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Wang Y, Abu-Sbeih H, Tang T, Shatila M, Faleck D, Harris J, Dougan M, Olsson-Brown A, Johnson DB, Shi C, Grivas P, Diamantopoulos L, Owen DH, Cassol C, Arnold CA, Warner DE, Alva A, Powell N, Ibraheim H, De Toni EN, Philipp AB, Philpott J, Sleiman J, Lythgoe M, Daniels E, Sandhu S, Weppler AM, Buckle A, Pinato DJ, Thomas A, Qiao W. Novel endoscopic scoring system for immune mediated colitis: A Multicenter Retrospective Study of 674 Patients. Gastrointest Endosc 2024:S0016-5107(24)00043-9. [PMID: 38272276 DOI: 10.1016/j.gie.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND & AIMS No endoscopic scoring system has been established for immune-mediated colitis (IMC). This study aimed to establish such a system for IMC and explore its utility in guiding future selective immunosuppressive therapy (SIT) use compared to clinical symptoms. METHODS This retrospective international 14-center study included 674 patients who developed IMC after immunotherapy and underwent endoscopic evaluation. Ten endoscopic features were selected by group consensus and assigned one point each to calculate an IMC endoscopic score (IMCES). IMCES cutoffs were chosen to maximize specificity for SIT use. This specificity was compared between IMCES, and clinical symptoms graded according to a standardized instrument. RESULTS A total of 309 (45.8%) patients received SIT. IMCES specificity for SIT use was 82.8% with a cutoff of 4 . The inclusion of ulceration as a mandatory criterion resulted in higher specificity (85.0% for a cutoff of 4). In comparison, the specificity of a Mayo Endoscopy Score (MES) of 3 was 74.6% while specificity of clinical symptom grading was much lower at 27.4% and 12.3% respectively. Early endoscopy was associated with timely SIT use (p<0.001, r=0.4084). CONCLUSIONS This is the largest, multi-center study to devise an endoscopic scoring system to guide IMC management. An IMCES cutoff 4 has a higher specificity for SIT use than clinical symptoms, supporting early endoscopic evaluation for IMC.
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Affiliation(s)
- Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030.
| | - Hamzah Abu-Sbeih
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030; Department of Internal Medicine, University of Missouri, Kansas City, MO, USA, 64110
| | - Tenglong Tang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030; Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Malek Shatila
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030
| | - David Faleck
- Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 10065
| | - Jessica Harris
- Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 10065
| | - Michael Dougan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA, 02114
| | | | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA, 37235
| | - Chanjuan Shi
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA, 37235
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington, Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA, 98109
| | - Leonidas Diamantopoulos
- Department of Medicine, Division of Oncology, University of Washington, Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA, 98109
| | - Dwight H Owen
- Division of Medical Oncology, The Ohio State University, Columbus, OH, USA, 43210
| | - Clarissa Cassol
- Division of Renal Pathology, The Ohio State University, Columbus, OH, USA, 43210
| | - Christina A Arnold
- Division of Gastrointestinal and Liver Pathology, The Ohio State University, Columbus, OH, USA, 43210
| | - David E Warner
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA, 48109
| | - Ajjai Alva
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA, 48109
| | - Nick Powell
- Royal Marsden Hospital, and Guy's and St Thomas' Hospital, London, UK, SE1 9RS
| | - Hajir Ibraheim
- Royal Marsden Hospital, and Guy's and St Thomas' Hospital, London, UK, SE1 9RS
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexander B Philipp
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jessica Philpott
- Center for Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Joseph Sleiman
- Center for Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, OH, USA, 44195; Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 15213
| | - Mark Lythgoe
- Department of Surgery and Cancer, Imperial College London, London, UK, SW7 2BX
| | - Ella Daniels
- Department of Oncology, Chelsea and Westminster Hospital, London, UK, SW10 9NH
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, 3000
| | - Alison M Weppler
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, 3000
| | - Andrew Buckle
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, 3000
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK, SW7 2BX; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy, 28100
| | - Anusha Thomas
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030
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Lilley CM, Arnold CA, Arnold MA, Booth AL, Gardner JM, Jiang XS, Loghavi S, Mirza KM. Virtual Pathology Elective, Real Education: The PathElective.com Experience as a Model for Novel Pathology Pedagogy and a Primer for Curricular Evolution. Arch Pathol Lab Med 2023:495410. [PMID: 37638521 DOI: 10.5858/arpa.2022-0259-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 08/29/2023]
Abstract
CONTEXT.— PathElective.com was created in response to the pandemic's restrictions on interactions with trainees, and since has been incorporated into many training programs worldwide, serving as a unique means of delivering high-quality pathology and laboratory medical education at multiple levels of training. OBJECTIVE.— To analyze student usage, performance, and satisfaction to provide insight into the effectiveness of virtual education to guide curricular evolution. DESIGN.— Squarespace (Squarespace, Inc) was used for website development and to collect website analytics. Students were assessed before and after course participation using a dual-form crossover quiz design. Quiz data were anonymous and analyzed with a paired t test to account for varying student background. A novel analysis was performed aimed at examining the attrition rate of students across multiple modules. RESULTS.— Over the study period (May 1, 2020 to October 31, 2021), PathElective.com received 577 483 page views, 126 180 visits, 59 928 unique visitors, and 10 278 registered users who earned 15 305 certificates. A total of 7338 premodule and postmodule quiz pairs were analyzed. The overall average increase in score was 13.83% (P = .02). All but 5 of the 56 courses experienced a statistically significant increase in score. All courses received median scores of Very Satisfied/Satisfied in all 6 assessment domains. Aggregate attrition data revealed a unique, negative polynomial relationship (R2 = 0.656). CONCLUSIONS.— PathElective.com is a free, effective means of enhancing anatomic/clinical pathology training in medical education. These analyses offer a unique perspective on the online user experience and could guide the development of future online medical education resources.
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Affiliation(s)
- Cullen M Lilley
- From Loyola University Stritch School of Medicine, Maywood, Illinois (Lilley, Mirza)
| | - Christina A Arnold
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora (C. A. Arnold, M. A. Arnold)
| | - Michael A Arnold
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora (C. A. Arnold, M. A. Arnold)
- Pathology Department, Children's Hospital Colorado, Aurora (M. A. Arnold)
| | - Adam L Booth
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Booth)
| | - Jerad M Gardner
- Departments of Pathology and Dermatology, Geisinger Medical Center, Danville, Pennsylvania (Gardner)
| | - Xiaoyin Sara Jiang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina (Jiang)
| | - Sanam Loghavi
- Department of Hematopathology, MD Anderson Cancer Center, Houston, Texas (Loghavi)
| | - Kamran M Mirza
- From Loyola University Stritch School of Medicine, Maywood, Illinois (Lilley, Mirza)
- Department of Pathology and Laboratory Medicine, Loyola University Health System, Maywood, Illinois (Mirza)
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3
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Karamchandani DM, Hammad H, Chetty R, Arnold CA. In Reply. Arch Pathol Lab Med 2022; 146:1180-1181. [PMID: 36174196 DOI: 10.5858/arpa.2022-0055-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/31/2022]
Affiliation(s)
| | - Hazem Hammad
- Department of Internal Medicine, Division of Gastroenterology and Hepatology Anschutz Medical Center, Aurora, Colorado
| | | | - Christina A Arnold
- Department of Pathology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
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Wong YP, Buckley K, Iwenofu OH, Singhi A, Kahwash SB, Arnold CA, Tan GC, Arnold MA. Selective Immunoreactivity for WT1 Carboxy-Terminus Distinguishes Desmoplastic Small Round Cell Tumor From its Histologic Mimics. Pediatr Dev Pathol 2022; 25:504-510. [PMID: 35488420 DOI: 10.1177/10935266221088151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Desmoplastic small round cell tumor (DSRCT) is an aggressive pediatric round cell sarcoma containing a characteristic EWSR1-WT1 gene fusion. In the absence of genetic data, distinguishing DSRCT from other small round cell tumors of childhood can be problematic due to overlapping histologic and immunohistochemical features. We studied the utility of immunohistochemistry with antibodies targeting both the amino-terminal and carboxy-terminal regions of the Wilms tumor-1 (WT1) protein in differentiating these groups of tumors. The study cohort included 33 cases of genetically confirmed pediatric round cell tumors (10 DSRCTs, 12 Wilms tumors, 10 Ewing sarcomas, and 1 CIC-rearranged sarcoma). Immunoreactivities and immunolocalization of both the WT1 amino-terminus and carboxy-terminus were scored and documented. All DSRCTs displayed selective reactivity for only the WT1 carboxy-terminus (10/10), while dual immunoreactivity for both the WT1 carboxy-terminus (12/12) and amino-terminus antibodies (12/12) were characteristic of Wilms tumors. CIC-rearranged sarcoma showed variable WT1 nuclear immunopositivity (1/1, 1/1) and Ewing sarcomas were consistently WT1-negative for both the WT1 amino-terminus (0/10) and carboxy-terminus (0/10). Dual WT1 amino-terminus and carboxy-terminus immunohistochemistry remains a helpful diagnostic tool in discriminating intraabdominal small round cell tumors, which serves as an adjunct to the genetic information in preventing misdiagnosis.
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Affiliation(s)
- Yin Ping Wong
- Department of Pathology, Faculty of Medicine, 458203Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kaila Buckley
- Department of Pathology, 2647The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - O Hans Iwenofu
- Department of Pathology, 2647The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aatur Singhi
- Department of Pathology, 6614University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Samir B Kahwash
- Department of Pathology, 2647The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Pathology and Laboratory Medicine, 2650Nationwide Children's Hospital, Columbus OH, USA
| | - Christina A Arnold
- Department of Pathology and Laboratory Medicine, 2932Children's Hospital of Colorado, Aurora, CO, USA
| | - Geok Chin Tan
- Department of Pathology, Faculty of Medicine, 458203Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Department of Pathology and Laboratory Medicine, 2650Nationwide Children's Hospital, Columbus OH, USA
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, 2932Children's Hospital of Colorado, Aurora, CO, USA.,Department of Pathology, 1878University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Karamchandani DM, Westerhoff M, Arnold CA, Gonzalez RS, Westbrook LM, Goetz L, King TS, Panarelli NC. Interobserver Variability in Assessment of Depth of Submucosal Invasion for Colonic Endoscopic Resections Among Subspecialized Gastrointestinal Pathologists. Arch Pathol Lab Med 2022; 147:534-545. [PMID: 35943856 DOI: 10.5858/arpa.2021-0598-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Recent data support that low-risk submucosally invasive (pT1) colonic adenocarcinomas (ie, completely resected tumors that lack high-grade morphology, tumor budding, and lymphovascular invasion) are considered cured via endoscopic resection, provided that the submucosal invasion is less than 1000 μm. Hence, the pathologists' assessment of depth of submucosal invasion may guide further management (ie, surveillance versus colectomy). OBJECTIVE.— To assess interobserver concordance among gastrointestinal pathologists in measuring submucosal depth of invasion in colonic endoscopic resections. DESIGN.— Six gastrointestinal pathologists from 5 academic centers independently measured the greatest depth of submucosal invasion in micrometers on 52 hematoxylin-eosin-stained slides from colonic endoscopic specimens with pT1 adenocarcinomas, per published guidelines (round 1 scoring). Two separate measurements (round 2 scoring) were subsequently performed by each pathologist following a consensus meeting, (1) from surface of lesion and (2) from muscularis mucosae, and pathologists were asked to choose their (3) "real-life (best)" assessment between the first 2 measurements. Interobserver agreement was assessed by the intraclass correlation coefficient (ICC) and Cohen κ statistics. RESULTS.— Round 1 had poor ICC (0.43; 95% CI, 0.31-0.56). Round 2 agreement was good when measuring from surface (ICC = 0.83; 95% CI, 0.76-0.88) but moderate (ICC = 0.59; 95% CI, 0.47- 0.70) when measuring from muscularis mucosae and became poor (ICC = 0.49; 95% CI, 0.36-0.61) for the best-assessment measurement. CONCLUSIONS.— Our findings indicate that clearer and reproducible guidelines are needed if clinical colleagues are to base important management decisions on pathologists' estimate of depth of submucosal invasion in the colonic endoscopic resections.
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Affiliation(s)
- Dipti M Karamchandani
- From the Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania (Karamchandani)
| | - Maria Westerhoff
- From the Department of Pathology, University of Michigan, Ann Arbor (Westerhoff)
| | - Christina A Arnold
- From the Department of Pathology, University of Colorado, Aurora (Arnold, Westbrook)
| | - Raul S Gonzalez
- From the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Gonzalez)
| | - Lindsey M Westbrook
- From the Department of Pathology, University of Colorado, Aurora (Arnold, Westbrook)
| | - Lianna Goetz
- From the Department of Pathology, Houston Methodist Hospital, Houston, Texas (Goetz)
| | - Tonya S King
- From the Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania (King)
| | - Nicole C Panarelli
- From the Department of Pathology, Albert Einstein College of Medicine, Bronx, New York (Panarelli)
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6
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Montgomery EA, Arnold CA, Lam-Himlin DM, McDonald OG, Poveda JC, Salimian KJ, Voltaggio L, Waters KM, Wood LD, Singhi AD. Some Morphology Frontiers of Dysplasia in the Tubular Gastrointestinal Tract: The Rodger C. Haggitt Memorial Lecture. Am J Surg Pathol 2022; 46:e1-e14. [PMID: 33284191 DOI: 10.1097/pas.0000000000001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review, based on the content of the 2020 US Gastrointestinal Pathology Society's Rodger Haggitt Lecture, concerns an array of tubular gastrointestinal tract dysplastic or possible "predysplastic lesions" with an almost purely morphologic focus based on our collaborative efforts over the past few years. These processes include esophageal epidermoid metaplasia, Barrett esophagus-associated dysplasia, polypoid gastric dysplastic lesions, small intestinal dysplasia, and the ability of metastases to mimic it, the controversial "serrated epithelial change" encountered in the setting of long-standing ulcerative and Crohn colitis, and recently described anal columnar human papilloma virus-associated neoplasms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Laura D Wood
- Department of Pathology, Johns Hopkins, Baltimore, MD
| | - Aatur D Singhi
- Department of Pathology, The University of Pittsburgh, Pittsburgh, PA
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7
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Abstract
CONTEXT.— With the increasing development and use of iatrogenic agents, pathologists are encountering more novel foreign materials in retrieved gastrointestinal specimens. These colorful and unusual-appearing foreign materials can pose a diagnostic dilemma to those unaware of their morphology, especially if the relevant clinical history is lacking. OBJECTIVE.— To discuss the histopathologic features, clinical scenarios and significance, and differential diagnosis of relatively recently described, yet quickly expanding, family of iatrogenic agents that can present as foreign materials in gastrointestinal specimens-pharmaceutical fillers (crospovidone and microcrystalline cellulose), submucosal lifting agents (Eleview and ORISE), lanthanum carbonate, hydrophilic polymers, OsmoPrep, yttrium 90 microspheres (SIR-Sphere and TheraSphere), and resins (sodium polystyrene sulfonate, sevelamer, and bile acid sequestrants). DATA SOURCES.— We collate the findings of published literature, including recently published research papers, and authors' personal experiences from clinical sign-out and consult cases. CONCLUSIONS.— Correct identification of these iatrogenic agents is important because the presence of some novel agents can explain the histopathologic findings seen in the background specimen, and specific novel agents can serve as diagnostic clues to prompt the pathologist to consider other important and related diagnoses. Awareness of even biologically inert agents is important for accurate diagnosis and to avoid unnecessary and expensive diagnostic studies.
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Affiliation(s)
- Dipti M Karamchandani
- From the Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (Karamchandani)
| | - Hazed Hammad
- The Department of Internal Medicine, Division of Gastroenterology and Hepatology (Hammad), University of Colorado, Anschutz Medical Center, Denver
| | - Runjan Chetty
- The Histopathology Department, Brighton & Sussex University Hospitals, Brighton, United Kingdom (Chetty)
| | - Christina A Arnold
- The Department of Pathology (Arnold), University of Colorado, Anschutz Medical Center, Denver
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8
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Karamchandani DM, Gonzalez RS, Westerhoff M, Westbrook LM, Panarelli NC, Al-Nuaimi M, King T, Arnold CA. Measuring depth of invasion of submucosa - invasive adenocarcinoma in oesophageal endoscopic specimens: how good are we?☆. Histopathology 2021; 80:420-429. [PMID: 34519098 DOI: 10.1111/his.14566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/12/2021] [Indexed: 01/10/2023]
Abstract
AIMS Emerging data support that submucosa-invasive (pT1b) esophageal adenocarcinomas are cured via endoscopic resection, provided that invasion measures ≤500 μm, they lack other histological features predictive of nodal metastasis and have negative margins. Hence, pathologists' measurement of the depth of submucosal invasion in endoscopic resections may dictate further management (i.e. endoscopic follow-up versus oesophagectomy). In this study, we assessed the interobserver agreement in measuring the depth of submucosal invasion in oesophageal endoscopic resections. METHODS AND RESULTS Six subspecialised gastrointestinal (GI) pathologists from five academic centres independently measured the depth of submucosal invasion in μm from the deepest muscularis mucosae on 37 oesophageal endoscopic resection slides (round 1 scoring). A consensus meeting with a systematic approach for measuring and discussion of pitfalls was undertaken and remeasuring (round 2 scoring) was conducted. Interobserver agreement was assessed by the intraclass correlation coefficient (ICC) and Cohen's kappa statistics. A lack of agreement was seen among the six reviewers with a poor ICC for both rounds: 1 [0.40, 95% confidence interval (CI) = 0.26-0.56] and 2 (0.49, 95% CI = 0.34-0.63). When measurements were categorised as < or >500 μm, the overall agreement among the six reviewers was only fair for both rounds: 1 (kappa = 0.37, 95% CI = 0.22-0.53) and 2 (kappa = 0.29, 95% CI = 0.12-0.46). CONCLUSIONS Our study shows a lack of agreement among gastrointestinal pathologists in measuring the depth of submucosal invasion in oesophageal endoscopic resections despite formulating a consensus approach for scoring. If important management decisions continue to be based upon this parameter, more reproducible and concrete guidelines are needed.
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Affiliation(s)
- Dipti M Karamchandani
- Department of Pathology, 1 Penn State Health Milton S. Hershey Medical Center/Penn State College of Medicine, Hershey, PA, USA
| | | | | | | | | | - Mayyadah Al-Nuaimi
- Department of Pathology, 1 Penn State Health Milton S. Hershey Medical Center/Penn State College of Medicine, Hershey, PA, USA
| | - Tonya King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Lilley CM, Arnold CA, Arnold M, Booth AL, Gardner JM, Jiang XS, Loghavi S, Mirza KM. The Implementation and Effectiveness of PathElective.com. Acad Pathol 2021; 8:23742895211006829. [PMID: 33884295 PMCID: PMC8040569 DOI: 10.1177/23742895211006829] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/03/2021] [Accepted: 02/14/2021] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 pandemic put most in-person pathology electives on-hold as departments adapted to changes in education and patient care. To address the subsequent void in pathology education, we created a free, virtual, modular, and high-quality pathology elective website. Website traffic from June 1, 2020, to October 1, 2020, was monitored using the built-in analyses on Squarespace. Twitter engagement was analyzed using Twitter analytics and the Symplur Social Graph Score. A voluntary satisfaction survey was sent to all PathElective users and results were analyzed. During this time, the site saw 25 467 unique visitors, over 34 988 visits, 181 302 page views, and 4449 subscriptions from 99 countries. Countries with the highest traffic are the United States (14 682), India (5210), and the Philippines (2195). PathElective’s Twitter social graph score increased from 63.59 to 89.3 with the addition of 1637 followers. Data from surveyed users (n = 177) show most to be pathology residents (41%). Most subscribers (89%) are committed to a career in pathology. The majority heard of the website via Twitter (55%). Almost half of those surveyed engaged with the PathTwitter community on Twitter and of those who participated, 99% found that interaction useful. In all survey questions surrounding satisfaction and usefulness, a large majority of the users were either satisfied or very satisfied. PathElective is a novel pathology elective that offers a unique opportunity to educate medical students and residents from around the globe and demonstrates high effectiveness and satisfaction among users.
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Affiliation(s)
- Cullen M Lilley
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Christina A Arnold
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Arnold
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Adam L Booth
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jerad M Gardner
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, PA, USA
| | | | - Sanam Loghavi
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kamran M Mirza
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.,Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
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10
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Hamnvåg HM, McHenry A, Ahmed A, Trabzonlu L, Arnold CA, Mirza KM. #TwitterHomework During Pathology Electives: Transforming Pathology Pedagogy. Arch Pathol Lab Med 2021; 145:1438-1447. [PMID: 33571353 DOI: 10.5858/arpa.2020-0391-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Twitter has become a popular platform for pathologists, where they share cases and educational content, arrange journal club meetings, network, and collaborate. OBJECTIVE.— To determine if composing original tweets or retweeting existing content can be used as an educational and networking tool for medical students during pathology electives. DESIGN.— In this retrospective study, a survey was sent to assess if medical students who used Twitter during their pathology electives found the platform useful for the attainment of medical knowledge, and for networking and professional development. A similar survey was sent to rotating students who did not use Twitter, asking if they thought using the platform could be beneficial. Additionally, we used Twitter analytical software (Symplur Signals) to determine the potential for networking by analyzing the number of retweets and impressions. RESULTS.— Most respondents who used Twitter described using the platform as helpful in increasing their medical knowledge and useful for networking and professional development. From August 1, 2017, to January 2, 2019, thirty-seven elective medical students composed a total of 527 original tweets. The tweets were retweeted a total of 3399 times by 810 nonstudent users, and this engagement resulted in 6 360 731 impressions. Most of the retweeting was done by pathologists and pathology residents. CONCLUSIONS.— The responses from the survey suggest that Twitter can be an educational tool during pathology electives and be useful for networking purposes. The number of retweets and impressions, and the demographics of the users who retweeted the students confirm the networking potential of Twitter.
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Affiliation(s)
- Hans Magne Hamnvåg
- From the Department of Pathology and Laboratory Medicine, Loyola University Chicago, Maywood, Illinois (Hamnvåg, McHenry, Ahmed, Trabzonlu, Mirza)
| | - Austin McHenry
- From the Department of Pathology and Laboratory Medicine, Loyola University Chicago, Maywood, Illinois (Hamnvåg, McHenry, Ahmed, Trabzonlu, Mirza).,McHenry is currently in the Department of Pathology at Yale School of Medicine in New Haven, Connecticut
| | - Aadil Ahmed
- From the Department of Pathology and Laboratory Medicine, Loyola University Chicago, Maywood, Illinois (Hamnvåg, McHenry, Ahmed, Trabzonlu, Mirza).,Ahmed is currently in the Department of Pathology at University of Arkansas for Medical Sciences in City
| | - Levent Trabzonlu
- From the Department of Pathology and Laboratory Medicine, Loyola University Chicago, Maywood, Illinois (Hamnvåg, McHenry, Ahmed, Trabzonlu, Mirza)
| | - Christina A Arnold
- and the Department of Pathology, Ohio State University, Columbus (Arnold).,Arnold is currently in the Department of Pathology at the University of Colorado Denver - Anschutz Medical Campus in Aurora
| | - Kamran M Mirza
- From the Department of Pathology and Laboratory Medicine, Loyola University Chicago, Maywood, Illinois (Hamnvåg, McHenry, Ahmed, Trabzonlu, Mirza)
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Alebrahim M, Akateh C, Arnold CA, Benissan-Messan D, Chavez JA, Singh N, Al-Adwan Y, El-Hinnawi A, Michaels A, Black SM. Liver Transplant for Management of Hepatic Complications of Dyskeratosis Congenita: A Case Report. EXP CLIN TRANSPLANT 2020; 20:702-705. [PMID: 33272154 DOI: 10.6002/ect.2020.0073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dyskeratosis congenita, a rare genetic disorder typified by progressive bone marrow failure, is classically characterized by the triad of abnormal skin pigmentation, nail dystrophy, and oral leukoplakia; however, it is a multisystem disease. Although hepatic involvement occurs in about 7% of patients with dyskeratosis congenita, end-stage liver disease is rare. Treatment of dyskeratosis congenita generally involves hematopoietic stem cell transplant. For patients with hepatic failure, liver transplant can be an option. Here, we describe a case of a patient with dyskeratosis congenita who presented with liver failure and pulmonary failure, precluding him from hematopoietic stem cell transplant. After liver transplant, the patient had significant improvements in pulmonary function and transfusion requirements, allowing the patient to qualify for hematopoietic stem cell transplant. Although hematopoietic stem cell transplant is typically the first step in the management of dyskeratosis congenita, for patients with severe hepatic manifestations of the disease, a liver transplant first approach may result in better disease management.
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Affiliation(s)
- Musab Alebrahim
- From the Division of Transplant Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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12
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Cassol CA, Owen D, Kendra K, Braga JR, Frankel WL, Arnold CA. Programmed cell death-1 (PD-1) and programmed death-ligand 1 (PD-L1) expression in PD-1 inhibitor-associated colitis and its mimics. Histopathology 2020; 77:240-249. [PMID: 32298485 DOI: 10.1111/his.14115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
AIMS Immune checkpoint inhibitors (ICIs) have revolutionised the treatment of advanced malignancies by boosting immune-mediated destruction of neoplastic cells, but are associated with side effects stemming from generalised immune system activation against normal tissues. Checkpoint ligand expression in non-tumoral cells of tissues affected by immune-related adverse effects has been described in ICI-associated hypophysitis, myocarditis, and acute interstitial nephritis. We aimed to investigate the tissue expression of the immune checkpoint receptor programmed cell death-1 (PD-1) and its ligand, programmed death-ligand 1 (PD-L1), in PD-1 inhibitor-associated colitis (PD1i colitis). METHODS AND RESULTS PD-1 and PD-L1 immunohistochemical expression levels were analysed in 15 cases of PD1i colitis and potential mimics-infectious colitis and inflammatory bowel disease (IBD). Increased epithelial expression of PD-L1 was observed in PD1i colitis as compared with normal colon and infectious colitis, but the expression level was lower than that in IBD. Conversely, PD-1 expression in inflammatory cells was higher in infectious colitis, intermediate in IBD, and minimal or absent in normal colon and in patients receiving PD-1 inhibitors. CONCLUSIONS Although our results do not justify the use of PD-L1 as a discriminatory marker of PD1i colitis against other entities within the differential diagnosis, they support the concept that PD1i colitis and IBD have similar pathogenetic mechanisms. They also highlight the fact that PD-L1 epithelial overexpression is a commonly used mechanism of the gastrointestinal tract mucosa to protect itself from inflammatory-mediated damage resulting from different aetiologies, which probably underpins the high incidence of gastrointestinal immune-related adverse effects in patients receiving ICI therapies, in whom this mechanism is disrupted.
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Affiliation(s)
- Clarissa A Cassol
- Department of Pathology, Division of Medical Oncology, Ohio State University, Columbus, OH, USA
| | - Dwight Owen
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University, Columbus, OH, USA
| | - Kari Kendra
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University, Columbus, OH, USA
| | - Juarez R Braga
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Wendy L Frankel
- Department of Pathology, Division of Medical Oncology, Ohio State University, Columbus, OH, USA
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13
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Krishna SG, Hart PA, Malli A, Kruger AJ, McCarthy ST, El-Dika S, Walker JP, Dillhoff ME, Manilchuk A, Schmidt CR, Pawlik TM, Porter K, Arnold CA, Cruz-Monserrate Z, Conwell DL. Endoscopic Ultrasound-Guided Confocal Laser Endomicroscopy Increases Accuracy of Differentiation of Pancreatic Cystic Lesions. Clin Gastroenterol Hepatol 2020; 18:432-440.e6. [PMID: 31220640 DOI: 10.1016/j.cgh.2019.06.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/18/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Imaging patterns from endoscopic ultrasound (EUS)-guided needle-based confocal laser endomicroscopy (nCLE) have been associated with specific pancreatic cystic lesions (PCLs). We compared the accuracy of EUS with nCLE in differentiating mucinous from nonmucinous PCLs with that of measurement of carcinoembryonic antigen (CEA) and cytology analysis. METHODS We performed a prospective study of 144 consecutive patients with a suspected PCL (≥20 mm) who underwent EUS with fine-needle aspiration of pancreatic cysts from June 2015 through December 2018 at a single center; 65 patients underwent surgical resection. Surgical samples were analyzed by histology (reference standard). During EUS, the needle with the miniprobe was placed in the cyst, which was analyzed by nCLE. Fluid was aspirated and analyzed for level of CEA and by cytology. We compared the accuracy of nCLE in differentiating mucinous from nonmucinous lesions with that of measurement of CEA and cytology analysis. RESULTS The mean size of dominant cysts was 36.4 ± 15.7 mm and the mean duration of nCLE imaging was 7.3 ± 2.8 min. Among the 65 subjects with surgically resected cysts analyzed histologically, 86.1% had at least 1 worrisome feature based on the 2012 Fukuoka criteria. Measurement of CEA and cytology analysis identified mucinous PCLs with 74% sensitivity, 61% specificity, and 71% accuracy. EUS with nCLE identified mucinous PCLs with 98% sensitivity, 94% specificity, and 97% accuracy. nCLE was more accurate in classifying mucinous vs nonmucinous cysts than the standard method (P < .001). The overall incidence of postprocedure acute pancreatitis was 3.5% (5 of 144); all episodes were mild, based on the revised Atlanta criteria. CONCLUSIONS In a prospective study, we found that analysis of cysts by nCLE identified mucinous cysts with greater accuracy than measurement of CEA and cytology analysis. EUS with nCLE can be used to differentiate mucinous from nonmucinous PCLs. ClincialTrials.gov no: NCT02516488.
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Affiliation(s)
- Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, Ohio.
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, Ohio
| | - Ahmad Malli
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, Ohio
| | - Andrew J Kruger
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Sean T McCarthy
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, Ohio
| | - Samer El-Dika
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, Ohio
| | - Jon P Walker
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, Ohio
| | - Mary E Dillhoff
- Division of Surgical Oncology, The Ohio State University, Columbus, Ohio
| | - Andrei Manilchuk
- Department of General Surgery, The Ohio State University, Columbus, Ohio
| | - Carl R Schmidt
- Division of Surgical Oncology, The Ohio State University, Columbus, Ohio
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University, Columbus, Ohio
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Christina A Arnold
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, Ohio
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Columbus, Ohio
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14
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Sachak T, Frankel WL, Arnold CA, Chen W. Multinucleated stromal giant cells in the gastroesophageal junctional and gastric mucosa: a retrospective study. Diagn Pathol 2019; 14:83. [PMID: 31351475 PMCID: PMC6661083 DOI: 10.1186/s13000-019-0860-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Atypical multinucleated stromal giant cells (MSGCs) are occasionally encountered in the esophagogastric mucosa. This study aims to investigate the origin and clinical association of MSGCs in the upper gastrointestinal tract. Methods Three hundred sixty-one contiguous biopsies and 1 resection specimen from the stomach and gastroesophageal junction (GEJ) were identified from archives for morphologic and immunohistochemical studies. Results MSGCs were identified in 22 cases (6%: 7 gastric, 15 GEJ). Patients’ average age was 53 years. There was no sex predilection. 77% cases had only 1 or 2 MSGCs per 10 high power fields. MSGCs were located in the lamina propria of the gastric or GEJ mucosa, with an accentuation in the subepithelial zone. The median number of nuclei in a MSGC was 5 (ranging from 3 to 16). The nuclei were touching/overlapping, often arranged into “wreath”, “caterpillar”, or “morula” configurations. MSGCs expressed smooth muscle actin, desmin, while negative for cytokeratin AE1/3, CD68, S100, chromogranin, and CD117. The most common clinical history was epigastric pain, gastroesophageal reflux, and Barrett esophagus. The most common associated pathologic diagnoses included reactive (chemical) gastropathy (71% gastric biopsies) and gastroesophageal reflux (73% GEJ specimens). Conclusions MSGCs in the esophagogastric mucosa show smooth muscle/myofibroblast differentiation by immunohistochemistry and likely represent a reactive/reparative stromal reaction associated with gastroesophageal reflux and reactive (chemical) gastropathy.
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Affiliation(s)
- Taha Sachak
- Department of Pathology, The Ohio State University Wexner Medical Center, S301 Rhodes Hall, 450 W. 10th Ave, Columbus, OH, 43210, USA
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, S301 Rhodes Hall, 450 W. 10th Ave, Columbus, OH, 43210, USA
| | - Christina A Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, S301 Rhodes Hall, 450 W. 10th Ave, Columbus, OH, 43210, USA
| | - Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, S301 Rhodes Hall, 450 W. 10th Ave, Columbus, OH, 43210, USA.
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15
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Rose GS, Arnold CA, Badizadegan K, Carter CM, Conces MR, Kahwash SB, Nicol KK, Arnold MA. Cytoplasmic Fibrillar Aggregates in Gallbladder Epithelium Are a Frequent Mimic of Cystoisospora in Pediatric Cholecystectomy Specimens. Arch Pathol Lab Med 2019; 143:1259-1264. [DOI: 10.5858/arpa.2018-0335-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Context.—Cystoisospora belli is an intracellular parasite associated with gastrointestinal disease in immunocompromised hosts. Although infection has been classically associated with intestinal disease, studies have identified Cystoisospora in the gallbladder of immunocompetent patients based on hematoxylin-eosin morphology. Recently, the identity of this histologic finding as Cystoisospora has been questioned based on negative results of nucleic acid studies.Objective.—To determine the prevalence of this histologic feature in pediatric patients, we retrospectively reviewed all cholecystectomy specimens from a pediatric hospital during a 24-month period.Design.—In 180 cholecystectomy specimens, we identified 11 cases (6.1%) with classical histologic features previously described to represent Cystoisospora organisms. To further investigate these structures, we retrieved tissue from paraffin-embedded blocks and performed electron microscopy.Results.—Ultrastructural examination identified ovoid perinuclear cytoplasmic structures composed of dense fibrillar aggregates rather than organisms. Patients with positive cases were similar in age to controls (positive cases: mean patient age 13.4 years [range, 2–23 years]; negative cases: mean patient age 14.7 years [range, 12 weeks–31 years]; P = .35). There was no significant association of this finding with cholelithiasis (54.5% versus 65.1%, P = .52), cholesterolosis (0% versus 22.5%, P = .12), acute cholecystitis (9.1% versus 10.1%, P > .99), or chronic cholecystitis (45.5% versus 66.3%, P = .20).Conclusions.—To our knowledge, this is the first positive identification of these structures as cytoplasmic fibrillar aggregates rather than parasitic inclusions by ultrastructural examination, and the first study of this histologic finding in pediatric cholecystectomies.
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Affiliation(s)
- Gary S. Rose
- From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conce
| | - Christina A. Arnold
- From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conce
| | - Kamran Badizadegan
- From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conce
| | - Christopher M. Carter
- From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conce
| | - Miriam R. Conces
- From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conce
| | - Samir B. Kahwash
- From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conce
| | - Kathleen K. Nicol
- From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conce
| | - Michael A. Arnold
- From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conce
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16
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Torbenson MS, Arnold CA, Graham RP, Jain D, Kakar S, Lam-Himlin DM, Naini BV, Wu TT, Yeh M. Identification of key challenges in liver pathology: data from a multicenter study of extramural consults. Hum Pathol 2019; 87:75-82. [PMID: 30857968 DOI: 10.1016/j.humpath.2019.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/01/2019] [Accepted: 02/24/2019] [Indexed: 11/25/2022]
Abstract
Extramural consultation for challenging pathology cases is an important part of patient care. The specific reasons why liver cases are submitted in consultation are poorly understood. To study patterns in extramural consultation, data were gathered from 1360 liver/GI/pancreatobiliary consults submitted to 7 academic centers. Liver cases comprised 40% of consults and are the focus of this paper. They were submitted for questions on medical (61%) and tumor pathology (39%). A preliminary diagnosis was provided by the referring pathologist in 65% of cases. The most common questions in medical liver pathology were on general classification of a hepatitic pattern of injury (37%), primary biliary cirrhosis (14%), fatty liver disease (13%), autoimmune hepatitis (12%), and etiology of cirrhosis (10%). Most tumor consults were submitted for classification (83%). The most common final tumor consultant diagnoses for benign tumors were hepatic adenoma or focal nodular hyperplasia (52%) and for malignant tumors were metastatic malignancies (47%), hepatocellular carcinoma (32%), or cholangiocarcinoma (8%). For cases submitted with a diagnosis of malignancy, the diagnosis was concordant (43% of cases), concordant but with a generic diagnosis for which a more specific diagnosis could be rendered (37%), or discordant with a major change in diagnosis from malignant to benign or change in tumor type (17%). In conclusion, analysis of consult patterns identifies challenging areas in medical and tumor liver pathology, areas that benefit from consult services and can be focused on by continuing medical educational activities.
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Affiliation(s)
- Michael S Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA.
| | - Christina A Arnold
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanjay Kakar
- Department of Anatomic Pathology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Dora M Lam-Himlin
- Department of Pathology and Laboratory Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Bita V Naini
- Department of Laboratory Medicine and Pathology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
| | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Matthew Yeh
- Department of Pathology, University of Washington Medical Center, Seattle, WA, USA
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17
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Luthra AK, Arnold CA, Manilchuk AV, Krishna SG. The spectrum of confocal endomicroscopy findings in a cystic neuroendocrine tumor of the pancreas. Endoscopy 2018; 50:E323-E324. [PMID: 30107632 DOI: 10.1055/a-0667-8978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Anjuli K Luthra
- Division of Gastroenterology, Hepatology and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Andrei V Manilchuk
- Division of General and Gastrointestinal Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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18
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Montgomery E, Arnold CA, Lam-Himlin D, Salimian K, Waters K. Some observations on Barrett esophagus and associated dysplasia. Ann Diagn Pathol 2018; 37:75-82. [PMID: 30312881 DOI: 10.1016/j.anndiagpath.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/26/2018] [Indexed: 02/08/2023]
Abstract
Biopsy samples from esophageal columnar metaplasia and dysplasia are commonly encountered in Western pathology practice and knowing a few pitfalls can save both pathologists and patients a great deal of anxiety. Herein we discuss criteria for Barrett esophagus, evaluation of dysplasia, and some pitfalls in reviewing endoscopic mucosal resections. Also included is a summary of suggested follow-up for patients with Barrett esophagus.
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Affiliation(s)
| | - Christina A Arnold
- Department of Pathology, Ohio State University, United States of America
| | - Dora Lam-Himlin
- Department of Pathology, Mayo Clinic Scottsdale, United States of America
| | - Kevan Salimian
- Department of Pathology, Johns Hopkins University, United States of America
| | - Kevin Waters
- Department of Pathology, Cedars Sinai Health System, United States of America
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19
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Graham RP, Naini BV, Shah SS, Arnold CA, Kannangai R, Torbenson MS, Lam-Himlin DM. Treponema pallidum Immunohistochemistry is positive in human intestinal Spirochetosis. Diagn Pathol 2018; 13:7. [PMID: 29378606 PMCID: PMC6389163 DOI: 10.1186/s13000-017-0676-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human intestinal spirochetosis (IS) has been recognized for decades, but whether it represents commensalism or a pathogenic process remains controversial. IS is diagnosed on routine stains with confirmation by silver stains but these stains are labor intensive and slow to read. We evaluated the Treponema pallidum immunostain as a diagnostic adjunct for IS. METHODS We retrieved biopsies from 33 patients with IS for this study. Each case was tested by Warthin-Starry (WS) and T. pallidum immunohistochemistry (IHC). Species specific genotyping was performed in 3 cases. RESULTS Patients with IS ranged from 22 to 82 years without gender predilection. IS involved normal (n = 15), and inflamed (n = 5) mucosa and colonic polyps (n = 13). Warthin-Starry and T. pallidum IHC were positive in all cases including both species of Brachyspira. Six (18%) symptomatic patients were treated for IS, and experienced resolution. In patients diagnosed with incidental IS on cancer screening (n = 5), follow up biopsies, without therapy, were negative for IS. T. pallidum IHC required 75 min less hands-on time than WS for performance and was faster to interpret. CONCLUSIONS T. pallidum IHC can be used to confirm the diagnosis of IS and is easier to perform and faster to interpret than WS.
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Affiliation(s)
- Rondell P. Graham
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Bita V. Naini
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave. Suite 27-061C7 CHS, Los Angeles, CA 90095 USA
| | - Sejal S. Shah
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Christina A. Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH 43210 USA
| | - Rajesh Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, 632004 India
| | - Michael S. Torbenson
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Dora M. Lam-Himlin
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Scottsdale, AZ 85259 USA
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20
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Singhi AD, Arnold CA, Lam-Himlin DM, Nikiforova MN, Voltaggio L, Canto MI, McGrath KM, Montgomery EA. Targeted next-generation sequencing supports epidermoid metaplasia of the esophagus as a precursor to esophageal squamous neoplasia. Mod Pathol 2017; 30:1613-1621. [PMID: 28731047 DOI: 10.1038/modpathol.2017.73] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 12/17/2022]
Abstract
Esophageal epidermoid metaplasia is a rare condition that involves the proximal-to-middle third of the esophagus. It is sharply demarcated and defined histologically by epithelial hyperplasia, a prominent granular cell layer, and superficial hyperorthokeratosis. In addition, preliminary studies have suggested an association between esophageal epidermoid metaplasia and esophageal squamous neoplasia (squamous dysplasia and esophageal squamous cell carcinoma). To further characterize esophageal epidermoid metaplasia and better define its relationship to squamous neoplasia of the esophagus, we performed targeted next-generation sequencing on uninvolved esophageal squamous mucosa and matching esophageal epidermoid metaplasia specimens from 18 patients. Further, we evaluated both synchronous and metachronous high-grade squamous dysplasia/esophageal squamous cell carcinoma by next-generation sequencing from 5 of the 18 (28%) patients, and compared these findings to corresponding esophageal epidermoid metaplasia specimens. Targeted next-generation sequencing revealed 12 of 18 (67%) esophageal epidermoid metaplasia specimens' harbored alterations in genes often associated with esophageal squamous cell carcinoma. The most frequently mutated genes consisted of TP53 (n=10), PIK3CA (n=2), EGFR (n=2), MYCN (n=1), HRAS (n=1), and the TERT promoter (n=1). Sequencing of synchronous and metachronous high-grade squamous dysplasia/esophageal squamous cell carcinoma identified shared genetic alterations with corresponding esophageal epidermoid metaplasia specimens that suggests a clonal relationship between these entities. In addition, the presence of a TP53 mutation in esophageal epidermoid metaplasia specimens correlated with concurrent or progression to high-grade squamous dysplasia/esophageal squamous cell carcinoma. No genetic alterations were detected in uninvolved esophageal squamous mucosa. On the basis of these findings, we conclude esophageal epidermoid metaplasia is a precursor to in situ and invasive esophageal squamous neoplasia. Further, the detection of TP53 mutations in esophageal epidermoid metaplasia specimens may serve as an early detection biomarker for high-grade squamous dysplasia/esophageal squamous cell carcinoma.
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Affiliation(s)
- Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, PA, USA
| | | | | | - Marina N Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, PA, USA
| | | | - Marcia I Canto
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kevin M McGrath
- Department of Pathology, University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, PA, USA
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21
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Joehlin-Price AS, Hardesty DA, Arnold CA, Kirschner LS, Prevedello DM, Lehman NL. Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing's disease. Diagn Pathol 2017; 12:34. [PMID: 28420444 PMCID: PMC5395789 DOI: 10.1186/s13000-017-0624-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023] Open
Abstract
Background Pituitary carcinoma is a rare entity requiring the presence of metastasis to confirm its malignant potential. We report a case of pituitary carcinoma and discuss the diagnosis and management of this lesion in relation to the existing literature. Case presentation The patient is a 51-year-old woman with Cushing’s disease and intact adrenal glands who was diagnosed with metastatic pituitary carcinoma to the liver, 29 months after initial resection of an ACTH-secreting primary atypical pituitary adenoma (APA). Prior to detection of this metastasis the patient underwent repeat resection and radiotherapy for residual cavernous sinus disease. The metastatic lesion was detected by interval surveillance of serum ACTH and 24-hour urine cortisol, which despite stable pituitary MRI, were significantly elevated. These abnormalities prompted a PET scan that demonstrated hypermetabolic liver parenchyma, which was suspicious for metastasis on abdominal MRI. An ultrasound-guided liver biopsy demonstrated nests of moderately-differentiated cells with intermediate-sized, monotonous nuclei, distinct nucleoli, and abundant basophilic cytoplasm, confirmed by immunohistochemistry to represent metastatic pituitary carcinoma. The liver lesion was subsequently successfully removed by wedge resection. One year later, the patient’s residual cavernous sinus disease grew markedly, and she was placed on dual-agent chemotherapy consisting of oral temozolomide and capecitabine, with stabilization of her intracranial disease to present, although liver metastases recurred. Conclusions Pituitary carcinoma is a rare entity impossible to recognize as a primary tumor because its diagnosis by definition requires the presence of metastasis. Maintaining awareness of the entity and its precursor lesion APA is essential for its accurate pathologic diagnosis and appropriate management.
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Affiliation(s)
- Amy S Joehlin-Price
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Douglas A Hardesty
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Christina A Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Lawrence S Kirschner
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Norman L Lehman
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH, 43210, USA.
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Affiliation(s)
- C Eric Freitag
- From the Department of Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus (Drs Freitag, M. A. Arnold, and C. A. Arnold); the Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio (Dr M. A. Arnold); and the Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner)
| | - Michael A Arnold
- From the Department of Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus (Drs Freitag, M. A. Arnold, and C. A. Arnold); the Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio (Dr M. A. Arnold); and the Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner)
| | - Jerad M Gardner
- From the Department of Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus (Drs Freitag, M. A. Arnold, and C. A. Arnold); the Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio (Dr M. A. Arnold); and the Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner)
| | - Christina A Arnold
- From the Department of Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus (Drs Freitag, M. A. Arnold, and C. A. Arnold); the Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio (Dr M. A. Arnold); and the Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner)
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Gonzalez RS, Lagana SM, Szeto O, Arnold CA. Challenges in Diagnosing Medication Resins in Surgical Pathology Specimens: A Crystal-Clear Review Guide. Arch Pathol Lab Med 2017; 141:1276-1282. [PMID: 28169559 DOI: 10.5858/arpa.2016-0587-ra] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Medication resins, including Kayexalate, sevelamer, and bile acid sequestrants, can be encountered in gastrointestinal tract specimens. Their classic histologic appearances have been well documented, but pathologist recognition of the resins is 75%, patient history is not always available, and atypical morphologic findings are sometimes present. OBJECTIVE - To offer a succinct overview of resins in the gastrointestinal tract, including typical and atypical appearances, in order to serve as a quick reference guide. DATA SOURCES - The study comprises published literature, survey data, and our personal experiences. CONCLUSIONS - Classic morphology is the benchmark for identifying these resins, but color, location, and fish scale pattern can deviate from the norm, making proper identification a challenge. Patient history should be sought whenever possible, and ancillary staining is an option when necessary. Additionally, the presence of resins should prompt the pathologist to search for potentially related diagnoses (namely, causes of diarrhea in patients on bile acid sequestrants and diagnoses associated with renal failure in patients on Kayexalate or sevelamer).
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Alsomali MI, Arnold MA, Frankel WL, Graham RP, Hart PA, Lam-Himlin DM, Naini BV, Voltaggio L, Arnold CA. Challenges to "Classic" Esophageal Candidiasis: Looks Are Usually Deceiving. Am J Clin Pathol 2017; 147:33-42. [PMID: 28158394 DOI: 10.1093/ajcp/aqw210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives We undertook the first case control study of histologically confirmed esophageal candidiasis (EC). Methods A computer search from July 2012 through February 2015 identified 1,011 esophageal specimens, including 40 cases of EC and 20 controls. Results The EC incidence was 5.2%; it was associated with immunosuppression and endoscopic white plaques and breaks. Smoking was a predisposing factor, and alcohol was protective. EC had no unique symptoms, and 54% of endoscopic reports did not suspect EC. Important histologic clues included superficial and detached fragments of desquamated and hyper-pink parakeratosis, acute inflammation, intraepithelial lymphocytosis, dead keratinocytes, and bacterial overgrowth. Thirty percent had no neutrophilic infiltrate. Pseudohyphae were seen on H&E in 92.5% (n = 37/40). "Upfront" periodic acid-Schiff with diastase (PAS/D) on all esophageal specimens would have generated $68,333.49 in patient charges. Our targeted PAS/D strategy resulted in $13,044.87 in patient charges (cost saving = 80.9%, $55,288.62). Conclusions We describe the typical morphology of EC and recommend limiting PAS/D to cases where the organisms are not readily identifiable on H&E and with at least one of the following: (1) ulcer, (2) suspicious morphology, and/or (3) clinical impression of EC.
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Affiliation(s)
- Mohammed I Alsomali
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Michael A Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | | | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus
| | - Dora M Lam-Himlin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - Bita V Naini
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | | | - Christina A Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
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Haraldsdottir S, Roth R, Pearlman R, Hampel H, Arnold CA, Frankel WL. Mismatch repair deficiency concordance between primary colorectal cancer and corresponding metastasis. Fam Cancer 2016; 15:253-60. [PMID: 26666765 DOI: 10.1007/s10689-015-9856-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Universal screening for mismatch repair deficiency (dMMR) in cancer is increasingly being implemented to detect Lynch syndrome and aid in treatment decisions. The mismatch repair (MMR) immunohistochemistry (IHC) concordance rate between primary colorectal cancer (CRC) and metastasis is unknown. At times, only metastatic tumor is available for screening (lymph node, liver, lung etc.) rather than the primary tumor. Therefore, it is important to confirm that tissue from metastases can be used for screening for dMMR. We tested dMMR primary and metastatic tumor to assess concordance between the two. We identified dMMR CRC resected at Ohio State University from 1999 to 2013 and stained a corresponding metastasis for all four MMR proteins (MLH1, MSH2, MSH6, PMS2) with IHC. A total of 50 primary CRC with dMMR and available regional lymph nodes (LN; 26 cases) or other metastatic tissue (24 cases) were identified. Thirteen cases were explained by MLH1 hypermethylation and 10 cases had Lynch syndrome. Two cases had somatic MMR mutations and the etiology for dMMR was unknown in 25 cases. All cases showed concordance in IHC staining between the primary tumor and corresponding metastatic tissue. In 36 cases, metastatic LN/other site was resected at the same time as the primary tumor. In 14 cases, time lapsed [median 16.5 months; quartile (Q)1 8.0; Q3 25; range 3-69] from the primary resection until metastatic resection. Metastatic tissue can be used to screen for Lynch syndrome and dMMR.
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Affiliation(s)
- Sigurdis Haraldsdottir
- Division of Medical Oncology, Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Rachel Roth
- Department of Pathology, Ohio State University Medical Center, Columbus, OH, USA
| | - Rachel Pearlman
- Division of Human Genetics, Department of Internal Medicine, Ohio State University Medical Center, Columbus, OH, USA
| | - Heather Hampel
- Division of Human Genetics, Department of Internal Medicine, Ohio State University Medical Center, Columbus, OH, USA
| | - Christina A Arnold
- Department of Pathology, Ohio State University Medical Center, Columbus, OH, USA
| | - Wendy L Frankel
- Department of Pathology, Ohio State University Medical Center, Columbus, OH, USA.
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26
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Conces MR, Arnold CA, Baker PB, Carter CM, Fung B, Prasad V, Arnold MA. A Strategy for Helicobacter Immunohistochemistry Utilization in Pediatric Practice: Insights From Morphologic and Cost-Benefit Analyses. Am J Clin Pathol 2016; 146:611-617. [PMID: 28430952 DOI: 10.1093/ajcp/aqw149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Recent studies in adults have examined the utility of immunohistochemistry (IHC) in detecting Helicobacter in gastric biopsy specimens and reached differing conclusions. Dedicated cost-benefit analysis of Helicobacter IHC in pediatric gastric biopsy specimens has not been performed. METHODS From 1,955 pediatric gastric biopsies in a 1-year period, we identified 63 Helicobacter -positive and 120 Helicobacter -negative biopsy specimens. All cases were scored according to the Updated Sydney System for the severity of inflammation. RESULTS We observed that pediatric Helicobacter infection was significantly associated with germinal center formation, active inflammation, oxyntic mucosa with moderate to severe chronic inflammation, and antral mucosa with any chronic inflammation, exclusive of mild and superficial chronic inflammation. At least one associated pattern was seen in each Helicobacter -positive biopsy specimen. In comparison with adults, pediatric Helicobacter -positive biopsy specimens are more likely to lack acute inflammation and more likely to show moderate to marked chronic inflammation. CONCLUSIONS We recommend performing Helicobacter IHC on pediatric gastric biopsy specimens with any of the above inflammatory patterns. This approach can sensitively identify pediatric patients with Helicobacter gastritis, limit IHC staining to approximately 30% of all gastric biopsy specimens, and reduce costs by up to $55,306.90 per 1,000 biopsy specimens.
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Affiliation(s)
- Miriam R Conces
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Christina A Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Peter B Baker
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Christopher M Carter
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Bonita Fung
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Vinay Prasad
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Michael A Arnold
- From the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
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Park JY, Dunbar KB, Mitui M, Arnold CA, Lam-Himlin DM, Valasek MA, Thung I, Okwara C, Coss E, Cryer B, Doern CD. Helicobacter pylori Clarithromycin Resistance and Treatment Failure Are Common in the USA. Dig Dis Sci 2016; 61:2373-2380. [PMID: 26923948 DOI: 10.1007/s10620-016-4091-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/16/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Helicobacter pylori antibiotic resistance leads to frequent treatment failure. However, the current US prevalence of H. pylori clarithromycin resistance and treatment failure is unknown. AIMS To determine the prevalence of clarithromycin-resistant H. pylori and its impact on treatment failure in the USA. METHODS A multicenter, retrospective, cohort study for clarithromycin-resistant H. pylori was conducted over four academic medical centers in different geographic regions of the USA. Gastric biopsy material, residual from standard clinical pathologic examination, was examined for clarithromycin resistance by DNA sequencing of H. pylori 23S rRNA. RESULTS One hundred and twenty-four cases of H. pylori gastritis were examined from medical centers in four different geographic regions of the USA. The overall prevalence of clarithromycin resistance was 32.3 % (range 23.1-45.8 %). There was no significant difference in the prevalence of clarithromycin resistance by study site, gender, age, or race/ethnicity. In a subset of 67 patients that had clinical follow-up data, the overall prevalence of clarithromycin resistance was 31.3 %. There was a 2.9-fold increase (p = 0.002) in treatment failure for cases with clarithromycin resistance (57.1 %) compared to wildtype H. pylori (19.6 %). CONCLUSIONS H. pylori clarithromycin resistance in the USA exceeds the estimated 20 % prevalence compatible with successful empiric antibiotic therapy. This resistance resulted in a significant rate of treatment failure in all sites surveyed. Empiric therapy in the USA should be used with caution until there is better regional or local determination of H. pylori antibiotic resistance.
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Affiliation(s)
- Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Department of Pathology, Children's Health Dallas, 1935 Medical District Drive, Dallas, TX, 75235, USA.
| | - Kerry B Dunbar
- Medical Service, Dallas Veterans Affairs Medical Center, Dallas, TX, USA
- Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Midori Mitui
- Department of Pathology, Children's Health Dallas, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Christina A Arnold
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dora M Lam-Himlin
- Department of Pathology and Lab Medicine, Mayo Clinic, Arizona, Scottsdale, AZ, USA
| | - Mark A Valasek
- Division of Anatomic Pathology, Department of Pathology, University of California, San Diego, San Diego, CA, USA
| | - Irene Thung
- Division of Anatomic Pathology, Department of Pathology, University of California, San Diego, San Diego, CA, USA
| | - Chinemerem Okwara
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth Coss
- Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Texas Digestive Disease Consultants, Dallas, TX, USA
| | - Byron Cryer
- Medical Service, Dallas Veterans Affairs Medical Center, Dallas, TX, USA
- Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher D Doern
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, VA, USA
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Roth RM, Haraldsdottir S, Hampel H, Arnold CA, Frankel WL. Discordant Mismatch Repair Protein Immunoreactivity in Lynch Syndrome-Associated Neoplasms: A Recommendation for Screening Synchronous/Metachronous Neoplasms. Am J Clin Pathol 2016; 146:50-6. [PMID: 27357288 DOI: 10.1093/ajcp/aqw067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Lynch syndrome (LS) predisposes individuals to developing synchronous and metachronous LS-associated neoplasms (LSANs). Mismatch repair protein (MMRP) immunohistochemistry (IHC) is widely used to identify LS, but its utility in patients with synchronous/metachronous lesions has not been studied. We studied MMRP IHC in patients with LS with more than one LSAN to provide screening recommendations in patients with synchronous/metachronous neoplasms. METHODS All patients with LS diagnosed at The Ohio State University Wexner Medical Center from 2009 through 2014 with more than one LSAN and available tumor tissue for immunostaining were identified. Tumors were stained for MLH1, MSH2, MSH6, and PMS-2 proteins, and immunoreactivity was scored as intact or lost. RESULTS Thirteen patients with LS with 29 synchronous and/or metachronous primary LSANs were identified. Neoplasms involved large and small intestine (n = 19), ampulla (n = 1), endometrium (n = 1), and skin (sebaceous neoplasms, n = 8). Nine (69%) of 13 patients showed concordant MMRP results in all tumors, and four (31%) showed discordant MMRP results. CONCLUSIONS LS diagnosis could have been missed in 31% of the study cases if only the LSAN exhibiting intact MMRP expression was screened. Accordingly, our findings support the recommendation to perform LS screening in all primary, synchronous, and metachronous intestinal and endometrial cancers if a previous tumor screened intact.
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Brosens LAA, Wood LD, Offerhaus GJ, Arnold CA, Lam-Himlin D, Giardiello FM, Montgomery EA. Pathology and Genetics of Syndromic Gastric Polyps. Int J Surg Pathol 2016; 24:185-199. [DOI: 10.1177/1066896915620013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Gastric polyps are found in 1% to 4% of patients undergoing gastroscopy. The vast majority are sporadic, but some gastric polyps indicate an underlying syndrome. Gastric polyps can manifest in each of the gastrointestinal polyposis syndromes, including the recently described gastric adenocarcinoma and proximal polyposis of the stomach syndrome. In addition, gastric polyps occur in Lynch syndrome and in a few rare conditions that are not primarily gastrointestinal. While some of these syndromes are clearly associated with an increased risk of gastric cancer, others are not. Interestingly, even in disorders with a well-established risk of gastric cancer, the neoplastic potential and the precursor status of these gastric polyps are not always clear. Although rare, recognition of syndromic gastric polyps is important for individual patient management. These conditions also serve as important models to study gastric homeostasis and gastric tumorigenesis.
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Affiliation(s)
| | - Laura D. Wood
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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30
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Arnold CA, Roth R, Arsenescu R, Harzman A, Lam-Himlin DM, Limketkai BN, Montgomery EA, Voltaggio L. Sexually transmitted infectious colitis vs inflammatory bowel disease: distinguishing features from a case-controlled study. Am J Clin Pathol 2015; 144:771-81. [PMID: 26486742 DOI: 10.1309/ajcpoid4jij6pisc] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Sexually transmitted infectious (STI) colitis often raises concern for inflammatory bowel disease (IBD). In this study, we compare histologic features of IBD with STI colitis caused by syphilis and lymphogranuloma venereum. METHODS The STI colitis group included 10 unique colorectal biopsy specimens in patients with clinically confirmed syphilis and/or lymphogranuloma venereum. The STI biopsy specimens were compared with patients matched for age, sex, and site with Crohn disease (n = 10) or ulcerative colitis (n = 10). All IBD controls had an established history of IBD (up to 276 months of follow-up, mean follow-up = 102 months). RESULTS Discriminating features (P < .05) of STI colitis included its exclusive identification in human immunodeficiency virus-positive men who have sex with men, anal pain, and anal discharge. STI colitis contained the triad of (1) minimal active chronic crypt centric damage, (2) a lack of mucosal eosinophilia, and (3) submucosal plasma cells, endothelial swelling, and perivascular plasma cells. Nondiscriminating features (P > .05) included rectal bleeding, endoscopic appearance, skip lesions, ulcerations, aphthoid lesions, granulomata, foreign body giant cells, neural hyperplasia, fibrosis, and lymphoid aggregates. CONCLUSIONS While STI colitis shares many overlapping features with IBD, histologic and clinical discriminating features may be helpful when confronted with that differential diagnosis.
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Roth RM, Hampel H, Arnold CA, Yearsley MM, Marsh WL, Frankel WL. A modified Lynch syndrome screening algorithm in colon cancer: BRAF immunohistochemistry is efficacious and cost beneficial. Am J Clin Pathol 2015; 143:336-43. [PMID: 25696791 DOI: 10.1309/ajcp4d7rxobhlkgj] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Somatic BRAF mutation in colon cancer essentially excludes Lynch syndrome. We compared BRAF V600E immunohistochemistry (IHC) with BRAF mutation in core, biopsy, and whole-section slides to determine whether IHC is similar and to assess the cost-benefit of IHC. METHODS Resection cases (2009-2013) with absent MLH1 and PMS2 and prior BRAF mutation polymerase chain reaction results were chosen (n = 57). To mimic biopsy specimens, tissue microarrays (TMAs) were constructed. In addition, available biopsies performed prior to the resection were available in 15 cases. BRAF V600E IHC was performed and graded on TMAs, available biopsy specimens, and whole-section slides. Mutation status was compared with IHC, and cost-benefit analysis was performed. RESULTS BRAF V600E IHC was similar in TMAs, biopsy specimens, and whole-section slides, with only four (7%) showing discordance between IHC and mutation status. Using BRAF V600E IHC in our Lynch syndrome screening algorithm, we found a 10% cost savings compared with mutational analysis. CONCLUSIONS BRAF V600E IHC was concordant between TMAs, biopsy specimens, and whole-section slides, suggesting biopsy specimens are as useful as whole sections. IHC remained cost beneficial compared with mutational analysis, even though more patients needed additional molecular testing to exclude Lynch syndrome.
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Affiliation(s)
- Rachel M. Roth
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Heather Hampel
- Department of Human Genetics, The Ohio State University Wexner Medical Center, Columbus
| | - Christina A. Arnold
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Martha M. Yearsley
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - William L. Marsh
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
| | - Wendy L. Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus
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Manoharan SRR, Shaw AB, Arnold CA, Farhadi HF. Infiltrative intramuscular myxoma of the cervical spine: a case report. Spine J 2015; 15:e1-4. [PMID: 25264316 DOI: 10.1016/j.spinee.2014.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/28/2014] [Accepted: 09/15/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Myxomas are benign tumors of mesenchymal cell origin that usually present as solitary lesions. They are infrequently associated with fibrous dysplasia, as in McCune-Albright or Mazabraud syndrome. Myxomas can develop in a variety of locations, although the most frequent sites are the thigh, buttocks, shoulder, and upper arm. Intramuscular myxomas (IMs) refer to lesions that occur within muscle compartments. They have been infrequently reported in the neck musculature. PURPOSE To date, only five cases have been reported within the posterior neck muscles without associated intraspinal extension. To our knowledge, this is the first case of an IM presenting with extension into the spinal canal. STUDY DESIGN We report a case of posterior cervical IM with intraspinal extension presenting in a 63-year-old woman as a palpable mass. METHODS Complete intralesional resection of the tumor was achieved by standard midline posterior approach. Meticulous resection of the entire capsule was achieved and all margins were confirmed to be free of neoplasm. RESULTS A diagnosis of myxoma was provided on pathologic evaluation. Follow-up at 1.5 years confirmed maintained complete resolution of the preoperative symptoms, with no evidence of local recurrence on imaging. CONCLUSIONS Intramuscular myxomas should be included in the differential diagnosis of cervical paraspinal tumors. Furthermore, we suggest that masses involving the axial muscles should be closely monitored and the patient counseled regarding potential neurologic sequelae.
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Affiliation(s)
| | - Andrew B Shaw
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, 410 W. 10th Ave., Columbus, Ohio 43210, USA
| | - Christina A Arnold
- Department of Pathology, Ohio State University Wexner Medical Center, 410 W. 10th Ave., Columbus, Ohio 43210, USA
| | - H Francis Farhadi
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, 410 W. 10th Ave., Columbus, Ohio 43210, USA.
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Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc 2014; 80:689-706. [PMID: 25070906 DOI: 10.1016/j.gie.2014.04.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 04/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- M Aamir Ali
- Department of Gastroenterology, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lysandra Voltaggio
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Agrawal M, Kanakry J, Arnold CA, Suzman DL, Mathieu L, Kasamon YL, Gladstone DE, Ambinder RF, Ghosh N. Sustained remission and reversal of end-organ dysfunction in a patient with anaplastic myeloma. Ann Hematol 2014; 93:1245-6. [PMID: 24232305 DOI: 10.1007/s00277-013-1950-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
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Voltaggio L, Lam-Himlin D, Limketkai BN, Singhi AD, Arnold CA. Message in a bottle: decoding medication injury patterns in the gastrointestinal tract. J Clin Pathol 2014; 67:903-12. [DOI: 10.1136/jclinpath-2014-202511] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Agbenyefia P, Arnold CA, Kirkpatrick R. Cholestatic Jaundice With the Use of Methylstenbolone and Dymethazine, Designer Steroids Found in Super DMZ Rx 2.0 "Nutritional Supplement": A Case Report. J Investig Med High Impact Case Rep 2014; 2:2324709614532800. [PMID: 26425606 PMCID: PMC4528888 DOI: 10.1177/2324709614532800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
"Nutritional supplements" that promise an increase in muscle mass and strength are becoming a go to item as enhancing one's physical appearance becomes a more important part of our society. This is alarming because many of these nutritional supplements rely on androgen precursors to deliver their promises, without adequately informing consumers of the potential side effects of such agents. These products may conceal the presence of potent androgens to avoid regulatory sanctions and become more appealing to consumers. Recent reports have shown that some products marketed as "nutritional supplements" have been found to contain androgenic anabolic steroids. Methylstenbolone and dymethazine are new androgenic anabolic steroids currently gaining popularity among body builders for their performance-enhancing properties and rapid effects on muscle mass. These agents are found together in Super DMZ Rx 2.0, a "dietary supplement" for bodybuilders. Here we report the first case of Super DMZ Rx 2.0-induced cholestatic jaundice in a 26-year-old previously healthy Caucasian male, who took the supplement according to the manufacturer's instructions for 30 days.
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Voltaggio L, Montgomery EA, Ali MA, Singhi AD, Arnold CA. Sex, lies, and gastrointestinal tract biopsies: a review of selected sexually transmitted proctocolitides. Adv Anat Pathol 2014; 21:83-93. [PMID: 24508691 DOI: 10.1097/pap.0000000000000014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are many insults that result in gastrointestinal tract inflammation. Infections can be particularly challenging because (1) only a limited number of organisms provoke a specific endoscopic and/or histologic appearance; and (2) although some organisms may be present on biopsies, the findings may be so subtle or organisms so few that they are easily missed if the reviewer is not performing a specific search for the offender. Sexually transmitted infections (STI) are rarely a consideration at the time of GI biopsy examination and clinicians rarely inquire about sexual behavior at the time of initial patient interview. Although establishing a definitive STI diagnosis is not possible on histology alone, these infections are associated with inflammatory patterns that may help raise this diagnostic possibility. Becoming familiar with these patterns is necessary as worldwide outbreaks of these infections are being reported. This review aims to provide the pathologist with histologic clues associated with the most frequently encountered bacterial pathogens in the setting of STI proctitis, namely, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum.
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Affiliation(s)
- Jennifer Seminerio
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christina A Arnold
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lysandra Voltaggio
- Department of Pathology, George Washington University, Washington, District of Columbia
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Durand CM, Marr KA, Arnold CA, Tang L, Durand DJ, Avery RK, Valsamakis A, Neofytos D. Detection of cytomegalovirus DNA in plasma as an adjunct diagnostic for gastrointestinal tract disease in kidney and liver transplant recipients. Clin Infect Dis 2013; 57:1550-9. [PMID: 23956167 DOI: 10.1093/cid/cit521] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) disease is the most common infectious complication after solid organ transplantation, frequently affecting the gastrointestinal (GI) tract. There are limited data on quantitative polymerase chain reaction (qPCR) for plasma CMV DNA as an adjunct diagnostic method for GI tract disease in kidney and liver transplant recipients. METHODS We reviewed all records of adult kidney and liver transplant recipients with a GI tract biopsy and plasma CMV qPCR result within 15 days of biopsy during a 6.5-year period at our center. CMV GI tract disease was defined as histopathologic evidence of CMV on biopsy by immunohistochemistry or visualization of inclusion bodies. RESULTS GI tract biopsy and qPCR results were available for 81 kidney and liver transplant recipients; 20 cases of confirmed CMV GI tract disease were identified. Overall, the sensitivity of qPCR for diagnosing CMV GI tract disease was 85% (95% confidence interval [CI], 61%-96%), and the specificity was 95% (95% CI, 85%-99%). For CMV-seronegative recipients (R(-)) with CMV-seropositive donors (D(+)), the sensitivity of qPCR was 100% (95% CI, 59%-99%), and the specificity was 80% (95% CI, 30%-99%). The lowest sensitivity was observed in CMV D(+)/R(+) cases (72.7%; 95% CI, 39%-93%). The mean plasma CMV copy number in patients with GI tract disease was 3.84 log10 (38 334 copies/mL). CONCLUSIONS Plasma CMV qPCR had good sensitivity and excellent specificity for CMV GI tract disease in kidney and liver transplant recipients. Its sensitivity was 100% in CMV D(+)/R(-) cases but 72.7% in CMV D(+)/R(+) cases. This variation in assay performance according to host serostatus may reflect differences in disease pathogenesis.
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Arnold CA, Montgomery EA, Voltaggio L. From the pathologist: review of sexual behaviors should be a routine component of clinical histories. Gastrointest Endosc 2013; 78:385-6. [PMID: 23867380 DOI: 10.1016/j.gie.2013.03.1323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/16/2013] [Indexed: 02/08/2023]
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Limketkai BN, Lam-Himlin D, Arnold MA, Arnold CA. The cutting edge of serrated polyps: a practical guide to approaching and managing serrated colon polyps. Gastrointest Endosc 2013; 77:360-75. [PMID: 23410696 DOI: 10.1016/j.gie.2012.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/06/2012] [Indexed: 12/13/2022]
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Salaria SN, Abu Alfa AK, Alsaigh NY, Montgomery E, Arnold CA. Composite intestinal adenoma-microcarcinoid clues to diagnosing an under-recognised mimic of invasive adenocarcinoma. J Clin Pathol 2013; 66:302-6. [PMID: 23393204 DOI: 10.1136/jclinpath-2012-201314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Microcarcinoids refer to microscopic nests of monotonous cells with endocrine and squamoid features. Their peculiar morphology can appear infiltrative with a desmoplastic-like background, raising concerns for an infiltrating adenocarcinoma. To further characterise microcarcinoids, we undertook a prospective clinicopathological study. METHODS 11 specimens originating from five men and six women (average age=58.9 years) were prospectively collected from December 2004 to December 2011. RESULTS Microcarcinoids were most commonly identified in high-risk adenomas (size ≥10 mm (n=10), villous components (n=8) and/or high-grade dysplasia (n=4)). All polyps had mucosal prolapse and four displayed background fibrosis reminiscent of desmoplasia. The microcarcinoid component was most often multifocal (n=7) within the individual polyp and extended over an average length of 3.9 mm. The individual microcarcinoid cells were cuboidal with abundant eosinophilic cytoplasm. All cases had monotonous nuclei which lacked pleomorphism, hyperchromasia and mitotic activity. All available microcarcinoids were β-catenin and synaptophysin reactive and non-reactive for chromogranin and p53 with a negligible Ki-67 proliferation index (<2%). In addition, the microcarcinoids were variably reactive for p63 and/or CK 5/6, thereby demonstrating focal squamoid features. Two of the study cases were submitted with a concern for invasive carcinoma. Clinical information was available in 10 patients with up to 24 months of follow-up: all patients are alive and well and no subsequent malignancy has been reported. CONCLUSIONS Awareness of this unique morphology is important to avoid overdiagnosing microcarcinoids as invasive adenocarcinoma. Moreover, this immunohistochemical panel can be helpful in discriminating microcarcinoids from its malignant mimic in challenging cases.
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Affiliation(s)
- Safia N Salaria
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Affiliation(s)
- C D Kemp
- Department of General Surgery, The Johns Hopkins Hospital, Baltimore, MD 21205, USA
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Arnold CA, Fernandes NJ, Perez CL, Raisanen J, Cavuoti D. A 90-Year-Old Man with Involuntary Right-Sided Movements. Lab Med 2007. [DOI: 10.1309/emc8pu01het21vkb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Affiliation(s)
- C A Arnold
- Orthopedic Department, Hamot Medical Center, Erie, Pennsylvania 16550, USA
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Arnold CA, Tavares JO. Long-term follow-up of bilateral steroid-induced osteonecrosis of the lateral femoral condyles in a patient with Crohn's disease. Am J Knee Surg 1998; 11:236-40. [PMID: 9854002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- C A Arnold
- Orthopaedic Department, Hamot Medical Center, Erie, Pennsylvania 16550, USA
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Gutteridge DH, Stewart GO, Stuckey BGA, Prince RL, Arnold CA, Kent GN, Price RI, Retallack RW, Bhagat CI, Nicholson GC, Thompson RI, Ward L. Intravenous pamidronate for Paget's disease — Optimal dosage for disease suppression. ACTA ACUST UNITED AC 1992. [DOI: 10.1016/0169-6009(92)92325-k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Monfardini S, Bajetta E, Arnold CA, Kenda R, Bonadonna G. Herpes zoster-varicella infection in malignant lymphomas. Influence of splenectomy and intensive treatment. Eur J Cancer 1975; 11:51-7. [PMID: 48460 DOI: 10.1016/0014-2964(75)90037-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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