bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invasive Solid Papillary Carcinoma of breast in an elderly male: a rare entity in an uncommon gender - case report and review of literature
Authors: Poombal F , Khan S , Siddique K 
Published: November 2023

Abstract

Introduction/Objective
Male breast cancers (MBC) account for less than 1% of all breast cancers. Papillary cancers constitute less than 3% of MBCs. Solid papillary carcinoma (SPC) is a rare subtype of papillary cancer with a solid growth pattern associated with fibrovascular cores. SPC is an indolent disease that typically presents in a post- menopausal woman as a central breast mass. Neuroendocrine differentiation, ER/PR positive status and Her-2 neu negative status are characteristic. SPC can be in situ or have invasive components. SPC is a rare entity in men and so far, approximately less than 40 cases of SPC in men have been discussed in literature. Here, we report a rare case of SPC with multiple invasive foci in an elderly male.

Methods/Case Report
An 84-year-old white male presented with a painless mass in his left breast. Excision biopsy revealed Solid Papillary Carcinoma. He subsequently underwent a Left Modified Radical Mastectomy with Left Sentinel Lymph Node Excision. The final histopathology report showed a background of SPC with multiple invasive foci with largest focus measuring 2 mm. Margins were negative and lymph nodes were negative for malignancy. The tumor was ER and PR positive, Her-2 neu negative and had a Ki-67 proliferation index of 42%. Negative IHC staining for Cytokeratin AE1/AE3 confirmed the absence of metastatic epithelial cells in the examined lymph nodes.

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

Conclusion
SPC is an uncommon subtype among the papillary lesions of breast. Furthermore, only a few cases of SPC have been reported in men. Despite its rarity, it has a good prognosis and lymph node positivity, distant metastasis and local recurrence are uncommon. However, there is limited data about SPC with invasive components which may behave like other invasive breast lesions leaving management a dilemma for clinicians. We believe this case will add to the scarce existing literature about invasive SPC in men.
Mucocele-like Lesion: To Excise or Not to Excise?
Authors: Roychoudhury S , Al-Refai R , Morrar D , Bendari A , Sham S , Hajiyeva S 
Published: November 2023

Abstract

Introduction/Objective
Mucocele-like lesions (MLLs) are characterized by cystically dilated, mucin-filled ducts, usually associated with rupture and extravasation of mucin into the stroma. The epithelium lining the ducts may be attenuated or show a spectrum of proliferative changes ranging from hyperplasia to atypical hyperplasia to ductal carcinoma in situ (DCIS). Our study aims to evaluate the necessity of excision of pure MLL without atypia diagnosed on core needle biopsy (CNB).

Methods/Case Report
We retrospectively identified all subsequent in-house CNBs obtained between January 2017- August 2022 with MLLs. We reviewed all CNB slides with the diagnosis containing a “mucocele-like lesion” and assessed radiologic-pathologic concordance. An upgrade was defined as invasive carcinoma and/or DCIS in the excision. The excision slides of all upgraded cases were re-reviewed. Out of ~16000 consecutive CNBs in the study period, 69 CNBs from 69 patients yielded MLL alone, MLL with atypia, or MLL with carcinoma. We excluded 43 CNBs (7 patients with prior/concurrent carcinoma and 36 without excision). The final cohort consisted of 25 CNBs (14 with pure mucocele-like lesions and 11 MLLs with atypia). The CNB targeted mammographic calcifications in 42 cases, and 4 sonographic mass.

Results (if a Case Study enter NA)
Subsequent excision or clinical follow-up was available for 14 pure MLLs—of which one was upgraded. Five excisions showed atypia (4 atypical ductal hyperplasias (ADH) and one atypical lobular hyperplasia (ALH)). Excisions of 11 MLL with atypia yielded 1 case upgraded to DCIS (9.09%, 1/11) and seven excisions showed atypia (5 ADH, 1 ALH, and 1 flat epithelial atypia). DCIS in an upgraded case was in an area with biopsy site changes. There was no upgrade to invasive carcinoma in either group. Among the 36 MLLs excluded from the study due to not having excision available for review, twelve were followed up with interval radiology and showed either stable lesions or no residual calcifications.

Conclusion
There was one case with upgrade of pure MLLs in our series. Clinicoradiological surveillance can be considered in a patient without prior/current carcinoma in pathological-radiological concordant CNB diagnosis of pure MLL.
Primary pericardial angiosarcoma with pleural metastasis: an unusual clinical presentation
Authors: Han F , Osmani M , Rashidbaigi A , Lazzaro R 
Published: November 2023

Abstract

Introduction/Objective
Primary pericardial angiosarcoma is an uncommon, aggressive cardiac neoplasm that arises from the endothelial cells of blood vessels. It typically affects middle-aged men and has a poor prognosis due to early metastasis. Unfortunately, there are currently no established guidelines or effective treatments for this rare malignancy. The purpose of this case study is to emphasize the significance of recognizing the unspecific presentations of pericardial angiosarcoma and ensuring timely diagnosis and appropriate treatment.

Methods/Case Report
A 56-year-old male presented with recurrent pericardial effusion and exudative pleural effusion. The radiologic studies showed a thickened pericardium with right-sided pericardial effusion and a large right- sided pleural effusion. Resected partial pericardium and parietal pleura showed the presence of epithelioid to spindled cells that formed solid sheets and vascular structures filled with numerous red blood cells. The tumor cells were cytologically malignant, with angulated shapes and hyperchromatic nuclei, and showed extensive invasion into the surrounding connective tissue. Mitotic figures were variably visualized, and there was abundant hemorrhage.
Immunohistochemical analysis of the lesional cells showed positivity for ERG, CD31, Factor VIII, and retention of Methylthioadenosine phosphorylase (MTAP) and BRCA1-associated protein 1 (BAP1), while they were negative for WT1, calretinin, claudin-4, and p40. Based on the morphology and immunoprofile, a diagnosis of high grade angiosarcoma was rendered, and the patient underwent chemotherapy. The overall survival of the patient was 8 months to date.

Results (if a Case Study enter NA)
NA

Conclusion
Prompt diagnosis of pericardial angiosarcoma is crucial, as nonspecific symptoms may lead to misdiagnosis, such as in this case where the patient was initially diagnosed with pericarditis. Video-assisted thoracic surgery and histologic analysis are necessary to reach a correct diagnosis, which ensures appropriate treatment, as a delayed diagnosis can worsen the prognosis and even lead to death.
Undetected Exogenous Insulin Administration in a Child: Assessment of Assay Limitations and Impact on the Practice of Laboratory Medicine
Authors: Najar A , Wu A H , Lynch K L , Akarca F G , Barbati Z 
Published: November 2023

Abstract

Introduction/Objective
The development of new synthetic insulin analogues over the past few decades has significantly impacted the management of hypoglycemia. However, accurately measuring these analogues presents challenges due to variable cross-reactivity with many insulin assays. Failure to consider cross-reactivity may lead to the misdiagnosis of exogenous insulin administration.

Methods/Case Report
A 13-year-old female with a history of type 1 DM was presented to an outside hospital emergency department with symptoms indicative of hypoglycemia. Multiple child protective services (CPS) referrals are noted. The patient had experienced several episodes of hypoglycemia over the prior week with blood glucose in the 30-40 mg/dL range. There were no associated symptoms of diarrhea, emesis, or fatigue. The patient was transferred to a pediatric hospital were preliminary investigations indicated abnormally low blood glucose levels with low insulin and C-peptide levels. Further evaluation was initiated to determine the underlying cause of these episodes and to ensure appropriate adjustments in insulin dosing and regimen. Initially, the Elecsys insulin assay (Roche Diagnostics) was utilized to quantify insulin levels which shows a low cross-reactivity for insulin lispro and glargine. To validate the hypothesis of an undetected exogenous insulin overdose, blood samples were sent to another laboratory employing The Advia Centaur insulin assay (Siemens) which exhibits a higher cross-reactivity for insulin lispro and glargine (89%-143%, respectively), indicating a higher recognition and measurement sensitivity for these insulin analogues. The analysis using this assay revealed significantly elevated insulin levels, corroborating the presence of an insulin overdose. The sample at the time of presentation at the outside hospital was confirmed to be 434.1 mU/L. A sample collected 17 hours later had an insulin level of 23.5 mU/L.

Results (if a Case Study enter NA)
NA

Conclusion
This case study highlights the critical issue of undetected insulin overdose in a child and emphasizes the limitations of the initial insulin assay employed. Improving assay sensitivity and reliability will enhance patient care and safety. This case study reminds clinicians and laboratory professionals of the need for ongoing quality assurance and vigilance in their practices.
Adiponectin/resistin evaluation is a gold biomarker for monitoring CVD in patients with metabolic syndrome
Authors: Abdelmonem M , Alawssi Y , Ahmed K , Alqaisi K , Wasim H , Abdelmageed M 
Published: November 2023

Abstract

Introduction/Objective
Introduction: Various studies have tried correlating specific inflammatory markers with metabolic syndrome. Serum adiponectin levels can serve as a biomarker that predicts metabolic syndrome development. Resistin is another adipose-tissue-derived hormone capable of promoting insulin resistance because it increases the reserve of triglycerides in the muscle and the liver rather than the adipose tissue.

Methods/Case Report
Objectives: To investigate the role of the adiponectin/resistin ratio in monitoring CVD in Jordanian adults with metabolic syndrome.

Methods
Eighty subjects were randomly selected from individuals who attended two clinical laboratories for routine checks during the period between January 2021 and March 2021. Forty-two participants had metabolic syndrome, while the other 38 represented the healthy group. Resistin and adiponectin were evaluated using the ELISA method, while the adiponectin/resistin ratio was calculated. Lipid profile, glucose and body mass index (BMI) were measured for all metabolic syndrome patients and healthy control ones.

Results (if a Case Study enter NA)
Results: Plasma resistin levels were significantly higher in metabolic syndrome patients than in healthy controls (p = 0.04), while no significance was found regarding adiponectin (p = 0.07). In contrast, the adiponectin/resistin ratio was highly significant (p &lt; 0.001). Resistin had shown a negative correlation with HDL (r= -0.33), whereas adiponectin was inversely correlated with LDL (r= -0.33) and LDL/HDL ratio (r= -0.34). Adiponectin/resistin ratio positively correlated with HDL (r= 0.45). The multiple linear regression analysis results revealed the predictive potential of adiponectin and resistin when used in different models for CVD risks using HDL as a risk factor. However, the results revealed that only the third model, which included the adiponectin/resistin ratio, was expected to have a higher CVD risk after controlling for the other predictors in the same model.

Conclusion
The studied metabolic syndrome markers might have an essential role in detecting cardiovascular events. It can be concluded that resistin can be used to evaluate the CVD risks. Furthermore, we found that the adiponectin/resistin ratio is the best marker in predicting CVD events in metabolic syndrome patients compared to other markers, including adiponectin and resistin alone.
The Diagnostic Performance of Serum Hyaluronic Acid and Collagen III in Differentiating Liver Fibrosis in HCV-Induced Patients
Authors: Abdelmonem M , Abdelmageed M , Wasim H , Eldaly R , Saleh Abdelfattah M 
Published: November 2023

Abstract

Introduction/Objective
Chronic liver diseases may lead to inflammation and progressive scarring, causing irreversible hepatic damage (cirrhosis). To avoid the complications of liver puncture biopsy, Collagen III and Hyaluronic acid are studied as non-invasive markers of liver fibrosis in chronic liver diseases.
Aim of the work: Discovering the diagnostic role of serum Hyaluronic acid and Collagen III in liver fibrosis associated with chronic HCV patients.

Methods/Case Report
The study was performed on 118 patients with liver fibrosis associated with chronic HCV (60 males and 58 females) and 50 age-matched healthy subjects (27 males and 23 females). Liver function tests were measured, including ALT, AST, [AST/ ALT] ratio, albumin, total bilirubin, and platelets counts. APRI was also calculated as [AST/ (upper limits of normal)/ platelets count 109/L]×100. Serum levels of Collagen III (ng/ml) and hyaluronic acid (µg/L) were determined. Plotted receiver-operating characteristic (ROC) curves were used to assess and compare the diagnostic accuracy of biomarkers.

Results (if a Case Study enter NA)
The area under ROC curve of collagen III in discriminating liver fibrosis in patients associated with chronic HCV infection and healthy ones was 0.805; P&lt; 0.0001. The Sensitivity and Specificity were 62% and 96%, respectively. While the area under ROC curve of hyaluronic acid in discriminating liver fibrosis patients associated with chronic HCV infection from healthy volunteers was 0.832; P &lt; 0.0001. The Sensitivity and Specificity were 72% and 94%, respectively. Also, there was no significant correlation between levels of collagen III and hyaluronic acid; (r=0.01 & P=0.714).

Conclusion
Collagen III and Hyaluronic acid can identify patients with liver fibrosis with a detection rate of 62% and 72%, respectively. So, both biomarkers are considered powerful non-invasive methods in discriminating and diagnosing liver fibrosis in chronic HCV patients.
Pioglitazone as a Treatment Option for Ataxia-Telangiectasia
Authors: Shackelford R , Tahir M 
Published: November 2023

Abstract

Introduction/Objective
The ataxia-telangiectasia mutated (ATM) gene product regulates cell cycle checkpoints, the cellular redox state, and DNA break repair. ATM loss causes the rare disorder ataxia-telangiectasia (A-T), characterized by progressive ataxia, telangiectasias, immune dysfunction, and an elevated cancer risk. The clinical course of A-T is relentless, causing death by the early twenties.

Methods/Case Report
A-T cells show extreme sensitivity to oxidants and ionizing radiation, impaired glutathione (GSH) synthesis, genomic instability, poor cell cycle checkpoint initiation, and increased reactive oxygen species. A-T cells also show unusual iron responses, with iron chelators increasing A-T cell growth, oxidant exposure resistance, and genomic stability, while labile iron exerts toxic effects not seen in ATM wild-type cells. Since GSH is dysregulated in A-T cells and much of the cellular iron is bound up in iron-sulfur clusters, we examined the cellular sulfur pool in A-T cells with and without an ATM expression vector, and in ATM wild-types cells. Free hydrogen sulfide and protein- bound sulfide levels were unchanged with ATM expression. However, iron-sulfur clusters (the acid-labile sulfur faction) were low in the A-T cells and dramatically increased with ATM expression. ATM expression also increased the expression of NFS1, NFU1, and several mitochondrial complex I iron-sulfur proteins. As NFS1 and NFU1 play central roles in the synthesis of iron-sulfur clusters, and ATM expression increases these clusters, our data reveals a role for ATM in iron metabolism. Interestingly, the type II diabetes drug pioglitazone increased the acid-labile sulfur and protein bound sulfur factions in both cell types. It also increased the A-T cell reduced GSH, cell viability following oxidative stress, and decreased oxidative stress-induced double-stranded DNA break formation.

Results (if a Case Study enter NA)
Our finding that pioglitazone increased both cellular acid-labile and protein-bound sulfur fractions, indicates that these sulfur pools may be a therapeutic target for some type II diabetes drugs. Our data also indicates that pioglitazone may have value in treating A-T

Conclusion
We propose that pioglitazone could be a promising A-T treatment drug. More clinical research and trials are needed to determine the potential advantages and side effects of using pioglitazone in A-T.
Clinicopathological features of superficial esophageal squamous cell carcinomas in patients without history of smoking and drinking
Authors: Tateishi Y , Fukuchi T , Hirasawa K , Okudela K , Nakanishi Y , Inayama Y , Nemoto T , Oyama T , Maeda S 
Published: November 2023

Abstract

Introduction/Objective
Cigarette smoking and drinking are the major causative risk factors for esophageal squamous cell carcinoma (ESCC). ESCCs in patients without history of smoking and drinking account for approximately 5% of all ESCCs. Clinicopathological features of superficial ESCCs in patients without history of smoking and drinking have not been well investigated.
The aim of this study is to clarify the clinicopathological features of superficial ESCCs in patients without history of smoking and drinking.

Methods/Case Report
A multicenter study including 12 leading institutions of the Japan Research Society of Early Esophageal Cancer and Chromoendoscopy was conducted. Clinical data and pathological features of 108 superficial ESCCs in endoscopic submucosal dissection (ESD) specimens of 102 patients without history of smoking and drinking (NSND group) were reviewed. For comparison, clinicopathological features of 767 superficial ESCCs in ESD specimens of 544 patients with history of smoking and drinking (SD group) were also reviewed. Clinicopathological features including age, sex, synchronous/metachronous cancer, gastroesophageal reflux disease (GERD), tumor size, tumor site, macroscopic type, Lugol-voiding lesion (LVL), invasion depth, and lymphovascular invasion were analyzed in both NSND group and SD group. LVLs were graded according to the number of LVLs in preoperative endoscopic examination (grade A, no lesions; B, 1 – 9 lesions; C, more than 9 lesions).

Results (if a Case Study enter NA)
The univariate analysis revealed that female predominance (95.1% vs. 11.6%, p&lt;0.001), absence of synchronous/metachronous cancer (81.4% vs. 60.8%, p&lt;0.001), grade A LVLs (74.5% vs.
6.6%, p&lt;0.001), presence of GERD (42.2% vs. 18.0%, p&lt;0.001), tumor location at the posterior wall (58.3% vs. 47.5%, p&lt;0.005), and 0-IIa macroscopic type (14.8% vs. 3.0%, p&lt;0.001) were significantly more frequently observed in NSND group than SD group.

Conclusion
ESCCs in patients without history of smoking and drinking are characterized by female predominance, absence of synchronous/metachronous cancer, grade A LVLs, presence of GERD, tumor location at the posterior wall, and 0-IIa macroscopic type.
The Biologic Diversity of Colorectal Carcinoma (CRC) is Present in the Early Stage: Quantitative Analysis of Malignant Polyps
Authors: Chand M T , Stashek K , Furth E E , Tondon R , Al Zeer A 
Published: November 2023

Abstract

Introduction/Objective
Risk factors in malignant polyps to predict recurrence in T1 colorectal carcinoma (CRC) include depth of invasion, margin status, lymphovascular invasion, tumor differentiation and budding. However, the effect of other factors, such as tumor volume and tumor cellularity, are not well studied. We quantitatively, using image analysis, determined the strength and interdependence of the depth of invasion, margin status, tumor volume and tumor cell density on the probability of having residual adenocarcinoma on resection and long term patient outcomes.

Methods/Case Report
Endoscopic mucosal resection (EMR) specimens of polyps with T1 CRC were identified by retrospective search of the pathology database over a 14-year period (01/01/2008 to 05/05/2022). Depth of invasion, distance of tumor to margin, tumor volume (defined by the invasive area comprising the tumor cells and associated others cells) and cellularity (number of adenocarcinoma cells/area) were measured using Aperio eSlide Manager Leica Biosystems Imaging, Inc. The depth of invasion was measured from the muscularis mucosa. Available outcome data was collected from subsequent segmental resection and oncology consultations and imaging from the patient charts.

Results (if a Case Study enter NA)
22 patients of malignant polyps with EMR were identified; 11 patients underwent subsequent resection with residual tumor in 4 and lymph node metastasis in 1. Follow-up period was from 3 to 12 yrs, with recurrence in none. The median tumor cellularity was 2712 cells/mm2 with SD 1421 cells/mm2 and was similar in residual versus non residual tumors with no correlation with LVI. Distance of tumor (um) from deep margin was measured in 20 cases and by Receiver Operator Characteristic analysis and calculation of the area under the curve (AUC) was a good test of residual tumor (AUC = 0.88) while depth of invasion was not a good test (AUC =0.5). Tumor volume and adenocarcinoma cells/area were not correlated; however, interestingly, tumor volume and depth of invasion were linearly correlated (p&lt;0.001).

Conclusion
The distance of tumor to the margin is a better predictor for residual cancer than depth of invasion. The linear correlation of tumor volume and depth of invasion implies the same shape of invasion which is interestingly independent of tumor cellularity. This finding further strengthens the hypothesis that cancer associated cells in the tumor microenvironment are important in driving the biological behavior of malignant polyps.
Unusual Cause of Small bowel Intussusception
Authors: Abdo M E , Sami F I , Hamza A 
Published: November 2023

Abstract

Introduction/Objective
Intussusception is uncommon in adults. When it occurs it is usually secondary to a mass lesion. The purpose of this report is to highlight an unusual cause of intussusception.

Methods/Case Report
A 48-year-old female presented with right lower abdominal pain, nausea, vomiting, and bloating. She didn’t have a bowel movement in 3-4 days. CT of the abdomen and pelvis demonstrated long segment small bowel intussusception in the right abdomen with a lead point mass. The patient subsequently underwent surgical resection. Grossly the specimen consisted of a 30cm segment of small bowel remarkable for two mucosal nodules measuring 1.9 cm and 1.0 cm in greatest dimension. Microscopically the nodules were composed of sheets of discohesive epithelioid cells with marked nuclear pleomorphism and prominent nucleoli, underlying the normal mucosa. Immunohistochemical studies revealed that the tumor cells to be positive for SOX-10 and MART-1and negative for pan-cytokeratin and DOG1. Diagnosis of malignant melanoma was rendered.

Results (if a Case Study enter NA)
NA

Conclusion
Intussusception due to malignant / metastatic melanoma is rare but should be on the differential for patients with symptoms of small bowel obstruction and intussusception with a lead point mass.