bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Unusual Case of Lymphoplasmacytic Variant of Multiple Myeloma
Authors: Raafey M , Youngberg G , Wheeler Y 
Published: October 2024

Abstract

Introduction/Objective
Multiple myeloma is characterized by unregulated growth of monoclonal plasma cells with overt production of nonfunctional intact immunoglobulins or immunoglobulin chains. Immunohistochemically, the plasma cells are positive for CD138 and CD38, and are rarely positive for CD20 or cyclin D1. CD20 positivity and plasmacytoid morphology in our case pointed towards a lymphoplasmacytic variant of multiple myeloma. The translocation t(11;14) has been detected in this variant, which can explain the positive cyclin D1 immunostaining. The differential diagnosis of this myeloma variant includes lymphoplasmacytic lymphoma.

Methods/Case Report
We present a case of a 75-year-old female with no significant past medical history who suffered a fall and hesitated to get evaluated until her pain persisted. Initial ER evaluation revealed she had a compression fracture of the T10 and T11 vertebrae with no other abnormality identified. Subsequently, she underwent kyphoplasty, and bone biopsies were performed. The biopsies showed prominent monotonous lymphocytes and some plasmacytoid cell proliferation. Immunostains showed the tumor cells were positive for CD20, Pax-5, Bcl-2, cyclin D1, CD138, and kappa light chain, weakly positive for CD23; and negative for CD5, CD3, CD10, Sox11, and lambda light chain. Based on the morphology and immunoprofile, current findings were considered suggestive of a low-grade B cell lymphoplasmacytic proliferation with cyclin D1 expression. The differential diagnosis includes a lymphoplasmacytic lymphoma or lymphoplasmacytic variant of multiple myeloma. This case was forwarded to a higher-level care facility for consultation and the diagnosis of plasmacytoma, kappa light chain restricted, was rendered.

Results (if a Case Study enter NA)
NA

Conclusion
Misdiagnosis of lymphoma can be made in lesions showing classic plasma cells, numerous lymphoplasmacytic cells, and cyclin-D1 positivity on immunohistochemistry if additional testing is not performed. We recommended further testing, including but not limited to bone marrow biopsy, molecular testing, FISH, and genetic testing for a definitive diagnosis.
Mixed Gangliocytoma-Pituitary Adenoma: Incidental Discovery During Eye Injury Evaluation: A Case Study
Authors: Blackburn S , Ibrahim N , Aljumaili Z , Brown C , Ak S , Bhattacharjee M 
Published: October 2024

Abstract

Introduction/Objective
Mixed gangliocytoma-adenoma is exceedingly rare, representing less than 0.5% of sellar tumors. We present a unique case of mixed gangliocytoma-pituitary adenoma incidentally diagnosed during the evaluation of traumatic eye injury. We aim to clarify the diagnostic process using real clinical data, stressing how such cases might be missed without careful histopathological examination

Methods/Case Report
A 32-year-old male presented for elective transsphenoidal resection (TSR) due to a suspected growth hormone (GH) secreting pituitary tumor. Surprisingly, the adenoma was discovered incidentally during an eye injury evaluation. Referred from an ophthalmology clinic, initial concerns were a possible blood clot or foreign body in the left eye, following a forceful encounter with a tree branch

Results (if a Case Study enter NA)
Imaging incidentally identified a 2 cm pituitary mass. Further evaluation showed elevated levels of insulin-like growth factor 1 (IGF1) at 1162 ng/ml and GH at 10.2 ng/ml. Remarkably, the patient had not observed signs of acromegaly, until photographic comparison between past and present appearances was made. TSR of the pituitary mass was done. Microscopic examination revealed monomorphic cells with round nuclei with the typical speckled chromatin pattern of neuroendocrine cells with cytoplasm ranging from chromophobic to eosinophilic, consistent with pituitary adenoma. An additional unexpected finding was the presence of large gangliocytic cells (large neurons), dispersed throughout the tumor as single or clustered cells. In some regions, distinct patches of fine neuropil stroma were associated with the clustered ganglion cells. IHC staining with synaptophysin and neurofilament highlighted the gangliocytic component. CAM 5.2 IHC stain showed perinuclear dot-like expression in the adenoma cells, GH IHC showed patchy expression, and prolactin IHC was expressed in scattered cells. Ki67 index was ~ 2%. There was no evidence of necrosis nor mitosis. The coexistence of sellar gangliocytoma with pituitary adenoma, as observed in this case, represents a rare entity known as mixed gangliocytoma-pituitary adenoma

Conclusion
The adenomatous component of mixed gangliocytoma-pituitary adenoma often secrete GH, leading to its classification as pituitary somatotroph adenoma. This poses a diagnostic challenge due to the lack of specific symptoms or unique brain imaging features, necessitating thorough histological evaluation for precise diagnosis and to ensure the gangliocytoma component is not overlooked
Multifaceted Interventions to Enable Elimination of Clinician-ordered Blood Smear Reviews: A Rural Academic Medical Center Experience
Authors: Ghafari G , Dhesi M S , Grant M 
Published: October 2024

Abstract

Introduction/Objective
Blood smears (BS) evaluate a variety of clinical disorders. At Geisinger, clinician ordered pathologist review of blood smears (CBS) have increased despite usage of highly sophisticated hematology analyzers and automatic blood smear (ABS) review criteria. We hypothesized that CBS impact pathologists’ and technologists’ workloads and increase costs and turn-around times, with rare improvement in value-based patient care. This study aimed to analyze CBS ordering practices and improve the utilization of BS review.

Methods/Case Report
In October 2020, a prospective CBS utilization study was completed by 8 clinical pathologists for 172 CBS. Subsequently, a clinical question was required for CBS orders from January 1, 2022, to January 1, 2023, to investigate clinician ordering practices based on campus, department, and indications. Findings were used to support new interventions including: clinician education; cancellation of repeat BS ordered within 24 hours, creation of alternative tests (schistocyte technologist smear review, clinician order for independent slide review), standardization of morphology reporting, ABS audits, and elimination of orderable CBS replaced by an electronic BS review request, that is reviewed by a clinical pathologist prior to determine if a BS is indicated.

Results (if a Case Study enter NA)
Part of the Conclusions section for Lab Practice abstract.

Conclusion
Prospective utilization audit of 172 CBS orders showed 17% changed clinical management. Audit of 3,693 CBS orders demonstrated common reasons for review included tick-borne illness, hemolysis, erythrocytosis, thrombocytosis, and iron deficiency anemia. Systematic implementation of multiple interventions enabled the elimination of CBS, with no known adverse effect on patient management to date. The streamlined BS review guidelines allowed for better-allocation of resources, appropriate patient turn-around times, empowerment of laboratory technologists and reduced hospital costs. We propose maximizing the incorporation of technologist skills to improve the utilization and efficiency of BS reviews and establishing standardized, evidence-based, and institutional- specific guidelines to determine BS reviews.
Laboratory Science Workforce Pipeline Strategies
Authors: Pregnall K , Mantooth M 
Published: October 2024

Abstract

Introduction/Objective
The U.S. Bureau of Labor Statistics projects 24,000 openings for clinical laboratory jobs each year until 2031 (BLS, 2022). The American Society for Clinical Pathology (ASCP, 2023) reported a 14.8% vacancy rate for medical laboratory scientists in the South-Central Atlantic region; this region includes South Carolina. There are not enough MLT or MLS certified laboratorians to keep up with current or future demands. On average, 3779 new certifications were awarded annually between 2019-2023. Pathology and Laboratory Medicine at the Medical University of South Carolina is taking short- and long-term approaches to address workforce challenges.

Methods/Case Report
Since 2018, Pathology and Lab Medicine has increased the number of clinical affiliates from 2 to 9 and have trained a total of 39 MLS students and 37 MLT students. In 2023, through collaboration with the MLT program at the local technical college, we began providing didactic education for 15 current lab team members with bachelor’s degrees but no clinical laboratory background.
Employing youth apprentices is a long-term strategy being initiated in the 24-25 academic year. Juniors and seniors in high school are eligible for a two-year paid apprenticeship. Training includes medical lab assistant and phlebotomy certification. Through recruitment activities, we can increase awareness of the role of laboratory professionals in medicine. Long-term, the apprenticeship training provides an academic pathway to MLT and MLS certification.

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

Conclusion
The short-term strategies have met with varying success and course corrections have been made. Successes and barriers will be discussed. Strategies for recruiting and selecting youth apprentices will be outlined. Training plans for youth apprentices will be presented.
Precision Pathology: Unveiling the role of Interval Sectioning Protocol for Optimal Diagnosis in Pancreatic, Ampullary, and Bile Duct Biopsies
Authors: Talbott P , Shilpa J 
Published: October 2024

Abstract

Introduction/Objective
Endoscopic techniques offer advanced diagnostics but encounter challenges in obtaining limited pancreaticobiliary biopsies, including ampullary (AMP), EUS-guided pancreatic (PAN), and spy bite biliary (BD) biopsies. Interval sectioning optimizes immunohistochemical stain utility and tissue conservation. This study evaluates interval sectioning protocols’ impact on diagnostic precision and tissue preservation at our institution.

Methods/Case Report
This analysis examines cases over four months before and after a protocol change, focusing on AMP, BD, and PAN biopsies. Previously, AMP and BD biopsies used three H&E-stained slides, while PAN required two H&E-stained and five unstained slides (USS). The new protocol adopts seven slides with H&E staining on levels 1, 4, and 7, emphasizing consistency. Parameters assessed include diagnosis, turnaround time (TAT), and USS utilization. A 30% USS utilization cutoff justifies upfront interval sectioning.

Results (if a Case Study enter NA)
A total of 77 cases from the old protocol and 142 from the new protocol were reviewed. No significant difference in TAT between old and new protocols was found (p=0.340). However, PAN TAT notably improved (4848 min vs. 2932 min). Usage rates varied by site: 22.2% (AMP), 33.3% (BD), and 34.4% (PAN).

Conclusion
USS usage was lowest for AMP cases (22.2%), below the 30% threshold for upfront interval sectioning justification. Eliminating interval sectioning for AMP would save 116 USS in the new protocol. BD and PAN cases warrant upfront interval sectioning, with USS usage rates of 31.5% and 33.7%, respectively. While PAN cases show no cost difference, the new protocol improves specimen visualization, correlates immunohistochemical stains better, and significantly enhances turnaround time.
Red Blood Cell (RBC) Antigen Confirmation Workflow – A Positive Impact at an Academic Medical Center
Authors: Abdelmonem M , Yoshizuka S , Quach T , Nguyen A , Vukic K , Chang S , Kilambi S , Virk M S , Pham T , Yunce M 
Published: October 2024

Abstract

Introduction/Objective
Introduction: Blood group antigens, present on the surface of red blood cells (RBCs), play a crucial role in transfusion medicine. These antigens are recognized serologically and form the basis of RBC phenotyping. Understanding the significance of antigen-negative RBCs is essential for mitigating the risk of hemolytic transfusion reactions and hemolytic disease of the fetus and newborn (HDFN). This study aims to assess the impact of implementing a new RBC antigen confirmation workflow on transfusion service efficiency and patient outcomes.

Methods/Case Report
Method: The study involved collaboration between our Transfusion Services Department (TS), the Blood Center supplier, and the Apheresis department. A comprehensive review of historical practices and FDA recommendations regarding RBC antigen labeling was conducted. Changes were implemented to streamline antigen confirmation testing and labeling processes. The impact on TS workload, turnaround time, and patient care metrics was evaluated.

Results (if a Case Study enter NA)
Results: Implementation of the new RBC antigen confirmation workflow led to a significant reduction in antigen confirmation tests performed by TS, with a 607% decrease observed from 2020 to 2023. Concurrently, the workload for reference lab workups increased by 337% over the same period. This shift in workload distribution allowed TS staff to focus more on patient reference workup cases and case review. The improved workflow efficiency resulted in enhanced turnaround times for providing patients with antigen-negative RBCs, ultimately improving the patient experience.

Conclusion
Conclusion: The adoption of the new RBC antigen confirmation workflow has resulted in compliance with FDA labeling requirements, efficient utilization of TS staff resources, and decreased turnaround times for blood delivery. These improvements have positively impacted patient care by ensuring timely access to compatible blood products. Future steps include developing reports to track turnaround time for patients with special blood product needs and continuing collaboration with the blood supplier and the Apheresis department to optimize inventory management and transfusion processes.
“You Should Get That Checked Out”: An Exploratory Analysis of Health-Related Discussions on Reddit
Authors: Chan G , Fung M , Warrington J , Nowak S 
Published: October 2024

Abstract

Introduction/Objective
Social media has become a widely-used way for people to share opinions about healthcare and medical topics. Social media data can be leveraged to understand patient concerns and provide insight into why patients may turn to an internet forum, rather than the healthcare system, for health advice. Data collected on users’ questions and discussions can be used to better manage healthcare resources, including laboratory tests. We aimed to investigate Reddit posts discussing medical conditions and characterize their implications.

Methods/Case Report
We collected one year of Reddit posts containing the phrases “get tested” and “get checked.” An initial selection of posts was manually read by the authors to categorize the issues discussed in the posts into conditions. An automated script was then developed to assign additional posts to conditions, based on keywords.
Condition assignment was performed on the entire one-year Reddit dataset. Related conditions were grouped into broader medical topics. Analysis of the condition assignments was then performed to assess condition and medical topic frequencies in medical condition-focused subreddits and general (non-medical-focused) subreddits.

Results (if a Case Study enter NA)
Among all conditions, STIs, eye disorders, anxiety, and pregnancy had the highest post frequency. Of the broader medical topics, the most frequent were psychiatry and mental health; genitourinary and reproductive health; infectious disease; and endocrinology, nutrition, and metabolism. Overall, conditions that appeared most frequently as a top-five condition in general subreddits included addiction and drug use, ADHD, abuse, and STIs. These conditions may be associated with fear of stigmatization.

Conclusion
Overall, we find that health discussions center on certain topics on Reddit. These topics may represent areas where people feel more comfortable discussing their health online, and where the healthcare system could focus additional outreach and resources. They may also shed light on how laboratory tests can be best managed.
Collaboration between a veterinary laboratory and a clinical cytogenetics laboratory
Authors: Van Rheeden R V , Nagy J , Robinson J , States K , Kuster C 
Published: October 2024

Abstract

Introduction/Objective
One major issue facing pig breeders is the presence of karyotypic abnormalities which reduce fertility. Karyotypic abnormalities may also persist in breeding population increasing the magnitude of lost animal production over time. Assessment of porcine chromosomes is a valuable service to be offered to the livestock industry.

Methods/Case Report
Chromosome testing of young boars prior to breeding is mandatory in France and much of Western Europe. Such testing is not common in the USA even though chromosome abnormalities are known to exist in swine breeding populations. Due to the lack of this service in the US, we established a collaboration between a clinical cytogenetics laboratory and a veterinary laboratory to validate and offer karyotype testing for breeder boards. To established this service Kuster Research and Consulting, Inc (KRC), a veterinary consulting service in Atkinson Illinois, reached out to the Shivanand R. Patil Cytogenetics and Molecular Laboratory at University of Iowa Healthcare for assistance in setting up chromosome testing for breeder boars based on the laboratory’s experience in culturing mammalian cells for chromosome analysis. Technologists from KRC traveled to the clinical cytogenetics lab for training. After a dedicated period of work and collaboration, a reproducible culture and harvest protocol was developed to obtain G-band metaphase spreads. Additional assistance for analysis was provided by Dr. Alain Pinton at the National Veterinary College (ENVT) in Toulouse, France. Dr. Pinton’s cytogenetic laboratory provided training in porcine chromosome analysis as well as providing protocols used in that laboratory. Kuster Research and Consulting also worked with SmartType to adapt proprietary karyotype software to assist in analysis of porcine chromosomes.
The collaboration established the first of its kind cytogenetic testing in a private USA veterinary laboratory,

Results (if a Case Study enter NA)
Active collaboration between clinical and veterinary service laboratories resulted in the successful development of testing protocols. In addition, the clinical lab gained experience in analysis of porcine chromosomes which has created opportunities for research using a porcine model.

Conclusion
Opportunities to share expertise should be sought and and encouraged to provide needed laboratory services in a non traditional setting.
Calcifying Nested Stromal-Epithelial Tumor of the Liver: A Rare Find
Authors: Talreja S , Laury R , Kumar S , Zahid H 
Published: October 2024

Abstract

Introduction/Objective
Calcifying Nested Stromal-Epithelial Tumor (CNSET) is a rare tumor of the liver with less than 40 cases described in the literature. It is a low-grade tumor characterized by a distinctive nested architecture surrounded by a cellular myofibroblastic stroma and psammomatous calcifications. CTNNB1 gene deletions have been identified in several cases. CNSET typically arises in the right lobe and there is a female predominance with a predilection for children, adolescents, and young adults.

Methods/Case Report
We report an interesting case of CNSET in a 13-year-old male with no pertinent medical history who presented with a one-month history of fatigue, paleness, and liver mass on physical examination. MRI abdomen showed a 9.8 cm heterogenous mass with a central scar involving the right lobe of the liver, radiologically favored to be fibrolamellar hepatocellular carcinoma. AFP levels were normal. The patient underwent a partial hepatectomy.
On gross examination, the specimen showed a yellow, circumscribed, firm mass. H&E slides showed scattered round to oval nests of bland spindle and epithelioid cells arranged in short fascicles at the periphery of nests. Collagenous stroma surrounding the nests showed spindle cells with tapered nuclei and pinpoint nucleolus. Areas with calcification and osseous metaplasia were also present. Immunohistochemistry performed showed the tumor cells to be positive for pan-cytokeratin (weak), WT-1, and vimentin, and negative for Hepar-1, arginase-1, synaptophysin, chromogranin, S100, NUT-1, myogenin, and desmin. Beta-catenin showed nuclear and cytoplasmic staining pattern. INI-1 was retained within the tumor cells and Ki-67 showed a proliferative index of approximately 10-20%. On MSK-Impact (next- generation sequencing), a mutation in CTNNB1 was detected. Archer FusionPlex was negative for gene fusions within the tumor.

Results (if a Case Study enter NA)
NA

Conclusion
It is crucial to become familiar with this rare entity and to avoid mistaking it for hepatoblastoma. CNSET exhibits a biphasic morphology characterized by a nested architecture featuring bland and uniform epithelioid and spindle cells, surrounded by a cellular myofibroblastic stroma. Confirming the diagnosis can be aided by nuclear β- catenin and the expression of WT1.
Comprehensive Analysis of Complex Copy Number Variations in the Plasmodium falciparum Genome via Long-Read Sequencing: Implications for Antimalarial Resistance and Broad Genomic Insights
Authors: Luniewski A , Guler J 
Published: October 2024

Abstract

Introduction/Objective
The genome of Plasmodium falciparum, characterized by a high AT content and a propensity for copy number variations (CNVs), presents a model for understanding how genomes adapt to stress. Our research focused on the prevalence and distribution of CNVs highlights long-read sequencing as a tool for detecting complex structural variants in other models.

Methods/Case Report
P. falciparum parasites were cultured and treated with DSM1 and aphidicolin that induce replication stress. Long-read sequencing was conducted using the Oxford Nanopore Technology Minion, with an emphasis on an optimizing DNA extraction method for preserving intact chromosomes. Visualization of CNVs, including tandem and inverted duplications, was achieved through a custom R Shiny application that allowed both quantitative and qualitative assessments.

Results (if a Case Study enter NA)
Long read sequencing identified an enrichment of multiple CNV types in treated samples, with a significant enrichment of inverted duplications as well as other types of structural variants. Aphidicolin and DSM1-treated samples demonstrated significant accumulation of these variations compared to controls (2.0 and 5.6-fold, respectively with a p value of &lt; 0.0001 in both treatment groups). These occurred mainly in core genomic regions that do not contain variable gene copies. An increase in the number of inverted duplications may be related to stress response to the treatment and may be a potential adaptive mechanism of the parasite. Our manual single-read visualization technique made it possible to visualize the structure of various CNV types, which provides unique insight on CNVs as they arise in single genomes.

Conclusion
We hypothesize that inverted duplications represent stalled replication forks, and we are currently assessing their frequency in replicating and non-replicating cells. This study highlights the role of long-read sequencing in detecting complex genomic structures in P. falciparum, which may influence the parasite’s resistance to drug treatment. These findings not only advance our understanding of malaria pathology but also aid our comprehension of how cancer cells might react to drug-induced stress and the mechanisms behind CNV formation in neoplastic cells.