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American Journal of Clinical Pathology

Hector Mesa, Ajay Rawal, Pankaj Gupta
Objectives: Advances in interventional techniques allow obtaining samples from most body sites through minimally invasive procedures that yield limited samples. We provide practical guidelines for diagnosis of lymphoid lesions in these samples. Methods: Guidelines for selection of biopsy site and triage of the specimen according to results of rapid on-site evaluation (ROSE), and description of the advantages and limitations of currently available ancillary studies are described, based on the experience of the authors, complemented by a comprehensive review of the literature...
August 4, 2018: American Journal of Clinical Pathology
Yanjun Hou, Harrison S Moosavi, Lai Wei, Anil V Parwani, Xiaoxian Bill Li, Zaibo Li
Objectives: To conduct a clinicopathologic study of male breast carcinoma with Magee equation recurrence score (RS). Methods: Seventy-four cases of male invasive breast cancers (MBCs) were studied, including 63 hormone receptor (HR)-positive, 10 human epidermal growth factor receptor 2-positive, and one triple-negative breast cancers. Results: Among 63 HR-positive MBC patients, nine patients developed distal metastasis. Statistical analysis demonstrated distal metastasis was significantly associated with positive lymph node, high Nottingham grade, and increased Magee equation RS...
August 4, 2018: American Journal of Clinical Pathology
Kevin R Anderson, Allison Onken, Benedikt H Heidinger, Yigu Chen, Alexander A Bankier, Paul A VanderLaan
Objectives: The eighth edition of the American Joint Committee on Cancer staging manual now stratifies nonmucinous lung adenocarcinomas (nmLACAs) by the size of the invasive component only. This is determined by direct gross or microscopic measurement; however, a calculated invasive size based on the percentage of invasive growth patterns has been proposed as an alternative option. Methods: To compare radiologic with different pathologic assessments of invasive tumor size, we retrospectively reviewed a cohort of resected nmLACAs with a part-solid appearance on computed tomography (CT) scan (n = 112)...
August 4, 2018: American Journal of Clinical Pathology
Kent Lewandrowski, Alissa Keegan, Vladislav Makarenko, Elena Maryamchak, Douglas A Mata, Michael J Palte, Joseph W Rudolf, Nida Safdar, Ryan J Schmidt, Lena Stuart, Yiqin Xiong, Lokinendi Rao, Stacy E F Melanson, L Michael Snyder
Objectives: To develop a curriculum for a commercial reference laboratory clinical pathology training elective. Methods: A 4-day elective at Quest Diagnostics was developed. The elective included 32 sessions composed of interactive didactic sessions and laboratory tours/demonstrations. Ten residents who attended the elective completed a written evaluation and scored each component of the curriculum. Results: Written comments were very positive and demonstrated the goals of the elective were achieved...
July 25, 2018: American Journal of Clinical Pathology
Tamar C Brandler, Cheng Z Liu, Margaret Cho, Fang Zhou, Joan Cangiarella, Melissa Yee-Chang, Yan Shi, Aylin Simsir, Wei Sun
Objectives: Recognizing preoperative characteristics of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is important for clinical management. Therefore, we assessed presurgical NIFTP molecular profiles using fine-needle aspiration (FNA) material. Methods: Presurgical FNA reports of 39 surgically confirmed NIFTP cases from January 2013 through May 2017 were assessed for Afirma and ThyroSeq results. Results: Twenty-one of 39 NIFTP nodules were preoperatively tested with Afirma with two benign and 19 suspicious results...
July 25, 2018: American Journal of Clinical Pathology
Thaer Khoury, Xuan Peng, Li Yan, Dan Wang, Vidya Nagrale
Objectives: The aims were to evaluate breast cancer (BC) tumor-infiltrating lymphocytes (TILs) interobserver variability, heterogeneity, and the fidelity of scoring TILs in core needle biopsy (CNB). Methods: Matching CNB and two full-face sections (FFSs) of BC cases (n = 100) were independently reviewed by two pathologists. Percentage of stromal lymphocytes (TIL-str) and intratumoral lymphocytes (iTu-Ly) were recorded. Results: The weighted κ values for the degree of agreement between both raters were 0...
July 25, 2018: American Journal of Clinical Pathology
Matthew M Klairmont, Deepthi Hoskoppal, Nour Yadak, John Kim Choi
Objectives: Immunohistochemistry (IHC) staining of core biopsy sections often plays an essential role in the diagnosis of acute megakaryoblastic leukemia (AMKL). The goal of this study was to define the relative sensitivities of commonly used stains for markers of megakaryocytic differentiation. Methods: The sensitivities of IHC stains for CD42b, CD61, and von Willebrand factor (vWF) were compared in 32 cases of pediatric AMKL. Results: The sensitivities of CD42b, CD61, and vWF were 90...
July 25, 2018: American Journal of Clinical Pathology
Stephen Young, Christen Griego-Fullbright, Aaron Wagner, Amanda Chargin, Bruce K Patterson, Devon Chabot-Richards
Objectives: We report on the validity of a fully quantitative technology to determine tumor cells' PD-L1 expression compared with a standard immunohistochemical (IHC) assay in non-small cell lung cancer. Methods: Nineteen fresh tissue specimens were processed into single-cell suspensions using the IncellPREP Kit. Cells were treated with the OncoTect iO Lung Assay, which quantitatively assessed tumor-infiltrating lymphocytes (TILs), DNA content, and PD-L1 expression on diploid and aneuploid tumor populations...
July 24, 2018: American Journal of Clinical Pathology
Mihai Merzianu, Adrienne Groman, Alan Hutson, Claudiu Cotta, Russell K Brynes, Attilio Orazi, Vishnu Reddy, Julie Teruya-Feldstein, Ramila Amre, Manjula Balasubramanian, Guilherme Brandao, Sindhu Cherian, Elizabeth Courville, David Czuchlewski, Guang Fan, David Grier, Daniela Hoehn, Kedar V Inamdar, Ridas Juskevicius, Prabhjot Kaur, John Lazarchick, Michael R Lewis, Rodney R Miles, Jerome B Myers, Michel Nasr, Hina N Qureishi, Horatiu Olteanu, Valentin G Robu, Gratian Salaru, Neerja Vajpayee, Jeffrey Vos, Ling Zhang, Shanxiang Zhang, Le Aye, Elisa Brega, James E Coad, John Grantham, Sinisa Ivelja, Robert McKenna, Kieran Sultan, Gregory Wilding, Robert Hutchison, LoAnn Peterson, Richard T Cheney
Objectives: To assess bone marrow (BM) sampling in academic medical centers. Methods: Data from 6,374 BM samples obtained in 32 centers in 2001 and 2011, including core length (CL), were analyzed. Results: BM included a biopsy (BMB; 93%) specimen, aspirate (BMA; 92%) specimen, or both (83%). The median (SD) CL was 12 (8.5) mm, and evaluable marrow was 9 (7.6) mm. Tissue contraction due to processing was 15%. BMB specimens were longer in adults younger than 60 years, men, and bilateral, staging, and baseline samples...
July 20, 2018: American Journal of Clinical Pathology
Chieh-Yu Lin, David Levy, John P T Higgins, Christian A Kunder, Chia-Sui Kao
Objectives: To report the presence and evaluate the frequency of plasma cell neoplasms within adrenal myelolipomas. Methods: Adrenal myelolipomas within our institution were reviewed for the presence of hematologic neoplasia, and a review of the literature was performed. Results: Two (9%) of 23 adrenal myelolipomas were involved by plasma cell myeloma. The patients were 71 and 81 years old, one woman and one man, with tumors measuring 7 cm and 8...
July 20, 2018: American Journal of Clinical Pathology
Jess F Peterson, Daniel L Van Dyke, Nicole L Hoppman, Hutton M Kearney, William R Sukov, Patricia T Greipp, Rhett P Ketterling, Linda B Baughn
Objectives: Chromosome (G-banding) and fluorescence in situ hybridization (FISH) serve as the primary methodologies utilized for detecting genetic aberrations in hematologic neoplasms. Chromosomal microarray can detect copy number aberrations (CNAs) with greater resolution when compared to G-banding and FISH, and can also identify copy-neutral loss of heterozygosity (CN-LOH). The purpose of our review is to highlight a preselected group of hematologic neoplasms for which chromosomal microarray has the greatest clinical utility...
July 20, 2018: American Journal of Clinical Pathology
Adriano Rodríguez-Trujillo, Cristina Martí, Martina Aida Angeles, Adriana Sierra, Roser Esteve, Adela Saco, Esther Barnadas, Lorena Marimón, Inmaculada Nicolás, Aureli Torné, Jaume Ordi, Marta Del Pino
Objectives: To assess the prognostic value of human papillomavirus (HPV) 16/18 genotyping and p16/Ki-67 dual staining cytology in high-risk HPV (hrHPV)-positive women with no lesion or minor abnormalities. Methods: We evaluated progression to high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grades 2 to 3 or cervical cancer (HSIL/CIN2+), persistence/regression of hrHPV infection in women referred to colposcopy showing hrHPV infection, histology diagnosis different from HSIL/CIN2+, and negative cytology...
July 20, 2018: American Journal of Clinical Pathology
Hong Fang, Rhett P Ketterling, Curtis A Hanson, Animesh Pardanani, Paul J Kurtin, Dong Chen, Patricia T Greipp, Matthew T Howard, Rebecca L King, Daniel L Van Dyke, Kaaren K Reichard
Objectives: Determine ancillary test utilization for the workup of isolated eosinophilia in otherwise morphologically unremarkable bone marrow (BM). Methods: We evaluated BM ancillary testing performed in cases with isolated eosinophilia and otherwise morphologically unremarkable BM. Cases with abnormal morphology (eg, dysplasia, basophilia) and/or findings suggestive of a disorder (eg, unexplained thromboses, lymphoma) are specifically excluded. Results: A total of 132 cases met inclusion criteria...
July 19, 2018: American Journal of Clinical Pathology
Olga Speck, Henry D Appelman, Scott R Owens
Objectives: We sought to characterize a histologic pattern of mid- and deep-zone gastritis, distinct from the typical pattern of Helicobacter pylori or autoimmune gastritis and to see if it had any clinicopathologic association(s). Methods: We analyzed inflammatory patterns and composition, excluded autoimmune gastritis using immunohistochemistry, and reviewed the medical record for demographics, medical/surgical history, presenting symptoms, endoscopic findings, and medications for 28 cases...
July 19, 2018: American Journal of Clinical Pathology
Joseph Rudolf, Jason Baron, John Branda, Elizabeth Lee-Lewandrowski
Objectives: We evaluated changes in the testing menu, volume, and positivity rates for tick-borne illnesses in a New England medical center over an 11-year time frame. Methods: Testing data were obtained by a retrospective review utilizing searchable data from a laboratory information system archive. Results: Testing for tick-borne infections (TBI) increased 5.3-fold over an 11-year time period and the number of positive test results increased threefold...
July 19, 2018: American Journal of Clinical Pathology
Romulo Celli, Andrea L Barbieri, Monica Colunga, John Sinard, Joanna A Gibson
Objectives: Intraoperative pathology consultation (IOC) to assess margins is frequently requested during surgery of the stomach and gastroesophageal junction. Methods: We studied 110 consecutive patients undergoing gastrectomy with IOC margin assessment. Results: Gastric margins at IOC utilized the most blocks but were least often positive. In 64% of patients, the entire gastric margin was examined using average six blocks; representative sections were examined in 25% of patients using two blocks...
July 17, 2018: American Journal of Clinical Pathology
Marcos M Siliézar, Catuxa Celerio Muñoz, Jon Danel Solano-Iturri, Laura Ortega-Comunian, Manuela Mollejo, Santiago Montes-Moreno, Miguel A Piris
Objectives: Spontaneous rupture of the spleen is occasionally seen as the presenting event in infectious mononucleosis (IM). Diagnosis of these cases can be very challenging. Methods: We describe the morphologic and immunohistochemical findings in a series of seven splenectomy specimens removed after spontaneous rupture in patients with IM. Most cases were submitted for a second opinion since the histology of the cases suggested malignant lymphoma. Results: All the cases showed similar findings, with red pulp expansion occupied by activated T and B cells, including scattered large lymphocytes with both T- and B-cell markers, together with a polymorphic background rich in cytotoxic T cells...
July 10, 2018: American Journal of Clinical Pathology
Marcello Bagnasco, Daniele Saverino, Francesca Pupo, Manuela Marchiano, Maria Grazia Alessio, Wolfgang Schlumberger, Antonio Antico, Giampaola Pesce, Nicola Bizzaro
Objectives: Anti-parietal cell antibodies (APCA) are a serologic marker of autoimmune gastritis. Their prevalence in healthy individuals is not well defined. Methods: We evaluated APCA prevalence in 515 healthy blood-donors by rat/primate tissue indirect immunofluorescence (IIF), enzyme-linked immunosorbent assay (ELISA), and immunoblot. Results: Fifty-three of 515 (10.3%) subjects were positive for APCA by at least one method: 18 only by ELISA, 10 by rodent tissue IIF, and one by primate tissue IIF; 18 were positive by ELISA and primate tissue IIF, and one by ELISA and rodent tissue IIF...
July 10, 2018: American Journal of Clinical Pathology
Linda J Titus, Lisa M Reisch, Anna N A Tosteson, Heidi D Nelson, Paul D Frederick, Patricia A Carney, Raymond L Barnhill, David E Elder, Martin A Weinstock, Michael W Piepkorn, Joann G Elmore
Objectives: The impact of malpractice concerns on pathologists' use of defensive medicine and interpretations of melanocytic skin lesions (MSLs) is unknown. Methods: A total of 207 pathologists interpreting MSLs responded to a survey about past involvement in malpractice litigation, influence of malpractice concerns on diagnosis, and use of assurance behaviors (defensive medicine) to alleviate malpractice concerns. Assurance behaviors included requesting second opinions, additional slides, additional sampling, and ordering specialized tests...
July 10, 2018: American Journal of Clinical Pathology
Mekonnen Girma, Adinew Desale, Fatuma Hassen, Abay Sisay, Aster Tsegaye
Objectives: The World Health Organization African Regional Office recommends ISO 15189 standards to improve performance quality in sub-Saharan African laboratories. We specify challenges Ethiopian laboratorians encountered applying ISO 15189 standards. Methods: From a structured survey at 12 Ethiopian government hospitals, 175 laboratory staff replied; all were aware of the ISO standards and 138 had been involved in the ISO 15189 inspection process. In addition, 11 laboratory heads, 10 quality officers, and three medical directors were interviewed in depth...
July 10, 2018: American Journal of Clinical Pathology
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