bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diffuse Pulmonary Meningotheliomatosis: A Case Report
Authors: Forsythe M L , Abdelsadek O A , Prasai K , Raval P A , Krantz S B , Shah R D , Groth J V 
Published: November 2022

Abstract

Introduction/Objective
Diffuse pulmonary meningotheliomatosis (DPM) is a pulmonary disease characterized by the presence of widespread bilateral minute pulmonary meningothelial-like nodules (MPMNs). It is exceedingly rare and predominantly seen in females. The nodules are typically asymptomatic and detected incidentally on imaging.

Methods/Case Report
We present a case of a 57-year-old woman with a history of chronic cough and CT imaging findings of bilateral multiple ground-glass nodules. Wedge resections from the right upper and right lower lobes were obtained, which revealed gross changes suggestive of interstitial lung disease. Histologic evaluation of the wedges showed similar morphology, consisting of discrete areas with variable interstitial expansion of the stroma with ovoid/spindle cells, collagen, elastosis, and mild chronic inflammatory cells, in a somewhat perivascular pattern. Some areas were also cystic. This appeared in a background of emphysematous change and focal foreign body giant cell reaction to non-polarizable material. Immunohistochemical stains were diffusely positive for vimentin, EMA , and PR, and CD163 highlighted increased cells that were S100 and CD1a negative. Additionally, the ovoid/spindle cells were negative for desmin, SMM, HMB-45, HHV8, pan-CK, chromogranin, and multiplex SOX10-MART1.

Results (if a Case Study enter NA)
NA

Conclusion
Diffuse pulmonary meningotheliomatosis is a rare entity that requires sufficient histological evaluation to identify the ovoid/spindle cell component histologically and immunohistochemically. This disease should be considered in the differential for cases of diffuse interstitial pulmonary infiltrates. Few cases have been reported in the literature, requiring further research to understand the mechanisms of this disease and its clinical significance.
Lady Windermere Syndrome: Historical Perspective and Report of a Rare Case
Authors: Al-kharouf I , Abdo M E , Hamza A 
Published: November 2022

Abstract

Introduction/Objective
Lady Windermere syndrome refers to Mycobacterium avium complex (MAC) pulmonary disease with an isolated lingular or middle lobe pattern of involvement. This is thought to be due to habitual suppression of the cough voluntarily. Typical demographics are that of elderly female patient. Although the etiology remains unclear high prevalence of pectus excavatum, scoliosis and mitral valve prolapse has also been noted in these patients. The purpose of this report this to describe a case of this syndrome.

Methods/Case Report
A 64-year-old female with a history of breast carcinoma status post bilateral mastectomies, and thyroid papillary microcarcinoma, status post thyroidectomy, presented with hemoptysis. Clinically and radiological findings were consistent with pneumonia which improved but did not completely resolve following antibiotic treatment. Computerized tomography (CT) revealed progressive infiltrates and bronchoscopy cultures grew Mycobacterium avium complex (MAC). Repeat antibiotic therapy resulted in only marginal improvement. Repeat CT showed diffuse bronchiectatic changes with scattered nodularity and tree-in-bud opacities, with majority of involvement in the right middle lobe and lingula. Multiple interventions were employed to ameliorate the patient’s condition including a positive expiratory pressure device, gastroesophageal reflux disease (GERD) precautions and combinations of 2 drug therapies without significant improvement in her condition. It was ultimately decided that she may benefit from a right middle lobectomy. Histologic sections from the lobectomy specimen showed necrotizing and non-necrotizing granulomatous inflammation and bronchiolectasis. Rare acid-fast microorganisms were identified on AFB special satin. Lady Windermere syndrome was suggested in the diagnostic comment after expert consultation. Patient’s symptoms improved after surgery and additional samples show no growth of MAC.

Results (if a Case Study enter NA)
NA

Conclusion
Although rendering a definite diagnosis is challenging in such cases, the constellation of clinical, radiologic, and histologic finding can be used to raise the possibility of Lady Windermere syndrome.
Cryptococcus Infection Mimicking Lipoid Pneumonia in a Lung Biopsy
Authors: Walkenhorst M , Hamza A 
Published: November 2022

Abstract

Introduction/Objective
Lipoid pneumonia is a non-infectious, rare entity which results from accumulation of exogenous or endogenous lipids in the lungs. It appears as intraalveolar macrophages filled with lipids in the form of fine spherical vacuoles. Cryptococcosis can also appear as vacuolated macrophages filled with yeasts. At low magnification, the distinction is very difficult. The co-existence of the two entities is noted in literature but is exceedingly rare.

Methods/Case Report
A 33-year-old male, status post renal and pancreatic transplant, on chronic immunosuppression therapy presented with dysphagia. Imaging studies showed cavitary and non-cavitary nodules, patchy, confluent consolidations in the bilateral lungs, and a patulous, debris filled esophagus. This raised the possibility of atypical infections as well as aspiration. Biopsy of a right lower lobe lung lesion was performed. Histology demonstrated fibrotic lung parenchyma with vacuolated histiocytes containing small spherical substances. The differential diagnosis included Cryptococcus infection versus exogenous lipoid pneumonia, both of which were consistent with clinical and radiologic findings. Few, scattered foreign body giant cells were found. Additionally, GMS and mucicarmine stains were positive in the small spheres within the macrophages. The final diagnosis of lung parenchyma with numerous yeast forms, morphologically consistent with cryptococcus species was rendered. The patient was additionally found to have esophageal candidiasis. Concurrent lipoid pneumonia was considered unlikely based on the patient's history of immunosuppression (which made infection a much more likely etiology) and paucity of foreign body giant cell reaction.

Results (if a Case Study enter NA)
NA

Conclusion
This case highlights the importance of knowledge of rare entities and correlation with clinical and radiologic findings in arriving at an accurate diagnosis.
The Spectrum of Pulmonary Histomorphology Changes in COVID-19 Cases
Authors: Ravikumar V , Cool C , Jing J 
Published: November 2022

Abstract

Introduction/Objective
Pulmonary specimens following COVID-19 virus infection demonstrate a spectrum of pulmonary histomorphology. Six patients with a history of COVID-19 infection are summarized in this review. The purpose of our study is to elucidate any possible correlations between clinical, laboratory, radiographic, and pathologic findings in COVID-19 patients. Further, we aim to characterize both non-specific and specific histomorphology and cytomorphology in COVID-19 patients.

Methods/Case Report
Six patients with known COVID-19 infection and lung biopsies/resections are identified. A chart review is performed to collect clinical histories, the results of COVID-19 PCR testing, radiographic impressions, pathologic interpretations of histology, and clinical outcomes. Information is summarized and tabulated.

Results (if a Case Study enter NA)
The most common, non-specific histological findings are focal/diffuse acute lung injury, organizing lung injury, or a combination of both patterns. Unique features of COVID-19 infection are identified in three cases, which illustrate viral cytopathic changes within hyperplastic pneumocytes. These include basophilic, vacuolated, granular cytoplasm and variably sized cytoplasmic/nuclear inclusions. Virus-loaded pneumocytes are typically identified in the organizing phase, and rarely in the acute lung injury phase. Immunohistochemical staining of anti-nuclear capsule antibody with appropriate controls shows focal positive staining in one case. SARS-CoV-2 PCR is positive in formalin-fixed paraffin-embedded (FFPE) tissue, while a serum PCR assay is negative.

Conclusion
The severity of clinical symptoms and clinical outcome are unrelated to the degree of lung involvement. Viral cytopathic changes are identified in three cases, with these specific findings associated with the organizing phase of lung injury, and either concurrent PCR positivity or positive immunohistochemical staining.
The Number of Calcium Oxalate Deposits Significantly Correlate with Elevated Serum Creatinine Levels in Calcium Oxalate Nephropathy
Authors: Kumar S , Zhang P 
Published: November 2022

Abstract

Introduction/Objective
Calcium oxalate nephropathy is defined as acute and/or chronic decrease in renal function due to deposition of calcium oxalate crystals in renal tubules leading to acute tubular injury, acute or chronic interstitial nephritis, and elevated serum creatinine levels. However, the correlation between serum creatinine (SCr) levels and the number of calcium oxalate deposits has not been well described in the literature.

Methods/Case Report
Eight controls with mild to moderate acute tubular injury and 10 cases with calcium oxalate nephropathy (calcium group) were selected for the study. The patient’s SCr values were obtained from electronic medical records and the number of polarizable calcium oxalate crystal deposits in the lumen of proximal tubules seen on Hematoxylin & Eosin stained slides at 40x high power field were recorded for each biopsy. Umpired student T-test was used to compare the two groups. Linear regression analysis was used to correlate SCr and the number of calcium oxalate deposits.

Results (if a Case Study enter NA)
Mean ages were not significantly different between two groups (49 ± 8 years in controls and 64 ± 6 years in calcium group). SCr was significantly higher in the calcium group (5.97 ± 0.68 mg/dl*) than in the control group (2.59 ± 0.37 mg/dl). No calcium oxalate deposits were seen in any of the controls, but the number of calcium oxalate deposits ranged from 3 to 7 in the calcium group (Table 1). In our study, we found a significant linear correlation between SCr and the number of crystals/high power field, when all cases were taken together (r value = 0.783, p value = 0.0002*).

Conclusion
Our data suggest that there is a direct association between the number of calcium oxalate crystals in proximal tubules with the severity of renal dysfunction. Although the etiologies for calcium oxalate nephropathy can be multifactorial, counting the deposit number on renal biopsies is simple method to predict SCr levels.
Continuing Profound Impact of Continued Education Sessions on Blood Bank Specimen Labeling Years Later at the Veteran Affairs Medical Center
Authors: Petersen J M , Jhala D , Patel V 
Published: November 2022

Abstract

Introduction/Objective
Proper patient identification is a critical safety element for transfusion medicine, particularly for the prevention of acute hemolytic transfusion reactions (AHTR). Mislabeled specimens have been documented to carry an increased risk of patient misidentification. Therefore, the submission of a mislabeled specimen to the blood bank generally results in a specimen rejection with a redraw. At the Philadelphia Veteran Affairs Medical Center, an identification bracelet with alphanumeric code is used to help improve transfusion safety but also has additional patient labeling requirements. The redrawing of blood bank specimens poses risks in phlebotomy, and a quality improvement initiative was previously undertaken to educate staff on proper blood specimen and band labeling and usage to prevent labeling errors, improve safety in patient care, and reduce intended redraws.

Methods/Case Report
Colorful laminated posters delineating the labeling requirements and process for blood bank specimens collected using the blood bank system were made and distributed at the time of in-service training by the blood bank in 2017 to the areas of the hospital whereby errors had been noted to occur in the past. The dedicated in-service training was repeated prior to the change in the identification blood band from the Hollister Ident-ATM Blood Recipient Band (Precision Diagnostics Corporation, Valencia CA) to the Typenex Blood Bands (Typenex Medical, Chicago IL) on 11/12/2019. As part of the quality metrics of the blood bank, blood bank specimen labeling errors was tracked from 2017 to track the persistence of the effect of the initial training.

Results (if a Case Study enter NA)
The percentage of properly labeled specimens as a percentage of total specimens increased after the in-service training; specifically, an increase from a low of 97% (December 2017) to a high of 99% (August 2018). The percentage of properly labeled specimens remains at the increased level of 99% and above even at the 4.5-year mark in mid-2022.

Conclusion
The continued availability of laminated educational posters on blood specimen labeling for the clinical service areas combined with initial in-service education can have lasting effects to improve the quality of care even years after the initial in-service education sessions.
Replicated Adsorption Technique used to Resolve ALX148 Interference in the Immunohematology Reference Laboratory
Authors: Flaws M , Hartman K , Geurkink C , Mullins D , Ha K , Zinni J G , Pahomi A 
Published: November 2022

Abstract

Introduction/Objective
Increased expression of CD47 by cancer cells inhibits macrophages' phagocytic activity through CD47-SIRPα interactions, allowing evasion of the innate immune system. Several drugs on the market have been developed to target this interaction, including monoclonal therapeutics and fusion proteins. ALX148 is a genetically engineered SIRPα fusion protein with an inactivated Fc portion. CD47 is expressed highly on red blood cells (RBC), resulting in strong interference in pre-transfusion compatibility testing of patients receiving ALX148. Consequently, trial patients are at increased risk of transfusion-related adverse events or delay of needed transfusion. Few resolutions of ALX148 interference to assess underlying alloantibody development have been reported. One such examiniation demonstrated x6 linear papain-treated RBC adsorptions removed ALX148 interference. This study aimed to replicate these findings.

Methods/Case Report
Three patients receiving combination ALX148 (dose 6.57-20mg/mL) and Azacitidine therapy with broad-reactive RBC antibody reactivity were selected. High volume alloadsorptions (8:1 RBC:plasma) were performed with papain-treated rr (ccdee) RBCs. Adsorptions were incubated at 37C for 10 minutes. Polyethylene glycol (PEG) was utilized in test tube indirect antiglobulin testing (IAT).

Results (if a Case Study enter NA)
Initial reactivity strength was 3-4+ at PEG-IAT and saline-IAT with a three-cell screening RBC reagent. Alloadsorbed plasma was non-reactive at IAT with a three-cell screening RBC reagent enhanced by PEG. Drug interference was removed following three times high volume papain-treated alloadsorption.

Conclusion
Cancer immunotherapies have transformed the standard of care in oncology. Despite the evident clinical success, the medical laboratory has been challenged with adapting to cancer drug therapies capable of causing interference in routine laboratory testing. Clinical trials of ALX148 are associated with interference in pre-transfusion compatibility testing. The use of extended phenotype matching for RBC transfusion can be utilized but incurs additional time and resources. These results suggest high volume linear papain RBC alloadsorptions may be incorporated into antibody resolution for patients receiving ALX148.
Highly Effective, Easy, & Simple Model for the Day-to-Day Monitoring of Blood Bank Inventory Leading to Successful Operations to Provide Blood Products in the Times of Blood Product Shortage Nationally Due to COVID-19 Pandemic
Authors: Patel V , Petersen J M , Jhala D 
Published: November 2022

Abstract

Introduction/Objective
Providing blood products in a timely manner is very important and is an integral part of the health care system to provide best patient care. Transfusion medicine services should be well prepared to respond to blood product demands in a timely manner. Due to the COVID-19 pandemic, all the transfusion medicine services nationally have been facing blood product shortages. A model was created in Pathology & Laboratory services (P&LMS) at the Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMC VAMC) to communicate effectively to the patient care team to keep up with ongoing clinical care demands despite the national blood shortage.

Methods/Case Report
Transfusion medicine team at CMC VAMC communicated to patient care team about the national shortage of blood products. All blood requests were evaluated for appropriate usage of blood. Also, PACS (Peri Operative cells Savers) services was considered for Operating room for patient with major blood loss. Daily blood inventory was evaluated, closely monitored, and communicated to patient care team to meet the demands from Jan 16th, 2022, to April 11th, 2022. Importantly, P&LMS created a simple model where each blood product in reduction was recorded every morning and evening. This simple method of 24/7 real time monitoring of the supply of blood products helped tremendously in decision making for procedure prioritization based on clinical indications and contributed to the continued successful clinical operation.

Results (if a Case Study enter NA)
Procedures were successfully prioritized according to the blood supply. Simultaneously, there was no delay in issuing blood products as clinically needed. A significant amount of reduced inventory noted from Jan 16th, 2022, to April 11th, 2022; the average reduction was O+ 53% reduced and A+ 44% reduced.

Conclusion
By monitoring the day-to-day blood bank inventory effectively, P&LMS at CMC VAMC was able to support all the critical clinical needs by providing blood products in a timely manner. P&LMS services was able to reduce the wastage and was able to provide all the critical blood product without any significant delays by monitoring in Realtime. The value of collaborating and communicating to the patient care team cannot be understated as it is both simple and highly cost effective.
Resident Physician “Moonlighting” for On-call in Transfusion Medicine: Educational Impact and Preparedness for Practice
Authors: Bharadwaj H , Alhusseiny A , Pandiri M , Khan A , Jawale R , Johari V 
Published: November 2022

Abstract

Introduction/Objective
Resident physician moonlighting is controversial and uncommon in Pathology, usually limited to anatomic pathology grossing support. Due to an acute staffing shortage in our department, we offered senior AP/ CP residents in our program a “moonlighting” opportunity involving partnership with attendings to supervise junior residents for transfusion medicine on-call (TMO) . Given the conflicting claims of educational benefit and detriment of moonlighting, we sought to evaluate impact of TMO moonlighting activities on residents' educational experience and preparedness for clinical practice.

Methods/Case Report
Residents selected for moonlighting TMO were PGY-3/4, “exceeded expectations” on their transfusion medicine rotation and had taken resident TMO. After initial “boot camp” exercises involving common TMO scenarios, they were added to the attending on-call schedule with a fair financial incentive. They were the first resource and provided in-person support for the TMO resident. Attendings were available for consultation via a secure communications platform (phone and text). After one year, residents were surveyed regarding overall experience, sense of graduated responsibility, impact of financial incentive, preparedness for future practice, and impact on day- time service commitment. "Resident In-Service Examination" (RISE) score was used to estimate impact of TMO on medical knowledge.

Results (if a Case Study enter NA)
NA.

Conclusion
Four out of the five residents took the survey. All 4 responded “definite” for positive experience, feeling of graduated responsibility and preparedness for practice. Financial incentive was assessed favorably. No resident reported an adverse impact on their daytime service responsibility. The group median score on RISE transfusion medicine 2022 was 75th percentile with median increase in 10 percentile points. As pathology moves towards sub- specialty practice, working fluency in some areas such as TMO remains a necessity for smaller group practices. Our experience (albeit with a small group of residents) suggests that TMO moonlighting activities may better prepare the residents for this unmet need.
Comparative Sensitivity of Solid-Phase Versus PEG Enhancement Assays for Detection and Identification of Red Blood Cell Antibodies
Authors: Abdelmonem M , Dussaq A , Cai W , Tang M , Nguyen A , Papakonstantino K , Cabungan M , Yoshizuka S , Hollenhorst M 
Published: November 2022

Abstract

Introduction/Objective
Identifying antibodies to red blood cell (RBC) antigens is one of transfusion medicine’s most critical and challenging issues. There are 354 RBC antigens recognized by the International Society of Blood Transfusion. Accurate identification of clinically significant alloantibodies is imperative for identifying and preventing hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. We compared the performance of the tube (polyethylene glycol–indirect antiglobulin test [PEG-IAT]) and solid-phase techniques for antibody identification.

Methods/Case Report
We performed a retrospective study on all antibody screens and identifications performed between 2007–2021 at Stanford Hospital. Over this period, 631,535 antibody screens were performed predominantly using an automated solid-phase technique. Subsequent antibody identification studies were performed using manual tube testing (PEG-IAT) and automated solid-phase techniques.

Results (if a Case Study enter NA)
Antibody screening resulted in 28,316 (4.5%) positive samples with at least one antibody. Antibody identification performed on both platforms identified 50 discordant [DMH1] samples. 8 anti-Jka, 2 anti-Jkb, 1 anti-S, and 1 anti-M were detected by automatic solid-phase technique but were not detected by PEG-IAT. 20 anti-E, 6 anti-K, 2 anti-Fya, 2 anti-c , 2 anti-C, 2 anti-Fyb, 1 anti-cE[DMH2] , 1 anti-e,1 anti-M, and 1 anti-S were detected by PEG-IAT but were negative by automated solid-phase technique. Anti-E had the least sensitivity (98.99%) in the automated solid-phase technique, while anti-Jkb had the least sensitivity (98.78%) in PEG-IAT.

Conclusion
This is the first robust 15-year study comparing methodologic sensitivity to detect clinically significant alloantibodies. The incidence of discordant results between the PEG-IAT and solid-phase technique was low. Among discordant samples, anti-Jka was commonly detected by solid-phase but not by PEG-IAT. In contrast, anti-E was commonly detected by PEG-IAT but not by the solid phase.