bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spectrum of Lymphomas involving Gastrointestinal tract in a Single Institution: A Retrospective Analysis
Authors: Huang H , Qing X 
Published: November 2023

Abstract

Introduction/Objective
Lymphomas affecting the gastrointestinal (GI) tract are relatively uncommon occurrences. Given that GI biopsies are primarily evaluated by pathologists specializing in GI pathology, a comprehensive understanding of GI lymphomas is essential for accurate diagnosis and appropriate referral. However, there is limited updated studies of the prevalence and distribution of GI lymphoma subtypes in diverse patient populations. Therefore, the objective of this study was to address this knowledge gap by characterizing the prevalence and distribution patterns of GI lymphoma subtypes in a diverse patient population residing in the west coast region.

Methods/Case Report
A comprehensive retrospective review was conducted on patients diagnosed with lymphomas involving GI tract between 2015 and 2023 at a single institution over 8 years. Clinical and pathological data, including age, gender, tumor locations, and histological diagnoses, were collected and analyzed.

Results (if a Case Study enter NA)
A total of 32 cases diagnosed with lymphomas involving GI tract were included in this study. The patient population consisted of 44% female and 56% male, with an average age of 61 years (range: 35 to 93 years). The most common tumor locations (figure 1) were the stomach (53%), followed by the duodenum (16%), ileum and colon (8%). The other less frequent locations such as the pancreas, jejunum, and rectum and esophagus (each 3%). Notably, 38% (12 cases) of the total cases exhibited involvement of two or more anatomical sites.

Conclusion
Our study findings are consistent with previous literature, confirming that Diffuse Large B-cell Lymphoma (DLBCL) remains the most prevalent subtype of gastrointestinal (GI) lymphoma. The high frequency of stomach involvement aligns with the recognized association between Helicobacter pylori infection and lymphomagenesis.
However, it is worth noting that the prevalence of MALT lymphoma has decreased, potentially indicating improved eradication efforts through antibiotic treatment. The observed proportion of cases with involvement of multiple anatomical sites highlights the diagnostic challenge of GI lymphomas and emphasizes the need for comprehensive evaluation.
Pre-germ cell neoplasia in-situ in a patient with complete androgen insensitivity syndrome
Authors: Muldoon J , Collins K , Ulbright T , González I A 
Published: November 2023

Abstract

Introduction/Objective
Complete androgen insensitivity syndrome is a disorder of sex development in 46, XY individuals with external female genitalia and undescended testes, often presenting with inguinal hernia in infancy and/or primary amenorrhea in adolescents. Given the increased risk for the development of germ cell neoplasms in the ectopic testis, early gonadectomy or orchidopexy may be indicated.

Methods/Case Report
We report a 21-year-old patient assigned female at birth (46, XY) with a history of bilateral inguinal hernia repairs (age 2) and later with lack of menarche (age 16). Additional work-up showed an elevated testosterone level (394 ng/mL) and normal luteinizing and follicle stimulating hormone values. On pelvic ultrasound, retained intraabdominal gonads were identified, but female sex organs were absent. During a gonadal relocation procedure, the gonads appeared irregular in shape with multiple cysts and small nodules, and bilateral gonadectomy was performed. Grossly, the gonads measured 4.9 and 4.3 cm with a smooth external surface and a lobulated cut surface with multiple cysts, up to 1.6 cm, containing clear, serous fluid. Histologic sections showed most seminiferous tubules were lined only by Sertoli cells with only occasional spermatogonia. Leydig cell hyperplasia and areas of ovarian-like stroma were seen. OCT4 immunostain highlighted the nuclei of individually disposed germ cells in the base of tubules (singly dispersed, non-linear pattern), raising concern for germ-cell neoplasia in-situ (GCNIS).
However, the histology and staining pattern were better interpreted as diagnostic of germ cells with delayed maturation and pre-GCNIS. Additionally, OCT4 showed rare single cells within the stroma and considered to represent residual undifferentiated gonadal tissue. After gonadectomy, the patient was started on hormone replacement therapy.

Results (if a Case Study enter NA)
NA

Conclusion
This case highlights the potential pitfalls in the interpretation of OCT4 immunostain to avoid misdiagnosis of germ cell neoplasia.
Selenium Deficiency is associated with inflammation and Cardio- metabolic dysregulation in women with Hypertensive disorders of Pregnancy
Authors: Nwadike C N , Nwanjo H U , Ikaraoha C I , Ogbuokiri A C 
Published: November 2023

Abstract

Introduction/Objective
Selenium (Se) deficiency has been speculated to enhance Oxidative inflammation in Pregnancy, leading to endothelial dysfunction, which has been implicated in the aetiopathogenesis of Hypertensive disorders of Pregnancy. This study aimed at evaluating the Selenium Status of pregnant women and its role in inflammation and cardio-metabolism in pregnant women with Hypertensive disorders of Pregnancy.

Methods/Case Report
The study involved 200 healthy women with Single Pregnancy who presented to Obstetrics and Gynaecology clinic of IMSUTH Teaching Hospital, Nigeria. These subjects were recruited between 10 to 15 weeks of gestation. 52 of the them who subsequently developed Hypertensive disorders ;Preeclampsia (PE)-15 and Pregnancy Induced Hypertension (PIH)- 37) were compared with their148 counterparts who remained Normotensive. The groups were matched for age, BMI, gestational age and parity. The blood Selenium levels were determined using Atomic Absorption spectrophotometer, while ELIZA was used for Markers of Inflammation and Cardio-metabolic risk (Hs Crp, Lipid profile, Insuline, MDA,TAC, GSH). P &lt;0.05 was considered statistically significant for all variables.

Results (if a Case Study enter NA)
There was significant reduction in the mean levels of Selenium in Pregnant women with PE and PIH (52.41 μg/L, 56.02 μg/L) when compared with Normotensive (68.84 μg/L). Hs-CRP, LDL and MDA showed significant increase in the study groups (PE and PIH) against the Normotensive group (p=0.001,
0.004 and 0.001) respectively. A significant reduction was observed in the TAC and GSH in PE and PIH (p&gt; 0.005).. There was also a significant increase in the Insulin levels of the PE group compared with the Control group. There was a negative correlation relationship between Selenium and Hs- CRP (r = -0.533, r=-601), serum lipids and Insulin and BMI in the study groups.

Conclusion
From our study, Selenium deficiency may be associated with Dyslipidemia, impaired Insulin Metabolism and may serve as a predictive Risk marker of Heart disease in women with Hypertensive disorders of Pregnancy.
Assessing the Impact of Race, Sexual Orientation, and Gender Identity on USMLE Style Questions: Preliminary Results of a Randomized Controlled Trial
Authors: Arnason T J , Mirza K M , Lilley C M 
Published: November 2023

Abstract

Introduction/Objective
Medical students are expected to graduate with cultural competence, which improves the quality of care of different minority groups and may help reduce health disparities. Incorporation of diversity, equity, and inclusion into medical teaching is critical to the development of culturally competent physicians; however, centuries of medical pedagogy have tied certain pathologies to racial and sexual/gender minority patients. This not only encourages stereotyping to arrive at the correct answer but also narrows the differential diagnosis developed by the future physician. We are surveying US and non-US third- and fourth-year medical students and first-year residents to demonstrate to what extent inclusion of race, sexual orientation, and gender identity data in question stems influences diagnosis and clinical decision-making.

Methods/Case Report
The survey consists of three sections. The first section collects demographic information, including age, race, gender identity, region, type of medical degree, current level of training, completion of examinations, and MCAT score. The second section presents one of two sets of twelve USMLE style questions with (experimental) or without (control) key demographic data, including race, sexual orientation, and gender identity. The third section presents four questions in order to assess participants’ understanding of the higher burden of hypertension among Black patients and attitudes regarding the role of their medical education in the development of biases. Participants were randomized to the set of twelve questions in the second section.

Results (if a Case Study enter NA)
Preliminary results from 25 medical trainees associated with Loyola University Chicago demonstrate that the presence of demographic data including race, sexual orientation, and gender identity impact answer choice on standardized questions.

Conclusion
The preliminary results of this study are significant because they suggest that race, sexual orientation, and gender identity are still being used in pathology education to highlight certain disease processes, potentially in a manner that is out of proportion to actual disease prevalence.
Systemic EBV-Positive T-cell Lymphoma of Childhood: A Case Report and Comprehensive Literature Review
Authors: Hwang C , Sae-Ow W 
Published: November 2023

Abstract

Introduction/Objective
Systemic EBV-positive T-cell lymphoma of childhood (SETLC) is an extremely rare disease in which most cases have been reported in Eastern Asian countries. It is characterized by a clonal proliferation of EBV- infected cytotoxic T cells that most commonly affect immunocompetent children and young adults. Patients present with systemic disease with rapid disease progression and multi-organ failure leading to death. Here, we report a case of SETLC in an 18 year old male, and review clinicopathologic features of the entity from 12 reported cases in the literature.

Methods/Case Report
A previously healthy 18 year old male presented with fever, abdominal pain, and vomiting. Clinical workup revealed elevated serum EBV viral load, hepatosplenomegaly, lymphadenopathy, pancytopenia, DIC, and multi-organ failure. Peripheral blood smear and bone marrow biopsy showed increased atypical lymphocytes with CD3+, CD8+, CD56-, TIA-1+ phenotype. In addition, prominent hemophagocytosis was noted in the bone marrow. T- cell receptor beta gene rearrangement was positive by PCR. A diagnosis of SETLC was established. Despite chemotherapy, he deteriorated rapidly and passed.

Results (if a Case Study enter NA)
NA

Conclusion
SETLC is an extremely rare disease in which most cases have been reported in Eastern Asian countries. Common clinical manifestations include fever, hepatosplenomegaly, lymphadenopathy, cytopenia, elevated LFT, coagulopathy, hyperferritinemia, hemophagocytic lymphohistiocytosis, and high serum EBV viral loads. It is a systemic disease with multiple organs involvement by EBV positive T cells. Comprehensive literature review of 12 reported cases along with our case demonstrated these neoplastic T cells were positive for CD2, CD3, CD8, TIA1 or granzyme, and EBER in situ hybridization; negative for CD56 in most cases. Hemophagocytosis was a common finding, and T cell receptor gene rearrangement confirmed clonality of the neoplastic T cells in all reported cases. Currently, there is no standard treatment. Most patient died from the disease weeks to months after disease onset.
Sclerosing Angiomatoid Nodular Transformation of The Spleen: A report of a rare entity
Authors: Raja F , Iqbal S , Hammad A , Ayub S 
Published: November 2023

Abstract

Introduction/Objective
Sclerosing angiomatoid nodular transformation (SANT) is a benign vascular lesion of spleen with uncertain etiology. It predominately affects women between 30 to 60 years of age. Clinically, it is asymptomatic or can cause abdominal pain, but usually discovered incidentally on imaging, which can identify a mass but may not provide a definitive diagnosis. In uncertain vascular lesions, there is always a risk of spontaneous rupture of large vessels and potential for spreading malignancy. Hence, the final diagnosis is rendered on microscopy after splenectomy

Methods/Case Report
A middle age female came to clinic complaining of abdominal pain. Radiology showed solid splenic mass and the patient underwent splenectomy. Gross examination showed a 3 cm white firm mass with focal hemorrhage. Microscopy revealed multiple nodules of variable sizes surrounded by fibrosclerotic stroma. The nodules showed round to slit-like vascular spaces with numerous red blood cells. The internodular stroma consisted of dense fibrous tissue with scattered plump myofibroblasts and lymphoplasmacytic cells. These distinctive features lead to the diagnosis of SANT

Results (if a Case Study enter NA)
SANT possessed characteristic histologic features with distinctive immunohistochemistry (IHC). IHC reveals three different types of vessels within the nodules: 1. Small veins (CD34- CD31+ CD8-); 2. Sinusoids (CD34- CD31+ CD8+); and 3. Capillaries (CD34+ CD31+ CD8-). All 3 vessels are negative for CD21/CD35 and CD68. Hemangioma and littoral cell angioma are two frequent vascular tumors in the spleen that should be differentiated. Both lesions lack microscopic features of SANT and have only a single type of vessels. The vessels in hemangioma are (CD31+ CD34+ CD8-); while in littoral cell angioma they are (CD31+ CD34- CD8- CD21+ CD68+)

Conclusion
There are no specific clinical or radiologic findings for SANT. It is important to recognize these characteristic features and to differentiate it from other benign and malignant lesions, such as angiosarcoma. A thorough histopathologic examination and IHC are helpful to make the correct diagnosis
Rapid Progression of Myelodysplastic/Myeloproliferative Neoplasm with Neutrophilia to Acute Myeloid Leukemia: A Case Report
Authors: Aljumaili Z , Wang X , Wang W , Hu Z 
Published: November 2023

Abstract

Introduction/Objective
Myelodysplastic/myeloproliferative neoplasms (MDS/MPN) with neutrophilia, formerly atypical chronic myeloid leukemia, is a subtype of MDS/MPN that is characterized by peripheral blood neutrophilia with frequent left-shifted myeloid cells, dysplastic granulocytes, and an absence of the Philadelphia chromosome or BCR- ABL1 fusion gene. Its clinical course is variable, ranging from a chronic indolent disease to an aggressive leukemia. Herein, we report a case of who was diagnosed with MDS/MPN with neutrophilia and had rapid progression to acute myeloid leukemia.

Methods/Case Report
A 63-year-old male patient with no significant medical history presented with incidental findings of abnormal peripheral blood counts: leukocytosis of 153 × 109/L, platelets of 82 × 109/L, and Hb of 6.7g/dl.
Flow cytometry (FCM) on peripheral blood was significant for increased granulocytes and a population of aberrant blasts (~7.3%) expressing CD5, CD11c, CD13, CD34, CD38, CD56 (partial), CD117, and HLA-DR. The initial Bone marrow biopsy showed a hypercellular marrow (90-100%), 3% blasts, dysgranulopoiesis, and dysmegakaryopoiesis. Fluorescence in situ hybridization (FISH) analysis for BCR-ABL1 fusion and MPN with Eosinophilia panel, including FIP1L1-CHIC2-PDGFRA; PDGFRB/5q33; FGFR1/8p12, were all negative. Next Generation sequencing (NGS) detected at least one variant of strong clinical significance (Tier I) including: ASXL1 c.1900_1922del23, NRAS c.35G&gt;C, U2AF1 c.470A&gt;C, potential clinical significance (Tier II) GATA2 c.1160_1165delCCATGA and unknown clinical significance (Tier III) SETBP1 c.2620G&gt;A. The chromosomal analysis showed trisomy 14. The patient received Decitabine for 2 months, but follow-up FCM on the subsequent bone marrow examination revealed 40% blasts, with marked erythroid hyperplasia. The patient was diagnosed with acute myeloid leukemia. Despite receiving Venetoclax and Azacitidine, the patient deteriorated and expired in 10 months after the initial diagnosis of MDS/MPN with neutrophilia.

Results (if a Case Study enter NA)
NA

Conclusion
This case highlights the poor prognosis associated with MDS/MPN with neutrophilia. Optimal management strategies for these patients are still evolving, and new targeted therapies are needed to improve outcomes.
Next-Generation Sequencing Testing and Triaging of Bone Marrow Samples: Indications, Pre-authorization and Medical Necessity for Patient Care
Authors: Haq H , Loos C , Wells A , Herschap B , Sanchez-Salazar A , Ehsan A 
Published: November 2023

Abstract

Introduction/Objective
Bone marrow biopsy (BMBx) is an invasive procedure and samples are usually obtained for diagnosis, staging and prognosis of hematolymphoid disorders (HDs). Given the need for WHO and ICC classification of HDs; the Next Generation Sequencing (NGS) testing (in addition to other esoteric testing) has become relevant and medically necessary. It is important to triage BMBx in real-time based on clinical indications; however, pathologists are challenged by limited published guidelines as well as need for pre-authorization (PA) thus resulting in claim denials.

Methods/Case Report
Retrospective analysis was performed (2018 to 2022) on 1610 BMBx submitted for various clinical indications. These were categorized as follows: Cytopenias 220 (MDS); Cytosis 250 (MPN); Lymphomas work-up 350 (LY), acute leukemias 440 (AL) and plasma cell disorders 350 (PCD). In addition to esoteric testing; the decision was made to perform NGS testing based on preview of aspirate slides, clinical history and CBC.

Results (if a Case Study enter NA)
Providers initially ordered NGS in 10% of cases; however, NGS was added later by pathologists in 30% of BMBx samples. Abnormal NGS results were obtained as follows: MDS (70%); MPN (75%); LY (15%); AL (90%) and PCD (40%). NGS testing provided clinically useful data for MDS, MPN and AL groups. Even though LY and PCD groups also yielded positive results; the concurrent esoteric testing (Flow, FISH and Cytogenetics) was useful thus making indication of NGS in these two subset groups less indicated.

Conclusion
Appropriate triaging of BMBx for NGS testing is medically necessary for following reasons: 1) Enables precise diagnosis in a timely manner; 2) to avoid repeat BMBx if triaging guidelines are followed; and 3) decision to order NGS is made in real-time as BMBx are time sensitive samples thus eliminating the need for PA as this study emphasize that NGS has become standard of care in the work-up of HDs.
First US Case of Vagococcus Lutrae Infection in a Human: A Case Report
Authors: Asfar M , Antoine-Reid T 
Published: November 2023

Abstract

Introduction/Objective
Vagococcus Lutrae is a gram-positive, catalase-negative bacterium, that has been isolated from different animal species. It is an extremely rare pathogen in humans and has been documented in only two human cases globally. We present a case of V. Lutrae infection in humans, which is the third in the world and first in the US to be documented in literature.

Methods/Case Report
Our patient was a 75-year-old male with a history of hypertension and hyperlipidemia who presented with a right groin abscess with associated skin necrosis and cellulitis. V. Lutrae was identified in the culture of the abscess fluid. The diagnosis was made after conventional biochemical tests, automated methodology, and mass spectrometry (MALDI-TOF MS). The patient underwent incision and drainage of the abscess, was treated with antibiotics, and showed improvement upon follow-up.

Results (if a Case Study enter NA)
NA

Conclusion
Our case highlights the importance of considering V. Lutrae as a potential pathogen in patients with skin infections, particularly those with a history of contact with contaminated water or soil. Further studies are needed to better understand the epidemiology and clinical manifestations of V. Lutrae infections in humans.
Viability of MDR bacteria against antibacterial biosynthesized ZnO and Au Nanoparticles
Authors: Abdelmonem M , Hammad S E , Elshikh H H , Mostafa M A , El-Rouby M N , Abdelmageed M , Wasim H , Eldaly R 
Published: November 2023

Abstract

Introduction/Objective: Background
Resistant strain diseases are increasing worldwide. Antimicrobials are concerned about pathogen-acquired resistance. Nanotechnology advances enable the creation of novel formulations based on various nanoparticles (NPs) with different sizes and antibacterial characteristics.

Methods/Case Report
Materials and methods
All fungi were isolated and cultivated on malt extract broth. The endophytic fungus was cultured. Zn and Au nanoparticles have been produced by adding 0.1 M, 1 mL of Zn SO4, and HAuCl4 to 10 mL of fungal filtrate. Characterization of nanoparticles by the extracts' UV-visible spectrum shows ZnO NPs and Au NPs' green synthesis. UV-Vis, HR-TEM, XRD patterns, EDX analysis, and a Zeta-sizer characterize NPs' optical properties and morphology. Using 2,3,5-triphenyl tetrazolium chloride, biosynthesized Au and ZnO NPs' MICs against bacteria were determined. The bacterial culture was cultivated until it reached an Mc-Farland standard of 0.5. After that, 10 uL of bacterial suspension was pipetted into 140 uL of nutritional broth with 0.12 to 31.25 ug/mL ZnO and Au NPs. ZnO- and Au-free nutrient broth was used as a control. Wells that didn't turn red was examined for MIC values.

Results (if a Case Study enter NA): Results
The fungal filtrate's color changed from light yellow to colorless and violet after mixing with ZnSO4 and HAuCl4, respectively, ensuring nanoparticle formation. UV-Vis spectra: ZnO NPs were confirmed by excitonic absorption peaks between 300 and 400 nm; the maximum absorbance peak was 305 nm, while Au NPs' peak was 520 nm. Results showed that Au NPs and ZnO NPs have a hydrodynamic diameter (HD) of 34.88 nm and 15.77 nm, respectively. Our EDX analysis revealed that both nanoparticles have 64.61 and 35.39 % Zn and O stoichiometric mass percent.
Energy dispersive X-rays showed a peak optical absorption band at 2.2 keV in gold nanocrystallites. Au NPs and ZnO NPs had MICs of 7.81 and 1.95 ug ml-1 against P. aeruginosa and 3.9 and 0.98 against E. coli, respectively. ZnO
NPs' MIC against E. coli and P. aeruginosa is lower than Au NPs'. ZnO NPs increased microbial cell proliferation, and its inhibition was affected by the concentrations, sizes, and forms.

Conclusion
Our study investigated that the number of pathogens Escherichia coli and Pseudomonas aeruginosa decreases as nanoparticle concentration increases. So, ZnO NPs and Au NPs can inhibit bacterial development and cytoplasmic leak contents at lower concentrations.