bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a Point of Care Urine Drug Test System for Application in Outpatient Pain Management Clinics
Authors: Overton J S , Kyle P 
Published: October 2024

Abstract

Introduction/Objective
Most states require testing for illicit and controlled substances in ambulatory, non-terminal pain management populations to ensure prescription compliance. Point of care (POC) urine drug testing (UDT) is a widely adopted testing method that assists with clinical decision making within minutes. However, these immunoassays may lack the sensitivity and specificity needed for potent medications such as fentanyl. This study compares the performance characteristics of a POC UDT to an in-house, high throughput, automated chemistry analyzer and the reference method, gas chromatography-mass spectrometry (GC-MS). Providers should be aware of the limitations of each methodology given the rise of synthetic opioid misuse, and the need to quantify multiple substances and metabolites within the same drug class.

Methods/Case Report
100 residual deidentified patient urine samples from an ambulatory pain management population were analyzed using GC-MS, Profile®-V MEDTOX Scan® POCT device (Burlington, NC), and a Beckman Coulter AU480® Chemistry Analyzer using EMIT® II Plus reagents (Beckman Coulter; Brea, CA). Drug classes on the Profile®-V included: amphetamines, barbiturates, benzodiazepines, buprenorphine, cocaine metabolite, methamphetamine, methadone, opiates, oxycodone, cannabinoids and phencyclidine. Drug classes on the AU480® included the same except without a methamphetamine-specific immunoassay.

Results (if a Case Study enter NA)
The results from GC-MS showed that 99% (99/100) of the samples were positive for one or more of the drug classes. Overall, the AU480® was 90% sensitive and 98% specific while the MEDTOX Scan® was 87% sensitive and 98% specific. Both devices exhibited variable performance across drug classes.
Neither the AU480® nor the MEDTOX Scan® detected fentanyl in five specimens.

Conclusion
POCT-UDS systems like the Profile®-V MEDTOX Scan® can provide good accuracy and may offer a time and cost benefit when compared to higher throughput analyzers like the AU-480®. Due to the low reference values of immunoassays, definitive testing such as GC-MS is recommended for use in the pain management population.
Who Keeps Changing My Results? - A Case of Heterophile Antibody Interference
Authors: Nwadukwe A H , Palamalai V 
Published: October 2024

Abstract

Introduction/Objective
Heterophile antibodies are known to cause interference in immunoassays leading to misleading results causing diagnostic confusion and unnecessary testing and/or treatment. Many clinically important analytes are tested using antibody-based assays, as such, these are prone to interference.

Methods/Case Report
We describe a case of a 73 year old male who was referred with history of hypocalcemia and his previous lab tests were suggestive for idiopathic hypoparathyroidism, Hashimoto’s disease and Addison’s disease raising physician concern for a possible Type 1 autoimmune endocrinopathy. One of his results (cortisol) was outside the analytical measurement range and hence the sample was diluted and tested again, but the result was much less than what was expected, prompting an investigation. Investigation for an interfering substance included serial dilution and analysis of the same sample for the same analytes by different methods (different immunoassay, mass spectrometry or both). Based on non-parallelism in serial dilution results, discordant results with other methods, and loss of interference after dilution it was determined that the most likely cause was a heterophile antibody.

Results (if a Case Study enter NA)
NA

Conclusion
Awareness of the possibility that interference by heterophile antibodies can lead to erroneous laboratory results is important to prevent unnecessary testing and inappropriate diagnosis/management.
Beyond the Surface: Uncovering the PML::RARA Fusion in Cytogenetically Cryptic and FISH-Negative Acute Promyelocytic Leukemia- A Case Report and Review of the Literature
Authors: Delikkaya B N , Morton A , Mikkilineni S , Gong J Z , Liu J 
Published: October 2024

Abstract

Introduction/Objective
Chromosomal t(15;17)(q22;q21), resulting in a fusion between the PML gene on chromosome 15q22 and the RARA gene on chromosome 17q21, is the cytogenetic hallmark of acute promyelocytic leukemia (APL). Conventional karyotyping, along with fluorescence in situ hybridization (FISH), can detect the PML/RARA rearrangements in up to 98% of APL cases. Reverse transcriptase-polymerase chain reaction (RT-PCR) is often used to confirm the initial diagnosis. APL with PML::RARA fusion, which is negative with FISH and conventional karyotyping approaches but positive with RT-PCR, is extremely rare. Herein, we report a de novo APL case that was positive by RT-PCR but negative by cytogenetics and FISH studies. A comprehensive review of the literature was also performed.

Methods/Case Report
A 23-year-old male presented to the ED for left upper extremity weakness 2 days after post- dental cleaning. Upon admission, he developed intracranial hemorrhage, necessitating urgent decompressive hemicraniectomy. Blood smear revealed promyelocytes; flow cytometric analysis showed a CD13+, CD33+, MPO+, CD117+, CD34-, and HLA-DR- abnormal cell population. STAT interphase FISH analyses for PML/RARA fusion and RARA break-apart were negative. A diagnosis of APL was made based on abnormal promyelocytes and characteristic flow cytometry findings. ATRA was immediately administrated. However, the post-operative course was complicated by significant coagulopathy, pancytopenia, and multi-organ failure, and the patient expired 7 days later. RT-PCR returned positive for PML::RARA long fusion transcript; the conventional cytogenetics study was uninformative. The clinical, pathological, and genetic features of 31 cases of FISH/Cytogenetics-negative APL harboring cryptic rearrangements of PML-RARA, detected by RT-PCR in the literature, have been reviewed. Various detection methods were also discussed.

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

Conclusion
Conventional cytogenetics, FISH and RT-PCR analysis are complementary studies for all clinical suspected APL cases. The clinicopathological characteristics also play critical roles in APL diagnosis when genetic confirmation of the PML::RARA fusion is unavailable.
Diagnostic workup of triple hit lymphoma by fine needle aspiration
Authors: Zhang L , Doan J V , Dinarvand P , Yared M , Zhang S 
Published: October 2024

Abstract

Introduction/Objective
Triple-hit lymphomas (THL) represent a rare and aggressive subset of high-grade B-cell lymphomas characterized by a triad of translocations involving MYC, BCL2, and BCL6. Patients with THL face poor outcomes when treated with the standard diffuse large B-cell lymphoma protocol. Thus, intensified regimens have emerged as a frontline strategy for managing these patients. Therefore, accurate diagnosis and molecular subclassification of these lymphomas are essential for guiding therapeutic decisions for these patients. Here, we report a case study detailing the diagnostic assessment of THL utilizing limited diagnostic material obtained through palpation-guided fine-needle aspiration (FNA).

Methods/Case Report
A 58-year-old male presented with a rapidly enlarging neck mass, accompanied by worsening dysphagia, pain, and fatigue over the course of two months. Laboratory testing showed leukocytosis and imaging studies revealed a partially necrotic, 7.8 x 9.1 x 9.4 cm right jugular nodal mass. The patient was referred to otolaryngology for further evaluation, where FNA of the mass was performed by the cytopathology team. The aspirate was sent for cytology with cell block and flow cytometry. The Romanowsky stain revealed abundant, large, discohesive cells with prominent nucleoli and scant cytoplasm with an abundance of lymphoglandular bodies in the background. Immunohistochemistry (IHC) on the cell block demonstrated BCL-2, BCL-6, and MYC expression, and a Ki-67 proliferation index &gt;95%. Concurrent flow cytometric analyses showed an aberrant B-cell population expressing CD19, CD20, CD22, CD23 and surface lambda light chain. Further fluorescence in situ hybridization (FISH) analysis performed on the cell block confirmed gene rearrangements in BCL2, BCL6 and MYC, thereby classifying this patient’s disease as THL.

Results (if a Case Study enter NA)
NA

Conclusion
Diagnosing THL typically demands sufficient tissue for histology, cytology, flow cytometry, IHC, and molecular testing. Herein, we showcase a notable example where the diagnostic evaluation of THL was accomplished using limited material obtained from FNA. This case highlights the efficacy of conducting comprehensive diagnostic studies even when tissue availability is constrained. Utilizing cytologic samples not only streamlines the diagnostic process but also minimizes the need for patients to undergo additional invasive procedures, thus potentially reducing delays in diagnosis and therapeutic intervention.
Case Report: Aspirated Airway Foreign Body Mimicking Endobronchial Mass: A Diagnostic Challenge
Authors: Salehiazar S , Mirzaei Baboli K , Chiu R , Yap C G 
Published: October 2024

Abstract

Introduction/Objective
Despite advancements in imaging modalities, identifying retained foreign bodies within the lung remains arduous. Detecting small foreign bodies is crucial as they can serve as a focal point for subsequent infections. Initial assessments may mimic malignancy. Herein, we present a case of a retained foreign body masquerading as an endobronchial mass, accompanied by unilateral pleural effusion and persistent hypoxia.
Subsequent bronchoscopy showed a pearly white endobronchial mass partially obstructing the segmental bronchus at the posterior basal segment of the right lower lobe of lung with accompanying right pleural effusion and atelectasis.

Methods/Case Report
This is a 58-year-old male with history of hypertension, deep vein thrombosis, transient ischemic attack, and a recent motor vehicle accident with blunt chest trauma. He had a thoracic spinal cord transection with grade III blunt thoracic aortic injury, developed anasarca, hypoxia, right pleural fluid requiring multiple thoracentesis, and right sided hemothorax requiring massive transfusion protocol. Subsequent evaluations, including bronchoscopic transbronchial forceps biopsies and bronchial wash and pleural fluid cytologic examinations showed no malignant cells. Repeat bronchoscopy was concerning for enlarging mass and obstruction. Bronchoscopy almost 2 months after MVA revealed an endobronchial foreign body (tooth) lodged in the left lower lobe of lung posterior segment.

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

Conclusion
While aspiration of foreign bodies into the tracheobronchial tree is not uncommon especially in children, foreign bodies, particularly teeth, are rare in adults. Bronchial foreign body aspiration may occur in trauma, with diagnosis typically relying on history and physical examination. Detection remains challenging despite imaging advancements, with implications including infection nidus formation. In our case, delayed diagnosis highlights the importance of considering unusual etiologies in persistent pulmonary pathology. Retrospective imaging analysis and CT findings suggested a foreign body, emphasizing the utility of imaging in suspected cases. Prompt surgical intervention is crucial to prevent complications such as recurrent infections.
Exploring Epidermodysplasia Verruciformis: A Case Report, Treatment Strategies, and Emerging Therapies
Authors: Christie-Nguyen P , Tschen J , mai B 
Published: October 2024

Abstract

Introduction/Objective
Epidermodysplasia verruciformis (EV) is a rare cutaneous disorder with both inherited and acquired forms. Inherited cases involve mutations in genes such as ERV1 and ERV2, crucial for HPV immunity, while acquired cases affect immunocompromised individuals. EV is linked to cutaneous squamous cell carcinoma (SCC), highlighting the need for prompt diagnosis and treatment.

Methods/Case Report
A 54-year-old HIV-positive man was referred with a persistent, itchy eruption on his forearms despite given ARV regimen, oral retinoids and topical therapies. Physical examination revealed hypopigmentation and hyperkeratotic plaques on both forearms. Histologic examination revealed large cells with blue-gray cytoplasm and perinuclear halo in the upper epidermis, consistent with EV. Although advised for papilloma virus vaccination and planned for a trial of topical cidofovir, the patient was lost to follow-up.
Treatment strategies for EV vary depending on lesion severity. Severe keratinized or precancerous lesions typically require surgical removal as the first-line approach. For early-stage EV with few small lesions, 5-FU, cidofovir, glycolic acid, and imiquimod is recommended. Tazarotene 0.5% cream used twice weekly has shown success in resolving lesions within 14 days. Topical imiquimod’s efficacy appears variable. In HIV-positive patients with EV, topical 1% cidofovir showed success in some cases. Systemic and topical retinoids are advised for diffuse lesions, with electrocautery or cryotherapy as options if initial treatments fail. HPV vaccination combined with oral acitretin, topical tretinoin and imiquimod led to lesion flattening. Continuous low-dose isotretinoin achieved prolonged remission of EV, but its efficacy in acquired EV remains unclear. Topical methyl aminolevulinate followed by photodynamic therapy has also shown promise.

Results (if a Case Study enter NA)
NA

Conclusion
Since its discovery in the 1970s, Acquired EV has been observed across diverse demographics, including HIV patients and organ transplant recipients. Advanced HPV typing and sequencing techniques aid in predicting SCC risk. Emerging treatments like topical cidofovir and combination therapies show promise, necessitating larger clinical trials for validation.
De-Differentiated Metastatic Melanoma: A Diagnostic Challenge
Authors: Raja F , ram B 
Published: October 2024

Abstract

Introduction/Objective
Melanoma is one of the common malignant neoplasms with several histological appearances. Its diagnosis is usually based on histomorphologic findings and immunohistochemistry (IHC). De-differentiated melanoma (DM) is a special form of malignant melanoma with different histo-morphologic and immunohistochemical characteristics than conventional malignant melanomas. It has a worse prognosis and can impose a diagnostic challenge.

Methods/Case Report
A 62-year-old male previously had melanoma on his chest, which was surgically removed with negative margins and no involvement of nearby sentinel lymph nodes. The patient presented two months later with a rapidly enlarging mass in the right axillary region. Subsequent lymph node dissection revealed several nodes, the largest measuring 14 cm with extensive necrosis. Microscopic examination of the largest mass revealed clusters of irregularly shaped cells displaying marked nuclear abnormalities, prominent nucleoli, and heightened mitotic activity. Immunohistochemical analysis of this mass showed negative results for SOX-10, HMB45, Melan-A, S100 protein, CAM5.2, BRAF, and myogenin. Conversely, the remaining lymph nodes exhibited typical signs of melanoma metastasis, expressing relevant melanoma markers. Given the patient’s history of melanoma and the presence of metastatic melanoma in nearby lymph nodes, the histological and immunohistochemical findings support the diagnosis of dedifferentiated cutaneous metastatic melanoma.

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

Conclusion
The distinctive appearance and lack of typical markers in this type of melanoma pose considerable difficulties in distinguishing it from other malignancies like poorly differentiated carcinomas and high-grade sarcomas. Furthermore, dedifferentiated melanoma tends to be highly aggressive, often resisting standard and immunological treatments. Therefore, comprehensive clinical and histomorphological assessments are crucial for accurately diagnosing these complex and challenging cases.
Implementation and reception of a semi-structured resident interview to improve equity
Authors: Hu Y , Bharani K , Amponsah A , Shane-Sanchez J , Janczewski O , Kao S , Lowe A C 
Published: October 2024

Abstract

Introduction/Objective
To improve equity and inclusion in the residency candidacy interview process, we collaborated with our human resources and graduate medical education colleges to develop standardized interview questions based on best practices reported in corporate and medical literature. These standardized questions were piloted by resident interviewers during the 2023-2024 Pathology residency application cycle in a semi-structured interview format.

Methods/Case Report
With consultants from the graduate medical education and human resources, we identified favored qualities of expectational candidates (e.g., passion for pathology, interest in program, collaboration, reliability, and compassion) and developed a list of standardized questions with a corresponding answer scoring guide to guide objective assessment of answers for each quality. Residents and fellows (“interviewers”) who volunteer to interview Pathology residency candidates (“candidates”) received training on interviewing best practices, identifying and mitigating bias, and the new semi-structured interview format at the beginning of the interview season. Interviewers were encouraged to use a semi-structured interview format where at least one standardized question is included in addition to their usual ad hoc interview questions and discussions. After the interview season concluded, we surveyed all interviewers (n=39) and candidates (n=90) who participated in this process, for feedback on the semi-structured interview process.

Results (if a Case Study enter NA)
31/90 (34%) applicants provided feedback about their interview with 15/29 (52%) applicants agreeing that the semi-structured interview format enhanced their experience. 20/31 (65%) applicants agreed that their impression of Stanford would be positively affected if all interviews were conducted in a semi- structured format. 24/31 (77%) think faculty members should use standardized questions while 17/31 (55%) think residents should use standardized questions in either a semi-structured or structured formats. 17/31 (55%) feel that structured interviews contribute to improving equity. 12/39 (31%) of current residents provided feedback about their interviews. All 12 (100%) respondents used standardized questions in a semi-structured interview format. 10/12 (83%) interviewers think the new format improves our resident interview process.

Conclusion
Overall, responses from both resident interviewers and applicants support the implementation of semi- structured interviews and the continuation and expansion of this initiative.
Adopting Covid-19 and Flu Testing Strategies In An Underserved Community
Authors: Li B , Donnachie E , Adebusuyi T , Meshack A , Poon I 
Published: October 2024

Abstract

Introduction/Objective
The COVID-19 pandemic has had a significant impact on communities worldwide, while little is known about how medically underserved minority communities perceive and experience COVID-19 and/or COVID- 19/Flu combined testing. This research target at a medically underserved community in east Harris County, Texas, and was designed to 1) understand the perception of the single COVID-19 test as well as the COVID-19 and flu combined test, 2) implement different testing strategies in collaboration with the local community.

Methods/Case Report
Residents in the eligible communities who are age ≥ 18 years or older are recruited through community engagement groups and community originations. Participant’s demographic information, perception and histories of vaccination and testing were collected through a cross-sectional questionnaire. Participants willing to undergo testing were assisted by community health workers, who then collected feedback on test acceptability via follow-up questionnaires.

Results (if a Case Study enter NA)
A total of 325 individuals participated in the study from Sept 2022-June 2023. 52% of participants are minority ethnicity, including 35% African American and 17% Latino. 11% of participants are uninsured and 32% of participants are from households with income lower than 25,000 a year. We surveyed our participants on their opinion of COVID-19 and Flu testing and vaccination, majority of our participants have had more experience in COVID-19 (92% had been tested and 93% had been vaccinated) than Flu (64% had been tested and 85% had been vaccinated). 96% consider COVID-19 testing tolerable, with major barrier of being tested is fear of painful sampling (49%). PCR testing is the dominant testing method in the community (&gt; 40%) for COVID-19, while only 16% received antigen testing.

Conclusion
Our findings suggest that while participants recognized the role of COVID-19 testing, there were significant barriers to access and uptake of testing, including concerns about painful sampling, inconvenience, and a lack of trust in the healthcare system. Participants also expressed a desire for clearer information about testing and more accessible testing sites. Participants have less experience with Flu testing and many of whom had never been tested in the past. Our study highlights the need for targeted community education and outreach efforts to increase testing uptake. Development and implementation of these efforts would better prepare us for combating other commutable diseases of public health significance in the future.
Benefits of Practicing Teaching as a Resident: A Single Institute Experience of a Formal Teaching Curriculum for Pathology Residents
Authors: Khatskevich K , Thompson C T , Baker T 
Published: October 2024

Abstract

Introduction/Objective
The practice of near-peer teaching, both in lecture style and small group formats, has been shown to have benefits for the educator in improving communication skills, gaining knowledge in a subject, and providing a tangible experience that may aid in applying for employment. The purpose of this study is to present the current curriculum and teaching opportunities at the Medical University of South Carolina (MUSC) and their impacts on developing pathology residents’ teaching skills and perceptions of their growth as educators.

Methods/Case Report
Data regarding curriculum format and learner surveys for various teaching programs at MUSC was gathered from residency program leadership and the MUSC College of Medicine. An anonymous survey was distributed to current MUSC pathology residents to assess their participation, current comfort level, and comfort level prior to the start of residency in regard to various teaching modalities.

Results (if a Case Study enter NA)
The resident curriculum offers teaching modalities such as small group co-leader for medical students, didactic presentations, and on-the-job teaching. On a Likert scale of 1 to 5, with 5 being very comfortable, residents reported an average comfort level with teaching before starting residency as 2.11 and a current comfort level with teaching as 2.67. Residents were split on their perception of what affect residency has had on their comfort in teaching. Medical student evaluations of their small group teaching sessions co-led by pathology residents averaged 77.6% approval per course.

Conclusion
Through providing an overview of required and voluntary teaching opportunities offered at one institute and residents’ perceptions on their experiences while teaching there, we hope to both provide curriculum examples for other institutions and to advocate for placing greater importance on providing opportunities for residents. Such opportunities to practice teaching help them develop skills to benefit them as pathologists and in their future employability.