bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Utility of Phosphohistone-H3 Immunohistochemistry (PHH3) in Pheochromocytomas
Authors: Canete Portillo S , Theriault A , Rosas F , Magi-Galluzzi C 
Published: November 2023

Abstract

Introduction/Objective
Most pheochromocytomas (PCC) are sporadic; ~40% present as part of familial syndromes and some cases are associated with germline mutations of succinate dehydrogenase (SDH) genes. Few cases are malignant. The Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) is a scoring system to predict behavior that includes evaluation of mitotic count, among other parameters. PHH3 has been used to assess mitosis in breast and glial tumors. The aim of this study was to assess the potential utility of PHH3 in pheochromocytomas.

Methods/Case Report
50 cases of PCC diagnosed between 2016 and 2020 at our institution were included in the study. Clinicopathologic data was recorded. One hematoxylin and eosin (H&E) slide was selected per case and mitotic count was evaluated at 40x high power-fields (HPF). PHH3 was performed on the same block to assess mitoses.
Cells with dark and coarsely clumped staining were considered positive for PHH3. PHH3-positive cells were counted also at 40x HPF. In one case with bilateral pheochromocytomas, the largest tumor was evaluated. Follow-up was available in 39 cases and recorded as no evidence of disease (NED), alive with disease (AWD), or dead of disease (DOD).

Results (if a Case Study enter NA)
21 patients were female, 29 were males. Age ranged from 24 to 95 (mean: 56). Tumor size ranged from 1.1 to 16.0 cm (mean: 5.6 cm). Mean follow-up was 13.6 months (1-32 months range). Mitotic count ranged from 0 to 7 and 0 to 21 per 10 HPFs, on H&E and PHH3, respectively. PHH3 showed higher mitotic count in 33 cases compared to H&E. In 11 cases, mitotic count was equal on H&E and PHH3, and in the remaining cases, mitotic count was higher on H&E than PHH3. In cases with PASS score ≥ 4, 50% and 27% of cases had mitotic count &gt;3/10HPF on PHH3 and H&E, respectively. Follow-up showed two patients AWD and one DOD, all of whom had PASS score ≥ 4, with mitotic count on H&E 7, 1 and 6 and mitotic count on PHH3 8, 4, and 21 respectively.

Conclusion
This is the first study evaluating the use of PHH3 in pheochromocytomas. Overall, mitotic count was higher on PHH3 than on H&E. This indicates PHH3 is a helpful tool in counting mitosis. Since the PASS score is an imperfect system to predict outcome, additional studies are needed to evaluate the use of PHH3 in prognostic scoring systems for PCC.
Prostein expression in human tumors: A tissue microarray study on 19,202 tumors
Authors: Viehweger F , Lennartz M , Blessin N C , Dum D , Burandt E , Sauter G , Simon R , Kluth M , Steurer S , Clauditz T S , Kind S 
Published: November 2023

Abstract

Introduction/Objective
Prostein (P501S), also termed solute carrier family 45 member 3 (SLC45A3) is an androgen regulated protein which is preferentially expressed in prostate epithelial cells. Because of its frequent expression in prostate cancer, prostein was suggested a diagnostic prostate cancer marker.

Methods/Case Report
In order to comprehensively assess the diagnostic utility of prostein immunohistochemistry, a tissue microarray containing 19,202 samples from 152 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry.

Results (if a Case Study enter NA)
Prostein immunostaining was typically cytoplasmic, granular and perinuclear and predominated in prostate cancer. Prostein positivity was seen in 96.7% of 419 prostate cancers including 78.3% with a strong staining. In 12,233 extra-prostatic tumors, prostein positivity was observed in 9.8% of cases but only 0.4% had a strong staining. Extra-prostatic prostein positive tumors were 50 different tumor categories, 12 of which included at least one strongly positive case. Extra-prostatic tumors with highest rates of prostein positivity included salivary gland tumors (7.6%-44.4%), neuroendocrine neoplasms (15.8%-44.4%), adenocarcinomas of the gastrointestinal tract (7.3%-14.8%), biliopancreatic adenocarcinomas (3.6%-38.7%), hepatocellular carcinomas (8.1%), and adenocarcinomas of other organs (up to 21%).

Conclusion
In summary, our data provide a comprehensive overview on prostein expression in human cancers. Prostein is a highly sensitive prostate cancer marker occurring in &gt;96% of prostate cancers. Because prostein can also be expressed in various other tumor entities, labeling of a tumor mass as a prostate cancer should not be based on prostein positivity alone.
Retroperitoneal sarcomatoid yolk sac tumor in a chemotherapy-naïve patient with testicular teratoma
Authors: Zhang B , Jia L , Kapur P 
Published: November 2023

Abstract

Introduction/Objective
Sarcomatoid yolk sac tumor (SYST) is a rare histologic subtype of yolk sac tumor. In patients with testicular germ cell tumor, it is most frequently seen at the metastatic sites in the post-chemotherapy setting. SYST is rarely reported in chemotherapy-naïve testicular cancer patients in the existing literature. Herein, we report a rare concurrent retroperitoneal SYST in a chemotherapy-naïve testicular teratoma patient.

Methods/Case Report
A 37-year-old male presented with a 3.4 cm right testicular mass and a radical orchiectomy was performed, which demonstrated a pT1 teratoma with a separate adjacent regression fibrous nodule. His staging computed tomography revealed a heterogeneously enhancing and lobulated retroperitoneal mass measuring 9.6 cm in the greatest dimension. One month later, the mass enlarged to 26.3 cm. Fine needle aspiration biopsy revealed malignant spindle cell neoplasm with myxoid features, which displayed immunoreactivities for AE1/AE3, SALL4 and glypican 3, while was negative for OCT3/4, myogenin, SMA, desmin, S100 and CD34. Based on these findings, it was most compatible with SYST. The subsequent resection specimen showed a mass with soft fleshy to rubbery and friable gelatinous cut surfaces, and thorough tissue sections revealed the same histologic and immunophenotypic features as the prior biopsy. Therefore, a final diagnosis of SYST was rendered. Four cycles of cisplatin, etoposide, and ifosfamide (VIP) were administered, and the patient tolerated it well at his 6-month follow-up.

Results (if a Case Study enter NA)
NA

Conclusion
Here we presented a rare concurrent retroperitoneal SYST in a chemotherapy-naïve male patient who initially presented with a testicular teratoma. Due to its rarity, SYST may cause a diagnostic dilemma, and our case could raise awareness of this uncommon event and potentially expand the tumor spectrum.
Adenomatoid tumor with extensive reactive smooth muscle: a diagnostic dilemma
Authors: Usman A , Cain S , Hamza A , Meyer A R 
Published: November 2023

Abstract

Introduction/Objective
Adenomatoid tumors are slow-growing benign tumors of mesothelial origin. They comprise 30% of all tumors of the paratesticular area. In this location, they commonly involve the epididymis, spermatic cord, ejaculatory duct and rarely testicular parenchyma. Histologically, a spectrum of growth patterns can be seen, such as adenoid, tubular, glandular, solid, or cystic. In some cases, a smooth muscle component can also be present. The purpose of this report is to describe a case of adenomatoid tumor with exuberant smooth muscle component, mimicking leiomyoma.

Methods/Case Report
A 28-year-old male presented with painless left inguinal bulge. He noticed it five years prior, and it had been slowly growing since then. Examination revealed a paratesticular mass which was subsequently excised. Grossly, the tumor was firm with smooth, white-tan cut surfaces. Microscopically, the tumor was well- circumscribed, showing predominance of smooth muscle bundles and rare cuboidal to ovoid cells in tubular growth pattern. In the background there was little intervening stroma. Immunohistochemical stains showed the cuboidal cells to be positive for WT1 and calretinin, confirming the mesothelial origin. Diagnosis of adenomatoid tumor was rendered. In contrast to adenomatoid tumors, leiomyomas are whiter and firmer on gross examination and lack the characteristic tubules or cystic spaces lined by mesothelial cells.

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

Conclusion
Exuberant smooth muscle differentiation in adenomatoid tumor can mislead to diagnosis of leiomyoma. Careful inspection for tubules of mesothelial origin and appropriate immunohistochemical stains are key to accurate diagnosis. Pathologists need to be aware of this potential pitfall.
10-year Observation of A Rare Presentation of Pure Fibromyxoid Nephrogenic Adenoma in the Renal Pelvis
Authors: Ren D 
Published: November 2023

Abstract

Introduction/Objective
Pure fibromyxoid NA is an unusual rare variant that typically presents with a well circumscribed bulbous, or tumefacient architecture composed of mitotically inactive bland spindled cells and rare tubular structures within a myxoid or collagenized stroma. Here we report a rare case of pure fibromyxoid NA involving the renal pelvis with over 10-year clinical observation and comparison and correlation of biopsy and resection findings. To the best of our knowledge, this is the first reported case of pure fibromyxoid NA in renal pelvis with close comparison and correlation of biopsy and resection findings with over 10-year clinical manifestation, hoping that knowledge of this long-term rare spindle cell lesion will enhance awareness of pathologists to carefully consider this unusual entity, especially in the biopsy specimen in which typical histologic features of fibromyxoid NA are usually absent, as well as prevent misdiagnosis and overtreatment of a typically benign process.

Methods/Case Report
A retrospective case study of a 37-year-old female with multiple previous biopsy of the nodule in the renal pelvis, and final resection specimen. Biopsies of the mass showed predominantly bland spindle cell lesion with smooth muscle differentiation and scant urothelial epithelial cells, but no tubular structure identified at the biopsy specimen. On the final resection specimen, a urothelium-lining polypoid nodule composing of abundant bland spindle- shaped cells and scattered conventional tubules lined by a single layer of cuboidal epithelial cells in hobnail arrangement that are positive for PAX8 and GATA3 was identified. These morphological and immunohistochemical findings were consistent with the diagnosis of pure fibromyxoid NA.

Results (if a Case Study enter NA)
NA

Conclusion
To the best of our knowledge, this is the first description of a pure fibromyxoid NA of the renal pelvis with more than 10-year clinical observation, as well as comparison and correlation of biopsy and resection findings.Close observation and comparison of the findinigs between biopsy and resection specimen will enhance awareness of pathologists to carefully consider this unusual entity, especially in the biopsy specimen in which typical histologic features of fibromyxoid NA are usually absent, as well as prevent misdiagnosis and overtreatment of a typically benign process.
Perceived Value of Graduate Education in Medical Laboratory Science
Authors: Grimaldi A , Viboud G 
Published: November 2023

Abstract

Introduction/Objective
A current challenge in the field of laboratory medicine is the limited availability of career advancement opportunities. While it is recognized that graduate education in general enhances professional skills and increases the likelihood of promotion, most medical laboratory scientists (MLS) do not pursue a master’s degree (MS). The reasons behind this trend are not clear, and there is a lack of literature on the perceived value of a MS degree in the field. To address this issue, a 25-questions anonymous online questionnaire was conducted among laboratory professionals.

Methods/Case Report
The survey was distributed through ASCLS forum, social media and MLS alumni email lists, which constitutes a non probability convenience sample.

Results (if a Case Study enter NA)
A total of 219 laboratory professionals participated in the study, including 115 in leadership positions and 104 working as medical technologists. Among those in leadership positions, 69% had a master’s degree or higher, compared to only 31% of laboratorians. Regarding the perceived value of graduate education in MLS, 62% of laboratory professionals with an MS degree were of the opinion that it enhances the competitiveness of MLS, whereas only 34% of respondents holding a bachelor's degree shared this viewpoint.
Moreover, a majority of participants without a MS expressed skepticism regarding the superior analytical and soft skills of individuals with master's degrees. Surprisingly, although 87% respondents in leadership positions perceive a master's degree as helpful for career advancement, this sentiment was only shared by 55% of laboratorians.
Interestingly, only half of the respondents with a bachelor's degree expressed their intention to pursue graduate education.

Conclusion
Despite recognition among leaders and professionals with advanced degrees that graduate education improves skills and promotes career growth, many medical technologists fail to perceive its value. Raising awareness about the benefits of pursuing graduate education can be advantageous for laboratory technologists.
A rare case of EBV-positive gray zone lymphoma
Authors: Hanan A , Khan A I , Geetha S , Khan A , Sheikh-Fayyaz S 
Published: November 2023

Abstract

Introduction/Objective
Gray zone lymphoma (GZL) is a rare and novel category of lymphoid neoplasms, first described in 2005. It is derived from B-cells and exhibits characteristics that fall between diffuse large B-cell lymphoma (DLBCL) and classical Hodgkin lymphoma(cHL). Its association with EBV is extremely rare. Here we present one such case

Methods/Case Report
80-year-old female presented with progressive neck swelling and significant weight loss for over a month. It was not associated with fever, pain, or night sweats. Her past medical history was significant for hypertension, cerebrovascular accident, breast carcinoma status post-mastectomy, and non-specific B-cell lymphoma on complete remission for 9 years (post rituximab therapy). Complete blood count and metabolic profile were within normal limits. A PET scan revealed hypermetabolic cervical, supraclavicular, right axillary, and mediastinal lymph nodes, suspicious for lymphoma recurrence. The patient underwent an excisional biopsy of the left cervical lymph node which on microscopy showed lymphoid tissue in a nodular pattern with fibrosis and large areas of necrosis. The well-preserved areas showed lymphohistiocytic proliferation composed of large atypical lymphoid cells with prominent nucleoli. An area with increased eosinophils was also noted. Immunohistochemical staining showed strong positivity for EBER, CD30, MUM1, and OCT2 with dim PAX5 positivity. The cells were negative for CD20 and BOB1.
Cytogenetics and molecular studies did not reveal any rearrangements or mutations. Flow cytometric study was inconclusive due to insufficient cells. A diagnosis of EBV-positive GZL was rendered. She has received brentuximab and her symptoms are improving with regressing lymph node size.

Results (if a Case Study enter NA)
NA

Conclusion
The presence of EBV positivity in GZL further complicates the diagnostic process, as it adds another layer of complexity in determining the appropriate classification and treatment. Our case highlights the importance of comprehensive morphologic phenotypic and cytogenetic investigation to diagnose GZL.
Disseminated histoplasmosis diagnosed on peripheral blood smear: a case report
Authors: Benchbani H , Hamidpour S 
Published: November 2023

Abstract

Introduction/Objective
Histoplasmosis is an infection caused by the inhalation of a dimorphic fungus, Histoplasma capsulatum. H. Capsulatum var capsulatum is the main variety we encounter in the United States and is endemic in the Mississippi river valley. In immunocompetent individuals the infection is usually asymptomatic or presents as flu- like symptoms. Disseminated histoplasmosis is a severe and often fatal opportunistic infection if not treated, usually seen in immunocompromised patients.

Methods/Case Report
We report a case of a 27-year-old female intra-venous drug user with past medical history of untreated HIV diagnosed in 2018, who is being admitted for suspected necrotizing fasciitis of the vulva. On admission, her complete blood count shows pancytopenia with a white blood cell count of 2.9 × 109/L (NR 4.3-10.8 × 109/L), hemoglobin 6.1 g/dL (NR 12-16 g/dL), and a platelet count of 43 × 109/L (NR 150-400 × 109/L). A peripheral blood smear obtained showing rare neutrophils with intracellular organism highly suggestive of histoplasma capsulatum. CT Chest showing diffuse ground glass opacities and a subsequent cytology from bronchoalveolar lavage performed revealed numerous macrophages filled with ovoid organism surrounded by a cytoplasmic halo, GMS stain highlights the rim consistent with histoplasma capsulatum. Patient expired after one week in the ICU for severe acute respiratory distress syndrome, sepsis, histoplasmosis, strep pneumonia and hepatic failure.

Results (if a Case Study enter NA)
NA

Conclusion
Careful examination of Peripheral blood smear along with correct clinical history can aid in early diagnosis of disseminated histoplasmosis.
Solving the mystery of Reed Sternberg like cells in a composite Peripheral T Cell Lymphoma with Epstein Barr Virus and Epstein Barr Virus driven Lymphoproliferative Disorder
Authors: Siddiq M , Shiwlani S , Ibrar W , Sonam F , Hashim M 
Published: November 2023

Abstract

Introduction/Objective
Nodal PTCL with EBV positivity can occasionally contain Reed Sternberg-like cells, and EBV- LPD can mimic Hodgkin lymphoma. Coexistence of these two unusual lymphomas in the same lymph node is very rare. We present a case of a 56-year-old male with Composite EBV+ PTCL NOS and EBV LPD, with positive B-cell gene rearrangement and negative T-cell gene rearrangement presenting a significant diagnostic challenge.

Methods/Case Report
A 56-year-old male with a history of abdominal tuberculosis presented with lethargy, fatigue, and poor appetite. Physical examination revealed generalized lymphadenopathy. CT scan confirmed lymphadenopathy in bilateral axilla, supraclavicular lymph nodes along with lytic lesions on illiac crest. Ill defined splenic lesions raised concerns for metastasis. Cervical lymph node and bone marrow biopsies were performed. Flow cytometry on the lymph node was not done due to tuberculosis history. Flow cytometry on the bone marrow showed an inverted CD4:CD8 ratio. H&E sections of the lymph node revealed a polymorphic lymphoid infiltrate with prominent Reed Sternberg-like cells. Immunohistochemical staining showed CD30-positive and CD45-negative large cells. T-cell and B-cell gene rearrangements were performed. Initially, B-cell gene rearrangements were positive, while T-gamma was negative. Further testing by IHC and morphological evaluation revealed two distinct cell populations, one with CD3, CD5, and CD7 positivity with partial weak positivity for PD1, CD43, and CD8 and the other consisting of B-cells expressing CD30, EBV, MUM1, and partial expression of BCL6 rare CD79a, and partial weak Pax5. Outside molecular testing showed positive T-cell gene rearrangements. The diagnosis of Composite EBV+ Peripheral T Cell Lymphoma, not otherwise specified, with cytotoxic profile along with EBV driven LPD was made. Bone marrow studies confirmed involvement by the same lymphoma.

Results (if a Case Study enter NA)
NA

Conclusion
Identifying EBV-positive Reed Sternberg-like cells in both EBV LPD and PTCL-NOS in a composite lymphoma can be challenging. In the absence of flow cytometry, a composite lymphoma can potentially be misdiagnosed, leading to under-treatment. Repeat testing can be helpful in case of any doubt. Although EBV-positive PTCL with cytotoxic profile and EBV-positive LPD has been reported, the combination of these two lymphomas together is exceedingly rare.
Acute myeloid leukemia with monocytic differentiation (myeloid sarcoma) masquerading as bone-soft tissue malignancy
Authors: Abdo M E , Al-kharouf I , Hamza A , Meyer A R , Kelting S 
Published: November 2023

Abstract

Introduction/Objective
Myeloid sarcoma is an extramedullary solid neoplasm composed of myeloid precursors with or without maturation. This tumor usually occurs simultaneously or following the onset of acute leukemia. Rarely, it can be the first manifestation of acute myeloid leukemia. We report a case of this rare tumor presenting histologically as a bone sarcoma with features of extraskeletal myxoid chondrosarcoma and myoepithelial carcinoma

Methods/Case Report
A 76-year-old female was referred to our institution for evaluation of a right foot mass associated with pain and swelling. MRI showed a 2.4 x 1.5x 1.2 cm soft tissue mass along the lateral margin of proximal and mid diaphysis of first metatarsal. The clinical and radiologic differential diagnosis was primary bone-soft tissue malignancy, or infection. Histologically, the biopsies showed sheets and cords of cells in a myxoid background. Cytologically the cells were plasmacytoid, mononuclear, mitotically active with immature chromatin, prominent nucleoli, and moderate to abundant cytoplasm. This morphologic appearance elicited the differential diagnosis of extraskeletal myxoid chondrosarcoma, myoepithelial carcinoma, and plasmacytoma. An initial panel of immunohistochemical stains showed the lesional cells to be negative for S-100, SOX-10, pancytokeratin, desmin, p63, EMA, CAM5.2, and CD138 but positive for CD43. Additional immunohistochemistry showed diffuse reactivity for CD33, and lysozyme; CD163 was focally positive, and the cells were negative for CD20, CD3, CD30, CD99, MUM1, CD138, and CD34. A diagnosis of extramedullary acute myeloid leukemia with monocytic differentiation (myeloid sarcoma) was rendered. Subsequently, patient underwent bone marrow biopsy which showed involvement by acute myeloid leukemia with monocytic differentiation.

Results (if a Case Study enter NA)
NA

Conclusion
Myeloid sarcoma is a rare tumor and presentation as an isolated metatarsal mass is highly unusual and exceedingly rare. This can mislead clinicians, radiologists, and pathologists. Pathologists need to keep hematopoietic tumors in their differential diagnosis even when the anatomic sites as well as the morphology are not typical of hematopoietic malignancies.