bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 47-Year-Old Woman With a Large Unusual Presacral Mass
Authors: Mayorga M R , Guerry-Force M L 
Published: November 2023

Abstract

Introduction/Objective
Tumors developing in the presacral space are rare, having been reported in 1 of every 40,000 admissions. Most presacral tumors are congenital defects arising from vestiges of embryonal tissue like neuroectoderm, notochord, and hindgut. For this reason, a wide array of benign and malignant presentations can be expected. Preoperative diagnosis is often challenging due to the risk of seeding malignant cells and the high risk of infection.

Methods/Case Report
A 47-year-old woman presented to our institution with complaints of abdominal pressure and pelvic heaviness for about a year, dyspareunia, epigastric pain, diarrhea, and early satiety with an unintentional weight loss of 30 lbs. On physical examination, a large firm, tender growth posterior to the rectum was palpated, deviating both the rectum and the vagina. An MRI confirmed a 9.3 cm complex mass. Due to the location of the lesion and some of the patient’s symptoms, malignancy could not be ruled out. The MRI was useful for planning the perineal resection as the mass was located below S3. However, the accuracy of MRI for specific histological tumor types has been reported to be only 28% therefore the true nature of the lesion could not be fully assessed. Complete resection was then recommended and performed. The mass was entered during dissection and copious thick consistency contents were encountered. Histopathology revealed a cyst lined by squamous epithelium and laminated keratin debris with the presence of chronic inflammatory cells compatible with an epidermoid cyst. The patient made an uneventful recovery and was discharged home.

Results (if a Case Study enter NA)
NA

Conclusion
In cases where a presacral mass of cystic nature is found, especially in middle-aged women, epidermoid cysts should be one of the diagnoses to consider. Imaging is a good aid for surgical intervention but has a very limited ability to identify the mass thus making the post-operative histopathologic diagnosis crucial.
“Case of the Week: The Value and Impact of Sharing Pathology Cases Online”
Authors: Crowe C , Buckelew H , Netto G 
Published: November 2023

Abstract

Introduction/Objective
Social media has become a driving force in the field of pathology in a variety of ways, including aiding in recruitment efforts for residents, fellows, and faculty members; promoting both individual practitioners and institutional programs; sparking discussion; creating and growing community; and sharing resources. Large teaching hospitals see an expansive number of cases, some of which are rare or have unusual features. The sharing of unique pathology cases through social media has become a robust online conversation, resulting in connections to pathologists worldwide through shared educational resources, and as examples to potential trainees and faculty of the wide variety of cases the institution sees.

Methods/Case Report
In 2017, under guidance of our department chair, we began posting one case per week to our website and newly created Twitter account. These posts featured recent, in-house cases contributed by faculty and trainees with slide images and de-identified case descriptions. This content began garnering a following as we shared an increasing number of more unusual cases. In 2018, our department added communications team who standardized the weekly cases and worked with resident leaders to organize and plan a schedule to collect cases from department members. The team posts these cases every Monday on the department website and on our Twitter account, alongside a poll for users to vote on their suspected diagnosis. Each Friday, the team posts the final answer with an educational explanation of the case.

Results (if a Case Study enter NA)
NA

Conclusion
Our weekly cases have become the most popular content shared across our department’s social media channels, garnering hundreds of votes on Twitter, and now Instagram story polls, every week. Building on its popularity, in 2022 we added a second case of the week, specific to cytopathology, shared each Wednesday. We archive the cases on our website, and they are being accessed as a learning tool.
Zoonotic transmission risk of Acinetobacter baumannii from Alaskan wildlife
Authors: Leu-Burke G , Edwards E , Jones H 
Published: November 2023

Abstract

Introduction/Objective
Acinetobacter baumannii is a multi-drug resistant gram-negative bacterium often isolated in water and soil. A challenge in both human and veterinary nosocomial infections, Acinetobacter is adaptable, forming biofilms and carbapenem resistance (CRAB). As an opportunistic infection, Acinetobacter is an emerging pathogen especially in immunocompromised individuals which include marginalized housing insecure populations. Anchorage dedicates large areas for urban park environments providing high impact of human and moose wildlife interaction.
Previous studies link zoonotic transmission of bacteria through direct fecal contact or water contamination. The significant number of vulnerable unsheltered individuals in Anchorage using public green belts presents a potential risk for Acinetobacter baumannii colonization.

Methods/Case Report
To assess environmental Acinetobacter exposure from urban wildlife, we ground collected 150 moose fecal samples between 2019-2022. Samples were placed into support medium, cultured onto MacConkey agar and incubated at 37C. Biochemical identification and antibiotic susceptibility testing were performed using MicroScan™ (Beckman/Coulter Brea, CA) conventional panels with antimicrobial interpretation along clinical laboratory standards (CLSI).

Results (if a Case Study enter NA)
Acinetobacter baumannii was isolated in moose feces, with proportion of positive samples increasing annually: 7.5% (2019), 12.5% (2020), and 14.2% (2021). Antimicrobial analysis found 100% of samples resistant to cefpodoxime, cefazolin, ceftriaxone, cefuroxime, ampicillin, and ampicillin-sulbactam, with 72% resistant to ertapenem and imipenem. Aztreonam resistance was 22%, cefepime 17%, with only 5% resistant to ciprofloxacin.

Conclusion
The increasing colonization of moose feces with multi-drug resistant Acinetobacter baumannii potentially poses a significant public health risk in Anchorage, Alaska. With moose inhabiting areas used by the vulnerable homeless and outdoor enthusiasts, there exists a high risk for exposure potential towards opportunistic infection, and colonization. The multi-drug resistance pattern on observed on several of A. baumannii isolates suggests the possibility of CRAB. As one of the five pathogens listed as an urgent threat by the CDC, it is imperative to study potential sources of carbapenem resistant A. baumannii, including environmental exposure. Finding moose fecal samples positive for A. baumannii indicates a need for continued surveillance and risk assessment for community acquired infection.
Characterization of innate immune response to hepatitis B virus genotype F acute infection in tree shrew (Tupaia belangeri) model
Authors: Or Rashid M 
Published: November 2023

Abstract

Introduction/Objective
Hepatitis B virus (HBV) infection is a global public health problem. The clinical outcomes of HBV infections are influenced by the host as well as viral factors, including viral genotypes and subgenotypes. The interplay between HBV and host innate immunity remains unclear because of the lack of a suitable small animal model. Tree shrews (Tupaia belangeri) have been utilized as a useful animal model for hepatitis viruses such as hepatitis B and C viruses.

Methods/Case Report
In this study, we characterized acute infections by HBV genotype F (HBV-F) wild type (Wt) and mutant type (Mt) viruses in adult tree shrews. Serum alanine aminotransferase levels were measured before and post-infection 7 and 14 dpi. Both HBV-F-Wt and Mt were detected in the HBV-F-infected tree shrew serum and liver tissue at 7 and 14 dpi.

Results (if a Case Study enter NA)
We examined the intrahepatic expression patterns of Toll-like receptors (TLRs) (TLR1–9 mRNAs), cGAS, several transcription factors such as STAT1, STAT2, IRF7, HNF4, PD-L1, and cytokines, including IFN-β, IFN-γ, IL-6, and TNF-α in HBV-F Wt/Mt-infected tree shrews. When compared with an uninfected animal group, significant suppression of TLR8 in HBV-F-Wt infected animals and significant suppression of PD-L1 in both HBV-F-Wt and Mt infected animals were observed.

Conclusion
Thus, tree shrew can be a useful animal model to characterize HBV-F pathogenesis.
Association between asymptomatic Plasmodium falciparum malaria infection, anemia and mean corpuscular volume of school children in the Volta Region of Ghana
Authors: Sanyaolu A , Orish V , Kwadzokpu P , Lokpo S , Marinkovic A , Prakash S , Okorie C 
Published: November 2023

Abstract

Introduction/Objective
Although several studies have reported abnormal MCV values and anemia associated with malaria infections with a focus on P. falciparum among patients with complicated and uncomplicated malaria. This study assessed the association between asymptomatic P. falciparum malaria infection, anemia, and the MCV values of school children in Ghana.

Methods/Case Report
We conducted a cross-sectional study using 3 ml of blood samples from 549 children aged 5- 17 years attending 5 schools selected in the Volta Region. Semi-structured questionnaires were administered to the children to obtain demographic data. Blood samples were collected into a K2EDTA tube and then used to estimate the children’s automated full blood count (FBC) and malaria status using microscopy. MCV was classified into low, normal, and high. Data obtained were analyzed using STATA 15 software. P-values less than 0.05 were considered statistically significant.

Results (if a Case Study enter NA)
Most of the children in this study (49.9%) had normal MCV (81.3-91.3 fL) with an overall malaria prevalence of 55.6 % (95% CI: 51.3-59.8) and anemia prevalence of 48.6% (95% CI 44.4-52.9). The majority of the anemic children had normal MCV (81.3-91.3 fL) (49.8, 95% CI 43.7-56.0). The predicted probability of malaria was highly likely among children whose MCV fell within the first and third quartiles.

Conclusion
This study shows a reduced predicted probability of malaria among children with low and high MCV, playing a protective function against malaria. Further studies are required to elucidate the association and interaction between MCV, anemia, and asymptomatic Plasmodium falciparum infection.
COVID-19 Pandemic: Total Testing Cost Impact on Neisseria Gonorrhoeae and Chlamydia Trachomatis Testing and Positivity Rate in the Veteran Population
Authors: Petersen J M , Jhala A 
Published: November 2023

Abstract

Introduction/Objective
The College of American Pathologists (CAP) checklist includes the quality assurance (QA) monitoring of the rate of diagnosis of Neisseria Gonorrhoeae (NG) and/or Chlamydia trachomatis (CT) by the molecular laboratory. Recently, the societal impacts of the economic lockdowns of the COVID-19 pandemic had a significant effect on the number of tests. However, the impact on the total testing costs as well as the positivity rate has not been well studied in the Veteran population.

Methods/Case Report
Quarterly quality assurance data from October 1st, 2018, to December 31st, 2022, was reviewed to obtain both the test volume for CT/NG and the number of positive test results at a Veterans Affairs Medical Center (VAMC). In addition, the cost to perform each test in reagents and consumables was also noted. Quarter 1 at the VAMC begins in October of the prior calendar year. The quarters in the period of April 1st, 2020, to December 31st, 2020 (corresponding to Quarter 3 2020 to Quarter 1 2021), was analyzed and compared to both the quarterly data prior to and after this period to note the impact of the COVID-19 pandemic on the quality assurance data. Testing had been performed using the Abbott m2000 RealTime System (Abbott Park, Illinois).

Results (if a Case Study enter NA)
A total of 18,904 tests for CT/NG had been performed on the Veteran population during the study period. Of these 18,904 tests, 385 were positive for NG and 515 were positive for CT. Quarterly percentage rates on a quarterly basis ranged from 1.58% to 4.53% (CT) and 1.16% to 4.53% (NG) with average rates of 2.78% and 2.13%, for Chlamydia and Gonorrhea respectively. The total reagent and consumable cost for each test was $28.84 per test. The period of Quarter 3 2020 to Quarter 1 2021 was marked by a decrease in total tests (331, 713 and 781 tests respectively compared with 1,049 tests in the quarter just before this period) with a corresponding decreased total test cost expenditure ($9,546.04, $20,592,92, and $22,524.04 respectively compared with $30,253.16 in the quarter just before this period) for performed tests. There was also an increase in the positivity rate (the highest positivity rate for both CT and NG of 4.53% was noted in quarter 3 2020) in this period of Quarter 3 2020 to Quarter 1 2021.

Conclusion
The initial period of the COVID-19 pandemic was marred by widespread economic lockdowns that impacted the total number of CT and NG tests performed, total test expenditures for tests performed, as well as the positivity rate.
Liquid Biopsy: A Highly Useful Tool to Decide Personalized Therapy in Veteran Patients with Metastatic Pancreaticobiliary Cancer
Authors: Dalal S , Petersen J M , Jhala D , Allbee A 
Published: November 2023

Abstract

Introduction/Objective
Pancreatic cancer is one of the leading causes of death in Veteran patients. Early detection and treatment of the pancreatic cancers are key to the successful management of pancreatic cancer with good patient outcome. The National Comprehensive Cancer Network (NCCN) recommends tumor molecular profiling in all patient cases of unresectable or metastatic pancreatic adenocarcinomas and biliary tract cancers who are candidates for chemotherapy. This testing can be performed using liquid biopsy to obtain this molecular profiling from circulating tumor cells (CTC) to obtain information that may impact treatment. However, the literature of metastatic pancreaticobiliary cancers targeted by liquid biopsies and the mutations found is sparse, particularly for the veteran population.

Methods/Case Report
A retrospective review was performed of all patients with a submitted liquid biopsy specimen at a Veteran Affairs Medical Center (VAMC) from April 2020 to March 3rd, 2023, to examine those patients with
metastatic pancreaticobiliary cancers, specifically pancreatic adenocarcinoma, and cholangiocarcinoma. Information on mutations detected was collected.

Results (if a Case Study enter NA)
There were a total of 5 patient specimens with a history of metastatic pancreatic
adenocarcinoma (4 cases/5) and cholangiocarcinoma (1 case/5). The first liquid biopsy from a patient with a history of metastatic pancreaticobiliary cancer was sent on April 14th, 2020, and the last was sent on November 12th, 2021.
TP53 was detected on all the successfully tested pancreatic adenocarcinoma cases. Other mutations detected in the individual pancreatic adenocarcinoma cases were KRAS, TET2 BCOR, DNMT3A, FUBP1, RAD21, and STAG2. The mutations found on the single cholangiocarcinoma case included DNMT3A and TP53. 1 of the 4 cases sent on a patient with pancreatic adenocarcinoma resulted in a sample failure.

Conclusion
Liquid biopsies provided comprehensive molecular profiling in cases of metastatic pancreatic adenocarcinoma and biliary tract cancer in the veteran population treated at a local VAMC to help decide on personalized therapy, in compliance with the recommendations of the NCCN. The results of this pilot quality assurance study help highlight the potential of liquid biopsies to detect most commonly mutated genes such as KRAS and T53 in pancreatic cancer.
MYC amplifications are a common event in urothelial bladder carcinomas associated with an aggressive tumor phenotype
Authors: Kluth M , Hitzschke M , Lennartz M , Blessin N C , Sauter G , Plage H , Klatte T , Schlomm T , Marx A H , Rink M , Slojewski M , Ecke T , Koch S , Horst D , Zecha H 
Published: November 2023

Abstract

Introduction/Objective
Gene amplifications of the proto-oncogen MYC are common events in carcinomas. In this study, we analyzed the impact of MYC amplifications on tumor aggressiveness and patient prognosis in urothelial bladder carcinomas.

Methods/Case Report
MYC copy number status was analyzed on more than 2,500 urothelial bladder carcinomas in a tissue microarray format by using dual-labeling fluorescence in-situ hybridization (FISH) with probes for centromere 8 and MYC (8q24). The results were compared with tumor phenotype and patient outcome.

Results (if a Case Study enter NA)
MYC amplification (ratio MYC/centromere 8 ≥2) occurred in 10% of 2,052 analyzable urothelial bladder carcinomas. Of these, 141 (6.8%) had a low level MYC copy number gain (MYC/centromere 8 ratio ≥2 and ≤ 3) and 68 (3.3%) had high-level MYC amplifications (MYC/centromere 8 ratio &gt;3) . The rate of MYC gain and MYC amplification increased from pTa G2 low (0.6%), to pTa G2 high (7.7%), and pTa G3 (8.2%) carcinomas, and were highest in muscle-invasive pT2-4 (13.2%) carcinomas (p&lt;0.0001). In muscle-invasive urothelial carcinomas, the MYC amplification rate increased from pT2 (13.1%), to pT3 (14.7%), and pT4 (19.8%) but these differences failed to reach statistical significance (p=0.0902). MYC amplification was also unrelated to patient survival in 526 patients with pT2-4 urothelial carcinomas who had undergone cystectomy (p=0.5526).

Conclusion
MYC amplification is a common event in urothelial bladder carcinoma - especially in case of pTa G3 and muscle-invasive carcinoma. The association of MYC amplification with advanced stage may reflect increasing genomic instability going along with tumor progression.
Pleomorphic Adenoma with a Novel Rearrangement - LINC01606::PLAG1
Authors: Naik U , Bellman A , Elsayad M , Saluja K , Zeybek A 
Published: November 2023

Abstract

Introduction/Objective
Pleomorphic adenoma (PA) is characterized by presence of three components including bi- layered ducts, myoepithelial cells, and chondromyxoid/fibrous stroma in varying proportions. Evaluation of molecular aberrations helps recognizing challenging cases. Pleomorphic adenoma gene 1 (PLAG1) and high-mobility group AT- hook 2 (HMGA2) are hallmark genes showing rearrangement with various partner genes. Here, we present a case of myoepithelial cell rich PA, showing PLAG1 rearrangement with a novel partner gene.

Methods/Case Report
A 77-year-old male with history of slow-growing, right post-auricular mass over 5-year duration, now presented with overlying skin ulceration and bleeding/intermittent oozing. CT scan showed a complex, lobular, enhancing 8.7 x 8.4 x 7.0 cm mass, arising from the right parotid gland. Fine needle aspiration was performed and reported inconclusive with blood and fibrin only. The patient elected to undergo total parotidectomy with cervical lymph node dissection. Histology revealed a circumscribed, cellular salivary neoplasm with extensive hemorrhage/infarction and cystic degeneration. The viable neoplastic cells composed of sheet of spindle and epithelioid/plasmacytoid cells, with focal glandular and cribriform areas. Very focally chondromyxoid change is noted. The tumor cells stained with CK7, S100, and SOX10, few scattered cells positive for SMA, p63, and p40, with Ki67 labeling index of 5-10%. None of the cervical lymph nodes showed metastatic tumor. Overall, the features were compatible with myoepithelial cell rich salivary neoplasm with working diagnosis of cellular pleomorphic adenoma.
Next generation RNA sequencing showed a LINC01606::PLAG1 [inv(8;8)(8q12.1;8q12.1)] fusion alteration.

Results (if a Case Study enter NA)
NA

Conclusion
PLAG1 is located at 8q12.1 and have been reported to be involved in chromosome rearrangements in various tumors including salivary gland tumors, mainly pleomorphic adenoma. Many fusion partners of PLAG1 have been reported. This report presents LINC01606 gene as a novel fusion partner of PLAG1 in a case of myoepithelial rich PA. This fusion leads to in-frame fusion of exons 1-2 of the LINC01606 gene to exons 3-5 of the PLAG1 gene.
Association of SARS-CoV-2 infection with Age and Gender deduced by RT PCR amplification of ORF1ab, E and N Genes Cycle Threshold (Ct)
Authors: Ullah R , Yousaf M , Rashid Z , Sajjad Naqvi S , Ur Rehman M , Ul Ain Q , Ammad M , Arshad N , Al Yafei Z , Noorul Hasan T , Hussain A 
Published: November 2023

Abstract

Introduction/Objective
COVID-19 pandemic caused by SARS-CoV-2 has significantly impacted public health globally. Accurate and rapid detection of the infectious agent is essential for disease control and management. RT-PCR amplifies the specific targets in viral genome. The amplification signals and the cycle threshold (Ct) value gives the idea of presence of the virus and their loads. Understanding the association between Ct values, age, and gender could provide insights into the viral load and could also shed light on the potential alterations in disease transmission, severity, clinical outcomes, and dynamics among different populations and age groups. The current study aims to elaborate the correlation between Ct values of (ORF1ab, E, and N) with age and gender.

Methods/Case Report
11,108 samples were tested for COVID-19 RT-PCR assay in the current study at PureLab Pure Health, Abu Dhabi, UAE.

Results (if a Case Study enter NA)
1009/11,108 (9.08 %) positivity was observed in the studied population. COVID- 19 was more prevalent in females (53.51%) as compared to males (46.48%). Significantly higher positivity was observed in age group (31-40 years) in both males (24.09%, 113/469) and females (24.44%, 132/540). The Ct values for all the three (03) targets were ranged from 11.37 to 39.39. Longitudinal analysis showed significant increased during the study period from starting to end as were hypothesized. Interestingly, all the three (03) targets (ORF1ab, E, and N) were present in all age groups. This may indicate the existing clade can infect all the age groups even children less than 01 years old.

Conclusion
In conclusion, between age groups, there was no significant difference in viral loads. In general, females had a larger viral burden than males. Studying the association between Ct values of SARS-CoV-2 genes age and gender is essential for understanding the viral load dynamics and potential variations in disease characteristics among different population groups. Such investigations could contribute to disease prognosis, risk stratification and the development of targeted interventions based on demographic characteristics. However, further research is essential to establish reliable patterns and unravel the complex interplay between viral load, gender, age, and clinical outcomes in COVID-19 patients.