bluuebunny/crossref_metadata_2025_split huggingface dataset:
CeruminousSyringocystadenoma papilliferum: An Extremely Rare Neoplasm of the External Ear
Authors: Ajmal I , Sonani H , Al Hmada Y 
Published: November 2022

Abstract

Introduction/Objective
Syringocystadenoma papilliferum (SCAP) is a rare benign adnexal tumor derived from the apocrine or the eccrine sweat glands on the face or the scalp. Ceruminous glands are modified apocrine glands in the external auditory canal and produce cerumen that helps the ear canal against physical damage and microbial invasion. Neoplastic transformation of these glands is even rarer among these benign tumors.

Methods/Case Report
Here we report a case of a 29-year-old female with a three-month history of progressively worsening right-sided ear pain, muffled hearing, aural fullness, and right-sided shooting aches. She reported that her ear felt sensitive to touch and was painful if she lay on it. Previous treatments included steroids and oral antibiotics without any improvement in symptoms. A physical exam revealed a right narrow ear canal with a cystic mass to the superior lateral canal wall. A CT Temporal Bone showed a 1 cm oval soft tissue lesion in the lateral osseous portion of the right external auditory canal with no underlying osseous erosions identified. This is nonspecific, and neoplasm cannot be excluded. The decision was made for excision. The mass ruptured during excision with dishwater appearing fluid. Microscopic examination showed papillae lined by bilayered glandular epithelium projecting into a cystic lumen. Well defined myoepithelial cell layer is appreciated. Decapitation secretions and plasma cells are noted to be present in the stroma. A final diagnosis of Syringocystadenoma papilliferum is made.

Results (if a Case Study enter NA)
NA.

Conclusion
Ceruminous Syringocystadenoma papilliferum is an extremely rare benign tumor of the ceruminous glands of the external ear. Complete excision is the treatment of choice
Racial Disparity in Antibody Against High Prevalence Antigen; Anti-U
Authors: Abdelmonem M , Cai W , Yunce M , Tang M , Shan H , Cabungan M 
Published: November 2022

Abstract

Introduction/Objective
Anti-U is an IgG antibody directed against the U antigen, which usually forms after exposure to U antigen via blood transfusion and/or pregnancy. U antigen is located on glycophorin B (GYPB) as part of the MNS blood group system. Approximately 2% of the African American population lacks this antigen, making them prone to developing anti-U. Anti-U can cause hemolytic disease of fetus and newborn (HDFN) and hemolytic transfusion reactions (HTR).

Methods/Case Report
A 60-year-old African American male underwent aortic valve surgery. The patient was A Pos with a negative antibody screen. During surgery, the patient was transfused with 3 random units of packed red blood cells (PRBCs). The postoperative course was uncomplicated, and the patient was discharged home. 6 months later, the patient was admitted for another procedure and was expected to require blood products. Thus, a type and screen test was ordered, revealing pan reactivity on screening cells. This prompted further investigation. Antibody detection was performed with the solid-phase technique followed by the tube method with Polyethylene glycol (PEG) as an enhancement medium. PEG technique is the next choice of method if the solid phase requires extended antibody work up, which was the case in our patient. PEG tube method successfully identified Anti-U, and the patient's phenotype was confirmed to be U negative.

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

Conclusion
It is imperative to stress the importance of racial disparity while investigating antibodies against high prevalence. In our case, our suspicion was high for Anti-U, given that patient was of African American descent. Tube methods with PEG and Solid Phase techniques are usually used for antibody identification. It is recommended that patients with rare antibodies carry an Antibody ID card indicating the rare antibody they have to prevent further exposure.
A Scalp Metastatic Follicular Thyroid Carcinoma with a Silent Thyroid History and Normal Thyroid Uptake by PET-CT
Authors: Huang H , Salehiazar S , Peng S 
Published: November 2022

Abstract

Introduction/Objective
Follicular thyroid carcinoma (FTC) accounts for 10%-15% of all primary thyroid cancers. Follicular thyroid cancer is known to metastasize hematogenously, with distant metastasis occurring in 6-20% of cases. Scalp metastasis with an underlying thyroid carcinoma is an exceedingly rare clinical entity; there are less than 15 case reports in the literature. 1-2. Here, we present a case of widely invasive FTC with skull metastases located on the parietal calvarium. The scalp mass was confirmed as follicular thyroid carcinoma via microscopic morphology and positive immunoreactivity for Vimentin, TTF1, thyroglobulin, and PAX8. We present this case not only because of the diagnostic challenge and rare scalp metastasis, but also because of the patient’s unusual “silent” thyroid medical history and no abnormal thyroid uptake by PET-CT.

Methods/Case Report
81-year-old female presenting 2-year history of right parietal scalp mass, which was previously suspected for lipoma with attempted resection in Mexico but interrupted due to severe hemorrhage. No palpable thyroid nodule was noted. PET-CT showed avid lesions of the right breast with nipple retraction, as well as avid suspicious lesions of bilateral lungs, calvarium, xiphoid process, right acetabulum, T spine most c/f widely metastatic cancer, most likely a breast primary; evaluation of the neck demonstrates physiologic FDG-activity in the thyroid. Thyroid studies showed hyperthyroidism: TSH (L) &lt;0.010 uIU/mL; Free T3 (H) 4.7 pg/mL and Free T4 1.00 ng/d. The patient was performed Ultrasound-guided FNA and core biopsy of the large parietal scalp lesion, however, FNA of the cystic component was nondiagnostic (no malignant cells seen).

Results (if a Case Study enter NA)
NA.

Conclusion
Core biopsy of the large parietal mass the tumor cells tend to form follicular or microfollicular architecture with colloid present, but no papillary nuclear features. Rare mitotic figures are seen. IHC stain of tumor cells are positive for AE1/AE3, Cam5.2, CK7, TTF1, thyroglobulin, PAX8, and Vimentin, which show strong evidence for metastatic follicular thyroid carcinoma (FTC) origin. Tumor cells are negative for Napsin-A, P63, Synaptophysin, Ck5/6, Ck20, EMA, WT1, CDX2, GATA3, Mammaglobin, ER, PR, and BRST2, which helps rule out the primary malignancy from lung, breast, neuroendocrine or other adenocarcinomas.
Gastric Spindle Cell Neoplasms With Mast Cells - A Pitfall In Diagnosis Of Gastric Biopsies.
Authors: Bal S K , Sieber S C 
Published: November 2022

Abstract

Introduction/Objective
Undifferentiated sarcoma, previously known as malignant fibrous histiocytoma (MFH), is a very rare primary neoplasm of stomach. It usually arises from soft tissue of extremities with an incidence of 1- 2/100,000, typically presenting in the 5th-7th decades of life with a slight male predominance. We report a case of gastric undifferentiated sarcoma which was interpreted as gastrointestinal stromal tumor (GIST) on initial biopsy.

Methods/Case Report
A 84 year old female presented to the Danbury Hospital emergency department with hematemesis and melena. Upper gastrointestinal endoscopy revealed a pedunculated mass in the cardia of stomach with ulceration, followed by a computed tomographic scan of chest and abdomen revealing a 2.9 cm mass along the proximal lesser curvature of the stomach. An endoscopic biopsy revealed a spindle cell neoplasm with immunohistochemical staining for c-kit consistent with GIST. She later underwent partial gastrectomy. Histopathology of the resected gastric tumor showed tumor cells arranged in sheets and storiform pattern, exhibiting spindled to polygonal morphology with marked nuclear pleomorphism, high mitotic activity (20 mitoses per 10 high power fields) and Touton type giant cells. Immunohistochemical stains demonstrated absence of staining for c-kit, DOG-1, CD34, actin, desmin, S100, cytokeratin AE1/AE3, CD3, CD5, CD20, CD21, CD15, CD30, ALK1, myeloperoxidase, CD1a and LCA. Numerous mast cells within the tumor stained for c-kit. Molecular testing for c-kit and PDGFRA mutations were negative. A final diagnosis of undifferentiated sarcoma with features of myxofibrosarcoma was rendered.

Results (if a Case Study enter NA)
NA.

Conclusion
Undifferentiated sarcomas are high grade malignant mesenchymal neoplasms without clear cellular differentiation or immunohistochemical marker. Only 4% of the total cases of undifferentiated sarcoma have been reported to be arising primarily from the gastrointestinal tract. They carry a poor prognosis with a 5 year survival of 47%. The main pitfall in our case was the positive uptake of c-kit stain by mast cells which led to the diagnosis of GIST in first gastric biopsy. We want to stress the importance of entertaining this diagnosis in the differential when encountered with a malignant gastric spindle cell neoplasm along with careful interpretation of c-kit stains in small biopsy specimens as the treatment and prognosis differs greatly from GIST.
Accurate Determination of Colorectal Polyp Counts Is Not Mission Impossible for Pathologists and Is Essential for Surveillance Interval Decision-Making: A Review of 1294 Specimens
Authors: Gamble D , Ziebell J , Chen W , Frankel W , Stanich P 
Published: November 2022

Abstract

Introduction/Objective
The US Multi-Society Task Force on colorectal cancer updated recommendations in 2020 for follow-up after colonoscopy. This emphasized differential surveillance intervals based on the number of polyps removed. We determined how often we accurately counted the number of polyps and what submission practices allowed accurate quantification.

Methods/Case Report
We reviewed consecutive colorectal polyp cases from 10/1 to 12/31, 2019, excluding inflammatory polyps in inflammatory bowel disease. Pathology reports were reviewed to determine if the polyp number could be determined from history, gross description, and histologic findings. When numbers did not match or were unclear, endoscopy reports and glass slides were reviewed.

Results (if a Case Study enter NA)
601 cases with 1294 specimens were identified. We accurately determined polyp number in 1235 (95.4%) specimens. 1072 (82.8%) specimens were submitted as single polyp per container (SP), while 222 (17.2%) were submitted with &gt; 1 polyp per container (MP). Polyp number was not quantifiable in 58 (26.1%) MP due to 11 labeled as “multiple polyps” in requisition/endoscopy reports and 47 submitted with polyp number different from number of tissue portions seen grossly and microscopically. In 1 (0.1%) SP, polyp number was unclear because separate portions of tissue contained two different diagnoses. Rate of accurate polyp count is significantly different between SP and MP (p&lt;0.01) by Fisher exact test.

Conclusion
We accurately determined number of polyps in most specimens (95.4%) because our gastroenterologists usually submit SP. In MP, polyp count in 26.1% of specimens was unquantifiable. This could lead to uncertainty in surveillance follow-up intervals. Therefore, we recommend submitting one polyp per container.
Gastrointestinal Stromal Tumors – Our Institutional 10-Year Experience
Authors: Proca D , Lazim A , Zenezan D , jhala N C 
Published: November 2022

Abstract

Introduction/Objective
Gastrointestinal stromal tumors (GIST), albeit very rare overall, with approximately 5,000 new diagnoses yearly in the US, represent the most common mesenchymal tumor involving the GI tract. particularly the stomach and small bowel. Pogress has been made in the past two decades in terms of describing pathogenesis, classification, and targeted therapy of GIST, however, their behavior is still quite challenging and unpredictable, and their prognosis remains guarded.

Methods/Case Report
We reviewed our institutional experience with GIST between 2010-2020; the review included surgical pathology reports, charts, and slides and we extracted data relevant for better characterization of these rare tumors.

Results (if a Case Study enter NA)
We identified a total of 53 GIST, with a preponderance of females (37 cases) versus males (16), and age ranging from 33yo (female) to 90yo (female). The majority of tumors were located in the stomach (39), with the remaining distributed between different locations: colon, small bowel, duodenum (3 each), esophagus and liver (2 each) and retroperitoneum (1). The GISTs ranged in size from 0.2 to 30 cm. 14 GISTs were smaller than 1 cm, with 8 of these being incidental findings: 4 associated with another tumor, 3 in sleeve gastrectomies, and 1 in a colon resected for perforated diverticulitis. Six GISTS were multiple, with 2-3 different tumors in the stomach, corresponding to a pT1m or pT2m stage. Majority of GISTs were spindled, while only 3 GISTwere mixed and 2 were epithelioid. All GIST in our review were c-kit positive.

Conclusion
In summary, we report data obtained from 53 resected GIST’s over a 10 year period. GIST ia a rare tumor overall, with an annual incidence of 10-20 new cases/ million, and therefore it is relatively difficult to study. Our findings confirm those reported in the literature as far as localization (preponderence of stomach), gender prevalence (female) and predominant proto-oncogen kit mutation, but shows a wider age range and interesting co-morbid associations in small, no risk GIST. These findings support the hypothesis that tumor microenvironment and host immune response are important factors in pathogenesis and provides empirical evidence that immunotherapy and immunomodulation should be studied as therapeutic additions in GIST.
Acute Hemorrhage Related Colonic Injury Misdiagnosed as Signet-Ring Cell Carcinoma
Authors: Pereira MD D , Jayaratne N , Crowley MD M , Jiang K 
Published: November 2022

Abstract

Introduction/Objective
Hypovolemic shock/hypoperfusion-related gastrointestinal injury is an unusual event in the practice of oncological pathology. The histologic findings can be ambiguous, potentially masquerading other entities, especially epithelial neoplasms. One needs to pay close attention to the subtle microscopic features and the associated sudden clinical event(s). Concordant hypovolemic history will help decision-making but can be overlooked or unaware of.

Methods/Case Report
A 72-year-old gentleman with prostate hypertrophy, rheumatoid arthritis, and hypertension presented to the emergency room with palpitation, dizziness, and dyspnea. He was diagnosed with atrial fibrillation and started on anticoagulation. Unexpectedly, the patient returned 3 days later with sudden gastrointestinal hemorrhage and severe anemia (hemoglobin 2.7). Emergency colonoscopy identified mucosal hemorrhage, erosion, and a friable, mass-like area in the sigmoid colon; the corresponding biopsy was called signet-ring cell carcinoma. Subsequently, the patient was referred to our institution for consultation.

Results (if a Case Study enter NA)
The provided biopsy showed multiple clusters of signet-ring-like cells with extravasated mucin, detached or distributed within edematous colonic fragments, resembling signet-ring cell carcinoma. However, no overt cytologic or architecture atypia or mitosis was appreciated; instead, microscopic hemorrhage, capillary thrombi, withering and distorted crypts, and mucosal necrotic sloughing were present, worse on the luminal surface. Furthermore, no background dysplasia or adenoma was identified. These findings uncovered an originally misdiagnosed acute colitis due to hypoperfusion. Subsequent imaging studies detected no gastrointestinal mass/lesion. 22-months later, the patient’s clinical follow-up was unremarkable.

Conclusion
Severe hemorrhage/hypoperfusion-induced colitis may pose a dilemma clinically and histopathologically when the contributing event is underrecognized. Detailed history and laboratory review and astute microscopic inspection are warranted.
Squamous Morules in a Fundic Gland Polyp: A Rare Benign Mimic of Well-Differentiated Neuroendocrine Tumor
Authors: Mitra A , Matsukuma K 
Published: November 2022

Abstract

Introduction/Objective
Fundic gland polyp is a benign polypoid lesion consisting of cystically dilated oxyntic glands; it can be either sporadic or associated with familial adenomatous polyposis or MUTYH-associated polyposis. Squamous morules are well-described in association with numerous epithelial lesions including tubular adenomas, cribriform- morular variant of papillary thyroid carcinoma, and endometrial neoplasia. However, to date only 2 cases have been reported in the stomach.

Methods/Case Report
We describe a third case, in a 53-year-old female who presented to endoscopy for hematemesis. Thirty-five sessile polyps ranging from 10-18 mm were identified and resected. On histologic sections, all were fundic gland polyps. Of these, one showed scattered small nests of epithelial cells with monomorphic round nuclei, inconspicuous nucleoli, and moderate eosinophilic cytoplasm, situated just below the luminal surface in continuity with adjacent glands. The nests showed focal expression of synaptophysin and cytokeratin 5/6, striking nuclear expression of β-catenin, and no expression of p63. Ki67 proliferative index was &lt;1%. Interestingly, all 3 cases of gastric squamous morules have arisen in adults with symptoms of reflux, including our patient who was on a proton pump inhibitor. All were identified in a gastric polyp (either hyperplastic or fundic gland) within a background of numerous large fundic gland polyps (up to 2 cm), and none were associated with lower gastrointestinal polyposis. Nuclear accumulation of β-catenin, a common feature of squamous morules, was demonstrated in the one prior case that was tested.

Results (if a Case Study enter NA)
NA.

Conclusion
Gastric squamous morules are a rare finding. Given the nested arrangement of cells and bland cytology, well-differentiated neuroendocrine tumor may enter the differential diagnosis. Features that can help distinguish squamous morules from neuroendocrine tumor are: (1) focal expression of synaptophysin, (2) superficial location and continuity with adjacent glandular epithelium, and (3) nuclear accumulation of β-catenin.
Hepar-1 Positive Prostatic Adenocarcinoma: A Case Report and Review of Literature
Authors: Lazim A , Balshan E 
Published: November 2022

Abstract

Introduction/Objective
Poorly differentiated metastatic malignancy in patients with a history of more than one known primary tumor, such as a history of both hepatocellular and prostatic carcinoma as seen in our case, can be challenging. Both tumors are CK7/CK20 positive, and both can be reactive for hepar-1, as has been demonstrated in the current case, and rarely described in the literature.

Methods/Case Report
Herein we present a sixty-three-year-old male who presented for follow-up of his lower back pain in the setting of hepatocellular carcinoma. MRI of the spine was suggestive of an expansile metastatic lesion in the C2 vertebral body with extraosseous soft tissue extension resulting in moderate to severe central canal and left foraminal narrowing at C2-3. Multiple additional metastatic lesions were visualized throughout the cervical upper thoracic spine as detailed above. Vertebral body biopsy showed metastatic adenocarcinoma with sheets of neoplastic cells infiltrating the medullary spaces. The patient’s history of hepatocellular carcinoma was noted, and immunohistochemical staining for HepPar1 with appropriate control was performed and found to be diffusely reactive in the tumor cells. However, tumor cells were also positive for PSA, PSAP, and NKX3.1 (Fig-1-A-D, H&E, Hepar-1, PSAP, PAP). This immunoprofile is consistent with a prostatic origin of the tumor cells, and a diagnosis of metastatic prostatic adenocarcinoma was given.

Results (if a Case Study enter NA)
NA.

Conclusion
Hepar-1 and even arginase-1 have been observed in rare subsets of prostatic acinar adenocarcinoma. Even in the setting of PSA and PSAP negative metastatic disease in patients with a history of hepatocellular carcinoma, we suggest utilizing additional stains suggestive of a prostatic origin, such as NKX3.1, and even molecular studies. This could be useful diagnostic approach to help differentiate between the two neoplasms in such patients.
Potential Therapeutic Effects of Morin Hydrate in Folic Acid-Induced Acute Kidney Injury
Authors: Ahmed A , Elgamal D , Mohammad Farrag A , Ali F , Abd El-Aziz M , Abd El-Maksoud M , Ibrahim I 
Published: November 2022

Abstract

Introduction/Objective
Acute kidney injury (AKI) causes significant morbidity and mortality and, if left unmanaged, can progress to chronic kidney disease. Despite the advances in our understanding of the pathogenesis of AKI, there are no available therapeutics to combat it effectively. Folic acid (FA)-induced AKI is a well established rat model characterized by acute renal injury due to the disturbance of the antioxidant system with subsequent renal fibrosis. Morin hydrate, a well-known bioactive flavonoid, has been proven to alleviate oxidative stress and exhibits anti- inflammatory, anti-apoptotic and neuroprotective activity.

Methods/Case Report
We investigated the potential protective and therapeutic effects of morin hydrate on FA-induced AKI. Thirty-five rats were divided randomly into 5 groups (6 rats/ group) as follows: control group received a vehicle for 10 days, FA group received a vehicle for 10 days with an intraperitoneal (IP) injection of a single dose (SD) of FA (250 mg/kg) on the 7thday, FA-Withdrawal group injected with a SD of FA (250 mg/kg IP) on the 1st day with a vehicle for 10 days, morin-pretreated group received morin hydrate (40 mg/kg orally) for 7 days, followed by a SD of FA (250 mg/kg, i.p), and morin-treated group injected with a SD of FA (250 mg/kg IP), then treated with morin hydrate (40 mg/kg orally) for 7 consecutive days. All animals were sacrificed after 10 days and then, blood samples and kidneys were collected for biochemical and histopathological examination.

Results (if a Case Study enter NA)
FA group showed extensive structural damage in renal tubules and glomeruli with no significant improvement in withdrawal and morin-pretreated groups. Morin treatment significantly attenuated histopathological changes and reduced FA-induced increase in serum creatinine, albumin and urea levels. This therapeutic role of morin was associated with suppression of inflammation, oxidative stress, and apoptosis.

Conclusion
These findings suggest that morin hydrate constitutes a potential natural therapeutic product for treating AKI.