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American Journal of Clinical Pathology

Adam C Seegmiller, Annette S Kim, Claudio A Mosse, Aaron C Shaver, Mary Ann Thompson, Shaoying Li, David R Head, Mary M Zutter
OBJECTIVES: To determine the effect of iterative refinement of standard ordering protocols on test utilization and results for bone marrow biopsy specimens. METHODS: Eighteen months of test utilization and result data were used to revise the protocols that determine cytogenetic and molecular test selection on bone marrow specimens and then compared with data obtained following protocol revision. RESULTS: Revision of protocols resulted in reduction in total tests and associated charges, due to a decrease in tests both concordant and discordant with the protocols...
October 20, 2016: American Journal of Clinical Pathology
Anna-Sophie Weidner, Nicole C Panarelli, Hanna Rennert, Jose Jessurun, Rhonda K Yantiss
OBJECTIVES: Gastrointestinal infections by cytomegalovirus (CMV) and adenovirus may complicate hematopoietic stem cell transplantation (HSCT). Although CMV and adenovirus produce recognizable cytopathic changes, these changes may be subtle or focal. The value of viral immunohistochemistry in detecting infection in HSCT recipients when cytopathic changes are not identified has not been demonstrated. METHODS: H&E-stained sections from gastrointestinal biopsy specimens were reviewed by three pathologists...
October 15, 2016: American Journal of Clinical Pathology
Georgia Karpathiou, Jean-Baptiste Giroult, Fabien Forest, Pierre Fournel, Alessandra Monaya, Marios Froudarakis, Jean Marc Dumollard, Jean Michel Prades, Marie Gavid, Michel Peoc'h
OBJECTIVES: Induction chemotherapy (IC) is occasionally used in head and neck cancer, leading to less extensive surgery and reduced need for irradiation. Factors predicting the response to IC have not been determined. In this study, we investigated the clinical and histopathologic factors that predict the response to IC. METHODS: Head and neck squamous cell carcinomas from 81 patients were analyzed; clinical factors, histologic parameters, and expression of p16 and p53 were correlated with response to chemotherapy and prognosis...
September 30, 2016: American Journal of Clinical Pathology
Robin T Vollmer
OBJECTIVES: Using data from former reports, this study reviews and analyzes the outcomes of tumor recurrence, tumor progression, and tumor-specific survival of patients with colorectal adenomas. METHODS: Data were collected from 32 longitudinal studies of outcomes after the first diagnosis of colorectal adenoma and collected as individual patient results, that is, as failure times from the first tumor to the three outcomes. Altogether, there were 45,286 patients, including 22,148 for the outcome of additional adenomas, 23,796 for the outcome of progression to invasive carcinoma, and 2,602 for the outcome of disease-specific survival (some patients were available for more than one outcome)...
September 27, 2016: American Journal of Clinical Pathology
Omonigho A Aisagbonhi, Mark A Tulecke, David C Wilbur, Atoussa Goldar-Najafi, Shams Iqbal, Peter M Sadow, William C Faquin
OBJECTIVES: Epithelial-myoepithelial carcinoma (EMC) is a rare salivary gland malignancy associated with an overall good prognosis. Fine-needle aspiration (FNA) typically shows a dual population of myoepithelial and ductal cells. Rarely, acellular matrix globules are present, raising a differential diagnosis of adenoid cystic carcinoma (AdCC), a more aggressive salivary gland malignancy associated with a poor long-term prognosis. We report an FNA case of EMC containing a predominant pattern of AdCC-like spherical globules...
September 10, 2016: American Journal of Clinical Pathology
Richard A Prayson, J Jordi Rowe
OBJECTIVES: Receiving and reflecting on feedback is a critical skill in medicine. Learning how to provide effective feedback is important in assessment and engendering performance improvement. METHODS: We outline a curriculum for laboratory medicine trainees on providing effective feedback. A group of trainees (26/30 attendees) was surveyed regarding their perspectives on effective feedback and impressions of an educational session focused on how to give effective feedback...
September 10, 2016: American Journal of Clinical Pathology
Theo L Winther, Magnus B Arnli, Øyvind Salvesen, Sverre H Torp
OBJECTIVES: This study investigated the prognostic value of the phosphohistone-H3 (PHH3) proliferation index (PI) in human meningiomas and compared the reliability with the conventional mitotic index and MIB-1 biomarker. METHODS: Proliferative activity was determined in 160 patients by standardized immunohistochemistry on tissue microarrays and related to recurrence. RESULTS: All three proliferation assessment methods were significantly associated with World Health Organization grade...
October 2016: American Journal of Clinical Pathology
Xiaoxian Li, Ceyda Sonmez Wetherilt, Uma Krishnamurti, Jing Yang, Yamin Ma, Toncred M Styblo, Jane L Meisel, Limin Peng, Momin T Siddiqui, Cynthia Cohen, Ritu Aneja
OBJECTIVES: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer, and there is no approved targeted therapy. We studied the expression of programmed cell death protein 1 (PD-1) and its ligand (PD-L1) in TNBC. METHODS: Full-face sections from 136 TNBC cases without neoadjuvant therapy between 2004 and 2013 were stained and evaluated for immune cell PD-1 staining and stromal or tumoral PD-L1 staining using the H-score (staining percentage × intensity)...
October 2016: American Journal of Clinical Pathology
Nasir Ud Din, Pingchuan Zhang, William R Sukov, Christopher A Sattler, Sarah M Jenkins, Leona A Doyle, Andrew L Folpe, Karen J Fritchie
OBJECTIVES: Spindle cell lipomas (SCLs) are benign lipomatous neoplasms that classically arise in the posterior neck, upper back, and shoulders of older male patients. We sought to characterize the occurrence of this entity at nonclassic sites. METHODS: All cases of SCL arising at atypical sites were retrieved from our archives. RESULTS: Of 439 total cases of SCL, 57 arose at atypical locations in 32 men and 25 women (age range, 27-79 years)...
October 2016: American Journal of Clinical Pathology
Eric K Morgen, Christopher Naugler
OBJECTIVES: While reference limits are foundational to interpreting clinical laboratory tests, they may not correspond to the actual values triggering clinical response. We propose to measure this using clinical action curves, which plot test values against an indicator of clinical action. METHODS: We selected repeat test ordering as a quantifiable, objective, useful measure that is readily calculable using available laboratory data. Using all results in Calgary in 2010-2011 for eight analytes, clinical action curves for each analyte were plotted as the relationship between index test value and retesting hazard, modeled using Cox proportional hazards with restricted cubic splines...
October 2016: American Journal of Clinical Pathology
Sarah M Burnett, Martin K Mbonye, Robert Martin, Allan Ronald, Stella Zawedde-Muyanja, Kelly S Willis, Robert Colebunders, Yukari C Manabe, Marcia R Weaver
OBJECTIVES: To evaluate the effect of on-site support in improving human immunodeficiency virus (HIV) rapid testing, tuberculosis (TB) sputum microscopy, and malaria microscopy among laboratory staff in a low-resource setting. METHODS: This cluster randomized trial was conducted at 36 health facilities in Uganda. From April to December 2010, laboratory staff at 18 facilities participated in monthly on-site visits, and 18 served as control facilities. After intervention, 128 laboratory staff were observed performing 587 laboratory tests across three diseases: HIV rapid testing, TB sputum microscopy, and malaria microscopy...
October 2016: American Journal of Clinical Pathology
Rachel D Le, Stacy E F Melanson, Athena K Petrides, Ellen M Goonan, Ida Bixho, Adam B Landman, Anne Marie Brogan, David W Bates, Milenko J Tanasijevic
OBJECTIVES: Most preanalytical errors at our institution occur during nonphlebotomy blood draws. We implemented an electronic health record (EHR), interfaced the EHR to the laboratory information system, and designed a new specimen collection module. We studied the effects of the new system on nonphlebotomy preanalytical errors. METHODS: We used an electronic database of preanalytical errors and calculated the number and type of the most common errors in the emergency department (ED) and inpatient nursing for 3-month periods before (August-October 2014) and after (August-October 2015) implementation...
October 2016: American Journal of Clinical Pathology
Juli-Anne Gardner, Jason D Peterson, Scott A Turner, Barbara L Soares, Courtney R Lancor, Luciana L Dos Santos, Prabhjot Kaur, Deborah L Ornstein, Gregory J Tsongalis, Francine B de Abreu
OBJECTIVES: To describe three methods used to screen for frameshift mutations in exon 9 of the CALR gene. METHODS: Genomic DNA from 47 patients was extracted from peripheral blood and bone marrow using the EZ1 DNA Blood Kit (Qiagen, Valencia, CA) and quantified by the Quant-iT PicoGreen dsDNA Assay Kit (Invitrogen, San Diego, CA). After clinical history, cytogenetics, and molecular tests, patients were diagnosed with either clonal or nonclonal hematologic diseases...
October 2016: American Journal of Clinical Pathology
Laila Nomani, Juraj Bodo, Xiaoxian Zhao, Lisa Durkin, Sanam Loghavi, Eric D Hsi
OBJECTIVES: Mutations in CALR (calreticulin) have been discovered in 50% to 80% of JAK2 (Janus kinase 2) and MPL (myeloproliferative leukemia protein) wild-type patients with Philadelphia-negative myeloproliferative neoplasm (MPNs). We evaluate the performance of a monoclonal antibody for immunohistochemical detection of CALR mutations. METHODS: A computerized archival search was performed for cases of non-chronic myeloid leukemia (CML) MPNs with available CALR and JAK2 V617F mutational analysis data...
October 2016: American Journal of Clinical Pathology
Lambert Busque, Anna Porwit, Radmila Day, Harold J Olney, Brian Leber, Vincent Éthier, Shireen Sirhan, Linda Foltz, Jaroslav Prchal, Suzanne Kamel-Reid, Aly Karsan, Vikas Gupta
OBJECTIVES: To standardize diagnostic investigations for myeloproliferative neoplasms (MPNs) to increase homogeneity in patient care and to streamline diagnostic approaches in the most efficient and cost-effective manner. METHODS: The development of Canadian expert consensus recommendations for the diagnosis of MPNs began with a review of the following: clinical evidence, daily practice, existing treatment guidelines, and availability of diagnostic tools. Each group member was assigned a specific topic, which they discussed with the entire group during several consensus meetings...
October 2016: American Journal of Clinical Pathology
Richard A Prayson
OBJECTIVES: Hyaline protoplasmic astrocytopathy is a rare condition marked by the accumulation of various proteins in the cytoplasm of protoplasmic astrocytes. METHODS: This study retrospectively reviews the clinicopathologic features of 14 patients (nine females; mean age, 9.1 years) with hyaline protoplasmic astrocytopathy. RESULTS: Patients had chronic seizures (mean duration, 101.1 months); mean age at seizure onset was 6.9 months. Three patients had Aicardi syndrome, and one patient had tuberous sclerosis...
October 2016: American Journal of Clinical Pathology
Katherine B Geiersbach, Carlynn Willmore-Payne, Alexandra V Pasi, Christian N Paxton, Theresa L Werner, Xinjie Xu, Carl T Wittwer, H Evin Gulbahce, Erinn Downs-Kelly
OBJECTIVES: Guidelines for HER2 testing define an equivocal range for HER2 using two approved testing methods, immunohistochemistry (IHC) and in situ hybridization (ISH). We investigated genome-wide copy number alterations in this subgroup. METHODS: Ten breast cancers with equivocal HER2 status by both IHC and ISH were analyzed by single-nucleotide polymorphism cytogenomic microarray (SNP array). DNA ploidy analysis by flow cytometry was performed on nine cases with sufficient material remaining...
October 2016: American Journal of Clinical Pathology
Nathan D Montgomery, N George Liomba, Coxcilly Kampani, Robert Krysiak, Christopher C Stanley, Tamiwe Tomoka, Steve Kamiza, Bal M Dhungel, Satish Gopal, Yuri Fedoriw
OBJECTIVES: The incidence of lymphoproliferative disorders (LPDs) is increasing in sub-Saharan Africa (SSA) due to population growth, aging, and human immunodeficiency virus (HIV). Despite significant burden, resources for diagnosis and treatment of LPDs are limited, with little infrastructure to deliver modern pathology services. Diagnostic and therapeutic decisions are therefore frequently made without tissue confirmation, leading to high rates of misdiagnosis and inappropriate treatment...
October 2016: American Journal of Clinical Pathology
Emilio Madrigal, Shyam Prajapati, Juan C Hernandez-Prera
OBJECTIVES: A proper examination of surgical specimens is fundamental in anatomic pathology (AP) education. However, the resources available to residents may not always be suitable for efficient skill acquisition. We propose a method to enhance AP education by introducing high-definition videos featuring methods for appropriate specimen handling, viewable on two-dimensional (2D) and stereoscopic three-dimensional (3D) platforms. METHODS: A stereo camera system recorded the gross processing of commonly encountered specimens...
October 2016: American Journal of Clinical Pathology
Thomas C Wright, Mark H Stoler, Shagufta Aslam, Catherine M Behrens
OBJECTIVES: With human papillomavirus (HPV) testing, patients' HPV status may be known when reviewing cytology specimens. METHODS: 41,955 women 25 years or older had cytology and HPV screening. Originally, cytology was reviewed blinded to HPV status. We re-reviewed unblinded to HPV status a subset of 428 cytology slides from women with cervical intraepithelial neoplasia grade 2 + (CIN2+) and 1,287 from women without CIN2+. RESULTS: Of the original interpretations of atypical squamous cells of undetermined significance (ASC-US), 33...
September 2016: American Journal of Clinical Pathology
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