributing factor to carcinogenesis in this case.
Glandular Malignant Peripheral Nerve Sheath Tumor
Authors: Nagasaka Tetsuro , Lai Raymond , Sone Michihiko , Nakashima Tsutomu , Nakashima Nobuo 
Published: January 2021

Abstract
In this report, we describe a highly unusual case of glandular malignant peripheral nerve sheath tumor presenting as a neck mass in a previously healthy 29-year-old man. Grossly, the tumor was found to arise from a swollen peripheral nerve trunk. The tumor was largely composed of spindle cells that demonstrated marked nuclear pleomorphism and numerous abnormal mitotic figures. In addition, histologically malignant glandular structures lined by simple nonciliated columnar cells with goblet cells were found clustered in the center of the tumor. Examination of the swollen peripheral nerve trunk revealed the presence of a plexiform neurofibroma. The spindle cells were positive for S100. The glands were negative for S100 but positive for keratin, epithelial membrane antigen, and neuroendocrine markers (somatostatin, chromogranin, Leu-7, and calcitonin). This patient was subsequently diagnosed as having von Recklinghausen disease and died of tumor metastasis to the lungs 34 months after the presentation. To our knowledge, only 3 similar cases have been previously described in the literature.
Incidental Prostatic Adenocarcinomas and Putative Premalignant Lesions in TURP Specimens Collected Before and After the Introduction of Prostrate-Specific Antigen Screening
Authors: Mai Kien T. , Isotalo Phillip A. , Green Jerome , Perkins D. Garth , Morash Christopher , Collins John P. 
Published: January 2021

Abstract
Background.—Since the introduction of prostate-specific antigen (PSA) screening for the detection of prostatic adenocarcinoma (PCA), there has been an increase in the incidence of stage T1c PCA. The purpose of this study was to compare the frequency of incidental PCA found in transurethral resection of prostate (TURP) specimens for a 14-month period during 1989–1990 (before PSA screening was available) with the incidence of PCA for a 32-month period during 1997–1999 (after PSA screening became available).
Design.—Consecutive TURP specimens from the 2 time periods were reviewed to identify incidental PCA, prostatic intraepithelial neoplasia (PIN), and atypical adenomatous hyperplasia (AAH). Cases of TURP for palliative treatment of known advanced PCA were excluded from the study. All TURP specimens were fixed in 10% buffered formalin and were processed according to the same protocol.
Results.—We reviewed 533 and 449 TURP specimens for the time periods 1989–1990 and 1997–1999, respectively. Comparison of the results for these 2 time periods revealed that the combined prevalence of T1a and T1b PCA decreased over time from 12.9% to 8.0% (P = .06) with the introduction of PSA screening. A new group of T1c PCA was established in the post-PSA screening period of 1997–1999. There were no statistically significant differences in the incidences of T1a PCA, PIN, and AAH in TURP specimens for the 2 time periods.
Conclusion.—The decreased incidence of T1b PCA in TURP specimens for the 1997–1999 period represents a shift in PCA staging. Some PCAs previously staged as T1b are now staged as T2 carcinomas, as a result of PSA screening and earlier clinical detection. The introduction of PSA screening has had no influence on the incidence of T1a PCA, PIN, or AAH in TURP specimens.
Multiparameter Immunohistochemical Analysis of the Cell Cycle Proteins Cyclin D1, Ki-67, p21WAF1, p27KIP1, and p53 in Mantle Cell Lymphoma
Authors: Izban Keith F. , Alkan Serhan , Singleton Timothy P. , Hsi Eric D. 
Published: January 2021

Abstract
Background.—Mantle cell lymphoma (MCL) is characterized by overexpression of cyclin D1, a G1 cyclin that participates in the control of cell cycle progression at the G1 to S phase transition. In addition to cyclin D1, other cell cycle regulatory molecules may be involved in the proliferation and progression of MCL. Mutation of p53, deletion of p16INK4a, and loss of p21WAF1 expression have been reported in some cases of blastoid MCL.
Objective.—We sought to examine levels of expression of these proteins in typical and blastoid MCL and to determine whether differences were present between these subtypes of lymphomas.
Design.—A retrospective series of typical and blastoid MCLs was evaluated for expression of the cell cycle–related proteins cyclin D1, p21WAF1, p27KIP1, Ki-67, and p53, as well as mitotic index. Paraffin-embedded archival tissues from 24 MCL specimens (17 typical, 7 blastoid) were immunostained with antibodies to p21WAF1, p27KIP1, p53, Ki-67, and cyclin D1. The percentage of positive cells for each specimen was estimated by counting 1500 cells under oil immersion microscopy. Levels of antigen expression were compared for the typical and blastoid MCLs. The mitotic index was estimated using twenty 100× oil immersion fields (OIFs) for each specimen.
Results.—Cyclin D1 expression was seen in 22/24 specimens (92%). Blastoid MCLs were characterized by a significantly higher mean mitotic index (&gt;20 mitoses/20 OIFs) and Ki-67 index (&gt;45%) when compared with typical MCLs (P &lt; .001 and P &lt; .008, respectively; Fisher's exact test). High expression of p27KIP1 (&gt;25% staining) was seen more frequently in typical MCLs than in the blastoid variants (P = .03; Fisher's exact test). No significant differences were found between typical and blastoid MCLs for the expression of p21WAF1 or p53.
Conclusions.—A significantly higher mitotic index and Ki-67 index were found in blastoid MCLs as compared with typical MCLs. Low p27KIP1 expression was associated with the blastoid MCL variant. These findings confirm the high proliferative nature of blastoid MCL and suggest a role for p27KIP1 in the negative regulation of the cell cycle in MCL.
Inflammatory Myofibroblastic Tumor (Inflammatory Fibrosarcoma) of the Bone
Authors: Watanabe Kazuo , Tajino Takahiro , Sekiguchi Mihoko , Suzuki Toshimitsu 
Published: January 2021

Abstract
Although inflammatory myofibroblastic tumors, originally described in the lung, have recently been recognized to occur in various sites, their origin in bone is exceptional. We present a case of inflammatory myofibroblastic tumor, so-called inflammatory fibrosarcoma, of the bone. The tumor occurred in the iliac bone of a 70-year-old woman. Standard radiographs and magnetic resonance imaging revealed a destructive bone tumor that expanded into the soft tissue. Although the patient underwent excision of the hemi-iliac bone, multiple pulmonary metastases were noted 1 year after the operation. On histologic examination, the tumor was found to be composed of a sarcoma-like cellular area and a hypocellular fibrous area. Inflammatory cell infiltration into the tumor was a distinctive feature and is analogous with that of conventional inflammatory myofibroblastic tumor or inflammatory fibrosarcoma of the soft tissue. This is the first report to our knowledge of an inflammatory myofibroblastic tumor of the bone with distant metastasis.
Adenoid Cystic Carcinoma of the Ovary
Authors: Zámečník Michal , Michal Michal , Čuřík Romek 
Published: January 2021

Abstract
We describe a case of ovarian adenoid cystic carcinoma (ACC) of the left ovary in a 23-year-old woman. The tumor had the typical cribriform pattern of ACC, lacked any component of surface epithelial carcinoma, and showed myoepithelial differentiation. The features of salivary gland–type tumor seen in this case are unusual and different from those of so-called ACC-like carcinomas of the ovary, which only resemble the salivary gland tumor histologically.
Hepatocellular Carcinoma and Non-Hodgkin Lymphoma in a Patient With Chronic Hepatitis C and Cirrhosis
Authors: Suriawinata Arief , Ye Ming Q. , Emre Sukru , Strauchen James , Thung Swan N. 
Published: January 2021

Abstract
Hepatitis C virus (HCV) is a hepatotropic virus, but its genome and replicative intermediates also have been detected in peripheral blood mononuclear cells in patients with chronic hepatitis C. Chronic HCV infection may lead to hepatocellular carcinoma and, in a small percentage of cases, to B-cell non-Hodgkin lymphoma. To our knowledge, coexistence of these 2 tumors has not been reported previously. We describe a case of chronic hepatitis C and cirrhosis with 2 small hepatocellular carcinomas and incidental non-Hodgkin lymphoma of a hilar lymph node found during liver transplantation. Although the mechanisms of HCV oncogenesis in hepatocellular carcinoma and in lymphoma are unclear, the presence of these 2 tumors in a single patient are in agreement with the tropism of HCV and its role in oncogenesis.
Effect of Image Compression on Telepathology
Authors: Marcelo Alvin , Fontelo Paul , Farolan Miguel , Cualing Hernani 
Published: January 2021

Abstract
Context.—For practitioners deploying store-and-forward telepathology systems, optimization methods such as image compression need to be studied.
Objective.—To determine if Joint Photographic Expert Group (JPG or JPEG) compression, a lossy image compression algorithm, negatively affects the accuracy of diagnosis in telepathology.
Design.—Double-blind, randomized, controlled trial.
Setting.—University-based pathology departments.
Participants.—Resident and staff pathologists at the University of Illinois, Chicago, and University of Cincinnati, Cincinnati, Ohio.
Intervention.—Compression of raw images using the JPEG algorithm.
Main Outcome Measures.—Image acceptability, accuracy of diagnosis, confidence level of pathologist, image quality.
Results.—There was no statistically significant difference in the diagnostic accuracy between noncompressed (bit map) and compressed (JPG) images. There were also no differences in the acceptability, confidence level, and perception of image quality. Additionally, rater experience did not significantly correlate with degree of accuracy.
Conclusions.—For providers practicing telepathology, JPG image compression does not negatively affect the accuracy and confidence level of diagnosis. The acceptability and quality of images were also not affected.
Fibroadenoma Mimicking Papillary Carcinoma on ThinPrep of Fine-Needle Aspiration of the Breast
Authors: Myers Timothy , Wang Helen H. 
Published: January 2021

Abstract
Objective.—To compare and contrast benign and malignant lesions of the breast that have similar appearances on fine-needle aspiration cytology and that constitute diagnostic pitfalls.
Design.—The cytology files (dated November 1995 through May 1998) of the Beth Israel Deaconess Medical Center were searched to identify cases of breast fine-needle aspiration biopsies that were highly cellular and composed of bland-appearing spindle/columnar cells and that could represent either epithelial or stromal cells; these cases were reported as indeterminate (atypical/suspicious) and had subsequent excisional biopsies taken.
Results.—Four such cases were found. Two were fibroadenomas and 2 were papillary carcinomas. Their appearances were strikingly similar on aspiration cytology. All cases were prepared with the ThinPrep method. On microscopic examination, all 4 cases were hypercellular and had many single cells and clusters of columnar/elongate cells. Immunocytochemistry proved these cells to be of epithelial origin. At least occasional bipolar stromal cells were seen in the background. The only appreciable difference between the benign and malignant cases was more significant nuclear atypia, which was barely discernible, in the malignant cases. Immunocytochemistry for smooth muscle actin was helpful in 2 cases that had sufficient material.
Conclusions.—Some cases of fibroadenomas and papillary carcinomas can be very difficult, if not impossible, to distinguish on fine-needle aspiration cytology. Immunocytochemistry may be helpful if sufficient material is available. To avoid false-negative or false-positive diagnosis on cytology, it is best to report such cases as atypical or suspicious with final diagnosis pending excisional biopsy.
Evaluation of Axillary Sentinel Lymph Node Biopsy by Immunohistochemistry and Multilevel Sectioning in Patients With Breast Carcinoma
Authors: Liu Lucy H. , Siziopikou Kalliopi P. , Gabram Sheryl , McClatchey Kenneth D. 
Published: January 2021

Abstract
Background.—Axillary lymph node dissection for evaluation of the presence or absence of metastatic disease is the single most important prognostic factor for patients with newly diagnosed primary breast cancer. Recently, sentinel lymph node (SLN) biopsy is being investigated as an alternative to the evaluation of the entire axilla. We evaluated whether the application of multilevel sectioning and immunohistochemistry in SLNs will increase the accuracy of detection of metastatic deposits.
Methods.—Between October 1998 and July 1999, 38 patients with breast carcinoma (25 ductal, 5 lobular, 4 tubular, and 4 mixed ductal and lobular) underwent successful SLN biopsy followed by complete axillary node dissection. Sentinel lymph nodes were localized with a combination of isosulfan blue dye and radionuclide colloid injection. Frozen sections and permanent sections of SLNs were examined. All negative SLNs were examined for micrometastases by 3 additional hematoxylin-eosin (H&E)-stained sections and immunohistochemistry with the cytokeratins AE1/AE3.
Results.—Sentinel lymph nodes were successfully identified surgically in 38 (93%) of 41 patients. There was a 97% correlation between the results of the frozen sections and the permanent H&E-stained sections. Twelve (32%) of 38 patients showed evidence of metastatic disease in their SLN by routine H&E staining. In 7 (58%) of 12 patients with positive nodes, the sentinel node was the only positive node. The 26 patients with negative SLN examination by H&E were further analyzed for micrometastases; 5 (19%) were found to have metastatic deposits by immunohistochemistry. Of these patients, 2 were also converted to node positive by detection of micrometastatic disease by examination of the additional H&E levels.
Conclusions.—Sentinel lymph nodes can be accurately identified in the axilla of breast cancer patients. Evaluation of SLNs provides reliable information representative of the status of the axilla in these patients. Immunohistochemistry and, to a lesser degree, detailed multilevel sectioning are able to further improve our ability to detect micrometastatic disease in SLNs of breast cancer patients.
The Institute of Medicine's Report on Medical Error
Authors: Sirota Ronald L. 
Published: January 2021

Abstract
Context.—During the past several years, more attention has been focused on the topics of medical error and patient safety than in the past. At the end of 1999, the Institute of Medicine (IOM) published a seminal report concerning medical error in the United States; this report will have sweeping implications for all disciplines of medicine, including pathology.
Objective.—To review the major findings of the IOM report on medical error and to discuss their implications for the field of pathology.
Methods.—Review of the IOM report on medical error and discussion of other relevant literature on medical error.
Results.—The IOM report on medical error highlights an unacceptable rate of medical error in the United States and mandates a 50% reduction in medical error during the next 5 years. It recommends regulatory solutions to this problem, as well as organizational approaches to error reduction. It proposes both mandatory and voluntary systems for reporting of medical error. The report suggests that systems should be examined for latent flaws and that individual culpability for error should not be overemphasized. The report recommends that error-reduction strategies that have been applied to other industries should be studied and that known concepts of error reduction should be applied to medicine. Strategies that the IOM suggests can be applied to pathology.
Conclusions.—Medical error occurs at an unacceptably high rate. Recommendations made in the IOM report on medical error and patient safety should be applied to the practice of pathology.