bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Rare Case of Incidental Primary Follicular Lymphoma Co-Existing With Grade Group 5 Prostatic Adenocarcinoma
Authors: Bal S K , Odujoko O , Sieber S C , Gupta G , Beck E , Fiedler J 
Published: November 2023

Abstract

Introduction/Objective
Primary lymphoma of the prostate is an exceedingly rare entity comprising less than 0.1% of all prostatic cancers with follicular lymphoma making up only 12% of primary prostatic lymphomas. There is very limited literature owing to their rarity and underdiagnosis. To the best of our knowledge, prostatic adenocarcinoma with an incidental follicular lymphoma presenting as a prostate imaging reporting and data system 4 (PI-RADS 4) lesion on multiparametric magnetic resonance imaging (mpMRI) with mildly elevated serum prostate specific antigen (PSA) has not been previously described.

Methods/Case Report
A 73 year old male presented to Danbury Hospital for follow up on benign prostatic hyperplasia (BPH) diagnosed in 2020. The patient was experiencing nocturia and had a serum PSA of 4.8. Multiparametric MRI revealed an enlarged, 5.5 x 4.1 x 3.3 cm, prostate gland (estimate weight of 45.5 grams) with a
1.2 cm PI-RADS 4 lesion in the right anterior mid gland. There was no evidence of metastatic disease on his most recent body imaging. He was subsequently scheduled for prostate needle biopsy. Histopathology showed a high grade prostatic adenocarcinoma, with a Gleason score 4 + 5=9, along with a focally prominent dense lymphoid infiltrate in four of four cores from the same area of abnormality that was detected on mpMRI. The latter comprised of ill defined follicles and sheets of small cleaved atypical lymphoid cells consistent with centrocytes and very few centroblasts. By immunohistochemical staining, the atypical cells in lymphoid follicles and interfollicular areas were positive for CD20, CD10 and BCL2 and negative for cyclin D1. CD21 stain highlighted the follicular dendritic cell meshwork in the germinal centers with a low Ki67 proliferation index. A final diagnosis of low grade follicular lymphoma (grade1-2) coexisting with the prostatic adenocarcinoma was rendered. The patient is currently undergoing lymphoma staging as the treatment for adenocarcinoma is planned.

Results (if a Case Study enter NA)
NA

Conclusion
Primary lymphoma of the prostate usually presents with non specific obstructive voiding symptoms and normal or near normal PSA levels which makes it challenging for physicians to suspect lymphomas. The lymphocytic infiltrate, originally thought to be prostatitis, underwent further evaluation with immunohistochemistry due to its monotonous appearance, which clinched the final diagnosis. Careful evaluation of prostate core needle biopsies is necessary even after spotting carcinoma in order to rule out low grade lymphomas.
High-Grade Urothelial Carcinoma with Divergent Prostatic Differentiation Mimicking a Collision Tumor
Authors: Budina A , El-Sharkawy Navarro F , Vergara N , Nayak A 
Published: November 2023

Abstract

Introduction/Objective
High-grade urothelial carcinoma (HGUC) shows marked morphologic plasticity with many recognized histologic subtypes that may coexist within the same tumor. These pose a diagnostic challenge and should be distinguished from collision tumors, defined by the coexistence of morphologically and genotypically distinct tumors at the same anatomic site. Herein, we present the first case of HGUC with malignant prostatic differentiation mimicking a collision tumor in a bladder diverticulum.

Methods/Case Report
68 yo male presented with gross hematuria and was found to have a 2.2 cm tumor in a posterior bladder diverticulum. Initial transurethral resection (TUR) suggested HGUC, while re-TUR showed prostatic adenocarcinoma. Subsequent diverticulectomy specimen revealed two morphologically and immunohistochemically distinct tumor components: 1) a papillary component associated with urothelial carcinoma in situ, positive for CK903 and GATA3, and compatible with HGUC of the bladder, and 2) a distinct and intimately admixed malignant glandular component, which was GATA3 negative, but positive for markers of prostatic differentiation such as NKX3.1, PSA and PSAP and displayed prostatic duct adenocarcinoma features. Accurate diagnosis of this lesion is crucial, and a few possibilities exist: 1) a collision process between urothelial carcinoma of the bladder and a previously undiagnosed duct carcinoma of the prostate metastatic to the bladder diverticulum; 2) prostate cancer arising from an ectopic prostatic epithelium located in the bladder submucosa; 3) HGUC with malignant divergent prostatic differentiation. To this end, papillary and glandular tumor components were macrodissected and subjected to targeted massively parallel sequencing. Disease-associated variants in EGFR, DDR2, KMT2D, and RB1 were identified and were identical and shared among the two histologically distinct components. These findings suggest that the two components are part of the same neoplastic process and represent a urothelial carcinoma with divergent prostatic differentiation. Of note, the patient’s initial and subsequent PSA levels were within normal limits, and magnetic resonance imaging of the prostate was unremarkable.

Results (if a Case Study enter NA)
NA

Conclusion
Awareness of divergent differentiation in urothelial carcinomas has important diagnostic, prognostic and therapeutic implications and can be resolved with the use of ancillary and molecular studies.
Sclerosing Perivascular epithelioid cell neoplasms (PEComa), a rare variant in a unique family of tumors
Authors: Kokabee M , Zhong X , Sham S , Unger P , Grasso M 
Published: November 2023

Abstract

Introduction/Objective
Perivascular epithelioid cell neoplasms (PEComas) are a rare group of neoplasms that characteristically show both smooth muscle and melanocytic differentiation. The most common tumor in this family is renal angiomyolipoma but may occur in various sites. Sclerosing PEComa (S-PEComa) is an extremely rare variant. its only reported in females and it is usually an incidental finding in the retroperitoneum, in close proximity to the kidney.

Methods/Case Report
. We present a 52-year-old female, who had a chest CT scan for worsening cough. An - 4 cm exophytic renal mass in the left renal upper pole was found. Patient underwent left partial nephrectomy. Grossly the specimen consisted of 2.5 cm well-circumscribed, white tan mass, abutting the renal capsule, and extending into perinephric adipose tissue. Histology revealed uniform bland epithelioid cells with palely eosinophilic cytoplasm and round nuclei embedded in abundant densely sclerotic stroma. No fat was identified. Immunohistochemistry showed the tumor to be positive for desmin, HMB-45 and SMA with focal staining for AE1/AE3 and negative staining for EMA, cam 5.2, CD 117, calretinin, CD 34, S-100, PAX 8, and Melan A, which confirming the diagnosis of S-PEComa.

Results (if a Case Study enter NA)
NA

Conclusion
PEComas, excluding the epithelioid variant, usually has a benign course. In the 13 cases previously reported S-PEComa, 2 patients had metastasis. Our patient, 3-month post-op, has no evidence of disease, but close follow up still warranted.
Primary Endometrial Carcinoma with Signet Ring Cells: A Rare and Unusual Entity
Authors: Hoang J M , Masand R P 
Published: November 2023

Abstract

Introduction/Objective
The presence of signet ring cells in an endometrial tumor is suggestive of metastasis, as primary tumors with this morphology are extremely rare. As a result, primary tumors are a diagnosis of exclusion, defined by the presence of signet-ring cells usually associated with mucinous endometrioid carcinoma without clinical or radiographic evidence of metastases from breast, stomach, or colon.

Methods/Case Report
A 64-year-old woman presented with vaginal bleeding. Ultrasound showed a large, heterogenous uterine mass that was diagnosed as poorly differentiated carcinoma on biopsy. Serum CEA was elevated, and CA-125 was normal. Hysterectomy with salpingo-oophorectomy showed a minor endometrial component of grade 3 endometrioid carcinoma and a predominant component of poorly differentiated carcinoma with signet ring cells. The myoinvasive component consisted of the signet ring cells with pools of acellular mucin. Extensive lymphovascular invasion was noted. Cervix, adnexa, and lymph nodes were free of disease.
The signet ring cells were positive for CK7, CK20, and CDX2, and negative for ER and Pax-8. The endometrioid component was positive for ER, Pax-8, and CK7, and negative for CK20 and CDX2. E-cadherin staining was lost in the myoinvasive component of the tumor. Loss of MLH1 and PMS2 nuclear expression was seen, and MLH1 promoter methylation was detected in both components of the tumor.
Subsequent colonoscopy and imaging did not reveal any other disease sites. Based on histology, pattern of uterine involvement, and lack of extrauterine disease, a diagnosis of primary poorly-differentiated endometrial adenocarcinoma with signet ring cell features was made.
The patient was treated with adjuvant chemotherapy and is currently being followed.

Results (if a Case Study enter NA)
NA

Conclusion
We present a rare case of primary signet ring carcinoma of the uterus, a challenging diagnosis made after extensive work-up to rule out metastases. Of the previous 9 reported cases, only one was similar to our tumor with distinct endometrioid and signet ring components. Although these primary endometrial tumors are unified by the presence of signet ring cells, there is considerable immunohistochemical heterogeneity. Some reports suggest the signet ring cells have a Mullerian phenotype, while others, including our case, suggest a gastrointestinal phenotype. In presenting this case, we hope to contribute to this entity’s characterization and bring further awareness that the presence of signet ring cells does not exclude a uterine primary.
A Large Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of Buccal Mucosa: Report of A Rare Case
Authors: McGowan L A , Xu Y , Feng Z , Hernandez D J 
Published: November 2023

Abstract

Introduction/Objective
Liposarcoma is not common in the head and neck, and extremely rare in the oral cavity: 7% occur in the head and neck and 0.3% in the oral cavity. We report an atypical lipomatous tumor/well-differentiated liposarcoma (ATL/WDL) of the buccal mucosa with recurrence.

Methods/Case Report
A 66-year-old female presented with a right facial mass that had been present for over 10 years and resected 6 times as lipoma in her home country. The mass had grown since the last resection two years ago. Computerized tomography of neck soft tissue displayed a heterogeneous 11 cm mass with fat density in the right buccal mucosal spaces, and a 4.8 cm connecting solid nodule in the right pharyngeal mucosal space. Complete resection of the mass/nodule was performed. Grossly, the specimen consisted of two nodular masses (separately cut during operation), 13.1 cm and 7 cm, respectively. The cut surfaces of the masses revealed yellow fatty tissue with focal fleshy areas corresponding to the nodule with solid density by imagining. Microscopically, the squamous mucosa had a lipomatous tumor composed of sheets of well-differentiated adipocytes that infiltrated the underlying and surrounding skeletal muscle and connective tissue. Upon extensive sampling, scattered lipoblasts were found in relatively cellular areas. The nonlipogenic stromal cells with nuclear pleomorphism were seen in the fibrous/solid areas. No mitosis or necrosis was identified. MDM2 amplification was detected by fluorescent in situ hybridization (FISH). These findings support the diagnosis of recurrent ATL/WDL.

Results (if a Case Study enter NA)
NA

Conclusion
We demonstrate the histological features of a large atypical lipomatous tumor/well-differentiated liposarcoma of buccal mucosa. Extensive sampling of the specimen to identify the lipoblasts and atypical stromal cells, and MDM2 FISH study on suspicious cases are the keys to achieve accurate diagnosis. The high recurrence rate of this entity in the head & neck region exhibited in this case warrants the need of long-term follow-up.
Mammary Analog Secretory Carcinoma (MASC) of the oral mucosa with proven ETV6- NTRK3 fusion gene as the gold standard for diagnosis – A case series and literature review
Authors: Hussain M , Zenezan D , Khouri K , Kuklani R , Proca D 
Published: November 2023

Abstract

Introduction/Objective
Mammary Analog Secretory Carcinoma (MASC) is a rare type of cancer that occurs in the salivary glands. It is named after its similarity in appearance and behavior to secretory carcinoma of the breast. The incidence of MASC is estimated at 0.3%, with less tha 500 cases reported.
The diagnosis of MASC is based on a combination of clinical, radiographic, and histopathologic features. Prognosis is generally good, with a low risk of recurrence and metastasis; its differential diagnosis includes: acinic cell carcinoma, adenocarcinoma (primary or metastatic), mucoepidermoid carcinoma, and low-grade cribriform cystadenocarcinoma.
MASC is characterized by ETV6-NTRK3 fusion gene, a translocation between the ETV6 gene on chromosome 12 and the NTRK3 gene on chromosome 15, leading to the fusion of these two genes and the production of a chimeric protein. FISH testing can detect the presence of the ETV6-NTRK3 fusion gene.
The detection of the ETV6-NTRK3 fusion gene is highly specific for MASC and can aid in the diagnosis and management of this tumor. In addition, the presence of this gene fusion can have implications for targeted therapy, as drugs that target the NTRK3 gene may be effective in the treatment of MASC.

Methods/Case Report
This review aims to compare the characteristics of MASC in cases we diagnosed since 2015.

Results (if a Case Study enter NA)
Cases
Case 1 (2015)
68yo Female
Right Lower Lip, Biopsy
Positive: S100, PAS with and without diastase and mammaglobin Negative: Mucicarmine
ETV6 +
Case 2 (2016)
54yo Female
Right Buccal Mucosa, Biopsy Positive: S100, Mammaglobin Weakly positive: p63
ETV6 +
Case 3 (2016)
42yo Male
Right Buccal Mucosa, Biopsy Positive: S100, Ck7, Ck5/6, Vimentin Weakly positive: GFAP, p63 Negative: SMA, MSA, Calponin ETV6 +
Case 4 (2018)
60yo
Female
Left Soft Palate, Biopsy Positive: CK7
Weakly positive: GATA-3
Negative: CK20, TTF-1, CDX-2, Napsin A ETV6 +
Case 5 (2019)
57yo Female
Right Palatal Mucosa, Biopsy Positive: S100, Ck7, Ck5/6, Vimentin Negative: p63, GFAP, Calponin, SMA ETV6 +

Conclusion
MASC is a very rare salivary gland tumor and the gold standard for its diagnosis is FISH for ETV6 gene rearrangement. All our cases showed ETV6- NTRK3 fusion gene, while 80% (4/5) of the patients were females. S100, mammaglobin and PAS were positive in all tested cases, consistent with previous reports. The histopathological diagnosis of MASC on a biopsy can be challenging; although immunohistochemical stains and morphology may be helpful hints, FISH testing should be considered when MASC is suspected.
MatchToPath.com: A Free Online Informative Platform to Help Applicants Navigate Pathology Residency Application Process
Authors: Baskota S , Herman M , Lopez-Nunez O , Chauhan A , Mirza K M , Jones T 
Published: November 2023

Abstract

Introduction/Objective
Information on how to apply to pathology residency in the US has traditionally been spread by word of mouth, with applicants relying on faculty contacts or their colleagues who have previously matched into the specialty for advice. However, not all pathology applicants have access to these resources, particularly international medical graduates or osteopathic medical students that may not have a pathology department at their home institution. We created MatchToPath.com as a free, online platform featuring informative webinars, blog posts, and podcasts on how to successfully apply to pathology residency in the US.

Methods/Case Report
Website (www.matchtopath.com) traffic from January 1, 2022 to December 31, 2022 was monitored using SquareSpace (New York, NY) analytics. Six live webinars were conducted from the period of February 1, 2022 to May 1, 2023, with registrant and attendee data collected from Zoom account reports. The average number of registrants, attendees, and the attendees/registrant ratio was calculated.

Results (if a Case Study enter NA)
During this time frame, the website received 1,889 total visits, with 45% representing direct navigations to the site and 34%, 7%, and 7% representing links to the site from Twitter, Facebook, and Google, respectively (Figure 1). The site was viewed internationally, with the highest traffic originating from the US (1,398 visits; 73.3%), Nepal (94; 4.93%), and Turkey (49; 2.57%) (Figure 2). The “Blog Entries, Surveys, and More” page had the most (52%) views, followed by the homepage (24%) and the webinars page (17%).
The six live webinars had average registrant rate of 88.3% (range: 54-120). Average attendees who attended our live webinar series is 58.6% (range 37-76). The average ratio of attendees/registrants is 58.6 (range: 59.1-112.9). The recorded webinars released on the website demonstrated 43-147 views (as of May 8, 2023).

Conclusion
MatchToPath.com is a novel online platform with a global presence that provides pathology residency applicants with a database of informative advice in the pathology Match process.
Evaluation and Modeling of Factors Associated with Drug Testing Appointment Absences
Authors: Xu R , Warrington J , Nowak S 
Published: November 2023

Abstract

Introduction/Objective
Why doesn't a patient show up for their appointment? Is it associated with the required travel distance? Urine drug testing clinics often observe patients' scheduled visit absenteeism and record the behavior on their profiles; these records were used to answer the question and explore other potential explanations.

Methods/Case Report
With a well-developed electronic health data system, a retrospective study was performed on a large data set collected across the US with more than half a million patient encounters to verify if our theories matched the statistical results. In addition, since the dataset was collected between January 2019 and December 2021, it has nearly a year of quarantine; thus, pandemic status was also analyzed as one variable. Patient demographic information (gender, race, and age), claimed drug use, participating programs, scheduling method, assigned risk of relapse, and collection site were included in the study too.

Results (if a Case Study enter NA)
For all required travel distance ranges, 40% of patients had unexplained absence on the record, and the frequency of missed appointments increased significantly (p &lt; 0.001) by geographic distance from a clinic, including long distance (&gt;20 miles) and walking distance (between 0-2 miles). Automated scheduling methods also demonstrated higher rates of missed appointments than manually scheduled visits. All demographic differences provide significant (p &lt;= 0.001) but minimal effects on missed appointments. The overall rate of missing test appointments during the pandemic was higher and returned to pre-pandemic levels in 2021. Factor analysis of mixed data was used to give a clean and easy interpretation of the data set.

Conclusion
The required travel distance had an interesting impact on patient absenteeism rate; it increases the rate for both long and short walking distances. This study provides an empirical basis for healthcare providers to personalize service plans when scheduling patients’ visits.
Demonstrable Equitable Access of Testing for Metastatic Prostate in a Veteran Affairs Medical Center (VAMC)
Authors: Dalal S , Petersen J M , Jhala D 
Published: November 2023

Abstract

Introduction/Objective
Prostate adenocarcinoma that has metastasized carries a significantly worse prognosis than prostate adenocarcinoma that is contained within the prostate. When there are metastases outside of the prostate, biopsies to diagnose this metastasis can help direct management and treatment of the patient. While there are known differences in the incidence of prostate cancer between different ethnic groups and differences in ethnic access to care and diagnosis varies widely between distinct medical practices, the ethnic access to biopsy diagnoses for metastatic lesions particularly in a Veteran population has not been well studied.

Methods/Case Report
A retrospective study was performed on cases from December 2019 to October 2022 to identify cases of metastatic prostatic adenocarcinoma seen at the Veteran Affairs Medical Center (VAMC). A comparison with the census data of the metropolitan area whereby the VAMC was located was also performed.

Results (if a Case Study enter NA)
A total of 21 cases demonstrating metastatic prostatic adenocarcinoma were found. The ethnic distribution of the cases included 12 African Americans (57%), 7 Caucasian Americans (33%), and 2 of unknown ethnicity (10%). The census of the metropolitan area where the VAMC was located demonstrated a general population ethnic composition of 43.6% African American and 44.4% Caucasian American.

Conclusion
The ethnic distribution of patients with pathology specimens demonstrating metastatic prostate adenocarcinoma is not significantly different than the census of the involved metropolitan area, demonstrating equitable access to biopsy diagnoses for metastatic lesions in patients with metastatic prostatic adenocarcinoma.
EFFECT OF EDUCATION FOR THE CLINICAL USAGE OF FRESH FROZEN PLASMA
Authors: Haeggstroem M , Asad M , Fiedler P , Pathan N 
Published: November 2023

Abstract

Introduction/Objective
Plasma is generally transfused to replenish coagulation factors to stop bleeding. It is processed as “Fresh Frozen Plasma” (FFP), wherein units are frozen within 8 hours of collection from the donor for storage, and thawed in a 30-37 C water bath before usage. The Association for the Advancement of Blood & Biotherapies (AABB) recommends a dose of 15 ml/kg plasma in adults, and one unit of FFP is 200-250 ml in volume. Plasma units are recommended to be transfused within 6 hours at a rate of 2-3 ml/kg/hour. At Danbury Hospital, Connecticut, there has been a tendency of clinicians to order only one unit of FFP, however, the recommended dose is at least two units. The exact incidence of one unit of FFP usage was not well known before the initiation of this study. This retrospective study aimed to focus on the incidence of the administration of single unit FFP and estimate the effect of education to clinicians regarding the recommended dosage of FFP.

Methods/Case Report
Inappropriate quantity was defined as the administration of only 1 FFP dose given more than 6 hours from any other FFP dose(s), either before or after. The study included all patient cases with orders of fresh frozen plasma at Danbury Hospital, Connecticut, from Dec 1, 2020 to April 30, 2022. Patients under 18 years of age were excluded from the study. Education was provided continuously during the time period through telephone calls.
Data was gathered both from blood bank records and the electronic medical record system. Trend analysis was performed on the incidence of recommended versus inappropriate dosage over the time period.

Results (if a Case Study enter NA)
94 patients were given FFP at Danbury Hospital, Connecticut, from Dec 1, 2020 to April 30, 2022. There were 49 instances of an inappropriate dose of FFP given more than 6 hours from any other FFP dose(s), resulting in a rate of 0.52 instances of inappropriate doses per patient. The rate of inappropriate doses of FFP per patient was 0.53 during the first half of the time period studied, and 0.52 during the second half. There was no significant trend in the rate of FFP doses per patient during the time period (P value: 0.9998).

Conclusion
We did not find a statistically significant change in the fresh frozen plasma (FFP) orders at our institution despite the education of clinicians by telephone contact. A robust systematic education of clinicians with digital order entry forms to actively motivate clinicians for at least two units may be required to result in a significant change in clinician practice.