bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Central Nervous System ALK-negative Anaplastic Large Cell Lymphoma, with TP53 Deletion
Authors: Li L , Baisre A , Nimchinsky E A , Liu J K 
Published: November 2023

Abstract

Introduction/Objective
ALK-negative anaplastic large cell lymphoma (ALCL) primary to the central nervous system (CNS), is a sporadic and rare lymphoma, characterized by neoplastic T-cells which are CD30 positive and ALK negative. It has a male predominance, mostly affects old adults and usually displays supratentorial, single or multiple lesions.

Methods/Case Report
We report the case of a 57-year-old woman with medical history of breast cancer, S/P lumpectomy and radiation therapy, who came to our institution with confusion, partial aphasia and headache. MRI showed a thick-walled, irregular, ring enhancing mass in the periventricular white matter of the occipital and temporal horns of the lateral ventricle with surrounding vasogenic edema and mass effect. It was isointense to cortex on T1- and heterogeneously hyperintense on T2-weighted images with mild diffusion restriction in the enhancing portion. A left parieto-occipital decompressive craniotomy was performed and tissue was procured for diagnosis. The biopsy showed an infiltrating, angiocentric neoplasm, composed of large anaplastic cells, including hallmark cells with "horseshoe" nuclei, abundant eosinophilic cytoplasm and occasional perinuclear clearing. Large areas of necrosis and pericellular reticulin deposits of the vascular walls were also noted. On immunohistochemistry, the neoplastic cells diffusely expressed CD45, CD2, CD3, CD25, CD43, MUM1, and CD30, and were negative for ALK, CD20, CD79a, PAX-5, CD15, CD5, BCL-6, BCL-2, Granzyme B, GFAP, Pancytokeratin. In situ hybridization for EBER was negative. The proliferative index (Ki-67), while variable, was as high as 80%. TP53 deletion was detected by FISH in 100% of the cells analyzed. No rearrangements in the ALK or MYC genes was noted by FISH. Additional studies revealed a complex karyotype including loss of chromosomes 9 and 10, gain of chromosome 17 and a marker chromosome, and structural rearrangements involving chromosomes 4, 10, and 13. Previously reported rearrangements involving DUSP22 (6p25) and TP63 (3q28) were not identified. TCR gene rearrangement was also identified by PCR. High dose Cytarabine/Methotrexate, and radiation were not successful in controlling disease progression and home hospice was recommended.

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

Conclusion
This is an infrequent type of primary CNS lymphoma with a poor prognosis and, while TP53 has been reported in sporadic, and cutaneous ALCL, to our knowledge, this is the first report of primary CNS ALK-negative anaplastic large cell lymphoma with TP53 deletion.
Lymph Nodes Triaging by General Surgical Pathologists – Flow Cytometry or Immunohistochemistry or Both?
Authors: Adhikari B , Herschap B , Sanchez-Salazar A , Ehsan A 
Published: November 2023

Abstract

Introduction/Objective
The diagnosis of lymphoma has become complex due to existing WHO/ICC classifications. Triaging Lymph Nodes (LN) is an important first step in making the correct and precise diagnosis in a timely and cost- effective manner, initiating appropriate treatment and predicting prognosis. Surgical Pathologists (SPs) face challenges when it comes to triaging LNs for Flow Cytometry (FC) and Immunohistochemistry (IHC), as limited guidelines are available for triaging and every practice doesn’t have hematopathologist (HP) on site.

Methods/Case Report
We retrospectively evaluated 850 LNs (excision, core or FNAs) during 2009-2022; and divided samples into two groups (without additional esoteric testing) that were blinded from each other: Group I: FC and morphology (460) and Group 2: IHC and morphology (390). Diagnostic categories (DC) were 1) Reactive (RE-140); 2) B-cell lymphomas (BLy-375); 3) T-cell lymphomas (TLy-75); 4) Hodgkin Lymphomas (HL-230) & 5) Non-heme malignancy (NHM-30).

Results (if a Case Study enter NA)
Group I – Diagnosis was made independently in 5 DCs as follows: RE (90%); BLy (45%); TLy (10%); HL (10%) and NHM (20%). Group II – Diagnosis was made independently in 5 DCs as follows: RE (70%); Bly (80%); TLy (70%); HL (90%) and NHM (100%).

Conclusion
We concluded that touch imprints or cytological preparation are important steps when triaging LNs and summarize our findings as follows: 1) Combination of both FC and IHC are useful when triaging LNs; 2) FC overall results in cost savings; 3) FC is a powerful tool to be used for initial work-up and guiding further IHC work-up and diagnosis can be rendered faster when FC data is available; 4) FC is more valuable in RE and low grade BLy, while IHC in high grade BLy; 5) IHC is more valuable in TLy, HL and NHM. Therefore, it is imperative for pathology practices to prioritize the triaging of LNs initially for FC followed by IHC as needed.
POEMS-associated Multicentric Castleman Disease: A diagnostic and Therapeutic Conundrum
Authors: Zahid H , Latif S , Baby S 
Published: November 2023

Abstract

Introduction/Objective
A rare multisystemic, paraneoplastic hematologic disorder, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) is associated with an overproduction of pro-inflammatory cytokines caused by a plasma cell proliferative disorder. Castleman disease is a rare clinical entity described as a polyclonal lymphoid proliferation, that leads to generalized lymphadenopathy. It is rarely presented in association with POEMS Syndrome.

Methods/Case Report
A 55-year-old hispanic male, when being evaluated for liver mass, revealed bile duct thickening and a pancreatic head mass. Endoscopic fine needle aspiration biopsies were negative; however, the cross sectional imaging identified enlarged left axillary lymph nodes. His excisional lymph node biopsy showed human herpese virus-8 (HHV-8) negative multicentric Castleman disease (MCD). Several features of POEMS syndrome were noted. The axillary lymph node biopsy demonstrated florid follicular hyperplasia, scattered regressed germinal centers and concentric rings of mantle zone lymphocytes. CD138, kappa-ISH, and lambda-ISH highlight scattered polytypic plasma cells. Our case fulfills the mandatory criteria of POEMS syndrome with the presence of neuropathy and a constellation of other major and minor criterion including, axillary Castleman, splenomegaly, hepatomegaly, skin changes, ascites and bilateral renal cortical lesions. Furthermore the patient also has a history of cerebrovascular accident and chronic cough favoring POEMS syndrome.

Results (if a Case Study enter NA)
NA

Conclusion
The complexity and multi-organ involvement, leads to frequent misdiagnosis of POEMS disease. In addition significant overlap of symptoms of POEMS syndrome makes it difficult to differentiate from other plasma cell disorders associated with MCD. Our study includes a brief review of the literature delineating the characteristics and overlap between POEMS syndrome and other diseases.
CD8+ aggressive T-cell lymphoma (T-NHL) involving the liver and skin: a case study
Authors: Ibrahim N , Wang W , Naik U , Abu Qubo A , Zhu H 
Published: November 2023

Abstract

Introduction/Objective
Aggressive T-NHL involving cutaneous and visceral organs is rare. We report a case with a complex presentation that was found to have hepatic and skin lesions simultaneously. We emphasize the importance of the clinicopathological correlation and diagnostic work-up for such a rare case

Methods/Case Report
A 60-year-old male with alcoholic cirrhosis presented with abdominal pain, fever, and night sweats for over two weeks. Detailed physical evaluation revealed a tender, indurated, erythematous papule on the left upper back. Lab results showed leukopenia, anemia, and increased LDH. PET-CT showed multiple hypermetabolic lesions in the liver, skin, and deep soft tissue above and below the diaphragm. A liver biopsy revealed a diffuse sheath of large atypical lymphoid cells with small lymphocytes in the background. Atypical lymphoid cells stained positive for CD45, CD2, CD3, CD8, TIA-1, CD5 (partial), granzyme B (partial), βF1 (partial); and negative for ALK, BCL-2, CD4, CD7, CD10, CD30, CD56, and TCRδ. Ki-67 was 70%. The skin punch biopsy revealed epidermotropic infiltration of lymphocytes with a similar immunophenotype as the liver lesion. Bone marrow biopsy showed no involvement.
The differential diagnosis includes primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-NHL with visceral dissemination, peripheral CD8+ T-NHL, lymphomatoid papulosis, CD8-positive mycosis fungoides, and hepatosplenic T-NHL. The visceral involvement excludes lymphomatoid papulosis and CD8-positive mycosis fungoides. The absence of bone marrow involvement excludes hepatosplenic T-NHL. The prominent liver involvement favors the diagnosis of peripheral CD8+ T-NHL. However CD8+ aggressive epidermotropic cytotoxic T-NHL still cannot be entirely excluded due to the epidermotropic CD8 positive T-cell infiltration of the dermis and subcutaneous adipose tissue. Further evaluation for JAK2 mutation and TBX21 amplification can help distinguish it from Peripheral CD8- positive T-NHL.

Results (if a Case Study enter NA)
NA

Conclusion
The subclassification of CD8+ T-NHL into distinct entities with overlapping clinical and histological characteristics is challenging without molecular tests.
However, clinicopathological correlation with appropriate work-up can help narrow the differential diagnoses.
Epidural mass in a 37-year-old male with progressive neurologic symptoms
Authors: Johal J J 
Published: November 2023

Abstract

Introduction/Objective
A 37 yo male with progressive thoracic myelopathy (bilateral lower extremity weakness, hyperreflexia, left foot drop and bowel/bladder incontinence) visited our hospital. MRI of the thoracic spine revealed an intradural-extramedullary mass measuring 3.3 x 2.1 x 1.1 cm with severe compression and leftward and anterior displacement of the spinal cord suggestive of spinal nerve sheath tumor versus less likely meningioma. Surgery was done and an extradural mass was found which was resected via T5/6 laminectomy.

Methods/Case Report
Pathology received a red black irregular mass measuring 2.9 x 1.1 x 1.0 cm. H&E showed predominantly distended vascular channels lined by a single layer of flat endothelial cells and filled with red blood cells. Immunohistochemical stains CD34, S100, SOX10 and EMA were performed. CD34 was positive in endothelial cells lining the ectatic channels. S100 and SOX10 are negative ruling out spinal nerve sheath tumor. EMA was negative effectively ruling out a meningioma. The diagnosis of cavernous hemangioma was made.

Results (if a Case Study enter NA)
NA

Conclusion
Hemangiomas are benign tumors of circumscribed proliferating blood vessels and are most often found superficially in head and neck region. Cavernous hemangiomas have markedly dilated vessels as in our case.
Cavernous hemangiomas of the spine are very rare and represent 5-12% of vascular lesions in the spine, with majority being an extensions from a vertebral hemangioma extending into spinal canal. Only 1-2 % are purely extradural spinal locations. Out of 54 cases, 36 were male and18 female, ages 5-78 showed 80% in the thoracic spine and 93% on the dorsal side. Patients typically present with insidious back pain, radiculopathy and myelopathy suspicious for disc herniation. They are most commonly found on the dorsal side of the thoracic spine. Epidural cavernous hemangiomas on MRI would often present as a mass and should be considered in the differential diagnosis along with nerve sheath tumors, meningiomas, abscess, and extradural hematoma.
False Negative Results of First-Tier Treponemal Antibodies in an HIV-Infected Patient
Authors: Daou L , Caturegli P P 
Published: November 2023

Abstract

Introduction/Objective
Syphilis diagnosis relies on detecting Treponema pallidum antibodies in serum or CSF. In the reverse syphilis screening algorithm, an automated enzyme immunoassay first detects serum antibodies against treponemal antigens. A negative result halts further testing; however, a positive result prompts manual testing for antibodies against non-treponemal antigens such as cardiolipin. The sensitivity of first-tier automated assays is typically high. We present a case of an HIV patient who initially tested negative for syphilis in the first-tier assay but was subsequently diagnosed with the infection.

Methods/Case Report
A 30-year-old HIV-positive female (CD4+ count 24/mm3), previously diagnosed with chlamydia and gonorrhea, experienced blurred vision, eye pain, fever, and a palmoplantar rash. Despite clinical suspicion of syphilis, the initial first-tier chemiluminescence immunoassay (CIA) for treponemal antibodies (LIAISON Treponema, DiaSorin, Stillwater, MN) returned a negative result, precluding any further syphilis testing at that time. However, a skin biopsy revealed interface dermatitis and spirochetes. CSF analysis showed pleocytosis, increased proteins, and borderline low glucose, with both VDRL and IFA assays negative. Based on these findings, we retested for serum antibodies by repeating the CIA test and performing RPR and TP-PA assays outside the algorithm sequence. Despite reconfirmation of the CIA negativity, both RPR (titer 1:64) and TP-PA were positive, leading to a secondary syphilis diagnosis and penicillin G treatment. Subsequent investigations aimed to explain the initial false negative CIA result. Serial dilution of the patient's serum up to 1:1000 did not alter the result, excluding the 'hook effect' caused by an excessive concentration of antibodies. Further serum testing at a different laboratory using another type of first-tier immunoassay yielded a positive result, pointing toward differences in the composition of treponemal antigens utilized across various manufacturer assays as the likely cause of the discrepancy.

Results (if a Case Study enter NA)
NA

Conclusion
Given their high sensitivity, automated first-tier treponemal assays rarely yield false negative results, whereas false positives are the most common ‘lab error’ and are typically resolved with second-tier assays.
Nevertheless, this case highlights that false negatives can occur and, thus, stresses the need to re-evaluate the approach in diagnosing syphilis, especially in patients with antibody production abnormalities, such as those with HIV.
Pre-Accessioning in Anatomic Pathology – Utilizing a Cloud-Based Laboratory Information System Reducing Error in Anatomic Pathology and Improving Patient Safety
Authors: Khatri R , Guerrero B , Garcia T , Perez J , Malik A , Ehsan A 
Published: November 2023

Abstract

Introduction/Objective
Typical workflow in Anatomic Pathology (AP) starts from accessioning of cases to sign out. Most Laboratory Information System (LIS) follow this cycle of sample tracking. However, at certain times, either samples are not received or get lost in transit without lab being notified. There is a need of pre-accessioning in AP especially for samples received from outpatients’ sites, so labs not only track samples during transit but also reduce typographical errors (name, DOB, Unique ID) and assess workload before arrival.

Methods/Case Report
From 2020-2022, we initiated e-requisition utilizing online cloud-based portal for submitting AP cases obtained at physician offices, clinics, and outreach satellite sites. Insurance information and clinical history were scanned and uploaded with e-requisition submission. Retrospective analysis was performed, and data was analyzed and compared for errors, QA metrics and workflow analysis on samples obtained with PRE (840 cases) and without pre-accessioning NON-PRE (1280 cases).

Results (if a Case Study enter NA)
PRE and NON-PRE (handwritten and manual submission) were compared. Results were as follows for PRE vs NON-PRE: 1) Typographical errors (0.1% vs 8%); 2) Insufficient clinical history and ICD-10 (1% vs 9%); 3) Sample types errors (0.2% vs 5%); and 4) Efficient workflow for data entry per case at accessioning (1min vs 4min)

Conclusion
We demonstrated pre-accessioning feature for AP samples utilizing cloud-based portal of LIS is an important tool that can 1) prevent/reduce laboratory accessioning errors; 2) help labs monitor sample tracking from the time sample is obtained to the time it got accessioned in the lab; 3) help labs improve turn around time in their workflow for quick accessioning and 4) improve patient safety by reducing errors for AP samples; and 5) can be integrated with any clinical electronic medical record.
Beyond the Obvious: Spectrum of Neuroendocrine Proliferation and Tumors in the Biliary Tree - A Case Series
Authors: Liu Y , Pyatibrat S , Shilpa J , Lin J , Panarelli N , Karamchandani D M 
Published: November 2023

Abstract

Introduction/Objective
Neuroendocrine tumors (NETs) in the biliary system are extremely uncommon and often pose a diagnostic challenge due to their non-specific presentation and radiological features. While typically NETs form mass lesions causing biliary obstruction, to the best of our knowledge, microscopic neuroendocrine cell proliferation without mass formation has not been formally reported in the literature. This study aims to describe the clinicopathological features of a series of NETs/neuroendocrine cell proliferation involving the biliary tree.

Methods/Case Report
Surgical resections of NETs/neuroendocrine cell proliferation affecting the extrahepatic bile ducts and gallbladder were identified from the electronic pathology databases of five institutions between January 2010 and May 2023. The clinical data was obtained through chart review, and histologic findings were reviewed by a gastrointestinal pathologist at each institution.

Results (if a Case Study enter NA)
The study involved six patients with a mean age of 66 years (range: 58-75 years, males:3, females:3). The patients presented with abdominal pain or biliary obstruction. Pathologic examination revealed that three cases showed visible mass-forming lesions (1.6-2.4 cm) in the gallbladder or common bile duct, diagnosed as well-differentiated NETs. The remaining three cases had no grossly visible masses but showed incidental microscopic neuroendocrine cell proliferation/NETs (either in cystic duct or common bile duct) ranging from 0.2-0.4 cm, all associated with biliary lithiasis. All patients recovered after surgical resection without metastasis or recurrence, except for one patient who died a month after surgery due to an unrelated cause (multisystem organ failure).

Conclusion
This study highlights the spectrum of neuroendocrine proliferation in the biliary tree, ranging from microscopic incidental findings to grossly visible mass-forming NETs, which may result in variable clinical management and outcomes. Notably, incidental neuroendocrine proliferations were found to be associated with biliary lithiasis in all 3 cases, raising a possibility of a potential neuroendocrine metaplastic pathogenesis, which should be explored more via additional studies.
Physico-Chemical Alternatives for Synthesis of Metal Nanoparticles Using Fusarium Chlamydosporum
Authors: Abdelmonem M , Elshikh H H , Mostafa M A , Eldaly R , Hammad S E , El-Rouby M N , Wasim H 
Published: November 2023

Abstract

Introduction/Objective
Background: Synthesizing metal nanoparticles (NPs) by chemical or physical methods is difficult due to energy and time consumption, equipment costs, and chemical toxicity. Chemosynthesis-derived NPs are unstable, limiting their biological applications. Thus, identifying alternative green sources to address these drawbacks is difficult scientifically. The hardest part of green metal nanoparticle synthesis is finding a nontoxic natural product and an eco-friendly solvent.
Objectives: Isolation of fungal endophytes from Eucalyptus sideroxylon leaves to synthesize ZnO and Au nanoparticles.

Methods/Case Report
Materials and methods: We used healthy Eucalyptus sideroxylon plant samples from the desert research center to separate endophytes. All fungi were grown on malt extract broth on a rotary shaker at 28 °C (120 rpm) for 96 hours after isolation. Biomass components were removed by filtration and washing in distilled water. Nanoparticles came from biomass cell filtrate.
0.1 M, 1 mL of Zn SO4, and HAuCl4 were added to 10 mL of fungal filtrate and agitated for 24 hours in the dark at room temperature to make Zn and Au nanoparticles separately. Characterization of nanoparticles shows a green synthesis of ZnONPs and AuNPs.

Results (if a Case Study enter NA)
Results: Fungal endophytes' filtrates were mixed with 1mM Zn SO4 and HAuCl4 solutions to test their extracellular biosynthesis of ZnO and Au NPs. The fungal filtrate became colorless and violet after mixing with Zn SO4 and HAuCl4. Only FI-03 is from 13 (FI-01 to FI-013). The most potent fungal strain for Zn O NP and Au NP nanoparticle synthesis was Fusarium Chlamydosporum. Pure, mostly spherical ZnO and Au NPs averaged 19.3 and 22.1 nm. UV-Vis absorption: Excitonic absorption peaks of ZnO NPs were between 300 and 400 nm. ZnO NPs' maximum absorption peak was 305 nm, while Au NPs' peak was 520 nm. One absorption peak indicates metallic gold nanoparticles. Au and ZnO NPs aggregate the most due to their hydrophilicity, HD of 34.88 and 15.77 nm, and PdI of 0.77, 1.00, and 0.952. Gold face-centered cubic fcc structure dominates Au NPs' XRD pattern. EDX shows 64.61 and 35.39 percent Zn and O, respectively, in both nanoparticles. The optical absorption band of gold nanocrystallites peaked at 2.2 keV in energy-dispersive X-rays.

Conclusion
Endophytic fungus biosynthesizes ZnO and Au NPs, which are bioactive compounds for medicine and food without toxic chemicals and are environmentally friendly.
Assessment of Improved Quality via the Adoption of Microbiology Automation
Authors: Lau J , Larsen J , Grys T , Rice F , Graf E 
Published: November 2023

Abstract

Introduction/Objective
Our laboratory implemented a full COPAN WASPLab microbiology automation line in March of 2023. Prior to this implementation, our laboratory routinely observed potential bacterial contamination of sterile specimens, as well as culture plates in which the specimens were not struck out, due to a large number of new staff members and heavy workloads. Both of these quality issues directly impact patient care due to potential misleading or delayed results. We hypothesized that automation of the plating and incubation steps would reduce both of these quality issues significantly.

Methods/Case Report
Potential contamination and plates not struck were self-reported by technologists during pre- implementation (July 2022-Feb 2023) and post-implementation (Mar-Apr 2023) periods. Potential contamination was defined as one or two colonies of bacteria on a single agar plate, consistent with skin fora, from a normally sterile source specimen and reviewed by the Director for potential clinical correlation. Plates unstruck in the post- implementation period continued to include those manually set up. A 2 two proportion z-test was performed to compare pre and post implementation data.

Results (if a Case Study enter NA)
A total of 3,055 and 1,750 sterile source cultures were analyzed in the pre- and post-implementation periods, respectively. Of these, 109 versus 8 were designated as potential contamination, respectively, resulting in a significant reduction (Z stat 6.7, p&lt;0.0001). For the plate streaking portion, 22,814 and 7,211 cultures were analyzed in the pre- and post-implementation periods, respectively. Of these, 21 versus 3 plates were not struck, respectively, resulting in a greater than 2-fold reduction per culture, but did not meet significance.

Conclusion
Implementation of microbiology automation significantly reduced skin flora contamination of sterile source cultures. Proportions of unstruck plates were also reduced, although these did not meet significance, likely due to the low numbers.