bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Rare Autopsy Case of Aggressive Combined Hepatocellular-Cholangiocarcinoma with Stem Cell Features in A 59-Year-Old Female
Authors: Ahmed A A , Gehris B T , McDonald M , Salihi S Al , Buja M 
Published: November 2023

Abstract

Introduction/Objective
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare liver tumor with histologic and phenotypic features of both hepatocellular carcinoma and intrahepatic cholangiocarcinoma. It is believed to arise from hepatic progenitor cells. It consists of intermingled malignant biliary and hepatic tissue and thus is a distinct entity, rather than two separate coexisting malignancies.

Methods/Case Report
A 59-year-old female with a history of hepatitis C and cirrhosis presented with abdominal pain, shortness of breath, and altered mental status. She developed hematemesis and went into cardiac arrest. Massive transfusion and cardiopulmonary resuscitation were initiated. She was intubated, and an esophageal/gastric balloon was placed. She then underwent a procedure to relieve portal hypertension and related gastrointestinal bleeding.
Despite extensive interventions, her condition continued to deteriorate. She expired one day after her initial presentation.

Results (if a Case Study enter NA)
At autopsy, the liver was diffusely and markedly fibrotic with numerous nodules of varying size with invasion into adjacent vasculature. Microscopic examination of the nodules revealed cHCC-CC with stem cell features and lymphovascular invasion. Further examination revealed tumor emboli scattered throughout the right lung.
The patient’s history of chronic hepatitis C may have contributed to the development of her cHCC-CC. Although gross appearance resembled cirrhosis, upon microscopic inspection the nodules showed excessive tumor burden.
Ultimately the patient had end stage liver disease due to the accumulation of damage and consequent fibrosis. This led to portal hypertension with subsequent massive gastrointestinal bleeding, hemorrhagic shock, and death.

Conclusion
cHCC-CC is a rare aggressive primary liver tumor with a poor prognosis. It can present with a cirrhotomemetic pattern with small nodules that can evade clinical and radiographic detection. Autopsy findings can provide valuable insights into the pathogenesis and clinical course of cHCC-CC, highlight the aggressive nature of the disease, and may inform future diagnostic and therapeutic strategies. Accurate diagnosis of this tumor is important for patient management and prognostication.
The Informative & Virtuous Role of Autopsy Observation Experiences in Medical Student Education
Authors: Hagen E S , Quintanilla-Arteaga A , Lilley C M , Mirza K M 
Published: November 2023

Abstract

Introduction/Objective
The autopsy is an extremely valuable resource to medicine and society. However, there has been a significant decline in autopsy rates. The autopsy is a currently overlooked part of medical education. We conducted a study to understand medical students’ experiences with observing an autopsy. We assessed the impact of autopsy observation on medical students’ consideration of Pathology as a specialty choice. We also explored the possible emotional burden of observing an autopsy.

Methods/Case Report
The Pathology Interest Group at the Stritch School of Medicine (SCOPE) collaborated with the LUMC Pathology department to offer medical students the opportunity to observe an autopsy performed at the university. Participants completed surveys before and after their autopsy observation experiences through Google forms. Data collected over one academic year was analyzed using descriptive statistics and independent sample T- tests where applicable. The participants’ responses to open-ended questions were reviewed and coded by ESH and ASQ.

Results (if a Case Study enter NA)
Nineteen students participated in the study. One participant’s data was excluded given conflict of interest; thus, 18 students’ data were analyzed. Eight students (44.4%) were M1’s, six (33.3%) were M2’s, and four (22.2%) were M3’s. None (0%) of the students previously observed an autopsy. Unifying themes emerged regarding students’ thoughts about the autopsy observation opportunity, including excitement, gratitude, nervousness, humility, learning opportunity/curiosity, and heart-wrenching. Ten (55.6%) students expressed at least some level of concern about the emotional burden of the autopsy, which four students (22.2%) endorsed feeling afterward. Likert scores revealed that none (0%) of the students felt uncomfortable describing the process of an autopsy to a decedent’s family after autopsy observation and 13 students (72.2%) felt highly comfortable.

Conclusion
The participants widely found autopsy observation to be highly valuable, regardless of their consideration of Pathology as a career. Although the autopsy observation experiences did not lead more students to consider Pathology, the autopsy is just one of the many aspects of Pathology and we encourage ongoing communication of this idea to trainees. The sentiments expressed by students could inform design of informative and virtuous autopsy observation opportunities. Limitations of the study included its limited generalizability and small sample size, yet data collection is ongoing.
A rare case of cardiac calcified amorphous tumor in a 34-year-old woman diagnosed at autopsy
Authors: Odujoko O , Asad M , Bal S K , Dodge J , Janjua J 
Published: November 2023

Abstract

Introduction/Objective
Cardiac calcified amorphous tumor (CAT) is an uncommon, non-neoplastic heart lesion with an unknown incidence due to its rarity. Some authors have reported a female predominance of 62.5%. Many cases are associated with end-stage renal disease, diabetes mellitus and coronary artery disease. Dysfunction of calcium- phosphorus metabolism and hypercoagulability are thought to contribute to its pathogenesis. This is the first case reported from our institution.

Methods/Case Report
We present the case of a 34-year-old woman with a remote history of ulcerative colitis, type 1 diabetes mellitus, hypertension, Hashimoto thyroiditis, cardiomegaly, and end-stage renal disease on continuous hemodialysis. She had multiple hospitalizations for mesenteric ischemia and small bowel resections. She was admitted multiple times in 2021 for complaints of pain in bilateral thighs, shortness of breath, frequent loose stools, and abdominal pain. She was poorly compliant with hemodialysis. A chest x-ray showed severe enlargement of the cardiac silhouette. A CT angiogram of the abdomen and pelvis showed arteriosclerosis of the superior mesenteric, inferior mesenteric and celiac arteries. The patient presented to the hospital in February 2022 with continuous abdominal pain, gluteal pain, and diarrhea. Her creatinine was consistently elevated at 3.52 mg/dL. On the sixth day of admission, she was found unresponsive and was pronounced dead. Autopsy showed cardiomegaly (600 grams) with left ventricular hypertrophy, recent myocardial infarction of the posterolateral left ventricle and moderate to severe coronary artery atherosclerosis. There were lesions composed of calcified amorphous material involving the mitral valve, the endocardium and subendocardial portions of the left and right ventricles, consistent with multifocal cardiac calcified amorphous tumor. The largest lesion measured 4.0 cm. The cause of death was myocardial infarction complicating type 1 diabetes mellitus and end-stage renal disease.

Results (if a Case Study enter NA)
NA

Conclusion
CATs are usually asymptomatic but possible symptoms include dyspnea and syncope. As a result, they are often incidental findings. The calcified deposits may embolize, causing pulmonary embolism and cerebral infarction. CAT is most frequently observed in the left heart, especially on the mitral annulus; however, the right side of the heart can also be affected. End-stage renal disease is a predisposing condition, as seen in this patient.
ACTB::GLI1 Gene Fusion Small Bowel Mesenteric Tumor; a Case Report and Review of the Literature
Authors: Abdelsadek O A , Mehreen A , Alnajar H 
Published: November 2023

Abstract

Introduction/Objective
GLI1 encodes a transcription factor that targets cell cycle regulators affecting stem cell proliferation. Activation of the GLI (glioma-associated oncogene homologue 1). GLI activity in adult tissues is restricted but has been identified in various neoplasms, as a result of mutations in the PTCH (patched) or SMOH (smoothened) genes, encoding components of the sonic hedgehog pathway, or by amplification of GLI. The B-actin (ACTB) gene, encoding an essential cytoskeletal component, is under the control of a conserved, strong, and complex promoter that assures a high level of expression in non-muscle cells. ACTB::GLI1 gene fusions have been reported in the tongue as the pathognomonic genetic abnormality defining an unusual subset of actin-positive, perivascular tumors with t (7;12) translocation.

Methods/Case Report
We report a case of 53-year-old male presented to the hospital with dizziness and bloody stools. CT scan of the abdomen and pelvis revealed a 10.5 x 7.7 cm large complex cystic and solid mass of the right lower quadrant of the abdomen adjacent to the cecum and terminal ileum. The patient has a past medical history of testicular germ cell tumor and underwent orchiectomy with adjuvant chemotherapy 30 years ago. The mass was excised and histological examination of the mass showed an unencapsulated, relatively circumscribed neoplasm composed of sheets of monomorphic bland spindle to ovoid cells. Immunohistochemical (IHC) stains, including pan- CK, SALL4, c-Kit, CD34, SMA, MDM2, HMB45, and MART1, were all negative. NGS sarcoma fusion panel was done and revealed ACTB::GLI1 gene fusion. The tumor was finally diagnosed as GLI1 -rearranged enteric tumor.

Results (if a Case Study enter NA)
NA

Conclusion
our case, in addition to, previously reported cases in the literature support the existence of a newly identified, seemingly discrete group of soft tissue tumors at different body locations. The morphology of these tumors is somewhat variable, making identifying and diagnosing these tumors more challenging. In addition to the morphologic variance, the diagnosis of these tumors in unusual locations is not uncommon, with some variations in IHC staining patterns. Identifying the molecular pattern of these tumors and the biological mechanism will facilitate more effective treatment options for patients, including targeted therapy.
Myxofibrosarcoma with false-positive EWSR1 FISH
Authors: Lack M , Cain S , Hamza A , Meyer A R 
Published: November 2023

Abstract

Introduction/Objective
Myxofibrosarcoma is a common sarcoma in elderly patients. It comprises a spectrum of malignant fibroblastic neoplasms with variable myxoid stroma, pleomorphism, and a distinctive curvilinear vascular pattern. As soft tissue tumors frequently exhibit overlapping histologic features, immunohistochemical stains and fluorescent in situ hybridization (FISH) studies are utilized to determine accurate diagnosis. The purpose of this case is to report a false-positive EWSR1 FISH in a myxofibrosarcoma.

Methods/Case Report
A 54-year-old male presented with a mass in his left forearm that had been present for four months. The mass was as painless and had not grown larger since it was initially noticed. A resection of the mass was performed which revealed monotonous, spindled to focally epithelioid cell population in a myxoid background that bordered on chondroid in some foci. While this raised concern for a translocation-associated sarcoma, particularly extraskeletal myxoid chondrosarcoma, the scattered pleomorphism expected in a myxofibrosarcoma was still present. Immunohistochemistry revealed diffuse reactivity for CD34 and negativity for pancytokeratin, EMA, S100, SOX10, desmin, SMA, CD117, TLE1, and STAT6 stains. FISH for EWSR1 gene arrangement to exclude extraskeletal myxoid chondrosarcoma was positive. However, a follow-up NGS study was negative for gene rearrangement, indicating a false-positive FISH result. The diagnosis of myxofibrosarcoma, FNCLCC grade 1 or 3 was rendered.

Results (if a Case Study enter NA)
NA

Conclusion
EWSR1 gene rearrangements represent one of the most commonly involved genes in sarcoma. FISH has a reported sensitivity and specificity for this rearrangement of 100% and 87% respectively. This case highlights a false-positive FISH result in a soft tissue tumor and the importance of correlating results with histology and molecular genetics for accurate diagnosis to guide appropriate management for patients.
Tissue microarray immnunohistochemical staining for androgen receptor in breast cancer in a Ghanaian cohort
Authors: Duduyemi B M , Ayibor W , Agyemang-Yeboah F 
Published: November 2023

Abstract

Introduction/Objective
Despite the advancement in therapy, breast cancer still remains the commonest malignancy in women globally due in part to its heterogeneity. Triple negative breast cancer (TNBC) represents up to 20% of all breast cancer variants, an aggressive disease with poorer outcomes compared to other breast cancer subtypes. No targeted therapies are currently approved for TNBC, and newer treatment approaches are seriously needed.
Androgen receptor (AR), another hormonal receptor, is often expressed in breast cancer and its role depends on the relative levels of circulating estrogens and androgens. This study aims to assess the expression of AR in breast cancer in a tertiary hospital in Ghana

Methods/Case Report
Immunohistochemical staining for AR was performed on tissue microarray (TMA) blocks of which ER, PR, Her-2/neu had already been done. 197 cases were suitable for the study. Results from the immunostaining were analysed using SPSS version 23 for descriptive statistics and correlations (X2 and Pearson tests)

Results (if a Case Study enter NA)
197 TMA cases were used. TNBCs constitute 61.9% of the cancers. The majority of these tumours were grade III, ductal carcinoma NST. The mean age was 49.86±14.09 and the modal age group was the 40-49 years. Our cases showed 23% AR expression in triple negative cancers. The study also established that AR is more frequently expressed in low grade tumours compared to the high-grade ones.

Conclusion
There is appreciable level of AR expression in our cases but most are quadruple negative. However, AR is more frequently expressed in low grade tumours than high grade ones
The correlation between Plasma Fibrinogen Levels and Glycemic Status in type 2 Diabetes Mellitus
Authors: Abdelmonem M , Abdulla S , Wasim H , Elawamy H 
Published: November 2023

Abstract

Introduction/Objective
Background: Fibrinogen is considered a well-known contributor to the progression of atherosclerotic lesions and a predictor of cardiovascular events. Patients with diabetes mellitus (DM) have higher levels of fibrinogen, which may raise their thromboembolic risk for cardiovascular disease (CVD). Plasma fibrinogen is an indicator of inflammation, and endothelial dysfunction has been described as an independent risk factor for cardiovascular morbidity in type-2 diabetes mellitus (T2DM) patients. Poor glycemic control has been reported to be associated with hyperfibrinogenemia.

Aim
This study aims to estimate the levels of fibrinogen in patients with type-2 diabetes mellitus and determine its correlation with glycated hemoglobin levels.

Methods/Case Report
Subjects and methods: It is a cross-sectional analytic study conducted in the Benghazi Diabetic Clinic, Libya. Patients who were diagnosed with type 2 diabetes mellitus, either newly detected or already on diet or treatments, were included in the study during the period between May 2022 to December 2022. A total of 231 adult subjects were selected, with ages ranging from 20-80 years. Random blood sugar levels were assessed. Plasma fibrinogen levels (mg/dl) were estimated by the "Clauss method" and glycosylated hemoglobin (%) by the "immunoturbidimetric method." Patients were categorized into three groups depending upon the HbA1c values, i.e., into &lt;5.7% (good control), 5.7-6.5% (fair control), and &gt;6.5% (poor control).

Results (if a Case Study enter NA)
Result: Out of 231 subjects, (40.6%) were males and (59.4%) were females, with a mean±SD of age was (47.03±15.54) years. There was a significant positive correlation between fibrinogen and HbA1c in the fair control group (r=0.424, p=0.003) and the poor control group (r=0.369, P=0.000). Moreover, the difference between fibrinogen and age in the good control group was significant (p&gt;0.05), whereas no significance was recognized in other groups.

Conclusions
Plasma fibrinogen levels are elevated in type 2 DM, and this elevation was associated with poor glycemic control; increased HbA1c levels. The other parameters which correlated with plasma fibrinogen levels were age. Lowering plasma fibrinogen levels could be an integral approach to cardiovascular complications reduction in type-2 DM.
Accuracy of prior cytology versus intraoperative consultation in predicting the final diagnosis of thyroid specimens
Authors: Zhao J , Ding L , Fung P , Mathews E , Sullivan P 
Published: November 2023

Abstract

Introduction/Objective
The aim of this study was to assess the accuracy of preoperative cytology and the additional contribution of intraoperative frozen section in predicting the final diagnosis of thyroid surgical specimens.

Methods/Case Report
A retrospective search was conducted for cases that underwent pre-surgical cytology of thyroid surgical specimens received from January 2017 to June 2022. A total of 99 cases were evaluated which were grouped into six categories according to the Bethesda system. The cytology results were compared with the corresponding frozen section and permanent section diagnoses. Indeterminate and discordant cases were further evaluated with molecular tests.

Results (if a Case Study enter NA)
Among the 99 cases, preoperative cytologic diagnoses were as follows: 1 was nondiagnostic, 9 were benign, 7 were AUS/FLUS, 3 were FN/SFN, 7 were suspicious for malignancy, and 72 were malignant. Using Bethesda categories V and VI as cytology “positive” cases and Bethesda category II as cytology “negative” cases, the sensitivity and specificity of cytology were 99% and 100%, respectively. The positive predictive value was 100%. The negative predictive value was 89%, which was affected by sampling error. Intraoperative frozen section was performed on 31 cases. In 4 indeterminate cytology cases (Bethesda III, IV), frozen section diagnosis was benign in 1 (confirmed on final) and remained indeterminate in 3 cases (3 benign on final). All 3 dual indeterminate cases showed a follicular pattern; molecular tests were predictive of the final diagnosis in these cases. All 21 malignant frozen section diagnoses had positive cytology.

Conclusion
Cytology has high sensitivity and specificity, making it a valuable preoperative tool in thyroid surgery. Practically, intraoperative frozen section has limited value in thyroid nodules classified as Bethesda categories V and
VI. Additional evaluation may be helpful for cases classified as uncertain Bethesda categories. For follicular patterned lesions, frozen section may have less value.
Fine needle aspiration cytology of metastatic tumors to the thyroid: a 20-years single institution retrospective study
Authors: Saeed O A , Segura S , Hou T , Saad M , Alkhaseen A 
Published: November 2023

Abstract

Introduction/Objective
Metastases to the thyroid are rare and represent approximately 2% to 3% of all thyroid malignancies. In this study we aim to report our institution experience with these tumors over the last twenty years.

Methods/Case Report
Our laboratory information system was searched for metastatic tumors to the thyroid diagnosed on fine needle aspiration cytology from 2003 to 2023. The pathology reports as well as clinical data for these cases were then reviewed retrospectively.

Results (if a Case Study enter NA)
A total of 35 cases were found over the period of twenty years. The ages ranged from 30 to 83 with a mean of 60 years. 19 patients were female (54%) while 16 were males (46%). Clear cell renal cell carcinoma was the most common source of metastasis (12 cases), followed by squamous cell carcinoma of the head and neck (6 cases), followed by lung or breast adenocarcinoma, and neuroendocrine tumors (3 each). There were four metastatic sarcomas to the thyroid: osteosarcoma, synovial sarcoma, angiosarcoma and leiomyosarcoma. There was two metastatic adenocarcinoma (unknown primary), one melanoma case as well as one case of colon cancer.

Conclusion
Although rare, metastasis to the thyroid gland do happen and could be a potential diagnostic pitfall in a limited cytology specimen.
Atypical Facial Chondroid Syringoma of Medial Canthus, A rare clinical entity
Authors: Salehiazar S , Mirzaei Baboli K , Lores Gonzalez M , Ji P , Peng S 
Published: November 2023

Abstract

Introduction/Objective
Chondroid syringoma (CS) is an uncommon, benign mixed tumor originating from the sweat gland. Its incidence rate is extremely low, estimated to be less than 0.01%. CS predominantly affects adult males and shows a preference for the head and neck region. Typically, the size of the lesion is smaller than 1.0 cm, and it presents as a solitary, painless, subcutaneous nodule that is soft to firm, non-ulcerative, and gradually progressive.
Histologically, CS is characterized by a neoplasm composed of epithelial and myoepithelial cells, which are surrounded by a myxomatous, pseudochondromatous, or hyaline stroma containing mucous secretions. Although atypia is rare in CS, there is a potential for it to undergo malignant transformation.

Methods/Case Report
A 49-year-old man presented with a slowly growing mass on the medial canthus that had been present for 6 months. Examination revealed a tender, mobile nodule measuring 1.1 cm. An MRI of the head confirmed a subcutaneous lesion without involvement of deeper structures. Excisional biopsy of the lesion suggested adnexal carcinoma with involvement of the margins. The patient underwent Mohs surgery.Histopathology revealed localized basaloid epithelial proliferation forming solid sheets, trabecular, ductal structures with, chondroid myxoid stroma.
Immunohistochemically, the tumor cells of solid sheets and trabeculae were positive for CK5/6, P63, and Vimentin, whereas the cells were focally positive for S100, Calponin, alpha Actin, and SOX10. Also, ductal epithelial cells were highlighted with CK7, Cam5.2, EMA, and CEA. Ki-67 showed 1–5% reactivity. A few satellite nodules with infiltrative margins were seen. The atypical features, including cell atypia and a focal infiltrating border, suggest atypical chondroid syringoma. This tumor is considered a low-grade lesion, and no unequivocal evidence of malignancy has been identified.

Results (if a Case Study enter NA)
NA

Conclusion
Awareness of chondroid syringoma as a rare cause of eyelid lesions is important because although it is a benign neoplasm, incomplete excision can lead to recurrence or malignant transformation. Chondroid syringoma rarely exhibits atypia but can convert to the malignant spectrum. When malignant, it has a significant potential for recurrence, metastasis, and even death. Due to the tumor's rarity, making an accurate preoperative diagnosis can be challenging. Therefore, the possibility of chondroid syringoma should be kept in mind when dealing with a gradually progressive, soft to firm subcutaneous swelling.