bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fine Needle Aspiration and Core Biopsy of Liver Mass as First Time Diagnosis of Sarcomatoid Anaplastic Thyroid Carcinoma, A Rare Malignancy Presenting at an Unexpected Body Site
Authors: Kamashki A , Rivera M , Sturgis C 
Published: November 2023

Abstract

Introduction/Objective
Anaplastic thyroid carcinoma (ATC) is a fatal malignancy. We report an unusual case of a patient with ATC whose chief complaint and clinical history were listed as “jaundice and liver mass” without mention of disease in the neck.

Methods/Case Report
A 66-year-old female presented to the emergency department with worsening “yellow-green skin discoloration” for a few weeks. She also reported worsening dyspnea and recent dysphagia with solid foods, fatigue, abdominal pain and recent hemoptysis. Physical examination revealed conjunctival icterus, jaundice, a tender neck mass, right upper chest wall tenderness and palpable lymphadenopathy in the lower neck. Assessment notes indicated inability to carry out self-care and being bedridden, even though she reported having been active, swimming and cycling, up to one month before her presentation.
Computed tomography studies confirmed findings compatible with widespread malignancy with mass lesions in her
liver, lungs, adrenals, kidneys, neck, pancreas, gallbladder, and brain. Mild anemia, hemoglobin 10.5g/dL, mild leukocytosis, leukocytes 17,000/mm3, were confirmed. Bilirubin was 15µmol/L, and hepatic enzymes were elevated. An ultrasound-guided liver biopsy was performed and evaluated for cytologic features, histologic features and pattern of immunoreactivity. The combined cytomorphologic and histologic features were those of a pleomorphic sarcomatoid high-grade malignancy with variably spindled to epithelioid morphology and associated necrosis.
Immunohistochemical studies performed on sections from the accompanying core biopsy confirmed the malignant cells to be positive with CK-AE1/AE3, CK 7, TTF-1, GATA3, PAX8, SATB2, and BRAF V600E. The malignant cells were nonreactive with CK 20, thyroglobulin, calcitonin, napsin, CDX2, PCEA, and ER.
The combined clinical setting, imaging findings, cytomorphology, histomorphology and ancillary testing results together allowed for a specific diagnosis of metastatic anaplastic thyroid carcinoma. The patient was referred for palliative care services and died within a few days of diagnosis.

Results (if a Case Study enter NA)
NA

Conclusion
Metastatic disease from a sarcomatoid ATC, as diagnosed in this case, is an important differential diagnosis to keep in mind when an elderly patient presents with multisite metastases from an undefined primary source. Clinical, radiological and laboratory correlations are of paramount importance in correlating with cytomorphology/histomorphology and in helping to determine the best panel of IHC studies to consider.
A Skin Inflammatory Myofibroblastic Tumor Penetrates Through Skull To The Dura: A Case Report
Authors: Xian L , Wei E 
Published: November 2023

Abstract

Introduction/Objective
Inflammatory myofibroblastic tumor (IMT) is currently accepted to be a true neoplasm with a wide spectrum of biological behavior, varying from benign lesions to the rare tumors which are multifocal and prone to recurrence. IMT is characterized by a proliferation of myofibroblastic spindle cells with an inflammatory infiltrate. It was first described in the lung and later on reported in various sites such as stomach, intestine, spleen, bone. Here we report a rare IMT case in that the tumor penetrates through skull and extends to the dura.

Methods/Case Report
A 29-year-old female presented with a slowly progressive upper head scalp mass of one-year duration. Magnetic resonance imaging showed a soft tissue mass that extended through the skull and into the dura. Patient denies headache, syncopal episodes, neck pain, back pain, radicular symptoms, weakness, ataxia, nausea, vomiting, bladder or bowel incontinence, saddle anesthesia, or changes from baseline hearing, vision, or speech.
Grossly, serial sectioning of the scalp skin specimen revealed a well-circumscribed mass lesion with white, firm, and homogeneous cut surface, with no hemorrhage or necrosis identified. The lesion measured 7.0 x 6.5 x 1.7 cm in greatest dimension. The lesion involved the deep margin and extended to the skull and dura. On histopathological examination, the lesion was composed of variable admixture of spindle cells with eosinophilic cytoplasm and inflammatory cells comprising of plasma cells and lymphocytes. The spindle cells were positive for smooth muscle actin, CD10 (partial), and negative for AE1/AE3, ALK–1, CD34, CD68, CD117, Desmin, Myogenin, p53, S-100, and SOX-10. The Ki-67 showed a spindle cell proliferation index at about 2%. The patient successfully went through surgery and was followed up without complications.

Results (if a Case Study enter NA)
NA

Conclusion
Our case showed a rare IMT case harboring histologically benign features like low cellularity, minimal nuclear atypia, and low proliferative index, but demonstrating locally very aggressive biological behaviors. Complete surgical resection and close follow up are suggested to avoid recurrence. Further studies are needed in this field to design in-depth investigation for accurate diagnosis and better clinical outcomes.
Like, Share, and Follow! Analysis of the Use of Social Media by Pathology Residency Programs
Authors: Khatskevich K , Baker T , Hartman C , Cha J , Nguyen A , Mason A 
Published: November 2023

Abstract

Introduction/Objective
To establish the patterns of social media usage across Facebook, Twitter, and Instagram for pathology residency programs and departments from January 2018 to August 2022. To our knowledge, this is the first study of its kind focused on pathology residency programs.

Methods/Case Report
A list of pathology residency programs was compiled from National Resident Matching Program data. Websites for pathology residencies and major social media platforms were searched for pathology program accounts. The date of creation, number of followers, and number of likes were tracked for each program’s account(s). Each post between January 2018 and August 2022 was categorized according to the content (i.e resident life, education, research announcements, etc.), the number of likes, comments, and shares. Data collection is ongoing with future plans to compare posts and social media popularity between programs based on residency program size, prestige, and geographic location.

Results (if a Case Study enter NA)
Preliminarily 86 residency programs and 110 social media accounts were identified. There was an increase in social media posts between 2018 and 2022 with Twitter being the most utilized platform. The most commonly posted content category was pathology education, particularly on Twitter. Programs can use this information to create education-based posts or expand on existing teaching programs through social media. While educational posts had the most likes on Facebook, posts focused on the MATCH (the process in which medical students are accepted into a residency program) garnered the most likes on Twitter and Instagram.

Conclusion
A closer look into how residency programs are using social media and the relative success of posts could be used to increase visibility of residency programs as the resident recruitment process continues to be conducted virtually. The prevalence and popularity of education-focused posts shows that social media is an effective platform to teach pathology and is well received by viewers. Future research can focus on how pathology residency social media posts may have impacted residents, students, and other social media consumers on their decision to apply or to attend a program and/or interest in pathology.
Chronic Myeloid Leukemia Presenting with Mixed Phenotype B/Myeloid Blast Phase: A Diagnostic Challenge
Authors: Rivera D , Shirai S , Moosvi A , Wahed M A , Armstrong J A 
Published: November 2023

Abstract

Introduction/Objective
Chronic myeloid leukemia (CML) is typically identified in chronic phase, however about 5% of cases present in a more advanced phase. In blast phase (BP), the blasts are most commonly of myeloid lineage, less commonly lymphoid, and rarely mixed lineage cases are encountered. A mixed phenotype at presentation raises the possibility of a de novo mixed phenotype acute leukemia (MPAL) with BCR::ABL1 fusion and requires careful correlation with ancillary studies to confirm the diagnosis.

Methods/Case Report
The patient is a 60-year-old man who presented with leukocytosis, anemia, normal platelet count, and blasts identified on peripheral blood smear examination. A bone marrow biopsy demonstrated hypercellular marrow and a dimorphic population of large and small blasts, comprising nearly 70% of cellularity. Flow cytometry demonstrated distinct myeloid and B-lymphoid blast populations, both of which expressed CD13 and TdT. Interphase fluorescence in situ hybridization (FISH) showed the BCR::ABL1 fusion in more than 90% of nuclei, including segmented nuclei, and conventional cytogenetic studies showed t(9;22)(q34.1;q11.2) in 19 of 20 metaphases.
Molecular studies demonstrated the minor BCR::ABL1 p190 transcript, as well as ASXL1 and dual RUNX1 mutations. The discrepant number of BCR::ABL1 positive cells by FISH and conventional cytogenetic studies compared to the proportion of blasts, and its presence in segmented nuclei, enabled a diagnosis of CML with mixed phenotype blast phase despite absence of features such as basophilia or significant granulocytic left shift.

Results (if a Case Study enter NA)
NA

Conclusion
We share this case of CML in mixed phenotype blast phase to highlight the importance of careful evaluation in distinguishing this rare presentation from de novo MPAL, particularly with BCR::ABL1 fusion. Features such as a disproportionate number of nuclei or metaphases carrying the t(9;22) translocation on FISH or conventional cytogenetic studies and the presence of BCR::ABL1 in mature granulocytes can be helpful when other morphologic features of CML are absent.
Angioimmunoblastic T-Cell Lymphoma with Concurrent EBV Viremia: A Challenging Case
Authors: Ak S , Wang W , Wahed M A , Armstrong J A 
Published: November 2023

Abstract

Introduction/Objective
Angioimmunoblastic T-cell lymphoma (AITL) represents only 1-2% of all non-Hodgkin lymphomas but is one of the most common non-cutaneous T-cell lymphomas. Although typically associated with latent Epstein Barr Virus (EBV) infection, recent studies have demonstrated the presence and prognostic impact of EBV viremia at the time of diagnosis. Here, we present a case of AITL in which the diagnosis was complicated by EBV viremia.

Methods/Case Report
A 41-year-old male presented to our hospital with generalized abdominal pain, diffuse lymphadenopathy, hepatomegaly, ascites, and diffuse body wall edema. A recent retroperitoneal lymph node biopsy reportedly demonstrated features suggesting an infectious process, and EBV PCR revealed a viral load of 141,050 copies/mL.
A left axillary lymph node was excised, which demonstrated vascular proliferation and diffuse architectural effacement by a polymorphous infiltrate including variably sized lymphocytes with moderate to abundant clear cytoplasm, and occasional admixed neutrophils, plasma cells, and eosinophils. Immunohistochemical staining demonstrated an atypical CD4-positive, CD7-negative T-cell population in a vaguely nodular distribution, expressing Bcl-6, PD-1, ICOS, and CXCL13 without definite CD10 expression. CD21 immunostaining demonstrated markedly expanded follicular dendritic cell meshworks in a distribution similar to the atypical T-cell population. No B-cell or cytotoxic T-cell proliferation was seen, and in situ hybridization for EBV-encoded RNA (EBER ISH) demonstrated only scattered EBV- positive cells. Taken together, these findings supported a diagnosis of AITL over an atypical reaction to EBV infection. Next-generation sequencing demonstrated mutations in TET2, IDH2, and RHOA, further confirming the diagnosis.

Results (if a Case Study enter NA)
NA

Conclusion
AITL manifests with a diverse range of clinical symptoms and pathological features and may mimic infection. Additionally, acute EBV infection is well-known to mimic various lymphomas and has rarely been reported to mimic AITL. We present this case to raise awareness of the concurrent presentation of AITL with EBV viremia and to highlight features that may be helpful in distinguishing between the two.
Expression of PD-L1 in human placenta and retained product of conception of early pregnancy loss
Authors: Singh K K 
Published: November 2023

Abstract

Introduction/Objective
Immune surveillance evasion and impeding rejection by the maternal immune response system are elemental in sustaining foetal development. The exact mechanism behind this paradoxical immune response remains unclear. Since the trophoblast directly interacts with the maternal immune-environment, these cells must have some contribution to local immunosuppression. The programmed death-1 receptor and its ligands (PD- 1/PDL1)illustrates a novel regulatory-costulatory pathway that plays a major role in establishing peripheral tolerance. It was recently proved that PDL1 is expressed at the feto-maternal interface is necessary for maintaining feto-maternal tolerance.
We undertook this study to determine the expression-pattern of PD-L1 in formalin-fixed paraffin embedded tissues of human placentas in third trimester and retained product in early spontaneous abortions.

Methods/Case Report
Clinical history were recorded. The H&E sections of 40 placenta & 20 RPOC cases were examined. After evaluation appropriate sections were selected for IHC examination using anti-PD-L1 antibodies of Lab-vision and Biogenic

Results (if a Case Study enter NA)
Main focus of study was to see expression of PD-L1 at feto-maternal interface. 30 out of 40 third-trimester placenta expressed PD-L1 immunohistochemistry (13, 11 and 6 cases showed intense, fair and weak positivity respectively on outer surface of syncytiotrophoblast). 2 out of 20 early pregnancy loss cases in 11 & 9wk gestation expressed PD-L1 positivity.

Conclusion
Fetal cells in direct contact with maternal blood villous syncytiotrophoblast are major source of PD-L1 at the maternal-fetal interface and may utilize these immuno-suppressive mechanisms to ensure tolerance of conceptus. Failure to adapt this mechanism can lead to pregnancy loss.
Comparative study of total antibody titer against SARS-CoV-2 spike protein between male and female COVID- 19 patients of different age groups in UAE
Authors: Rashid Z , Ullah R , Yousaf M , Rajabudeen A , Ur Rehman M , Sajjad Naqvi S , Ul Ain Q , Ammad M , Arshad N , Al Yafei Z , Noorul Hasan T , Hussain A 
Published: November 2023

Abstract

Introduction/Objective
Currently, there is increasing evidence that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes men to experience more serious symptoms and have a higher mortality rate than women, but the associations between gender and age groups are still elusive. This study aimed to examine the associations with age, gender, and clinical parameters of total antibody responses against the spike protein of SARS- CoV-2 after infection in UAE population.

Methods/Case Report
In this study, spike protein antibody titer estimation for COVID-19 positive individuals (n = 1070) was determined. A cross-sectional study design was planned in which patients were divided into nine groups (based on their age) and further subdivided into two groups based on their genders (9 x 2). Serum was collected from the patients after 17 days of diagnosis as COVID-19 positive by RT-PCR method. Concentrations of SARS-CoV-2 Total antibody (COV2T) were measured by chemiluminescent immunoassay using ADVIA Centaur® XPT systems.
We used a mixed effects model to investigate the potential associations of antibodies by bootstrapping t-tests of the putative effects of gender and age of the individuals.

Results (if a Case Study enter NA)
There were significant differences (P&lt; 0.05) between males and females for SARS-CoV-2 total antibody reactivity. Total 645 (50.4%) male were found reactive compared to 425 (31.2%) female. Noteworthy, the group having middle-aged (41-50 years) participants depicted a higher antibody titer in both males and female against SARS-CoV-2. A significant decrease in titers also observed with different age groups. Highest number of reactive individuals were observed in 41-50 years age group (31%), followed by 31-40 years (27.34%), 51- 60 years (15.21%) and 21-30 years (13.04%). Same pattern of number of reactive individuals was found in male and female of different age group. Moreover, despite there being a weak significant positive association between age and total antibody titre in male patients, while there was no significant correlation between gender and age for the antibody response.

Conclusion
In a nutshell, total antibody (COV2T) reactivity was found significantly associated with male group and that was highest in 41-50 years age group, irrespective of the gender. These findings are crucial to treat and care for male and female patients infected with COVID-19 at hospitals.
Breaking Barriers in Pathology Education: Embracing the Straight Path to Reform
Authors: Saxena R , Shaw A , Skildum A 
Published: November 2023

Abstract

Introduction/Objective
The field of pathology and preclinical education is undergoing significant changes, with a shift towards student-centered approaches that emphasize self-directed learning. One such approach is case-based learning, which promotes active engagement and critical thinking. Technological advancements, such as digital pathology and radiology, offer several advantages in facilitating case-based learning.

Methods/Case Report
In this study, we implemented a unique educational strategy that combined digital pathology and radiology resources with case-based learning and team-based learning methodologies. Our approach involved designing and delivering modules, and subsequently collecting feedback from participants.

Results (if a Case Study enter NA)
Significant findings indicate that the integration of digital pathology and radiology has been highly appreciated by students. The majority of students acknowledged that it effectively aligned with the learning objectives. The survey responses also revealed the successful integration of early holistic pedagogy, the development of team-working skills, and the delivery of authentic and challenging clinical problems. These outcomes greatly contributed to achieving the desired learning outcomes.

Conclusion
The utilization of digital pathology and radiology resources, alongside well-designed modules, has proven successful in providing long-term access to educational materials and optimizing the presentation and systematization of the learning environment. Our innovative case-based study design, complemented by team-based learning, addresses the current demands of pathology concepts and modern curricula, facilitating a seamless transition into the clinical years. This approach holds great promise for enhancing the effectiveness of pathology education.
Correlation Between Large-Scale Health System Operational Parameters and Laboratory Test Utilization
Authors: Zhou Y , Windham A K , Staker C , Whitted M , Brimhall B , Podichetty A 
Published: November 2023

Abstract

Introduction/Objective
The extent of correlation between clinical laboratory test utilization and large-scale operational parameters would be helpful to adjust for these parameters when benchmarking utilization.

Methods/Case Report
We compared clinical laboratory and imaging utilization over 3 years (2019-2021) for adult patients hospitalized for specific surgical, medical, and obstetrics diagnoses at multiple academic hospitals (N=58; 625,436 hospitalizations) ranging in size from 250-1300 hospital beds. We queried the Vizient Clinical Data Base with permission from Vizient, Inc.® employing Medicare Severity Diagnosis Related Groups (MSDRG), used by the US Centers for Medicare and Medicaid Services (CMS), to identify hospitalizations for gastrointestinal (GI) surgery (MSDRG triplet 329/330/331), sepsis (MSDRG triplet 870/871/872), and vaginal delivery (MSDGR triplet 805/806/807). We stratified patients within each diagnostic group for comorbid conditions and complications into high, moderate, and low severity groups. We compared mean laboratory tests and Resource Intensity Weight (RIW) per hospitalization and hospital day. The RIW is based on the CMS Ambulatory Payment Classification (APC) weights.
We measured correlation of laboratory utilization with hospital bed size as well as annual discharges (sepsis group), surgical procedures (GI surgery group), births (vaginal delivery group), and diagnosis-specific discharges.

Results (if a Case Study enter NA)
For sepsis hospitalizations, there were small significant (p&lt;.01) negative correlations (r2 0.05-0.16) between laboratory utilization, measured as test numbers or RIW, and diagnosis-specific discharges for low and moderate severity groups; there was no significant correlation with either bed size or overall annual discharges. There were no consistent correlations of laboratory utilization with bed size, annual surgical procedures, or diagnosis-specific discharges for GI surgery patients. Hospitalizations for vaginal delivery demonstrated small negative correlations between laboratory utilization and bed size, annual births, and diagnosis- specific discharges.

Conclusion
For specific diagnostic groups, laboratory utilization (tests as well as laboratory RIW) exhibited negative correlations with large-scale hospital operational parameters. These correlations were typically weak with varying statistical significance. The findings suggest that laboratory test utilization efficiency may require evaluation of individual health systems on a case-by-case basis.