bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malakoplakia, a rare inflammatory condition presenting as a colon polyp
Authors: Hassan A , Bandara K , Hamidpour S , Hamdan H 
Published: October 2024

Abstract

Introduction/Objective
Malakoplakia is a rare histiocytic disease caused by defects in phagocytic or degradative functions of histiocytes in response to gram negative coliforms (E. coli or Proteus) that results in chronic inflammatory state, followed by intracellular deposition of iron and calcium (known as Michaelis-Gutmann bodies). It’s more common in immunocompromised patients and the mean age at diagnosis is fifth decade. It occurs in all organs, common in GU tract, particularly bladder, but also seen in gastrointestinal tract (most commonly colon, followed by stomach and duodenum), central nervous system and female genital tract. In gastrointestinal tract, it can present as a polyp with diffuse mucosal involvement, submucosal thickening, and even may cause mass.

Methods/Case Report
A 60 -year-old male smoker presented to our hospital with history of colon polyps; colonoscopy revealed a 6 mm sessile polyp at the hepatic flexure. A biopsy was performed which showed numerous epithelioid histiocytes with granular eosinophilic cytoplasm, abundant Michaelis-Gutmann bodies and increased lymphocytes. Immunohistochemical stains showed diffuse positivity for CD68; and PAS stain was positive for histiocytic cytoplasmic granules. Based on this data, the diagnosis of Malakoplakia was confirmed. Malakoplakia is treated with antibiotics that concentrate in macrophages (quinolones or trimethoprim-sulfamethoxazole), antibiotics directed against E. coli, surgery and possibly discontinuation of immunosuppressive drug therapy.

Results (if a Case Study enter NA)
Malakoplakia, in this case, was presented clinically as a sessile colon polyp and histologically showed numerous epithelioid histiocytes with granular eosinophilic cytoplasm, with Immunohistochemical stains (CD68; and PAS stain) the correct diagnosis was made. Other presentations of Malakoplakia include diffuse mucosal involvement, submucosal thickening, or mass. Histologically, it may rarely be mistaken as signet ring carcinoma. These variable presentations in GU tract or colon can be interpreted as malignancy with consequent unnecessary interventions. Hence, awareness of Malakoplakia with careful histopathologic examination and the use of immunohistochemical studies are advisable in that cases.

Conclusion
We would like to emphasize that Malakoplakia can be clinically and histologically misdiagnosed as a malignant condition; therefore histopathologic and immunohistochemical studies are needed to correctly diagnose this entity.
Pathologist Workload Assessment in Gastrointestinal Subspecialty: A Pilot comparative study in an academic setting
Authors: Razzano D , Wang C , Shen J , Chada A 
Published: October 2024

Abstract

Introduction/Objective
There are no official guidelines regarding the workload to be received by pathologists, and it is challenging to distribute equivalent workloads across subspecialties. This study aims to determine whether slide count is a reliable workload metric in gastrointestinal (GI) pathology. Additionally, we seek to compare the time allocation differences between GI pathologists involved in medical resident teaching and those dedicated only to anatomical pathology duties.

Methods/Case Report
This is an observational retrospective cohort study. We recorded the first two hours of a workday of three experienced GI pathologists at Stanford Healthcare in 2022, two of whom were engaged in teaching. The authors carefully retrospectively reviewed the recorded videos to extract relevant information: teaching activities, number of histological slides, specimens, types of tissues analyzed, and resultant diagnosis.

Results (if a Case Study enter NA)
Two attendings (2 and 3) signed out with residents, while only one worked alone (1). The mean time spent on each case was 199 and 486 seconds different between attendings 1 and 2 and 1 and 3, respectively (p&lt;.01). There was a strong positive correlation between the number of slides and time spent analyzing each case, r =.607. The number of slides per case statistically explained 36.8% of the time spent per case, p &lt;.001.

Conclusion
In conclusion, the slide count metric only explains 36.8% of the time expenditure, suggesting that more sophisticated workload assessment methods must be developed, particularly if used for workload distribution purposes. Also, GI pathologists involved in medical training take longer to sign out cases than GI pathologists who are not, suggesting that this is an essential factor that should be considered when distributing workloads.
Adenoma, Hamartoma, or Something Else? Unique Diagnostic Challenges in Mixed Epithelial-Mesenchymal Lesions of the Gastrointestinal Tract
Authors: NIGAM A , AYDIN H B , DABAGHIAN A , PACHECO R , Lee H 
Published: October 2024

Abstract

Introduction/Objective
Mixed epithelial-mesenchymal lesions (MEMLs) are well-known in the gynecologic tract and, to a lesser extent, in the lungs and kidneys. However, the literature is mostly lacking in the GI tract. These cases pose significant diagnostic challenge when encountered upon, as there are many pitfalls and gray areas exist in characterization. Amongst other entities, hamartomas can account for a portion of these cases. Herein, we present a unique case of MEML identified in duodenum, which was reported as a hamartoma.

Methods/Case Report
A 59-year-old male presented with persistent upper GI bleeding requiring multiple transfusions. Initial upper GI endoscopy revealed an oozing ulcer as part of a 30 mm polyp in the second portion of duodenum opposite to ampulla. Epinephrine was injected for homeostasis. After repeat endoscopy failed to completely resect the lesion, the patient underwent exploratory laparotomy with resection of the 2nd portion of duodenum. The sections showed a submucosal proliferation of epithelial and mesenchymal elements. The epithelial component consisted of bland-appearing foveolar type mucinous glands, partly showing cystic dilation, while the mesenchymal component consisted of lymphovascular and neural structures as well as a population of small round cells that showed patchy SMA immunolabeling and low Ki67 proliferation index. The case was reported as hamartoma, however, a Brunner’s gland cyst and pericytic tumors (i.e. glomus tumor) were also considered. While the histologic features did not suggest malignancy, the patient had been followed-up closely for 6 months. Recurrence or malignant transformation was not reported.

Results (if a Case Study enter NA)
NA

Conclusion
MEMLs in the GI tract are always challenging to diagnose due to their rarity, unknown etiology and natural history, and lack of established risk factors. Furthermore, mesenchymal component is often difficult to characterize due to multiple differentiations and patchy/unrevealing immunohistochemistry. We report this unique case to enhance the awareness and recognition of MEMLS in the GI tract.
Crystal-Storing Histiocytosis of the Stomach
Authors: Shealy L , Khatskevich K , Magri J , Hajar C , Lewin D 
Published: October 2024

Abstract

Introduction/Objective
Crystal-storing histiocytosis (CSH) is an infrequently seen lesion comprised of eosinophilic histiocytes filled with refractile crystalline structures that most often have been characterized as IgG kappa restricted monoclonal immunoglobulins. The etiology for the mechanism of accumulation of the immunoglobulins is incompletely elucidated but numerous mechanisms have been postulated, including overproduction, faulty secretion, and impaired breakdown. Though CSH itself is a benign lesion, it has repeatedly been noted to be a harbinger of a concurrent or developing lymphoproliferative disorder. Literature review revealed a wide age range of presentations with no gender predilection and reports of this lesion occurring most commonly in the bone, kidneys, lungs, lymph nodes, and head and neck region. The gastrointestinal tract is uncommonly involved, with the stomach being the most frequently cited location. Reports of CSH in this setting have noted simultaneous infections with Helicobacter pylori and a range of associated lymphomas.

Methods/Case Report
We report a lesion from the stomach of a 45 year old female endoscopically described as containing patchy atrophic and nodular mucosa that was biopsied for gastric mapping in a patient with a reported history of autoimmune atrophic gastritis but without confirmatory antibodies on serology. Immunohistochemical stains highlighted a CD68 positive, smooth muscle myosin and cytokeratin negative, population of cells with cytoplasmic kappa positivity. CSH was diagnosed in a background of chronic inactive gastritis of both the antrum and fundus without evidence of H. pylori via staining or associated extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue on biopsy. Recent imaging revealed no concerning lymphadenopathy, lytic lesions, or masses.

Results (if a Case Study enter NA)
NA

Conclusion
Increasing pathologists’ awareness of this entity and its potential to be a paraneoplastic lesion is crucial, as further work-up is needed to exclude an underlying hematolymphoid neoplastic process.
A case of EBV-Negative Primary Intestinal Diffuse Large B Cell Lymphoma Involving Multiple Anatomic Sites and Lymph Nodes
Authors: Han F , Lakhani K , Harris J 
Published: October 2024

Abstract

Introduction/Objective
Extranodal lymphomas in the gastrointestinal tract are rare, with colonic lymphomas representing less than 0.5% of colorectal neoplasms. The most common type is Non-Hodgkin lymphoma. Treatment typically involves chemotherapy and surgical resection, with prognosis depends on various factors including age, genetic alteration, and bone marrow involvement.

Methods/Case Report
An 82-year-old female patient presented with abdominal pain and constipation. Radiological imaging revealed a mass in the ascending colon extending to the ileum. Histological examination following biopsy revealed to be a diffuse large B-cell lymphoma (DLBCL) of germinal center origin. The resected specimen showed two separate centrally ulcerated fungating masses in the ileum (4 x 4 x 1 cm) and ascending colon (8.5 x 5 x 4 cm).
Microscopic examination showed a diffuse infiltrate of large, discohesive, atypical lymphoid cells with vesicular chromatin and prominent nucleoli. Abundant mitoses and apoptotic bodies are evident. The lesional cells were diffusely infiltrating into the lamina propria, submucosa, muscularis propria, and serosa associated with geographic necrosis. The appendix was also transmurally involved by the neoplastic cells. Multiple pericolonic lymph nodes were also involved by the lesional cells (6/15). Immunnohistochemical stains showed the neoplastic cells are positive for CD20, CD10, BCL6, while negative for MUM1, BCL2, C-MYC, and EBER. Ki67 index was 70%. CMV was negative. FISH result for MYC gene rearrangement with reflex to BCL2 and BCL6 was negative, which excludes double/triple-hit high grade B-cell lymphomas. The patient received chemotherapy with R-CHOP after the surgery and stayed recurrence-free for 15 months.

Results (if a Case Study enter NA)
NA

Conclusion
We reported a case of EBV-negative primary intestinal diffuse large B-cell lymphoma with germinal center cell origin involving multiple anatomic sites and pericolonic lymph nodes in an elderly immunocompetent woman.
Rare Seminal Vesicle Cystadenoma: Case Report and Literature Review
Authors: Mohammed I , Garrett F 
Published: October 2024

Abstract

Introduction/Objective
Primary neoplasms of seminal vesicles (SV) are rare, with the majority being metastatic tumors, often from prostatic carcinoma. SV cystadenoma is an exceedingly rare benign epithelial tumor that arises from the remnants of the Mullerian duct. The tumor formed of cysts of variable sizes lined by bland cuboidal epithelium. Herein we present a case of SV cystadenoma in a 38-year-old male, underscoring its rarity and risk of progression to higher grades, as outlined in literature review.

Methods/Case Report
A 38-year-old male with a history of left atrophic kidney and intermittent pelvic pain due to recurrent obstruction of the SV. Pelvic Magnetic Resonance Imaging revealed a 5.3 cm benign unilocular cyst within the SV, along the posterior aspect of the urinary bladder. The patient underwent successful laparoscopic excision of the left SV. Gross examination of the excised SV demonstrated a 3.5X 2.7X 1.5 cm cyst within the SV. Microscopic examination displayed a benign cyst lined by single to multiple layers of cuboidal epithelium, surrounded by unremarkable SV stroma. The epithelial lining cells exhibited round nuclei with inconspicuous nucleoli, lacking dysplasia. Immunohistochemistry revealed positive staining for cytokeratin 7 and PAX 8 in the epithelial cells, whereas prostatic specific antigen staining was negative.

Results (if a Case Study enter NA)
NA

Conclusion
Cystadenoma and mixed epithelial stromal tumors of the SV (MEST) are rare entities, with approximately 30 reported cases. This case demonstrates classic histologic features consistent with low-grade MEST, as per recently proposed grading criteria. Notably, a recent case report has suggested a potential for malignant transformation to high-grade dysplasia and adenocarcinoma in SV cystadenoma, as evidenced by focal epithelial dysplasia.
A Quality Improvement Study for Cervical Cancer Screening: Estimating the use of cotesting versus Reflex HPV testing at the time of screening
Authors: Waqar S , Hirschhorn J W , Wolk D 
Published: October 2024

Abstract

Introduction/Objective
The recommendations for cervical cancer screening have changed over the years. One of the major changes include inclusion of HPV testing in the screening protocols. A brief scan of our lab data indicated that during the period of Jan-Oct 2023, a small group of women over the age of 30 have not been co-tested. While cytology alone is acceptable, it is less sensitive than other recommended screening options. Therefore, the quality of care these women receive is acceptable but not preferred. We aim to quantify those cases, find reasons why HPV testing was not ordered, and estimate the usage of reflex HPV testing.

Methods/Case Report
A retrospective analysis was performed of patients screened for cervical cancer with pap testing over 10 months (Jan - Oct 2023) at Geisinger Medical Laboratories. Out of 32849 patients screened for cervical cancer, we identified 546 cases without HPV testing. A chart review of the cases was performed, followed by sending a survey to the respective providers to find out when they prefer reflex HPV testing over cotesting.

Results (if a Case Study enter NA)
Data analysis showed that 546 out of 32849 cases were screened without co- testing by 102 providers. These providers checked the “HPV if ASCUS” option in the HPV permission section of the cytology requisition form. These cases were diagnosed as Negative for Intraepithelial Lesion on a pap test. We sent a survey to the providers, and responses showed that the reflex HPV testing option is used for patients younger than 30 years by 90% of the providers. Only 10% of providers use cytology alone due to cost issues for patients over 30. Most providers (60%) do not want the reflex testing option to be removed from the HVP permission section.

Conclusion
The majority of the women above 30 years of age are screened for cervical cancer with co-testing, but a small group (1.6%) is tested with cytology alone mainly due to cost-benefit hence compromising on the sensitivity of the screening test. We recommend the following changes to our cytology requisition form. If the provider selects HPV Reflex testing, the HPV test should be performed in the following scenarios: a) The pap test’s final diagnosis is NIL, and the patient is between ages 30-64. b) The pap test’s final diagnosis is ASCUS, and the patient is between ages 21 and 64. c) The pap test’s final diagnosis is LSIL; the patient is non-pregnant and between ages 25 and 64. Modifying the HPV Reflex option will improve the quality of our patient care and align our practices with current recommendations.
Anaplastic transformation of papillary thyroid carcinoma in the cervical lymph nodes showing a variety of rhabdoid, epithelioid and spindle cell phenotype
Authors: Yu Q , Husson M 
Published: October 2024

Abstract

Introduction/Objective
Anaplastic thyroid carcinoma (ATC) is a rare undifferentiated tumor of thyroid follicular cells with a dismal prognosis. Most ATCs derive from pre-existing, well-differentiated thyroid carcinomas, most commonly papillary thyroid carcinoma (PTC). In nearly all instances, ATC arises within the thyroid gland. Completely divergent morphologies of this tumor between the bilateral cervical nodes as well as the almost exclusive presence of ATC in the metastatic and nodal locations are very unusual and are reported here.

Methods/Case Report
A 67-year-old man presented with a rapidly enlarging left cervical mass, hoarseness, dry cough, and drooping left eye. MRI demonstrated bilateral enlarged cervical lymph nodes spanning levels II to V, and nodules in thyroid lobes. Subsequent total thyroidectomy with bilateral radical neck dissection was performed.
Histologically, the left lateral cervical masses revealed undifferentiated tumor cells with rhabdoid, epithelioid and spindle cells features. Conversely, the tumor within the thyroid lobes and the right cervical lymph nodes exhibited PTC with tall cell features.
All undifferentiated tumor components stained positive with AE1-3, CK7, PAX8, and negative with thyroglobulin, EMA, CD34, S100, Melan-A, Sox 10, desmin, myogenin, and P40. INI-1 staining is retained. Only the spindle cell component stained positive with TTF1. Based on the morphology and immunoprofile, a diagnosis of anaplastic thyroid carcinoma was rendred.

Results (if a Case Study enter NA)
NA

Conclusion
Diagnosing anaplastic thyroid carcinoma outside the thyroid lesion can be challenging. In our case, only extensive sampling of the surgical specimen identified a small focus of well-differentiated PTC, staining positive for thyroglobulin, in the left cervical anaplastic carcinoma component, identifying its origin. This case adds to the scarce literature documenting unilateral anaplastic transformation in the left cervical metastatic lymph nodes, while the right cervical lymph nodes contained pure well differentiated PTC. This represents a significant potential pitfall in presurgical fine needle aspiration (FNA) evaluation of patients with ATC.
Navigating Uncharted Territory: High-Grade B-Cell Lymphoma Coexisting with Warthin Tumor – Lessons Learned from an Unusual Encounter
Authors: Pham T , Vo T , Rao R 
Published: October 2024

Abstract

Introduction/Objective
High-grade B-cell lymphomas (HGBCL) coexisting with Warthin tumors (WT) are infrequently encountered, yet each case offers valuable insights. This introduction sets the stage by highlighting the rarity of such occurrences and emphasizing the importance of thorough evaluation in diagnosing and managing salivary gland neoplasms.

Methods/Case Report
We present the case of a 78-year-old man with longstanding bilateral parotid gland masses, initially presumed to be benign WT based on prior biopsies. However, surgical intervention unmasked a surprising twist – concurrent presence of HGBCL within the WT. This rare juxtaposition posed a diagnostic and management conundrum, underscoring the importance of thorough evaluation and consideration of atypical presentations.
Pathological examination revealed a landscape of large-sized cells with aberrant expression profiles, including CD20, Pax-5, BCL2, and MUM-1 positivity, along with a MYC rearrangement. Despite the rarity of this phenomenon, the case serves as a poignant reminder of the necessity for comprehensive assessment in seemingly benign conditions.

Results (if a Case Study enter NA)
N/A

Conclusion
By dissecting this unique encounter, we glean invaluable lessons in diagnostic vigilance, emphasizing the need for heightened awareness and multidisciplinary collaboration in the management of salivary gland neoplasms. This case underscores the significance of recognizing unusual presentations and leveraging them to refine diagnostic and therapeutic approaches, ultimately enhancing patient outcomes and guiding future clinical practice.
Fibrin-Associated Large B-Cell Lymphoma in a Young Patient in the Setting of Pleural Effusion
Authors: Bladek P , Frederiksen J K , Ananthanarayanan V 
Published: October 2024

Abstract

Introduction/Objective
Fibrin-associated large B-cell lymphoma (FA-LBCL) is a proliferation of EBV-positive large B- cells in association with fibrinous debris, typically in the context of prostheses, hematomas, pseudocysts and myxomas. It is a newly described entity and is extremely rare, with no deaths reported as a direct result. It is indolent and not visible on imaging, instead being found incidentally on microscopy. It is mainly a diagnosis of exclusion and is characterized by sheets of neoplastic lymphocytes contained within a fibrin background. The median age of presentation is 55, with 75% of cases being reported among elderly patients. The prognosis is excellent and surgery is considered curative. It needs to be distinguished from malignant lymphomas, mainly diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI), which is also EBV-positive but occurs in elderly patients with a longstanding history of inflammation. The two have identical immunohistochemical profiles but vastly different clinical presentations and outcomes.

Methods/Case Report
A 35-year-old male with end-stage renal disease and a history of recurrent pleural effusions presented with dyspnea. CT showed a large loculated right-sided pleural effusion with no lymphadenopathy. Pleural fluid cytology was negative for any malignant cells. He underwent decortication to relieve pleural rind constriction.
Microscopy revealed small layers of fibrin with an infiltrate of atypical, EBV-positive B-cells with a Ki-67 index of 60%. As the morphological findings and clinical presentation did not fit other known lymphomas, the case was signed out as FA-LBCL. The patient has followed up with oncology and PET scans have been negative for any malignancy. He is currently on the waiting list for a renal transplant.

Results (if a Case Study enter NA)
NA

Conclusion
FA-LBCL is a rare benign neoplasm, identified incidentally and cured by surgical resection. It is mainly diagnosed in the elderly, but the number of cases is limited and the age distribution may be skewed. This case involved a much younger patient and is the first known diagnosis in the pleural setting. It is important to differentiate this entity from DLBCL-CI, which is aggressive and requires intense oncological treatment. In addition, patients with FA-LBCL can undergo immediate solid organ transplantation, whereas those with DLBCL-CI need to be in remission for at least three years before receiving a transplant.