bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epithelioid Gastrointestinal Stromal Tumors: A Retrospective Look
Authors: Khandakar Binny , Ghosh Sharmila , Sun Jihong 
Published: September 2019

Abstract

Objectives
Gastrointestinal stromal tumor (GIST) is the most common primary mesenchymal tumor of the gastrointestinal tract (GIT). Most tumors are of spindle cell type. Approximately 20% of the cases are of epithelioid histologic variant and approximately 10% are mixed epithelioid and spindle type. We sought to identify the clinical and pathologic features of GIST with epithelioid features diagnosed at our institute.

Methods
The database was searched (2017-2018) and 26 cases were included for the series. The data were analyzed systematically for histologic subtype, age, site, stage, risk group, and immunohistochemical findings.

Results
Pure epithelioid GIST (PE-GIST) was seen in nine cases (35%). Seventeen tumors were mixed subtype (M-GIST). PE-GIST was more common in females. Mean age of patients was similar in both subtypes. PE-GIST most commonly involved stomach (n = 8). Small intestine was the most commonly involved by M-GIST (n = 10). Mixed tumors were larger in size (6.0 cm, mean) compared to PE-GIST (4.2 cm, mean). Tumors showing pure epithelioid subtype were more in the high-risk category, compared to the mixed subtype (33% vs 23%). Most cases of M-GIST were pT3. M-GIST expressed both c-Kit and DOG-1 more frequently than the PE-GIST (70% vs 55%).

Conclusion
Mixed epithelioid and spindled GIST was more common than the pure form. Coexpression of DOG-1 and c-Kit was less frequent in PE-GIST. Mixed tumors tend to have higher stage than the pure type at presentation.
Detecting FLI1 Fusion by Immunohistochemistry (IHC) Stain in Prostatic Adenocarcinoma
Authors: Xu Kemin , Budhai Alexandra , Pattarkine Rugved , Zhong Minghao 
Published: September 2019

Abstract

Objectives
The most common genetic alterations in prostate cancer are fusions of ERG and other members of the E26 transformation-specific (ETS) family of transcription factors, including ETV1, ETV4, and FLI1. Analyzing TCGA data, we found that similar to ERG fusion, FLI1 fusion-associated FLI1 mRNA level increases. ERG IHC stain has been a surrogate test for ERG fusion. Therefore, we hypothesize that FLI IHC stain could also be used to detect FLI1 fusion in prostate cancer.

Methods
In total, 111 primary prostate adenocarcinoma (>10% by volume) cases from our institute were selected for tissue microarray (TMA) construction. The regular full section slides and TMA slides were subject to IHC stain of ERG and FLI1 (Santa Cruz, SC-113). The criteria for positive FLI1 are (1) nuclear staining; (2) only in tumor cells, not in nontumor cells; and (3) FLI1-positive cells should be negative for ERG IHC staining.

Results
For prostate TMA slides, ~50% of cases were positive for ERG; ~30% of cases were weakly positive for FLI1. However, all of the FLI1 weakly positive cases were positive for ERG as well possibly due to cross-reactivity between ERG and FLI1, which was demonstrated in other studies.

Conclusion
Overall, we conclude that the cross-reactivity between FL1 and ERG precluded the detection of FLI1 fusion in prostatic adenocarcinoma under current conditions. We are in the process of selecting some cases to detect FLI1 fusion by next-generation sequencing (NGS) and FISH.
Endoscopically Unresectable Paneth Cell (PC)–Containing Adenomas and the Risk of Developing Colorectal Neoplasia
Authors: Saade Rayan , Fu Zhiyan , Lee Hwajeong 
Published: September 2019

Abstract

Objectives
Whether the presence of Paneth cells (PCs) in colorectal adenomas indicates an increased risk of colorectal neoplasia or not is controversial. We examined the clinicopathologic features of PC-containing adenomas (PCAs) that were surgically removed, focusing on the risk of developing subsequent colorectal neoplasia on follow-up.

Methods
A retrospective cohort of 154 patients with endoscopically unresectable colorectal adenomas who underwent surgical removal was retrieved. Archived pathology slides were evaluated for the presence of PC, villous features, and high-grade dysplasia. Demographic and clinical data were obtained by reviewing electronic medical records. A minimum 12 months of follow-up was considered valid follow-up data. Fisher’s exact test and Student t test were performed when indicated (P < .05 was considered statistically significant).

Results
PCAs were identified in 84 out of 154 cases (54.5%), commonly in the proximal as compared to distal colorectum (60.7% vs 38.1%, P = .018). There was no significant difference in patient age (mean, 66.0 vs 63.8), gender (M:F, 42:42 vs 35:35), adenoma size (mean, 3.18 cm vs 2.78 cm), villous features (69.0% vs 68.6%), and high-grade dysplasia (44.0% vs 35.7%) between PCA and non-PCA groups. After the mean follow-up duration of 65.8 months (range 12-169), 11 out of 30 patients (36.7%) had recurrent colorectal neoplasia, including 2 adenocarcinomas in the PCA group, as compared to 8 out of 27 (29.6%) in non-PCA group with no adenocarcinoma (P > .05). No statistical difference in the risk of developing colorectal neoplasia was noted between proximal PCA (24%), distal PCA (33.3%), and non-PCA (29.6%) groups.

Conclusion
PCAs are more common in the proximal colon, consistent with normal anatomic distribution of PC in the colon. No association was observed between PCA and high-grade dysplasia or colorectal neoplasia risk in endoscopically unresectable adenomas. PCA location was not a significant marker for future adverse outcomes.
Paratesticular Adipocytic Neoplasms Evaluated at a Single Institution
Authors: Mustafa Mohamed , Priemer David , Idrees Muhammad , Chen Shaoxiong 
Published: September 2019

Abstract

Objectives
Some of the scrotal masses are extratesticular neoplasias and develop from paratesticular tissues. Paratesticular region has a complex anatomy and contains epididymal and testicular appendages as spermatic cord, testicular tunicas, epididymis, and vestigial remnants. Therefore, neoplasms originating from this region comprise a heterogeneous group of tumors. Herein, we document paratesticular adipocytic neoplasms and the patient’s mean age and the mean size of tumor at presentation.

Methods
We retrospectively searched our database for paratesticular adipocytic neoplasms from the year 2001 to 2015. A total of 47 cases were identified and reports were reviewed.

Results
Of the total 47 cases, 28 (60%) spermatic cord lipomas, 9 (19%) well-differentiated liposarcomas, and 10 (21%) dedifferentiated liposarcomas were identified. The mean age for presentation for these diseases was of 41, 59, and 68 years, respectively.

Conclusion
The most common paratesticular adipocytic neoplasm in our institution is spermatic cord lipoma (60%), occurring in younger age group (mean age 40 years). However, up to 40% cases are malignant and include well-differentiated and dedifferentiated liposarcoma, occurring at a relatively older age population (59 and 68, respectively).
Results of Baseline Assessments of Two Viral Load and Early Infant Diagnosis Laboratories in Gaza Province, Mozambique
Authors: Nhabomba Augusto , Assane Mariamo , Adamo Noorbebi , Benzane Octavia , Pinto Isabel , Macave Admiro , Basu Debby , Landgraf Kenneth 
Published: September 2019

Abstract
Following the WHO 2013 recommendations for routine HIV viral load (VL) testing as the tool to monitor antiretroviral therapy, countries have prepared for massive testing scale-up. However, developing countries that also bear the highest HIV prevalence often lack qualified human resources and basic infrastructure. Mozambique has established 13 VL laboratories, including 2 in the province with the highest overall HIV prevalence, Gaza. The challenges to VL testing implementation and this rapid scale-up demand an urgent investment toward laboratory accreditation to ensure accurate and reliable VL results. To identify gaps and areas for improvement where additional resources may be needed to provide high-quality VL testing services, the CDC developed a VL and Early Infant Diagnosis (EID) scorecard (106 points; 5 levels). The scorecard evaluates 9 key areas, including (1) Personnel, (2) Facility/Environment, (3) Safety, (4) Procurement/Inventory, (5) Sample Management, (6) Equipment, (7) Process Control, (8) M&E Documents and Records, and (9) Internal Quality Audits/Quality Indicators. These 9 essential areas cover the pretesting, testing, and posttesting phases along the continuum of care for HIV patients. Baseline assessments in the two VL and EID laboratories in Gaza Province, Carmelo Molecular Laboratory and Xai-Xai Molecular Laboratory, were recently conducted. Personnel standards and M&E documentation represented strengths across both laboratories, with over 70% of the master list of M&E documents having been developed and in use. The overall gaps identified included poor segregation and prioritization of higher VL results (>1,000 cp/mL), lack of internal audits, and no follow-up of nonconformities. Both laboratories scored in the level 2 range, with a total of 68 points (Carmelo) and 78 points (Xai-Xai). Considering this is a baseline assessment, we conclude that both labs are on an excellent path toward accreditation; however, additional laboratory quality mentorship is needed in order to reach accreditation standards.
Association of Inflammation With Markers of Atherogenicity in Subjects With New-Onset Atria Fibrillation in a Nigerian Community
Authors: Nwadike Constance , Nwakamma Amarachi , Nwanjo Harrison , Nwosu Denis , Ezekwe Roy 
Published: September 2019

Abstract

Objectives
The evidence supporting the role of circulating markers of inflammation in the pathogenesis of atria fibrillation remains controversial. This study investigated the levels of serum lipids, C-reactive proteins, erythrocyte sedimentation rate, prothrombin time, and platelet count in subjects with new-onset atria fibrillation (NAF), but with no established cardiac disease, in a Nigerian community.

Methods
The case control study involved a total of 200 subjects: 110 subjects with NAF and 90 apparently healthy subjects without AF, as control. AF was confirmed by a 12-lead electrocardiogram (ECG), while excluding subjects with high risk. Blood samples from the subjects were analyzed for the following parameters: C-reactive proteins using ELISA method and serum lipids using an enzymatic, colorimetric method; erythrocyte sedimentation rate, by Westergreen method; platelet count using a Midray hematology auto analyzer; and the prothrombin time using a tissue thromboplastin method. Data collected from the result were analyzed using SPSS version 15.

Results
There was a significant increase in the levels of C-reactive proteins and ESR in subjects with NAF when compared with the control subjects. A significant increase was observed in the mean values of total cholesterol and low-density lipoproteins in subjects with NAF, while that of high-density lipoproteins was lower in NAF than in controls. There was no significant difference in the mean values of triglyceride in NAF and the control. Results also showed significantly reduced prothrombin time, with more platelet count in subjects with NAF. The result demonstrated that females (56.3%) had greater risk of developing AF than males (45.8%), while incidence of AF was observed to increase with age.

Conclusion
The results of the markers assayed suggest marked dyslipidemia, inflammation, and thrombogenesis in subjects with new-onset AF. Hence dyslipidemia and inflammation play critical roles in the pathogenesis of atria fibrillation.
Positive Propoxyphene Test Result for Drug-Free Serum or Plasma Obtained When Using the Roche Cobas c502 Urine Propoxyphene Screening Test
Authors: Jagannathan Geetha , Curtis Mark , Stickle Douglas 
Published: September 2019

Abstract

Introduction
During a recent autopsy case, we were asked to investigate possible surreptitious inpatient use of drugs of abuse (DOA). As serum was the only sample type available for this subject, we initially ran serum samples on our urine drugs of abuse (DOAU) assays. Results were unexpectedly positive for propoxyphene (PPX). We immediately determined, however, that all plasma or serum samples, selected randomly from the hospital laboratory as presumed-negative controls, produced PPX-positive test results on the urine PPX assay. We report our investigation of this finding.

Methods
The PPX urine assay (Roche Cobas c502, Indianapolis, IN) is a semiquantitative screening test based on kinetic interaction of microparticles in solution (KIMS), with a cutoff concentration of 300 ng/mL. The assay was conducted according to manufacturer’s instructions, other than the substitution of plasma for urine as described below. Plasma or urine samples were obtained from to-be-discarded samples residual from routine testing in the hospital laboratory.

Results
Pooled plasma required a 1:4 dilution with drug-free urine to produce a PPX-negative test result. Bovine serum albumin (7 g/dL), mimicking total protein of plasma, produced a PPX-negative test result. Pretreatment of plasma using heterophilic antibody blocking reagent (Scantibodies Laboratory, Santee, CA) did not alter the PPX-positive test result. However, pretreatment of plasma by polyethylene glycol (PEG) to precipitate immunoglobulins altered the test result to PPX negative. PEG pretreatment did not alter PPX-positive results for PPX-spiked urine.

Conclusions
An autopsy case produced an incidental finding of false-positive test results for plasma tested on the Roche urine PPX assay. Based on PEG pretreatment data, it appears that some common component of immunoglobulins in plasma produces a positive interference in this assay. In principle, rare circumstances of severe renal dysfunction to produce plasma-like urine could potentially lead to false-positive results with the Roche urine PPX screening test.
Verification of Access OV Monitor (Cancer Antigen 125) Assay on Beckman Coulter Unicel DXI 800
Authors: Ollila Eric , Cao Liyun , Hardy Robert 
Published: September 2019

Abstract
CA 125 levels are increased in ovarian carcinoma and other benign and malignant conditions. Levels are used to monitor response to therapy and disease progression. The objective of this study was to assess the analytical performance of the Access OV Monitor assay on the Beckman Coulter DXI. CA 125 was quantitatively determined on Beckman Coulter DXI following CLSI guidelines. Performance was evaluated for linearity, sensitivity, reference range, and precision. Within-run and between-run precisions were assessed by analyzing QC material at low and high concentrations. Accuracy was assessed by comparing 147 consecutive values with the previously established Siemens ADVIA Centaur XP. Antigen levels were classified as positive or negative based on the upper limit of the reference range to assess concordance between the two analyzers. The analytic measurement range was linear between 0.5 and 5,000 U/mL with a slope of 0.983 and intercept of 0.46. The reference range was 0 to 35 U/mL. Within-run CVs were 3.4% and 3.5% at low (53.81 U/mL) and high (392.78 U/mL) levels, respectively. Between-run CVs were 3.46% and 3.0% at low and high levels, respectively. The comparison results showed slope was 1.319 with an intercept of 12.61 and correlation coefficient of 0.9868 (Deming regression). The mean bias was 57.36 (33.98%). The correlation coefficient was 0.9633 and 0.9833 when CA 125 was negative and positive, respectively. The bias was 3.51 (25.73%) and 142.12 (34.41%) when CA 125 was negative and positive, respectively. The agreement was 94% (n = 138) and disagreement was 6% (n = 9). In conclusion, CA 125 on Beckman Coulter DXI has good linearity and precision and shows positive bias. There is good correlation and agreement between the two methods. Clinicians can reliably use the assay but should consider the potential bias when interpreting values near the upper end of the reference range.
Real-Time Detection of Analytical Outliers on the Roche Troponin T Generation 5 Assay
Authors: Wockenfus Amy , Hartung Katherine , Kelley Brandon , Katzman Brooke , Donato Leslie , Jaffe Allan , Karon Brad 
Published: September 2019

Abstract

Introduction
Analytical outliers occur with most troponin assays and can adversely affect patient management. We developed a system to detect analytical outliers for the Roche Troponin T (cTnT) Gen 5 assay using repeat analysis of samples manifesting changing values over 2 to 6 hours.

Methods
In our ED practice, troponins are collected at baseline, 2 hours, and at times at 6 hours in plasma separator tubes and processed on the Roche Cobas e411 (Indianapolis, IN). When troponin values change by ≥10 ng/L or ≤10 ng/L in the 2- or 6-hour sample compared to baseline, the sample that produced the result is repeated. If initial and repeat values differ by > ±5 ng/L (cTnT <100 ng/L) or ±5% (cTnT ≥100 ng/L), the initial value is deemed to be an analytical outlier. Outliers are confirmed by a third measurement.

Results
Since March 2018, 19 of 17,154 (0.11%) troponin samples analyzed have been labeled outliers. Outliers were falsely elevated in 14 cases and falsely decreased in 5. Mean (range) of initial cTnT values for outliers was 39 ng/L (18-621 ng/L), with only one initial value >100 ng/L. All changes could affect analysis of change over time. Eleven of 19 outliers were outside gender-specific reference interval on both samples and thus did not cause a change from abnormal to normal. Repeat measurements on 8 of 19 outliers were within the URL, which may have greater clinical consequences.

Conclusions
Repeat analysis upon observation of changing values allows detection of analytical outliers in real time, prior to reporting results. These outliers are almost always clinically significant in terms of interpretation of changing values and at times change patients from above to below the URL. If we tested more than just changing samples, we might detect still more outliers.
Detecting Liver Fibrosis by Recent Reliable Biomarkers in Viral Hepatitis Patients
Authors: Addissouky Tamer 
Published: September 2019

Abstract

Objectives
By far, chronic viral hepatitis and its complications have been considered a fatal health public issue. Liver biopsy has a pivotal role to distinguish patients who need proper care and regular screening. The correlation between alternative biomarkers and liver fibrosis has been studied by current research to avoid histopathology techniques.

Methods
Several biomarkers such as COLL-IV, COMP, and hyaluronic acid besides scoring systems (FIB-4, APRI, NAFLD, and SHASTA) were measured and calculated in 143 infected cases with HCV and HBV. Also, the same parameters were determined in 75 healthy persons as controls. The Metavir system was used to classify infected cases from F0 to F4. Alternative marker levels were determined by using the ELISA technique. HBV DNA and HCV RNA were quantified by implementing the RT-PCR assay. Noninvasive markers were approved by comparison with the mentioned scoring indexes.

Results
Our research has indicated that hyaluronic acid, COMP, Coll-IV, and scoring indexes of fibrosis discriminate fibrosis cases from the nonfibrosis group. The studied biomarkers have high sensitivity from 77.05% to 96.72% and accuracy from 89.71% to 97.79% as well as their cutoff, which approved the aim of this study. Thereafter, the studied markers’ reports assisted in differentiating primary stages F1+F2 from late levels F3+F4 of fibrosis.

Conclusions
According to reports of the current study, serum markers including HA and CO-IV have performed better than biopsy in excluding advanced fibrosis from mild fibrosis patients comfortably as well as differentiating fibrosis patients from healthy individuals, while the COMP test has low accuracy and needs further research. Scoring systems alone are likely not sufficiently sensitive to rule out significant disease. Hence, gathering serological markers and scoring indexes are being perfected to determine all stages of fibrosis definitely. However, further research is needed to prove reliable noninvasive markers of liver fibrosis.
Paroxysmal Nocturnal Hemoglobinuria: Grasping the Flow of Diagnostic Dilemmas
Authors: Nguyen Phuong-Lan 
Published: September 2019

Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare life-threatening condition due to an acquired somatic mutation of the PIGA gene, leading to nonmalignant clonal expansion of hematopoietic stem cells, which are deficient in glycosyl phosphatidylinositol-anchored proteins (GPI-APs). Fluorescein-labeled proaerolysin (FLAER) and flow cytometry are key tools in the diagnosis of PNH. While clonal detection of PNH in both tests has a sensitive diagnostic threshold of 0.01% in erythrocytes and 0.05% to 1% in leukocytes, one must be cautious in ruling out the possibilities of myelodysplastic syndrome (MDS) or aplastic anemia. We propose guidelines in the differential diagnosis and evaluation of PNH from these and other hematologic disorders that can arise from GPI-AP deficient cells. These guidelines are based on a meta-analysis of five research literature sources, including four case studies. We also compare and contrast our limits of quantification of the in-house PNH assay at University of Kentucky Healthcare with those of an interlaboratory validation of 11 institutions within the United Kingdom. Our report advocates for thorough evaluation of multiple laboratory and clinical variables affecting sensitivity and accuracy of flow cytometry and FLAER in PNH. Furthermore, we recommend lowering of the in-house limit of quantification from the current 1% to 0.01%. This allows for the critical consideration of conditions such as MDS and aplastic anemia and their disease courses, all of which can present with PNH clones as low as 0.01% on flow cytometry and FLAER.
Primary Chondroblastic Osteosarcoma of the Breast in a Teenager: What Is Changing?
Authors: Yahaya James 
Published: September 2019

Abstract

Background
Nonepithelial tumors of the breast are extremely rare and have an incidence of less than 1%. The most common nonepithelial breast tumor is phyllodes tumor (PT), which accounts for 61%. Primary osteosarcomas of the breast contribute up to only 12.5% of all the extraosseous osteosarcomas, and among young females, they are extremely rare, especially in those without a previous history of primary bone osteosarcoma. A case of a 16-year-old female with primary chondroblastic osteosarcoma of the left breast is herein presented.

Case Description
In this report, we describe and report a 16-year-old female with neither a previous history of bone osteosarcoma nor a family history of breast cancer who was diagnosed with a primary chondroblastic osteosarcoma of the left breast. The mass was shining, warm, firm, and slightly fixed. The excisional biopsy showed a large tumor measuring 11 × 9 × 7 cm, encapsulated, grayish-white, and nodular. The H&E-stained sections showed a tumor composed of atypical spindle cells, large pleomorphic epithelioid cells, and multinucleated cells of osteoclastic type with osteoid formation with abundant areas having malignant chondroid matrix. About 40 atypical mitoses/10 HPF were seen. A diagnosis of primary osteosarcoma was made. Immunohistochemically, the tumor was triple negative, vimentin was strongly positive, SMA was focally positive, and AE1/AE3 was negative. The patient was put under observation. Her postoperative course is generally promising without any complaint of pain. We present a case of a very young female with the rarest diagnosis of primary osteosarcoma involving the left breast.

Conclusion
Primary osteosarcomas of the breast carry poor prognosis by being triple negative, and because of being the rarest tumors, they pose a challenge in managing the patients due to lack of established treatment modalities.