bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expression of Estrogen, Progesterone Receptors, and Human Epidermal Growth Factor Receptor 2 in Women With Breast Cancer
Authors: Mlole Angela 
Published: September 2019

Abstract

Introduction
Globally, breast cancer is a leading cause of female cancer-related mortality and most predominant in the premenopausal stage. Expression of hormone receptors and human epidermal growth factor receptor 2, HER2/neu, appears to be different in the premenopausal group. However, there are limited data on hormone receptor expressions among women in Uganda. Therefore, the objective of this study was to determine the expression of estrogen, progesterone receptors, and human epidermal growth factor receptor 2 in women with breast cancer.

Methods
This was a retrospective descriptive cross-sectional laboratory-based study conducted in the Department of Pathology, Makerere University. Paraffin-embedded tissue blocks were retrieved from the archive and stained with H&E for histological confirmation and establishment of histological grade and type. Immunohistochemistry staining using a mouse-derived monoclonal antibody for hormonal receptors and HER2/neu expression was also done. Data were analyzed using STATA version 13.

Results
A total of 103 patients’ tissue blocks were analyzed. The mean ± SD age of the cases was 49 ± 15 years. The majority, 55/103 (53.4%), had intermediate cancer grade and 39/103 (37.9%) had triple-negative breast cancer. The majority, 55/103 (53.4%), were positive for ER hormone expression, 48/103 (46.6%) showed positive PR hormone expression, and only 19/103 (18.5%) were HER2/neu positive. Age of the cases showed statistical significance with hormonal receptor expressions and triple-negative breast cancer (P < .05), with high-grade cancers being more common among premenopausal women.

Conclusion
The study found that the mean age of breast cancer was 49 years, invasive carcinoma of no special type (NST) was the commonest histological type, and the majority were of intermediate cancer grade. In total, 53.4% of patients were ER positive, 46.6% were PR positive, 18.5% were HER2/neu positive, and 37.9% were triple negative. Age was the only factor significantly associated with hormonal receptors and triple-negative breast cancers.
Recurrent Male Breast Cysts in the Absence of Gynecomastia: A Rare Case Report
Authors: Zayko Maria , Rollins Susan 
Published: September 2019

Abstract
Publications focusing on male breast neoplasms are underrepresented in literature as most lesions are benign and less prevalent than their female counterparts. Only one case of benign male breast cyst without gynecomastia has been reported in English literature thus far, although without recurrence. We highlight the case of a 73-year-old male with history of remote non-Hodgkin lymphoma and prostate carcinoma who underwent an ultrasound-guided fine-needle aspiration (US-FNA) of a palpable 4-cm soft, nontender, mobile, left subareolar breast mass. He had no nipple discharge, skin changes, or family history of breast carcinoma. Ultrasound revealed an anechoic mass devoid of blood flow and no lymphadenopathy. US-FNA yielded 13 mL of colorless fluid and no residual lesion was visualized on postprocedural ultrasound. Microscopically, the smears were acellular and the filter preparation demonstrated crystalline debris with rare fragments of epithelial tissue, favoring the diagnosis of cyst fluid with degenerated cyst lining. Due to the lack of lobular units and a less developed ductal system compared to females, cysts are highly unusual in the male breast, and thus close follow-up was recommended. The patient returned 10 months later with a recurrent 4-cm fluctuant mass in the same location. Two adjacent anechoic cysts with a submillimeter mural projection were seen on ultrasound and targeted during US-FNA. Both cysts disappeared after drainage of 13 mL of colorless fluid. Again, cytology showed a predominantly acellular collection with scant morphologically similar epithelial fragments. All breast masses in men warrant evaluation, especially in patients with a history of malignancy. Although rare, benign male breast cysts without associated gynecomastia do occur. The lesions are amenable to both diagnosis and treatment by FNA, allowing for a less invasive procedure, without undermining patient care.
Pancreatic Cyst Cytopathology: Is It Still Worthwhile to Do It?
Authors: Zhao Xiaofeng , Arriola Aileen Grace 
Published: September 2019

Abstract

Objectives
Cystic lesions are relatively common in the pancreas, with pseudocysts accounting for 75% to 90% among other etiologies. In contrast to cysts in other organs, cysts in the pancreas are more likely to be neoplastic rather than benign or insignificant. EUS-guided FNA has served as a minimally invasive and fast diagnosis methodology. However, the efficacy of FNA on pancreatic lesions is controversial.

Methods
A 10-year retrospective study of upper EUS-guided FNA specimens on all cystic lesions in pancreas was conducted at the pathology department of a university hospital. Diagnoses and patient demographics were obtained. The frequency of diagnosis was investigated. When available, the endoscopic findings and CEA levels were obtained for analysis.

Results
A total of 188 pancreatic cyst FNA cases were collected. Approximately 80% of the specimens were satisfactory for cytology evaluation, and the diagnosis of “negative for dysplasia/malignancy” accounted for the majority of the cases (77.6%). The presence of communication with the pancreatic duct or elevated CEA level (>192 ng/mL) does not change the frequency of negative diagnosis significantly (P = .25). Among the 29 cases with a benign impression on EUS, only 1 case was upgraded to a higher lesion on cytology (3.5%) and this cyst measured >3 cm. Among 86 cysts ≤3 cm, only 1 case was diagnosed as an IPMN and high-grade dysplasia was not identified. All 41 cases with unsatisfactory cytology were due to insufficient cellularity, including 14 cases with an impression of a questionable lesion on EUS.

Conclusion
In our patient population, EUS-guided FNA of pancreatic cysts does not add significant diagnostic value to EUS findings of benign-appearing pancreatic cysts ≤3 cm and may not be cost-effective overall. Additional molecular testing on cyst fluid obtained by EUS-FNA, especially on cases with insufficient cellularity, may enhance the value of this minimally invasive procedure and improve its diagnostic performance.
Fine-Needle Aspiration Biopsy of Neuroendocrine Neoplasms in the Liver: A 9-Year Retrospective, Single Institutional Study
Authors: Zhang Lin , Cai Zhenjian , Zhu Hui 
Published: September 2019

Abstract

Objectives
Neuroendocrine neoplasms (NENs) are divided into two major categories according to the 2018 WHO expert consensus proposal: well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinoma (NECs). Primary liver NENs are very rare and majority of NENs in the liver are metastatic. In this study, we retrospectively reviewed NENs in the liver diagnosed by fine-needle aspiration biopsy (FNAB).

Methods
We retrospectively reviewed malignant neoplasms diagnosed by imaging-guided liver FNAB performed between 2010 and 2018 in our institution. Patients’ electronic medical records and selective slides were reviewed.

Results
A total of 624 liver FNAB cases with a diagnosis of positive for malignancy were identified. Among those cases, 56 cases (9%) were NENs. Poorly differentiated NECs constituted 71% (40/56) of cases, and well-differentiated NETs constituted 29% (16/56) of cases. The most common primary sites of poorly differentiated NECs were lung (35%, 13/40), followed by pancreas (20%, 8/40), GI tract (17.5%, 7/40), GU (7.5%, 3/40), breast (5%, 2/40), head and neck (2.5%, 1/40), GYN tract (2.5%, 1/40), and CNS (dedifferentiated glioblastoma, 2.5%, 1/40). The remaining three cases (7.5%, 3/40) were diagnosed as primary liver NECs based on the clinical presentation. All three patients presented with a single large liver mass with no other mass lesions identified in other organ systems. For well-differentiated NETs, majority were from the GI tract (81.3%, 13/16), followed by pancreas (6.25%, 1/16) and lung (6.25%, 1/16). One patient was diagnosed with metastatic NET of unknown primary.

Conclusion
NENs in liver are predominantly metastatic, and majority of them are high-grade NECs. Most of well-differentiated NETs are metastases from the GI tract, while more than one-third of poorly differentiated NECs are metastases from the lung. Primary liver NENs also occur and all three cases in this study are poorly differentiated NECs.
Fine-Needle Aspiration Cytology in Diagnosis of Tuberculous Lymphadenitis: Experience From a Tertiary Hospital in Tanzania
Authors: Ngimba Caroline , Mwakigonja Amos 
Published: September 2019

Abstract

Objectives
Tuberculous lymphadenitis is among the common causes of lymphadenopathy in low-resource countries. Data regarding diagnosis of tuberculous lymphadenitis based on fine-needle aspiration cytology of the lymph nodes are scant in our setting. The current study was conducted to determine the usefulness of fine-needle aspiration materials in the diagnosis of Tb lymphadenitis among patients who presented with enlarged lymph nodes.

Methods
A prospective study was conducted at Muhimbili National Hospital for the duration of 1 year (April 2016 to March 2017). Patients with enlarged lymph nodes were subjected to fine-needle aspiration cytology and smears were stained with Papanicolaou stain as well as Ziehl Nielsen (ZN). Criteria for diagnosing TB on cytology included granulomas, caseous necrosis, and epithelioid cells. All aspirates were subjected to GeneXpert assay for Mycobacterium tuberculosis. All cases diagnosed with TB based on cytological materials were initiated anti-TB. Follow-up of patients was done and response to treatment was used to confirm the diagnosis.

Results
One hundred sixteen cases were studied. Out of 116 cases of lymph nodes aspirated, 58 cases (50%) were diagnosed as tuberculous lymphadenitis. Females represented the majority of the cases, 31/58 (53%), and the most affected age group was 18 to 35 years. Cytomorphology of TB was found in 40/58 cases (68%) and ZN positivity for acid-fast bacilli (AFB) was found in 14/58 (24%) while Gene Xpert assay was positive in 29/58 (50%) of cases. The response to treatment was 100%.

Conclusion
Fine-needle aspiration cytology (FNAC) has shown to be simple, safe, and with higher accuracy in diagnosis of tuberculous lymphadenitis based on evaluation of cytomorphology with complementation of ZN stain for AFB in TB endemic areas. The diagnostic accuracy can be further increased by GeneXpert analysis, which can test the drug resistance of the Mycobacterium.
Four Cases of Esophageal Diverticulum Presented as Incidentally Discovered Asymptomatic Posterior Thyroid Nodules
Authors: Gao Guofeng , Zhou Chihong 
Published: September 2019

Abstract
Esophageal content in the thyroid by fine-needle aspiration is a rare occurrence. Here are four cases of esophageal diverticulum that presented as incidentally discovered asymptomatic posterior thyroid nodules in four patients (one 85-year-old female, one 85-year-old male, one 57-year-old male, and one 26-year-old female) who underwent ultrasound-guided fine-needle aspiration (FNA). The FNA cytopathological findings include bland mature nonkeratinizing superficial squamous cells, abundant filamentous bacteria, scattered degenerated chronic inflammatory cells, and amorphous debris, consistent with oral pharyngeal contents. These findings in the thyroid FNA biopsy may raise differential diagnoses, including Zenker diverticulum and Killian-Jamieson diverticulum of the esophagus, thyroglossal duct fistula and a third or fourth branchial fistula, and benign epidermal inclusion cyst. Thyroglossal duct fistula appears as a midline tract, which may connect the thyroid gland and the foramen cecum, as well as the branchial fistula usually present in the pediatric population, and it may connect the thyroid gland and the hypopharyngeal piriform sinus, although with an unusual presentation seen in adults. However, all four cases were reviewed with radiologists and confirmed as deep posterior thyroid nodules. The squamous epidermal inclusion cyst is usually in the superficial dermis and has predominantly anucleated squamous cells and very few if any well-preserved nucleated squamous cells. The abundant filamentous bacteria/yeast may represent colonization and no infection, which is confirmed by almost absence of neutrophils. So, the final diagnosis of these four cases is suggestive of esophageal diverticulum and no surgical treatment is necessary with the recommendation of esophagogastroduodenoscopy. As noted above, there is no evidence of malignancy; however, the false-negative rate of FNA diagnosis in a squamous-related entity is reported to be about 2% to 5%, so these patients are deemed appropriate for follow-up. In summary, we presented four cases of incidentally discovered asymptomatic posterior thyroid nodules suggestive of esophageal diverticulum by FNA biopsy.
Cytomorphological Patterns of Palpable Breast Lesions Diagnosed in Selected Teaching and Referral Hospitals in Kenya: A Prospective Study
Authors: Rioki Josephine , Rogena Emily 
Published: September 2019

Abstract

Objective
To study the patterns of breast lesions among women with palpable breast lumps presenting to fine-needle aspiration clinics.

Methods
This study involved 768 women aged 16 to 97 years who presented with palpable breast lumps to fine-needle aspiration clinics (FNACs) at Kenyatta National and Nakuru Teaching and referral hospitals from September 2016 to December 2018. The study was approved by Kenyatta National Hospital–University of Nairobi Ethical Review Committee (KNH-UoN ERC); P 334/16. A structured questionnaire was used to obtain qualitative data. Fine-needle aspiration was performed after obtaining informed consent and smears were stained with both H&E and Papanicolaou stains.

Results
Lesions were categorized as fibroadenoma, 287 (44.1%); ductal carcinoma, 59 (9.1%); breast abscess, 39 (6%); benign cysts, 33 (5.1%); galactocele, 32 (4.9%); fibrocystic changes of the breast, 29 (4.5%); suspicious of malignancy, 27 (4.1%); duct ectasia and inflammatory breast lesions, 24 each (3.7%); atypia, 12 (1.8%); invasive ductal carcinoma, metastatic carcinoma, and lipoma, 4 each (0.6%); anaplastic carcinoma and malignant phylloides, 1 (0.2%); and others. Out of 768 smears evaluated, 117 (15.2%) smears were nondiagnostic. The age group most affected was 20 to 34 years (47.2%) followed by 35 to 49 years (26.2%). Women between 24 and 30 years had the following frequencies: anaplastic cancer (100%), invasive ductal and metastatic cancer (50%), and suspicious of malignancy (56%).

Conclusion
Fibroadenoma was the most frequent lesion followed by ductal carcinoma, breast abscess, benign cysts, and galactocele, respectively. Generally, benign lesions formed the bulk of all lesions diagnosed in the two referral facilities. From this study, it is evident that the young age group (reproductive age) is the one most affected with ductal carcinoma, anaplastic carcinoma, and invasive carcinoma. The number of nondiagnostic category was quite high and this warrants proper training and competence evaluation for the clinicians/health care workers who participate in performing fine-needle aspirate procedures.
Diffuse Large B-Cell Lymphoma of the Cervix Diagnosed on Cervical Screening Cytology
Authors: Needs Todd , Bonneau Peter , Cardoza-Favarato Gabriella 
Published: September 2019

Abstract

Case Presentation
Primary lymphoma of the cervix is an uncommon entity and far more rarely diagnosed on routine screening cervical cytology. We present a case of a 38-year-old female with a 1-year history of heavy cyclical menstrual bleeding and interval spotting. She had no other significant past medical or obstetric history. On cervical exam, obscuring blood was noted without distinct abnormalities of the visualized cervix.

Pathologic Findings
Cervical cytology by ThinPrep (Hologic, Marlborough, MA) liquid-based cytology preparation demonstrated atypical squamous cells of undetermined significance as well as an abundant population of atypical lymphoid-appearing cells. Morphology of this second population was characterized by large cells (2-3 times the size of background inflammatory cells) with high nuclear-to-cytoplasm ratio, vesicular chromatin, occasional nucleoli, marked nuclear membrane irregularities, and scant cytoplasm. A cell block of the specimen was performed and demonstrated a mature but cytologically large and atypical lymphoid population. Immunohistochemistry on the cell block specimen was consistent with a B-cell immunophenotype with strong CD45 and CD20 immunolabeling. Subsequent radiologic workup showed a diffusely enlarged cervix with increased metabolic uptake, as well as bilateral metabolically active pelvic lymph nodes.

Conclusion
Cervical and endometrial curettings obtained at an outside facility confirmed the diagnosis of lymphoma that was further categorized as diffuse large B-cell lymphoma, germinal center B-cell type. This case highlights an uncommon diagnosis found on screening cervical cytology. It reinforces awareness of the potential for lymphoid neoplasms on cervical cytology and the differential diagnosis associated with such cases.
Examination of Clinical Internship Impact on Critical Thinking Utilizing the Health Science Reasoning Test
Authors: Smith Catherine , Key Jason , Anders Michael 
Published: September 2019

Abstract

Introduction
The Health Science Reasoning Test (HSRT) is a validated instrument to assess critical thinking skills and is specifically calibrated for trainees in undergraduate and graduate health science educational programs. The objective of this study was to examine the association of scores on the HSRT with clinical internship education in laboratory science students.

Methods
In March 2019, assessment of clinical reasoning skills by the HSRT was administered to 29 laboratory science students in the following programs: medical laboratory science and cytotechnology. As this was a pretest/posttest design, the HSRT was also administered after the completion of a 5-week clinical internship.

Results
Significant positive correlations were found between clinical internship education and HSRT scores. Changes in the HSRT scores occurred in overall scores and in the subdomains of deduction, evaluation, and inference after the students completed the 5-week clinical internship.

Conclusion
Clinical internships are an opportunity for students to develop critical thinking by participating in higher levels of learning objectives, including application, analysis, synthesis, and evaluation. However, the impact of clinical internships on critical thinking is unknown, and this study has shown a significant improvement in HSRT scores following student participation in a 5-week clinical internship. The HSRT was useful in measuring the association and impact of clinical internship education and critical thinking. Therefore, it is reasonable to conclude clinical internships are valuable educational experiences fostering critical thinking in laboratory science students.
Thinking, Creating, Innovating: Utilizing Algorithms in PBL Setup to Enhance Pathology Education
Authors: Saxena Ritcha , Carnewale Kevin , Saxena Ritwik , Moyer Christopher , Sahota Navjyot , Lamar Gillett Richard , Raj Ananya 
Published: September 2019

Abstract

Objectives
Exponential development in the depth and breadth of information in pathology has been challenging for the learners, because the pressure it creates to move quickly beyond content knowledge, to critical analysis, and to the process of applying pathophysiological concepts to clinical scenarios creates cognitive dissonance that impairs near-term performance and long-term retention. We propose an instructional approach where well-organized information is amalgamated with radiological imaging, immunohistochemistry, and molecular pathology, in the form of executable computer programs, to help students categorize the material and retain it as a way to activate multiple sensory systems.

Methods
A demonstration to convey a basic setup of Java to the students was delivered by IT support in the beginning of the semester. PowerPoint presentations on selective systemic pathology topics were used as an in-class vehicle by the large groups to learn, and by the small groups as a tool to create and design computer algorithms with essential checklists in select pathophysiology topics, like solid tumors. Data comprising gross and microscopic histopathological findings, pathophysiology, and differential diagnoses, woven into correlated clinical vignettes, were then provided to small groups, who worked in a PBL setup using patient cases and the already designed computer algorithms, to present their diagnoses. Continuous faculty assessment of student performance was done.

Results
Overall data analysis of block exams revealed that the mean scores were considerably higher for participants, compared to the average results of nonparticipant batches in the same exam. These participants reported better retention and development of significantly higher levels of interest in the subject.

Conclusion
Our preliminary experience suggests that our new instructional methodology can revitalize pathology education by aligning it better with medical students’ inherent enthusiasm for learning and retention. We will continue developing the computational pathology model in various clinicopathological topics as an undergraduate pathology education strategy.
Flow Cytometry Psychomotor Exercise in Medical Laboratory Science Curriculum Facilitates Correct Interpretation of Lymphocyte Subset Analysis
Authors: Kraj Barbara , Ruffy Cristina 
Published: September 2019

Abstract

Objectives
To effectively include flow cytometry psychomotor objectives in medical laboratory science curriculum as recommended in the entry-level curriculum for MLS published by the American Society for Clinical Laboratory Science.
Until fall 2018, our university-based MLS program’s coursework included one to two lectures by the FC operator from the local hospital, tour of their facility, interpretation of cases using histograms, and occasional observations of analyses during clinical practicum. Hands-on performance by 18 to 20 students annually was not possible. We secured an ASCP Foundation Laboratory Science Program Educational Grant for faculty training in flow cytometry and reached out to flow cytometry core facility on the university campus for permission to use the facility with supervision and at a discounted rate.

Methods
Each group of three to four students spent 120 to 160 minutes at the facility, including instruction by the manager, hands-on contact running the instrument by each student, and observation of other classmates. The activity included whole-blood antibody staining prior entry to the facility and CD3/CD4/CD8 lymphocyte subset analysis using MACSQuant Analyzer 10 (Miltenyi Biotec) to distinguish normal versus abnormal control and to infer the status of an assigned deidentified patient with prior HIV-1 infection (University Biosafety IBC# 18–021). Following the experience, students completed online homework, including multiple-choice and open-ended questions, which required interpretation of images recorded during the exercise.

Results
Blackboard test item analysis revealed that median percent of students correctly answering each question was 88 (n = 17). Students received individual feedback on each missed question. On the final Immunology exam, 100% of students provided correct interpretation (active infection or infection under control/normal result).

Conclusion
The results indicated good comprehension of lymphocyte subset analysis concepts. Additional exercise in immunophenotyping is under way in the Hematology class. We believe that inclusion of the flow cytometry psychomotor objectives in the curriculum will improve the students’ preparation for practice.