bluuebunny/crossref_metadata_2025_split huggingface dataset:
Loss of α-smooth muscle actin immunostaining is not a useful marker for functional impairment: a comparison from patients with and without small bowel motility disorder
Authors: Collins K , González I A , Idrees M T , Saeed O A , Gupta A , Wo J M 
Published: November 2023

Abstract

Introduction/Objective
Prior studies have reported the loss α-smooth muscle actin (α-SMA) immunostaining in the inner circular layer of the muscularis propria in small bowel motility disorder cases, but this remains controversial with conflicting data. In this study we aimed to characterize the immunoreactivity of α-SMA expression in the muscularis propria of the small intestine, specifically jejunum, in patients with and without small bowel motility disorder.

Methods/Case Report
A total of 28 samples of transmural proximal jejunum biopsies from adult patients with small bowel motility disorder by manometric and/or radiologic testing and 47 control tissues were evaluated. The controls were full thickness, longitudinal tissue sections from segmental resections performed due to trauma from gunshot wound (n= 30), multi-visceral transplant for neoplasms (n= 4), liver failure with concurrent portal vein thrombosis (n= 9), and isolated intestinal transplant for Crohn disease (n= 4). Immunostaining for α-SMA was performed with appropriate controls to confirm the presence of staining in the circular and longitudinal muscle layers of the muscularis propria in each sample and recorded as retained or diminished.

Results (if a Case Study enter NA)
In the small bowel motility disorder and control cases, 43% (12/28) and 62% (29/47) of the cases showed no or minimal α-SMA expression in the inner circular layer with peripheral accentuation (p = 0.113), respectively. The remaining small bowel motility disorder cases (16/28, 57%) and the control group (18/47, 38%) showed retained expression of α-SMA in both layers of the muscularis propria.

Conclusion
Loss or diminished α-SMA expression in the inner circular layer of muscularis propria is present in similar frequency in cases with and without small bowel motility disorder and does not correlate with impairment of function.
Primary Renal Well Differentiated Neuroendocrine Neoplasm with Nodal Metastasis Possibly Originating from A Teratoma
Authors: Lazim A , Hennawy R 
Published: November 2023

Abstract

Introduction/Objective
Well differentiated neuroendocrine tumors (WDNETs) of the kidney are extremely rare and are aggressive tumors with higher rate of metastasis, even those with low proliferative rates. Primary WDNET arising in a renal teratoma is an exceedingly rare entity.

Methods/Case Report
Herein, we describe a case with a primary WDNET and possible mature cystic teratoma of the right kidney of a 22-year old male who presented with an epigastric/right upper quadrant abdominal pain. Abdominal MRI identified a 4.4cm isointense mass in the mid-lower pole of the right kidney within renal sinus. Robotic assisted partial nephrectomy was performed. Grossly, the 56gm excised mass is well circumscribed with tan- brown friable homogeneous cut surface. Histologically, tumor cells show round to oval nuclei with speckled chromatin and calcifications. The tumor metastasized to two hilar lymph nodes. The tumor is positive for AE1/AE3, vimentin, synaptophysin, CD99, INI-1 (SMARCB1), FLI-1, and chromogranin. While negative for CK7, CK20, PAX-8, CD10,
WT-1, CEA, and CDX-2. Ki-67 is 2% and the mitotic count is &lt; 1 per 10 HPF. The histology and immunoprofile are consistent with WDNET. No pathogenic fusions detected on Next Generation Sequencing (NGS) targeting RNA and DNA panels. Adjacent to the tumor, there is a cystic structure lined by intestinal mucosa positive for CDX2.

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

Conclusion
Neuroendocrine cells are not identified in the normal parenchyma of the kidney, while noted in adjacent intestinal mucosa raising the possibility that renal WDNET is arising from mature renal teratoma.
Ultrasound-MRI Fusion Prostate Biopsy: Experience from a Cancer Center in the Midwest
Authors: Al-Kharouf I , Sami F I , Abdo M E , Hamza A 
Published: November 2023

Abstract

Introduction/Objective
Majority of literature with few exceptions suggests ultrasound-magnetic resonance imaging (MRI) fusion biopsy of prostate to be superior in diagnosing cancer compared to systematic transrectal ultrasonographic (TRUS) biopsy. However, it is highly dependent on the expertise of the person performing the biopsy and comes at a higher cost. The purpose of this study is a to evaluate the effectiveness of ultrasound-MRI fusion prostate biopsy at our institution.

Methods/Case Report
All prostate biopsies received at our institution from January to December 2022 were included. Data such as patient age, presence of region of interest (ROI) biopsy, presence of cancer in any core, presence of cancer in ROI core, total number of cores with cancer, highest Gleason score in ROI core, and highest Gleason score in other cores were collected.

Results (if a Case Study enter NA)
A total of 448 consecutive cases were identified. Of these 214 (47.8%) were transrectal ultrasonographic and 234 (52.2%) were ultrasound-MRI fusion biopsies. Mean age of patients with TRUS biopsy was 64.3±8.6 years and mean age of patients with MRI-guided biopsy was 65.4±6.9 years, a statistically comparable population (p-value 0.001). Among TRUS cases, 133 (62.1%) had tumor. Among ultrasound-MRI fusion cases, 169 (72.2%) had tumor.
Among ultrasound-MRI fusion cases with tumor, 31 had cancer only in ROI core, 55 had cancer only in other cores and 83 had cancer in ROI core as well as at least one additional non-ROI core. Among 83 cases with tumor in ROI as well as non-ROI cores, 12 had higher Gleason score in ROI core, 18 had higher Gleason score in non-ROI core and in 53 cases the Gleason score in ROI core and highest Gleason score in any of the other positive cores were equal.

Conclusion
In our experience ultrasound-MRI fusion biopsy improves cancer detection; however, it does not improve the rate of detection of higher-grade cancer.
INCIDENTAL BLADDER MELANOSIS WITH CHRONIC CYSTITIS
Authors: Asad M , Vidhun R , Okby N 
Published: November 2023

Abstract

Introduction/Objective
Melanosis is a black or brown discoloration due to melanin deposition in the skin or on the mucosa of body organs such as conjunctiva, lips, mouth, genitalia, colon, and rectum. For example, melanosis coli is associated with chronic laxative use. However, melanosis on the bladder mucosa is an extremely rare, incidental, and benign finding which is commonly associated with bladder cancer or melanoma. We report an unusual case of incidental bladder melanosis with chronic cystitis in a patient diagnosed with bladder cancer.

Methods/Case Report
A 77-year-old male current smoker presented for a follow-up of recurrent bladder cancer (high-grade T1 Transitional Cell Carcinoma, TCC) diagnosed in 2016 with currently no symptoms. His past medical history included high blood pressure, papillary thyroid carcinoma status post thyroid lobectomy, and Type 2 diabetes mellitus. He had completed two cycles of treatment of Bacillus Calmette-Guerin (BCG) and BCG/Interferon for 6 weeks each. He had multiple transurethral bladder resections and biopsies in the past which revealed invasive high- grade papillary urothelial carcinoma, not invading muscularis propria. A recent computerized tomography scan of the abdomen and pelvis revealed diffuse bladder wall thickening and trabeculation along the dome and posterior urinary bladder. His lab workup including urinalysis, complete blood count, and chemistry were within normal limits. This time, the patient underwent urinary bladder midline and back wall cystoscopic biopsies and transurethral resection of the right lateral wall. The biopsies showed mild chronic cystitis with melanosis, however, the resection showed non- invasive high-grade papillary urothelial carcinoma.

Results (if a Case Study enter NA)
NA

Conclusion
Bladder melanosis has been reported less than 25 times in the literature worldwide. The etiology of melanosis is still unknown. No specific symptoms or treatment guidelines have been established for bladder melanosis so far due to decreased number of cases reported and therefore, reduced follow-up surveillance.
Nonetheless, the general behavior of bladder melanosis alone seems to be benign. To the best of our knowledge, this is the first report of bladder melanosis with chronic cystitis. Further studies are required to establish the association of bladder melanosis with chronic cystitis and to probe its clinicopathologic course, and implications.
Immunoreactivity of Histiocytes to OCT4; a diagnostic pitfall
Authors: Al-kharouf I , Stoieva M , Hamza A 
Published: November 2023

Abstract

Introduction/Objective
Immunohistochemical stains are supposed to make a Pathologists’ life easier; however, interpretation of some stains in isolation can be a diagnostic pitfall. Immunoreactivity of paraganglia to OCT4 stain is a known pitfall for this stain when evaluating retroperitoneal lymph node dissection specimens for germ cell tumour metastasis. The purpose of this report is to highlight another pitfall of the OCT4 stain, albeit in a similar clinical scenario.

Methods/Case Report
A 49-year-old male with a history of left testicular seminoma metastatic to periaortic, retroperitoneal and left supraclavicular lymph nodes, status post orchiectomy and chemotherapy, presented with a rising B-HCG and PET scan evidence of recurrent/refractory disease. His imaging showed interval increase in FDG uptake of left periaortic lymph nodes despite a decrease in size. A biopsy was performed. Pathologic evaluation showed predominantly necrotic tissue with rare clusters of atypical cells with clear to pink cytoplasm, monotonous nuclei, and rare admixed lymphocytes. Immunohistochemical stains showed the atypical cells to be positive for OCT4 stain, raising the possibility of viable seminoma. However, additional satins showed the cells to be positive for CD68 and CD163, and negative for CD117, SALL-4, pancytokeratin, SF-1, GATA3 and synaptophysin. Therefore, the atypical cells were interpreted to represent histiocytes; no viable germ cell tumor was identified.

Results (if a Case Study enter NA)
NA

Conclusion
This case highlights the importance of using a panel of immunohistochemical stains, instead of relying on one stain, even if the stain is thought to be fairly specific. Pathologists need to be aware of immunoreactivity of histiocytes to OCT4 as a potential diagnostic pitfall in addition to the paraganglion cells staining for OCT4 being a pitfall.
Ethnic Incidence of Metastatic Prostate Carcinoma in a Veteran Affairs Medical Center’s (VAMC) And Early Surveillance Guided by Sites of Metastases
Authors: Dalal S , Petersen J M , Jhala D 
Published: November 2023

Abstract

Introduction/Objective
Ethnic difference in incidence, mortality, and prognosis for prostate adenocarcinoma is well known with disparities between African American (AA), Caucasian and Asian origin population reported by tumor heterogeneity and increased number of gene mutations in genomic profiling. Early metastasis of prostate cancer with younger age at the presentation in AA ethnicity has been noted. Earlier screening, biopsy and tumor molecular profiling may lead to a decrease in morbidity and mortality related to metastatic prostate cancer. While there are known differences in the incidence of prostate cancer between different ethnic groups and differences in ethnic access to care and diagnosis varies widely between distinct medical practices, the ethnic incidence of diagnoses of metastatic prostatic adenocarcinoma and distribution of sites particularly in a Veteran population has not been well studied.

Methods/Case Report
A retrospective search was performed from December 2019 to October 2022 for metastatic prostatic carcinoma specimens at regional Veteran Affairs Medical Center (VAMC). Both H & E and immunohistochemical antibodies for prostate were reviewed and used in the diagnosis of metastatic carcinoma of prostate origin.

Results (if a Case Study enter NA)
A total of 21 cases with metastatic prostatic adenocarcinoma were found from which 9 were metastases to bone, 5 were metastases to lymph node and 7 were metastatic to other organ sites. Majority of the cases were of ethnic African American veterans (12/21, 57%), followed by Caucasian Americans (7/21, 33%), and 2 of unknown ethnicity (2/21, 10%). On examination, most frequent site of metastases by ethnic African Americans was lymph node in 4 out of the 5 (80%) total cases metastatic to lymph node, and 5 out of 6 total cases (83%) with metastases to different organ sites together. On the other hand, ethnic Caucasian Americans the most common metastatic site was bone with 6 out of 10 total cases (60%) metastatic to bone.

Conclusion
African American Veteran patients have a higher incidence of metastatic prostate carcinoma and a higher incidence of earlier metastases. A similar trend was seen in the study population with African Americans making up most of the study population and also suggestively having more cases of lymph node and other organ metastases. The increased proportion of African Americans in the study population with lymph node metastases suggests targeting lymph nodes for biopsy for early detection of the metastatic prostatic carcinoma.
Bilateral Gonadoblastoma in a 13-Year-Old Female with Turner Syndrome and Y Chromosome: A Case Report
Authors: Pokharel A , Lamb C A , Micale M A , Zhang P L 
Published: November 2023

Abstract

Introduction/Objective
Gonadoblastoma is a relatively rare type of ovarian tumor that has a high risk for patients with 45X/46XY. It is derived from the Y chromosome at its long arm GBY region, which contains the most likely candidate gene called testis-specific protein Y-encoded (TSPY).

Methods/Case Report
In this case report, we present a case of a 13-year-old girl with Turner syndrome whose cytogenetic test showed 45X with monosomy X and a siodicentric Yq chromosome. As she carried a high risk for the development of gonadoblastoma due to the presence of the Y chromosome and clinically had premature ovarian failure, she received further imaging studies, which did not reveal obvious ovarian masses. She underwent resections of bilateral fallopian tubes and ovaries. Bilateral fallopian tubes were unremarkable. However, within the bilateral ovarian tissue, foci of gonadoblastoma were found (0.5 to 0.6 cm), composed of large round germ cells (confirmed by positive OCT 3/4 and SALL4 stains) intermingled with oval-shaped sex cord-stromal cells forming tubular/cribriform structures (confirmed by positive staining for inhibin, calretinin, and FOXL2). The stromal cells of gonadoblastoma, but not germ cells, were positive for androgen receptor staining, while both components were negative for estrogen receptor staining. No invasive germ cell tumor or sex cord tumor was present.

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

Conclusion
The positive androgen receptor staining in stromal cells of the gonadoblastoma supports the view that the Y chromosome-driven androgen system may play a role in the development of gonadoblastoma in a bi-cellular pattern.
Enteric adenocarcinoma of the Thymus
Authors: Abu-Salah A , Kraft A , Mesa H , Loehrer P 
Published: November 2023

Abstract

Introduction/Objective
Thymic adenocarcinomas are extremely rare. Enteric type thymic adenocarcinoma is an even more rare subtype morphologically and immunophenotypically indistinguishable from colorectal primaries.

Methods/Case Report
We report a case of a 63-year-old female who presented with shortness of breath and cough. Computerized tomography (CT) scan showed an 11 x 6 cm right-sided anterior mediastinal mass extending from the great vessels to the diaphragm. Within the mass, there was a 4.8 cm possible thymic cyst that had been originally identified in 2005. Multiple right pleural and bilateral intrapulmonary nodules, and a 2 cm pericardial lymph node were also observed. A core biopsy showed a mucinous adenocarcinoma that was positive for the colorectal markers CK20, CDX2, MUC-2 and the thymic marker C-KIT, and negative for CD5, PAX8, CK7, TTF-1, and ER immunostains. The tumor was negative for PDL1 22c3 (CPS&lt;1) and positive for TROP2. PET-CT did not reveal any other primary. A diagnosis of enteric adenocarcinoma of the thymus Masaoka stage IV was established and the patient is scheduled to receive chemotherapy. Genomic testing is pending to guide potential targeted therapy.

Results (if a Case Study enter NA)
NA

Conclusion
A recent compilation of 29 cases mostly from the literature described aggressive clinical behavior, high association with thymic cysts, and coexpression of CD117 and enteric markers similar to this case. All patients had poor response to conventional platinum-taxanes regimens. Two patients received targeted therapy without benefit. None of these patient received colorectal type regimens. Although the number of reported cases is still very small, these results suggest that optimal therapy for these aggressive tumors has yet to be defined.
Odontogenic Carcinoma with Dentinoid of the Left Maxilla
Authors: Fernandez-Hazoury D A , Ji P , Chiu R 
Published: November 2023

Abstract

Introduction/Objective
Odontogenic carcinoma with dentinoid is a very rare dentinoid producing odontogenic tumor with 10 cases reported in literature, and it is not currently defined by the World Health Organization. It has been described to have a locally aggressive and non-metastatic course with high level of recurrence after excision.

Methods/Case Report
We report a case of odontogenic carcinoma with dentinoid located in the left maxilla of an otherwise healthy, 22-year-old male. The patient initially endorsed left upper molar tooth pain for 2 months that led him to receive medical attention. Initial examination revealed a 3 x 2 cm firm, non-mobile and non-pulsatile lesion on buccal and lingual surface of the left maxilla with imaging revealing a 2.9 x 2.7 x 2.7 cm mixed radiolucent/radiopaque lesion in the posterior left maxilla with expansion on the buccal and palatal surfaces. Incisional biopsy of the left maxilla (soft tissue) was initially diagnosed as suspicious for osteosarcoma, which was later changed to odontogenic carcinoma with dentinoid. One year later, the mass had increased to 4.5 x 3 x 4 cm in size. Left hemi maxillectomy was performed, and the specimen was diagnosed with odontogenic carcinoma with dentinoid. Previously described histological features of clear cell change, low grade appearance, focal calcification, and dentinoid formation are present in our case. Our case is the first to describe glandular formation of the tumor cells.

Results (if a Case Study enter NA)
NA

Conclusion
The histopathological changes of our case reflect previously reported microscopic descriptions for this exceedingly rare tumor that is unclassified by the World Health Organization. It has been reported to occur in both male and female patients without predilection and a wide age range from 14-61 years. To our knowledge, this is the 11th reported case, and the 5th case described in the maxilla. Further studies, including NGS sequencing to determine genetic alterations, will be performed on our case to further elucidate pathophysiological mechanisms. Long term follow up with our patient will be attempted to determine tumor behavior.
Technical and Professional Components in Pathology Practices – Business and Educational Opportunities for Community Based Pathologists
Authors: Zahid H , Loos C , Cornish C , Wells A , Herschap B , Ehsan A 
Published: November 2023

Abstract

Introduction/Objective
Community based Pathologists (CBPs) are challenged by limited resources, decreasing revenue, continuous learning, workload burnout and acquisition by corporate health care groups. Pathology residency programs (PRPs) are traditionally offered at academic centers and are focused on teaching, research, clinical work, and residents are graduated with core diagnostic competencies. Upto 60% graduates usually join private practices, therefore, understanding the business aspects of pathology and abreast with innovative technologies continue to be challenge among CBPs. We conducted and presented our survey to evaluate opportunities and challenges for CBPs for adopting various technical and professional components (TC and PC) in their practices.

Methods/Case Report
Survey was conducted via interview for a total of 42 CBPs. Questions related to TC and PC were divided into 1) Immunohistochemical stains (IHC); 2) Flow cytometry (FC); 3) Fluorescence in-situ hybridization (FISH); and 4) Clinical pathology professional component (CPPC).

Results (if a Case Study enter NA)
CBPs understands the importance of TC and PC services, however 25/42 (60%) have been using it to some extent. Of those that are utilizing such TC services, 10/25 (40%) were using IHC and FC; 4/25 (16%) were using FISH. The CPPC was used by 26/42 (61%)

Conclusion
We concluded that there are several reasons for CBPs who are not utilizing TC and PC services to its full capacity such as 1) not trained well enough to read TC of IHC, FL and FISH; 2) No formal educational opportunities available to train CBPs; 3) Cumbersome lab portals to access data; 4) Billing of such services becomes complicated;
5) Workload burnout and no added incentives by practices; and 6) Limited resources to capture CPPC due to interface and integration of billing software’s. We suggest PRPs to offer electives and incorporate private practice experience for trainees, so they are prepared to embrace such business and educational opportunities.