bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of Additional Tissue Sections in Genitourinary Specimen
Authors: Hamza Ameer , Alrajjal Ahmed , Salehi Sajad , Qu Hong 
Published: September 2019

Abstract

Objectives
Adequate sampling of surgical pathology specimens is vital to arriving at the correct pathologic diagnosis. To minimize sampling error and to establish an accurate pathologic diagnosis, pathologists use recuts and/or additional tissue sections (ie, more tissue sections in addition to initial representative sections). This study explores the utility of additional tissue sections in genitourinary specimen.

Methods
Following institutional review board approval, we did a retrospective analysis of genitourinary pathology specimens received in our institution from 2012 to 2016 on which additional tissue sections were requested. A total of 59 specimens were identified.

Results
Among total of 59 specimens, 23 (39%) were nephrectomy, 14 (23.7%) were orchiectomy, 13 (22%) were cystectomy/cystoprostatectomy, and 9 (15.3%) were adrenalectomy. Mean initial representative sections were 12.4 ± 4.1 in nephrectomy, 29.7 ± 13.7 in cystectomy/cystoprostatectomy, 9.1 ± 5.0 in orchiectomy, and 7.2 ± 3.4 in adrenalectomy specimens. Mean additional tissue sections were 9.0 ± 8.1 in nephrectomy, 19.5 ± 15.1 in cystectomy/cystoprostatectomy, 10.4 ± 7.3 in orchiectomy, and 10.6 ± 8.7 in adrenalectomy specimens. Significantly higher number of initial representative sections (P < .0001) and additional tissue sections (P = .02) were submitted in cystectomy/cystoprostatectomy specimens as compared to other specimens. Additional tissue sections proved useful in two nephrectomy specimens whereby renal vein invasion was identified; however, staging remained unchanged, and in one cystprostatectomy specimen whereby no residual was initially identified while on additional sampling, a focus of tumor was identified, changing the pathologic stage from ypT0 to ypT1.

Conclusion
Renal vein is frequently undersampled in nephrectomy specimens. Cystectomy and cystoprostatectomy specimens are complex and require thorough sampling. If initial representative sections are deemed inadequate, additional tissue sections should be submitted to arrive at an accurate diagnosis.
Lupus Enteritis, a Severe and Potentially Fatal Complication of Systemic Lupus Erythematosus
Authors: Meawad Hany , Kobalka Andrew , Alastal Yaseen , Koltz Brooke 
Published: September 2019

Abstract

Objectives
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that can show wide manifestations in many organs. The gastrointestinal tract (GI) is commonly affected in SLE; symptoms are often related to the side effect of medications or to infections. One rare GI complication of SLE is lupus enteritis, a complex of manifestations including intestinal vasculitis and enteric ischemia, which presents with vague symptoms of severe abdominal pain, nausea, vomiting, and diarrhea.

Methods
We present the case of a 25-year-old female who was admitted to the hospital with complaints of abdominal pain, vomiting, diarrhea, and a history of SLE. Complicating the patient’s clinical picture and diagnosis was gastrointestinal bleeding requiring multiple blood product transfusions secondary to bleeding Meckel’s diverticulum, lupus flare, and positive stool culture for campylobacter antigen. Repeated upper and lower GI endoscopies with biopsy failed to identify the exact cause of bleeding and GI symptoms; the patient underwent exploratory laparotomy with right hemicolectomy to control bleeding. Microscopic examination revealed marked small vessel acute vasculitis consistent with lupus enteritis, ischemic enteritis, and Meckel’s diverticulum with gastric heterotopia.

Results
Our patient was subsequently aggressively treated; however, she developed further associated complications and died.

Conclusion
The pathologic diagnosis of lupus enteritis is challenging due to the nonspecific clinical symptoms and paucity of pathologic findings on most biopsy specimens. Lupus enteritis must be considered in the differential diagnosis of severe abdominal pain in lupus patients to aid in early diagnosis and treatment as this condition could be severe and potentially fatal.
Contemporary International Society for Urological Pathology Grade Group System 2014: A 2-Year Retrospective Review of Prostate Cancers Diagnosed in Lagos University Teaching Hospital
Authors: Odukoya Lateef , Adebayo Luqman , Anunobi Charles 
Published: September 2019

Abstract

Introduction
Prostate cancer is the second most frequent cancer worldwide. It is the commonest cancer among men in Nigeria. Gleason grading and scoring system constitute the most useful prognostic indicator in prostate cancer diagnosis and management. Over the years, it has gone through important modifications. The most recent of these changes was in 2014 by the International Society for Urological Pathology (ISUP). The WHO adopted the new grading system in 2016. It was not adopted as part of routine reporting of prostate cancer biopsies in Lagos University Teaching Hospital (LUTH) until 2017. The aim of this study is to categorize prostate cancers diagnosed in LUTH based on the grade group system and determine the pattern of prognostic distribution of prostate cancer cases since its adoption.

Methods
This is a descriptive study; data were retrieved from the histopathologic records of the Department of Anatomic Pathology. Prostate cancers cases diagnosed between 2017 and 2018 were stratified using the WHO-adopted 2014 ISUP grading system.

Results
During the 2 years, 93 cases of prostate cancers were diagnosed by core needle biopsies. Overall, mean age of cases was 69.85 years (SD 8.49, median = 70 years). Nearly 39% of the 93 cases were ISUP grade group 5 and about 24% were ISUP grade group 4. Together ISUP grade groups 3, 4, and 5 constituted 76.35% of all cases of prostate cancers. There was no statistically significant association between ISUP grade group and age (P = .266). Perineural invasion was present in 35.82% of cases. Sixty-seven percent of these were ISUP grade group 5.

Conclusion
The data from this study suggest that high-grade cancers, particularly those of the ISUP grade group 5, are the most frequently diagnosed prostate cancers in our institution. Further studies are required to document biochemical recurrence-free progression and survival among our patients.
Intraconal Metastasis Leading to the Diagnosis of Hepatocellular Carcinoma
Authors: Madabhavi Irappa , Mallikarjuna Vinay Sakaleshpura , Sandeep K S , Sarkar Malay , Shah Mansi , Modi Mitul 
Published: September 2019

Abstract
Hepatocellular carcinoma (HCC) is the most common malignant cancer of the liver, with intrahepatic and extrahepatic metastasis accounting for 50% to 75% of HCC cases. Lung and regional lymph nodes are the most common sites of metastasis; however, bone, skin, and adrenal glands are rare sites. Orbital metastasis and intracranial invasion are extremely rare and believed to occur in 2% to 3% of patients with systemic cancer. Here, we present a case report of a 72-year-old man evaluated for progressive painful proptosis of the left eye with weight loss, loss of appetite, and generalized weakness of 3 months duration. Physical examination showed a 5.5 × 3.5-cm, firm, mildly tender mass in the upper and lateral part of the left eye with proptosis and hepatomegaly with no ascites. Laboratory investigations were within normal limits except for positive hepatitis B surface antigen and HBV-DNA. CT scan of the head and neck revealed a 5.7 × 4.7-cm heterogeneously enhancing irregular extraconal mass seen in superolateral aspect of the left orbit. Abdominal CT scan showed hepatomegaly with multiple heterogeneous enhancing lesions in the liver. Fine-needle aspiration from the orbital and liver lesions showed individually scattered clusters and sheets of round to polyhedral cells with enlarged, hyperchromatic nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Immunohistochemistry showed tumor cells strongly positive for hepatocyte paraffin 1 (HepPar 1) and CD10 but negative for TTF-1, CEA, ALK-1, LCA, vimentin, S-100, and chromogranin, consistent with the diagnosis of HCC. Patient was started on chemotherapy and showed significant improvement with decrease in the size of the liver and orbital mass. Based on the present case and review of literature published since 2009, the current study recommends that metastasis must be considered when diagnosing retrobulbar head lesions in patients with HCC, regardless of contradictory imaging findings and other clinical indicators.
Submucosal Lifting Agent ORISE Gel Remnants Histopathologically Mimic Mucin and Malignancy: A Case Series
Authors: Cypher Luke , Sun Shaoli , Forster Erin , Hoffman Brenda , Lewin David 
Published: September 2019

Abstract

Introduction
There were an estimated 18.1 million new cancer cases in 2018, with colon cancer being the third most common worldwide. Colon cancer development is an accumulation of mutations resulting in normal epithelial cells transforming into adenomas and then adenocarcinomas. In certain scenarios, endoscopic interventions have gained considerable momentum over invasive surgery as an alternative to manage early gastrointestinal lesions. New techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection allow for removal of large, flat sessile polyps. Successful EMR is dependent on expanding the submucosal space to create adequate lift of the polyp to facilitate tissue capture and to avoid perforation and excess bleeding. ORISE gel (Boston Scientific) is a submucosal lifting agent currently in use in the United States.

Methods
We present three cases of gastrointestinal specimens obtained using ORISE gel. Histological analysis with hematoxylin and eosin revealed submucosal amorphous deposits that appeared to be mucin. Due to the concern for malignancy, additional stains were performed, including periodic acid–Schiff with diastase digestion (DPAS) to identify mucin. DPAS staining for mucin was negative, indicating the mucinous-appearing amorphous material seen on hematoxylin and eosin staining was not mucin but a likely remnant ORISE gel used during EMR. Additional immunohistochemical stains for epithelial cells (cytokeratin AE1/AE3) were also performed to exclude the presence of infiltrating tumor cells.

Conclusion
These three cautionary cases reveal the importance of good communication between endoscopists and pathology. In an effort to avoid overdiagnosis and/or the usage of unnecessary additional stains, pathologists should be alerted of ORISE gel usage.
First Reported Case of a Well-Differentiated Neuroendocrine Tumor (WDNET) Arising Within Diffuse Ganglioneuromatosis (DGN) in a Patient With Neurofibromatosis Type 1 (NF-1)
Authors: Cox Brian , Balzer Bonnie , Dhall Deepti , Guindi Maha , Gangi Alexandra , Larson Brent 
Published: September 2019

Abstract

Case Report
A 51-year-old female with NF-1 underwent flexible sigmoidoscopy, which revealed a 1.8-cm mass in the upper rectum. The noncircumferential mass was located predominantly at the posterior rectal wall and was suspicious for a neurofibroma. The biopsy revealed a WDNET arising in a ganglioneuroma that extended to the edges of the biopsy tissue. The patient underwent a segmental resection, and sections revealed residual grade 1 WDNET intimately admixed with DGN. The area of DGN also showed multifocal microscopic clusters of neuroendocrine cells limited to the lamina propria.

Discussion
NF-1 involves the gastrointestinal tract in 10% to 25% of affected individuals. DGN is a poorly circumscribed, frequently transmural gastrointestinal lesion composed of spindled and ganglion cells that may be seen in PTEN hamartomatous tumor syndrome, multiple endocrine neoplasia syndrome type 2B, and (less commonly) NF-1. Though malignant transformation of neurofibromas to malignant peripheral nerve sheath tumors is well documented in NF-1, malignant transformation of DGN is extremely rare. To our knowledge, this is the first reported case of a WDNET arising in DGN.
In addition to being the first reported case of WDNET in this setting, this is the first case to describe microscopic neuroendocrine cell nests in DGN. Similar proliferations have been described in the setting of inflammatory bowel disease, termed microcarcinoid or neuroendocrine cell micronests, which are not thought to have malignant potential. However, given the presence of these microscopic neuroendocrine cell nests within the larger DGN lesions and adjacent to the WDNET, we hypothesize that in the setting of NF-1, microscopic neuroendocrine cell clusters may serve as a precursor of WDNET. While this is a rare situation, these novel findings should prompt careful examination for WDNET and microscopic neuroendocrine cell nests in future cases of DGN.
An Autopsy Case of Severe Nonimmune Hydrops Fetalis Secondary to Premature Closure of the Foramen Ovale
Authors: Gao Guofeng , Tovar Jason , Raven Katherine 
Published: September 2019

Abstract
Hydrops fetalis is a condition in the fetus characterized by excessive fluid accumulation within the fetal extravascular compartments and body cavities occurring prenatally. Nonimmune hydrops fetalis is the predominant (>85%) cause of all affected individuals (cardiovascular is the leading etiological category). Herein we present an autopsy case of severe nonimmune hydrops fetalis. The decedent was delivered from a blood type A Rh-positive mother. The overall autopsy findings are diffuse subcutaneous edema, significant ascites, pleural effusion, and pericardial effusion. The major autopsy finding is the premature closure of the foramen ovale of the heart, in addition to enlarged heart and liver. Premature closure of the foramen ovale may occur at any stage of pregnancy and may be due to multiple causes and has been reported as a cause of hydrops fetalis. It is well known that the foramen ovale is the shortcut through which the fetal heart provides oxygenated blood to preferential organs, mainly the brain and the heart itself, and normally closes at birth. The timing of the premature closure of the foramen ovale in fetus is critical: its closure late during pregnancy has been associated with right heart failure, while its closure very early during pregnancy frequently results in a hypoplastic left heart due to decreased blood flow, with an aneurysm consistently bulging into the left atrium, which ultimately leads to right heart failure. Both, if uncorrected in time, can ultimately lead to hydrops fetalis and fetal death. Other structural abnormalities, like pulmonary vascular disease/irreversible pulmonary hypertension, and enlarged edematous placenta, may further aggravate obstruction to venous return to fetal heart, setting up a vicious cycle. In summary, the newborn baby died of complications of nonimmune hydrops fetalis due to the premature closure of the foramen ovale of the heart.
Six-Year Experience (2013-2018) With College of American Pathologists Programs at King Hussein Cancer Center in Jordan
Authors: Bohisi Salah , Sughayer Maher , Alsalahat Heba 
Published: September 2019

Abstract

Objectives
Proficiency testing (PT) includes interlaboratory comparisons that are organized regularly to assess the performance of individual laboratories for specific tests or measurements and it is used to monitor laboratories’ continuing performance.

Background
The College of American Pathologists (CAP) requires laboratories to participate in PT programs and to perform the investigation and root cause analysis for unsatisfactory PT results, which is valuable to improve the laboratory performance.

Methods
The data were extracted from the CAP PT results of the laboratory from 2013 to 2018 in the areas of Biochemistry, Immunology, Hematology, Microbiology, Anatomic Pathology and Cytology, and Blood Bank. The data were PT scores and consisted of values between 0 and 100, representing the percentage of correct response for each analyte.

Results
There were 211 analytes (502 event) in 2018, 215 analytes (547 event) in 2017, 204 analytes (531 event) in 2016, 210 analytes (519 event) in 2015, 228 analytes (443 event) in 2014, and 158 analytes (528 event) in 2013 that were covered by CAP PT surveys in different laboratory areas. Over the 6 years of experience, there were 57 (1.86%) unsatisfactory results for all PT events. It was seen that the rates of unsatisfactory results in that period were gradually decreased with each year of experience, which was 1.1% (2018), 1.6% (2017), 1.9% (2016), 1.5% (2015), 2.4% (2014), and 2.6% (2013). The top 3 reasons for unacceptable results were random error, analytical error, and procedural error, which accounted for 21.0% random error (2013 (9%), 2014 (4%), 2015, 2016, 2017, & 2018 (2%)), 19.3% analytical error (2013 (2%), 2014 (5%), 2015 (5%), 2016 (3.5%), 2017 (2%), & 2018 (1.8%)), and 17.5% procedural error (2013 (4%), 2014 (4%), 2015 (0%), 2016 (2%), 2017 (5%), & 2018 (3.5%)).

Conclusion
The proficiency testing performance showed a trend of improvement from 2013 to 2018, which contributed to the improvement of laboratory performance and declining the unacceptable results that affected positively on patient test performance.
Evaluation of Quality Control in Clinical Chemistry and Hematology Using Sigma Metrics
Authors: Njeru Carol 
Published: September 2019

Abstract

Objectives
The aim of this study was to evaluate clinical chemistry and hematology laboratory performance using six sigma metrics.

Methods
Clinical chemistry data and hematology data were analyzed from Bungoma Referral Hospital. Five parameters from renal and liver function tests were studied over a period of 6 months (December 2016 to May 2017). Data from IQC and EQA participation were used. The analytes were plasma creatinine, aspartate transaminase (AST), alanine transaminase (ALT), total serum protein, and total and direct bilirubin. Hematology parameters, namely white blood cell count (WBC), red blood cell count (RBC), and hemoglobin (Hb) levels, were studied. Data from IQC and EQA participation were used. Sigma metrics was calculated using total allowable error as per CLIA recommendations. Bias was calculated from HUQAS EQA participation while coefficient of variation was calculated from IQC data collected during the abovementioned months.

Results
Clinical chemistry had sigma metrics below 3; the highest sigma value was 2.01 while the lowest sigma value was 0.85. Hematological parameters had sigma levels above 3. The highest sigma value was 7.21 while the lowest sigma value was 3.87. Only one level of sigma was below 4.

Conclusion
Clinical chemistry analytes had sigma levels less than 3; method performance improvement with stringent internal quality control and correct setting of control limits need to be applied. Application of sigma metrics in addition to daily internal quality control can identify analytical deficits and improvement in clinical laboratories. Most hematological parameters had sigma levels above 3. The highest sigma value was 7.21 while the lowest sigma value was 3.87. Only one level of sigma was below 4.
Evaluating Percentage-Based Reporting of Glucose-6-Phosphate Dehydrogenase (G6PD) Enzymatic Activity in a National Reference Laboratory: Assessment of Patient Eligibility for Plasmodium vivax Radical Cure Therapy
Authors: Calvaresi Emilia , Genzen Jonathan 
Published: September 2019

Abstract

Objectives
The World Health Organization recommends measurement of G6PD activity prior to initiation of 8-aminoquinolones for the treatment of P vivax malaria. An estimated 400 million people worldwide have G6PD deficiency, making them susceptible to hemolysis under oxidative stress. A new single-dose therapy (radical cure) for malaria with tafenoquine is contraindicated in patients with <70% normal G6PD activity due to its prolonged circulating half-life. However, most clinical laboratories report G6PD activity in units g/Hb or units/1012 RBC and do not provide percentage of normal activity, making potential eligibility determination challenging.

Methods
Using an IRB-exempt protocol, a limited data set of consecutive G6PD quantitative results was retrieved from the clinical laboratory’s enterprise data warehouse. Laboratory testing of these specimens was previously performed at 37°C using an automated enzymatic assay (Pointe Scientific) configured on a cobas c501 chemistry analyzer (Roche Diagnostics). Data were assembled to include adults age 18 to 89 years and excluded repeat results from the same patients as well as outliers.

Conclusion
The final data set included 52,216 results (female, 55.9%, n = 29,173; male, 44.1%, n = 23,043) from 47 US states. An adjusted male median (100% G6PD activity) was derived using an approach proposed by the Bangkok Workshop guidelines (Domingo et al., Malaria Journal, 2013), modified to more accurately differentiate bimodal peaks in population G6PD histograms. The laboratory-specific, adjusted male median was 12.7 U g/Hb and was similar to peak values derived from alternative curve-fitting approaches. Applying this median to gender-specific data sets, 5.4% of males and 3.8% of females were found to have <70% of normal activity (<8.9 U g/Hb). This study demonstrates the feasibility of percentage-based G6PD result reporting in adults; further studies will query percentage-based reporting in pediatric populations. Population-based medians will vary based on G6PD assay type and temperature and should be established by laboratories prior to percentage-based reporting.
Parallel Comparison of Cancer Antigen 15.3 and Cancer Antigen 27.29 in Breast Cancer
Authors: Wei Qing , Cao Liyun , Hardy Robert 
Published: September 2019

Abstract

Objectives
Mucins are large and complex glycoproteins expressed by several epithelial tissues. The expression of MUC1 mucin is upregulated in breast cancer and the protein is released in high amounts in patients’ blood. Cancer antigens (CA) 15.3 and CA 27.29, which measure different epitopes of MUC1 protein, are useful biomarkers for postoperative surveillance and therapy monitoring of advanced breast cancer. The aim of this study was to compare CA 15.3 assay and CA 27.29 assay by using paired patient samples.

Methods
The study was performed in 523 patient samples. CA 15.3 was measured by a sandwich assay on Beckman Coulter UniCel® DxI 800. CA 27. 29 was measured by a competitive immunoassay on Siemens ADVIA Centaur System.

Results
On Deming regression, the slope was 0.310 with an intercept of 8.6 and correlation coefficient of 0.951. The mean bias between the two assays was –39.2 (–56.6%). The agreement of the two methods was 89% (n = 467), among which, 12% (n = 62) were positive for both CA 15.3 and CA 27.29 (above the upper limit of the reference range), and 77% (n = 405) were negative for both assays (within the reference range). The disagreement was 11% (n = 56), which showed positive CA 27.29 and negative CA 15.3. The correlation coefficient between CA 15.3 and CA 27.29 is 0.9085 when both are positive and 0.6315 when both are negative. The bias is –238.9 (–84.7%) when both are positive and –8.5 (–52.4%) when both are negative. Paired t tests showed significant difference (P < .001) between the CA 15.3 and CA 27.29 in both positive samples and both negative samples.

Conclusion
In summary, there is a good correlation between CA 15.3 tested on Beckman Coulter UniCel® DxI 800 and CA 27.29 on ADVIA Centaur System. However, with the negative bias, they should not be used interchangeably.