Digital Commons Network^™

A State-Wide Population-Based Evaluation Of Cervical Cancers Arising During Opportunistic Screening In The United States, Christopher Mathews, Michael Robertson, Charles L. Wiggins, Yolanda J. Mcdonald, Daniel W. Goldberg, Isabel C. Scarinci, Jack Cuzick, Cosette M Wheeler, Rebecca Landy, Peter D. Sasieni

Pathology Research and Scholarship

OBJECTIVE: Despite widespread cervical screening, an estimated 13,800 women will be diagnosed with cervical cancer in the United States in 2020. To inform improvements, the screening histories of women diagnosed with cervical cancer in New Mexico were assessed.

METHODS: Data were collected on all cervical screening, diagnostic tests and treatment procedures for all women diagnosed with cervical cancer aged 25-64 yrs. in New Mexico from 2006 to 2016. Women were categorized by their screening attendance in the 5-40 months (screening interval) and 1-4 months (peri-diagnostic interval) prior to cancer diagnosis.

RESULTS: Of the 504 women diagnosed between May 2009-December 2016, …

Transfusion Of Blood Components Containing Abo-Incompatible Plasma Does Not Lead To Higher Mortality In Civilian Trauma Patients, Jansen N. Seheult, Nancy M. Dunbar, John R. Hess, Erin E. Tuott, Mohammad Bahmanyar, Jessica Campbell, Magali Fontaine, Jenna Khan, Ara Ko, Jian Mi, Michael F. Murphy, Tara Nykoluk, Jessica Poisson, Jay S. Raval, Andrew Shih, Jason L. Sperry, Julie Staves, Michelle Wong, Matthew T S Yan, Alyssa Ziman, Mark H. Yazer

Pathology Research and Scholarship

BACKGROUND: This study investigated the effect on mortality of transfusing ABO-incompatible plasma from all sources during trauma resuscitation.

METHODS: Demographic, transfusion, and survival data were retrospectively extracted on civilian trauma patients. Patients were divided by receipt of any quantity of ABO-incompatible plasma from any blood product (incompatible group) or receipt of solely ABO-compatible plasma (compatible group). The primary outcome was 30-day mortality, while other outcomes included 6- and 24-hour mortality. Mixed-effects logistic regression was used to model the effect of various predictor variables, including receipt of incompatible plasma, on mortality outcomes.

RESULTS: Nine hospitals contributed data on a total of …

Severe Acute Respiratory Syndrome Coronavirus 2 Neutralizing Antibody Titers In Convalescent Plasma And Recipients In New Mexico: An Open Treatment Study In Patients With Coronavirus Disease 2019, Steven B. Bradfute, Ivy Hurwitz, Alexandra V. Yingling, Chunyan Ye, Qiuying Cheng, Timothy P Noonan, Jay S. Raval, Nestor R. Sosa, Gregory J. Mertz, Douglas J. Perkins, Michelle S. Harkins

Pathology Research and Scholarship

BACKGROUND: Convalescent plasma (CP) is a potentially important therapy for coronavirus disease 2019 (COVID-19). However, knowledge regarding neutralizing antibody (NAb) titers in donor plasma and their impact in patients with acute COVID-19 remains largely undetermined. We measured NAb titers in CP and in patients with acute COVID-19 before and after transfusion through the traditional Food and Drug Administration investigational new drug pathway.

METHODS: We performed a single-arm interventional trial measuring NAb and total antibody titers before and after CP transfusion over a 14-day period in hospitalized patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection.

RESULTS: NAb titers in …

Giant Gastric Ulcers: An Unusual Culprit, Aamer Abbass, Sameen Khalid, Vaishnavi Boppana, Joshua Hanson, Henry Lin, Denis Mccarthy

Pathology Research and Scholarship

Mycophenolate Mofetil (MMF) is routinely used immunosuppressant in solid organ transplantation is commonly associated with several gastrointestinal (GI) side effects. Here we present a case of giant gastric ulcer of 5 cm from MMF use post cardiac transplant. CASE DESCRIPTION: A 56-year-old male with history of severe ischemic cardiomyopathy post heart transplant was on immunosuppression with MMF, tacrolimus and prednisone for 5 months. He presented with severe epigastric pain and intermittent episodes of melena for 1 month. His pain radiated to back that is worsened with eating. Associated with loss of appetite, vomiting and 16-pound weight loss in 3 months. …

Covid-19: Postmortem Diagnostic And Biosafety Considerations, J Matthew Lacy, Erin G. Brooks, Joshua Akers, Danielle Armstrong, Lauren Decker, Adam Gonzalez, William Humphrey, Romana Mayer, Matthew Miller, Catherine Perez, Jose Antonio Ruiz Arango, Lakshmanan Sathyavagiswaran, Wendy Stroh, Suzanne Utley

Pathology Research and Scholarship

As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (eg, cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with-but not of-COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have …

Postmortem Computed Tomography In Firearm Homicides: A Retrospective Case Series, Marloes E M Vester, Kurt B Nolte, Gary M. Hatch, Chandra Y. Gerrard, Reinoud D. Stoel, Rick R. Van Rijn

Pathology Research and Scholarship

Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner's office that occurred during 2016. Autopsies were performed or supervised by board-certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re-evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head-neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and …

Therapeutic Plasma Exchange Taper Does Not Decrease Exacerbations In Immune Thrombotic Thrombocytopenic Purpura Patients, Jay S. Raval, Marshall A. Mazepa, Marian A. Rollins-Raval, Raj S. Kasthuri, Yara A. Park

Pathology Research and Scholarship

BACKGROUND: Despite rapid and intensive treatments with therapeutic plasma exchange (TPE) and immunosuppression, immune thrombotic thrombocytopenic purpura (TTP) patients are at risk of disease exacerbation, i.e., early recurrence of TTP within 30 days of achieving treatment response. TPE taper, a practice of performing additional TPE procedures after achieving treatment response, is commonly performed for decreasing exacerbations, although no evidence supports this practice.

STUDY DESIGN AND METHODS: In this prospective observational investigation over four years, our center switched its standard of care for treating all TTP patients from not performing TPE taper after achieving treatment response (i.e., no-taper cohort) to performance …

Telemedicine In Liver Disease And Beyond: Can The Covid-19 Crisis Lead To Action?, Marina Serper, Allen W. Cubell, Mary Elisabeth Deleener, Tara K. Casher, Dale J. Rosenberg, Dale Whitebloom, Roy M. Rosin

Project ECHO Bibliography

Evidence strongly supports that access to specialty gastroenterology or hepatology care in cirrhosis is associated with higher adherence to guideline-recommended care and improves clinical outcomes. Presently, only about one half of acute care hospitalizations for cirrhosis-related complications result in inpatient specialty care, and the current hepatology workforce cannot meet the demand of patients with liver disease nationwide, particularly in less densely populated areas and in community-based practices not affiliated with academic centers. Telemedicine, defined as the delivery of health care services at a distance using electronic means for diagnosis and treatment, holds tremendous promise to increase access to broadly specialty …

Sars-Cov-2 Reverse Genetics Reveals A Variable Infection Gradient In The Respiratory Tract, Yixuan J. Hou, Kenichi Okuda, Caitlin E. Edwards, David R. Martinez, Takanori Asakura, Kenneth H. Dinnon, Takafumi Kato, Rhianna E. Lee, Boyd L. Yount, Teresa M. Mascenik, Gang Chen, Kenneth N. Olivier, Andrew Ghio, Longping V. Tse, Sarah R. Leist, Lisa E. Gralinski, Alexandra Schäfer, Hong Dang, Rodney Gilmore, Satoko Nakano, Ling Sun, M Leslie Fulcher, Alessandra Livraghi-Butrico, Nathan I. Nicely, Mark Cameron, Cheryl Cameron, David J. Kelvin, Aravinda De Silva, David M. Margolis, Alena Markmann, Luther Bartelt, Ross Zumwalt, Fernando J. Martinez, Steven P. Salvatore, Alain Borczuk, Purushothama R. Tata, Vishwaraj Sontake, Adam Kimple, Ilona Jaspers, Wanda K. O'Neal, Scott H. Randell, Richard C. Boucher, Ralph S. Baric

Pathology Research and Scholarship

The mode of acquisition and causes for the variable clinical spectrum of coronavirus disease 2019 (COVID-19) remain unknown. We utilized a reverse genetics system to generate a GFP reporter virus to explore severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis and a luciferase reporter virus to demonstrate sera collected from SARS and COVID-19 patients exhibited limited cross-CoV neutralization. High-sensitivity RNA in situ mapping revealed the highest angiotensin-converting enzyme 2 (ACE2) expression in the nose with decreasing expression throughout the lower respiratory tract, paralleled by a striking gradient of SARS-CoV-2 infection in proximal (high) versus distal (low) pulmonary epithelial cultures. COVID-19 …

The Influence Of Telehealth For Better Health Across Communities., Jane A. Mcelroy, Tamara M. Day, Mirna Becevic

Project ECHO Bibliography

Rapid spread of coronavirus disease 2019 (COVID-19) forced an abrupt shift in the traditional US health care delivery model to meet the needs of patients, staff, and communities. Through federal policy changes on telehealth, patient care shifted from in-person to telephone or video visits, and health care providers reached out to patients most at risk for exacerbation of chronic disease symptoms. ECHO (Extension for Community Healthcare Outcomes), a videoconferencing peer learning application, engaged health care providers across Missouri in the treatment and management of complex COVID-19-positive patients. Re-envisioning health care in the digital age includes robust utilization of telehealth to …

Clinicopathologic Implications Of Myb And Beta-Catenin Expression In Adenoid Cystic Carcinoma, Susan Park, Manali Vora, Annemieke Van Zante, Joseph Humtsoe, Hyun-Su Kim, Sue Yom, Shweta Agarwal, Patrick Ha

Pathology Research and Scholarship

BACKGROUND: Adenoid cystic carcinoma (ACC) is the second most common malignancy of the salivary glands, accounting for ~ 1% of malignant tumors of the head and neck region and 10% of salivary gland neoplasms. Predicting the long-term outcomes of patients with ACC is still challenging, as reliable prognostic biomarkers are not available. Among salivary gland tumors, Myb overexpression is highly specific for ACC. In addition, the MYB-NF1B fusion translocation is a hallmark of ACC, and although the detection of this translocation does not appear to impact prognosis, the MYB-NF1B fusion is also implicated in MYB upregulation. Myb has recently been …

Comparison Of Tissue Molecular Biomarker Testing Turnaround Times And Concordance Between Standard Of Care And The Biocartis Idylla Platform In Patients With Colorectal Cancer, Gregory J. Tsongalis, M Rabie Al Turkmani, Michael Suriawinata, Michael J. Babcock, Kristi Mitchell, Yi Ding, Lisa Scicchitano, Adrian Tira, Lela Buckingham, Sara Atkinson, Amy Lax, Dara L. Aisner, Kurtis D. Davies, Holly N. Wood, Stacey S. O'Neill, Edward A. Levine, Judy Sequeira, Shuko Harada, Gina Defrank, Ravikumar Paluri, Bradford A. Tan, Heather Colabella, Christopher Snead, Marcia Cruz-Correa, Virginia Ramirez, Arnaldo Rojas, Huiya Huang, Alexander C. Mackinnon, Fernando U. Garcia, Sharon M. Cavone, Mutasim Elfahal, Gyorgy Abel, Mohammad A. Vasef, Andrew Judd, Mark W. Linder, Khaled Alkhateeb, William L. Skinner, Ralph Boccia, Kashyap Patel

Pathology Research and Scholarship

OBJECTIVES: Management of colorectal cancer warrants mutational analysis of KRAS/NRAS when considering anti-epidermal growth factor receptor therapy and BRAF testing for prognostic stratification. In this multicenter study, we compared a fully integrated, cartridge-based system to standard-of-care assays used by participating laboratories.

METHODS: Twenty laboratories enrolled 874 colorectal cancer cases between November 2017 and December 2018. Testing was performed on the Idylla automated system (Biocartis) using the KRAS and NRAS-BRAF cartridges (research use only) and results compared with in-house standard-of-care testing methods.

RESULTS: There were sufficient data on 780 cases to measure turnaround time compared with standard assays. In-house polymerase chain …

Randomized Controlled Trial Of A Multilevel Intervention To Address Social Determinants Of Refugee Mental Health, Jessica R. Goodkind, Deborah Bybee, Julia Meredith Hess, Suha Amer, Martin Ndayisenga, R Neil Greene, Ryeora Choe, Brian Isakson, Brandon Baca, Mahbooba Pannah

Pediatrics Research and Scholarship

Understanding processes that support the well-being of the unprecedented numbers of forcibly displaced people throughout the world is essential. Growing evidence documents post-migration stressors related to marginalization as key social determinants of refugee mental health. The goal of this RCT was to rigorously test a social justice approach to reducing high rates of distress among refugees in the United States. The 6-month multilevel, strengths-based Refugee Well-being Project (RWP) intervention brought together university students enrolled in a 2-semester course and recently resettled refugees to engage in mutual learning and collaborative efforts to mobilize community resources and improve community and systems responsiveness …

Viscoelastic Testing In Covid-19: A Possible Screening Tool For Severe Disease, Jay S. Raval, Allison E. Burnett, Marian A. Rollins-Raval, Joseph R. Griggs, Lizabeth Rosenbaum, Nathan D. Nielsen, Michelle S. Harkins

Pathology Research and Scholarship

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) that manifests with variable severity. 1 A subset of symptomatic individuals develop proinflammatory or prothrombotic profiles requiring additional testing and interventions. 2-5 It is unclear which COVID-19 patients will ultimately develop severe disease that would have benefitted from early and aggressive interventions.

Relationships Of P16 Immunohistochemistry And Other Biomarkers With Diagnoses Of Cervical Abnormalities: Implications For Last Terminology, Philip E. Castle, Rachael Adcock, Jack Cuzick, Nicolas Wentzensen, Norah E. Torrez-Martinez, Salina M. Torres, Mark H. Stoler, Brigitte M. Ronnett, Nancy E. Joste, Teresa M. Darragh, Patti E. Gravitt, Mark Schiffman, William C. Hunt, Walter K. Kinney, Cosette M. Wheeler

Pathology Research and Scholarship

CONTEXT.—: Lower Anogenital Squamous Terminology (LAST) standardization recommended p16

OBJECTIVE.—: To describe the relationships of p16 IHC and other biomarkers associated with cervical cancer risk with biopsy diagnoses.

DESIGN.—: A statewide, stratified sample of cervical biopsies diagnosed by community pathologists (CPs), including 1512 CIN2, underwent a consensus, expert pathologist panel (EP) review (without p16 IHC results), p16 IHC interpretation by a third pathology group, and human papillomavirus (HPV) genotyping, results of which were grouped hierarchically according to cancer risk. Antecedent cytologic interpretations were also available.

RESULTS.—: Biopsies were more likely to test p16 IHC positive with increasing severity of CP …

Traumatic Injury Results In Prolonged Circulation Of Ultralarge Von Willebrand Factor And A Reduction In Adamts13 Activity, Mitchell R. Dyer, William E. Plautz, Margaret V. Ragni, Wyeth Alexander, Shannon Haldeman, Jason L. Sperry, Francis X. Guyette, Brian S. Zuckerbraun, Marian A. Rollins-Raval, Jay S. Raval, Matthew D. Neal

Pathology Research and Scholarship

BACKGROUND: Increases in plasma von Willebrand Factor (VWF) levels, accompanied by decreases in the metalloprotease ADAMTS13, have been demonstrated soon after traumatic injury while downstream effects remain unclear.

STUDY DESIGN AND METHODS: A cohort of 37 injured trauma patients from a randomized control trial investigating the use of prehospital plasma transfusion were analyzed for activity and antigen levels of ADAMTS13 and VWF at 0 and 24 hours after admission. Relevant clinical data were abstracted from the medical records. Trauma patient plasma was analyzed via agarose gel electrophoresis to evaluate the effects of injury on VWF multimer composition compared to healthy …

Tetraspanin Cd82 Drives Acute Myeloid Leukemia Chemoresistance By Modulating Protein Kinase C Alpha And Β1 Integrin Activation, Muskan Floren, Sebastian Restrepo Cruz, Christina M. Termini, Kristopher D. Marjon, Keith A. Lidke, Jennifer M. Gillette

Pathology Research and Scholarship

A principal challenge in treating acute myeloid leukemia (AML) is chemotherapy refractory disease. As such, there remains a critical need to identify key regulators of chemotherapy resistance in AML. In this study, we demonstrate that the membrane scaffold, CD82, contributes to the chemoresistant phenotype of AML. Using an RNA-seq approach, we identified the increased expression of the tetraspanin family member, CD82, in response to the chemotherapeutic, daunorubicin. Analysis of the TARGET and BEAT AML databases identifies a correlation between CD82 expression and overall survival of AML patients. Moreover, using a combination of cell lines and patient samples, we find that …

Accelerating Care Through Echo: Case Examples From The Field., Mirna Becevic, Emmanuelle Wallach, Lincoln R. Sheets, Hope Misterovich, Susan Norris, Evelyn Aboagye, Jonathan A Dyer, Bruce R Bacon, Karen Edison, Kristin Sohl

Project ECHO Bibliography

In this article, we describe three life-changing patient cases demonstrating high-quality and timely care they received in their communities, thanks to the Show-Me ECHO project. Early autism diagnosis, a potentially deadly tumor manifesting as a benign-looking rash, a recalcitrant case of hepatitis C: rural and underserved Missourians now have access to state-of-the-art care through their local providers receiving interdisciplinary telementoring on evidence based practices.

Association Of Immunophenotype With Expression Of Topoisomerase Ii Α And Β In Adult Acute Myeloid Leukemia, Andrew P. Michelson, Shannon Mcdonough, Cheryl L. Willman, Eric R. Koegle, John E. Godwin, Stephen H. Petersdorf, Alan F. List, Megan Othus, Frederick R. Appelbaum, Jerald P. Radich, Mahrukh K. Ganapathi, Anjali S. Advani, Ram N. Ganapathi

Pathology Research and Scholarship

Anthracyclines used in the treatment of acute myelogenous leukemia (AML) inhibit the activity of the mammalian topoisomerase II (topo II) isoforms, topo II α and topo IIβ. In 230 patients with non-M3 AML who received frontline ara-C/daunorubicin we determined expression of topo IIα and topo IIβ by RT-PCR and its relationship to immunophenotype (IP) and outcomes. Treatment outcomes were analyzed by logistic or Cox regression. In 211 patients, available for analysis, topo IIα expression was significantly lower than topo IIβ (P < 0.0001). In contrast to topo IIα, topo IIβ was significantly associated with blast percentage in marrow or blood (P = 0.0001), CD7 (P = 0.01), CD14 (P < 0.0001) and CD54 (P < 0.0001). Event free survival was worse for CD56-negative compared to CD56-high (HR = 1.9, 95% CI [1.0-3.5], p = 0.04), and overall survival was worse for CD-15 low as compared to CD15-high (HR = 2.2, 95% CI [1.1-4.2], p = 0.02). Ingenuity pathway analysis indicated topo IIβ and immunophenotype markers in a network associated with cell-to-cell signaling, hematological system development/function and inflammatory response. Topo IIβ expression reflects disease biology of highly proliferative disease and distinct IP but does not appear to be an independent variable influencing outcome in adult AML patients treated with anthracycline-based therapy.

Drug Resistance Of Previously Treated Tuberculosis Patients With Diabetes Mellitus In Shandong, China, Wan-Mei Song, Yi-Fan Li, Jin-Yue Liu, Ning-Ning Tao, Yao Liu, Qian-Yun Zhang, Ting-Ting Xu, Shi-Jin Li, Qi-Qi An, Si-Qi Liu, Chun-Bao Yu, Lei Gao, Cui-Xiang Yu, Min Zhang, Huai-Chen Li

Pathology Research and Scholarship

BACKGROUND: Although the association between diabetes mellitus (DM) and tuberculosis (TB) has been well-documented for centuries, evidence of the link between diabetes and drug resistance among previously treated TB patients remains limited and inconsistent.

METHODS: An observational study was performed that involved 1791 retreated TB-no DM patients (refers to TB cases without diabetes) and 93 retreated TB-DM patients (refers to TB cases with diabetes) in Shandong, China from 2004 to 2017. Baseline data including demographic and clinical characteristics, drug susceptibility test (DST) results, and diabetes status were collected. Categorical baseline characteristics were compared by Fisher's exact or Pearson Chi-square test. …

Evaluating Screening Participation, Follow-Up, And Outcomes For Breast, Cervical, And Colorectal Cancer In The Prospr Consortium, William E. Barlow, Elisabeth F. Beaber, Berta M. Geller, Aruna Kamineni, Yingye Zheng, Jennifer S. Haas, Chun R. Chao, Carolyn M. Rutter, Ann G. Zauber, Brian L. Sprague, Ethan A. Halm, Donald L. Weaver, Jessica Chubak, V Paul Doria-Rose, Sarah Kobrin, Tracy Onega, Virginia P. Quinn, Marilyn M. Schapira, Anna N A Tosteson, Douglas A. Corley, Celette Sugg Skinner, Mitchell D. Schnall, Katrina Armstrong, Cosette M. Wheeler, Michael J. Silverberg, Bijal A. Balasubramanian, Chyke A. Doubeni, Dale Mclerran, Jasmin A. Tiro

Pathology Research and Scholarship

BACKGROUND: Cancer screening is a complex process encompassing risk assessment, the initial screening examination, diagnostic evaluation, and treatment of cancer precursors or early cancers. Metrics that enable comparisons across different screening targets are needed. We present population-based screening metrics for breast, cervical, and colorectal cancers for nine sites participating in the Population-based Research Optimizing Screening through Personalized Regimens consortium.

METHODS: We describe how selected metrics map to a trans-organ conceptual model of the screening process. For each cancer type, we calculated calendar year 2013 metrics for the screen-eligible target population (breast: ages 40-74 years; cervical: ages 21-64 years; colorectal: ages …

Transfusion Of Uncrossmatched Group O Erythrocyte-Containing Products Does Not Interfere With Most Abo Typings, Mark H. Yazer, Philip C. Spinella, Leilani Doyle, Richard M. Kaufman, Robyn Dunn, John R. Hess, Luiz Amorim Filho, Magali Fontaine, Birgit Gathof, Bryon Jackson, Michael F Murphy, Jeremiah Pasion, Jay S. Raval, Kristin Rosinski, Jansen Seheult, Andrew W. Shih, Jason Sperry, Julie Staves, Erin E. Tuott, Alyssa Ziman, Darrell J. Triulzi

Pathology Research and Scholarship

BACKGROUND: Group O erythrocytes and/or whole blood are used for urgent transfusions in patients of unknown blood type. This study investigated the impact of transfusing increasing numbers of uncrossmatched type O products on the recipient's first in-hospital ABO type.

METHODS: This was a retrospective cohort study. Results of the first ABO type obtained in adult, non-type O recipients (i.e., types A, B, AB) after receiving at least one unit of uncrossmatched type O erythrocyte-containing product(s) for any bleeding etiology were analyzed along with the number of uncrossmatched type O erythrocyte-containing products administered in the prehospital and/or in hospital setting before …

Sclerosing Epithelioid Mesenchymal Neoplasm Of The Pancreas - A Proposed New Entity, Olca Basturk, Britta Weigelt, Volkan Adsay, Jamal K Benhamida, Gokce Askan, Lu Wang, Maria E. Arcila, Giuseppe Zamboni, Noriyoshi Fukushima, Rodrigo Gularte-Mérida, Arnaud Da Cruz Paula, Pier Selenica, Rahul Kumar, Fresia Pareja, Christopher A. Maher, John Scholes, Yoshinao Oda, Donatella Santini, Leona A. Doyle, Iver Petersen, Uta Flucke, Christian Koelsche, Samuel J. Reynolds, Aslihan Yavas, Andreas Von Deimling, Jorge S. Reis-Filho, David S. Klimstra

Pathology Research and Scholarship

We have encountered pancreatic tumors with unique histologic features, which do not conform to any of the known tumors of the pancreas or other anatomical sites. We aimed to define their clinicopathologic features and whether they are characterized by recurrent molecular signatures. Eight cases were identified; studied histologically and by immunohistochemistry. Selected cases were also subjected to whole-exome sequencing (WES; n = 4), RNA-sequencing (n = 6), Archer FusionPlex assay (n = 5), methylation profiling using the Illumina MethylationEPIC (850k) array platform (n = 6), and TERT promoter sequencing (n = 5). Six neoplasms occurred in females. The mean age …

Protocols, Practices, And Needs For Investigating Sudden Unexpected Infant Deaths, Carri Cottengim, Sharyn Parks, Dale Rhoda, Tom Andrew, Kurt B. Nolte, John Fudenberg, Mary Ann Sens, Jennifer Brustrom, Betsy Payn, Carrie K. Shapiro-Mendoza

Pathology Research and Scholarship

Understanding case identification practices, protocols, and training needs of medical examiners and coroners (MEC) may inform efforts to improve cause-of-death certification. We surveyed a U.S.-representative sample of MECs and described investigation practices and protocols used in certifying sudden unexpected infant deaths (SUID). We also identified MEC training and resource needs. Of the 377 respondents, use of the SUID Investigation Reporting Form or an equivalent was 89% for large, 87% for medium, and 52% for small jurisdictions. Routine completion of infant medical history, witness interviews, autopsy, photos or videos, and family social history for infant death investigations was ≥80%, but routine …

A Multicenter Study Of The Revogene C. Difficile System For Detection Of The Toxin B Gene From Unformed Stool Specimens, Michael J. Mashock, Matthew L. Faron, Karen C. Carroll, Christina Dang, Shawna Lewis, Hossein Salimnia, Paul Lephart, Vivian G. Loo, Bryan H. Schmitt, Stephen Young, Blake W. Buchan, Nathan A. Ledeboer

Pathology Research and Scholarship

Clostridioides difficile is the leading cause of diarrhea in hospitalized U.S. patients and results in over 400,000 cases of C. difficile infection per year. C. difficile infections have mortality rates of 6 to 30% and significantly increase health care costs, because of increased length of stay and increased frequency of readmissions due to recurrences. Efforts to reduce the spread of C. difficile in hospitals have led to the development of rapid sensitive diagnostic methods. A multicenter study was performed to establish the performance characteristics of the Revogene C. difficile test (Meridian Bioscience, Cincinnati, OH, USA) for use in detection of …

Heparin-Induced Thrombocytopenia Associated With Collection Of Hematopoietic Progenitor Cells By Apheresis, Jay S. Raval, Yara A. Park, Irina Perjar, Marshall A. Mazepa, Benjamin G. Vincent, Alice D. Ma, Marian A. Rollins-Raval

Pathology Research and Scholarship

Heparin-induced thrombocytopenia (HIT) can occur following exposure to heparin and is characterized by thrombocytopenia with increased risk for thrombosis. This condition is mediated by formation of immunoglobulin G antibodies against platelet factor 4/heparin complexes that can subsequently lead to platelet activation. Herein, we detail the clinical and laboratory findings, treatments, and outcomes of two patients who developed HIT and thrombosis after undergoing collection of hematopoietic progenitor cells by apheresis (HPC-A) for autologous HPC transplant. Given that heparin may be used during HPC-A collections, these cases emphasize the importance of prompt consideration of HIT in patients that develop thrombocytopenia and thrombosis …

Therapeutic Plasma Exchange For Neuromyelitis Optica Spectrum Disorder: A Multicenter Retrospective Study By The Asfa Neurologic Diseases Subcommittee, Tina S. Ipe, Jay S. Raval, Leonor P. Fernando, Amit Gokhale, Cyril Jacquot, Andrew D. Johnson, Haewon C. Kim, Grace F. Monis, Yunchun D. Mo, Shanna M. Morgan, Monica B. Pagano, Huy P. Pham, Kimberly Sanford, Amy E. Schmidt, Joseph Schwartz, Jennifer Webb, Jeffrey L. Winters, Yanyun Wu, Chisa Yamada, Edward C C Wong, Amy Waldman

Pathology Research and Scholarship

IMPORTANCE: Neuromyelitis optica/neuromyelitis optica spectrum disorder patients' response to therapeutic plasma exchange (TPE) is currently incompletely characterized.

OBJECTIVE: Our study aims to understand the clinical status improvement of neuromyelitis optica/neuromyelitis optica spectrum disorder patients treated with TPE.

DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter retrospective study conducted between 1 January 2003 and 31 July 2017 at 13 US hospitals performing apheresis procedures. Subjects studied were diagnosed with neuromyelitis optica/neuromyelitis optica spectrum disorder who received TPE during presentation with acute disease.

MAIN OUTCOMES AND MEASURES: The primary outcome was clinical status improvement in patients treated with TPE. Secondary measures were …

Getting The Gist Of A Schwannoma, Rishabh Gulati, Joshua A. Hanson, Gulshan Parasher, Daniel Castresana

Pathology Research and Scholarship

A small subepithelial esophageal lesion was seen 21 cm from the incisors in an otherwise unremarkable examination. Subsequent upper-EUS examination revealed a 14 mm by 21 mm well-circumscribed, hypoechoic lesion originating from the muscularis propria (layer 4). The initial EUS impression was suggestive of a GI stromal tumor, however, examination of EUS-guided fine-needle biopsy specimens showed a haphazard arrangement of spindle cells in a fibrotic stoma.

Diagnostic Performance Of Two Molecular Assays For The Detection Of Vaginitis In Symptomatic Women, Alexandra Thompson, Karen Timm, Noelle Borders, Liz Montoya, Karissa Culbreath

Pathology Research and Scholarship

The three main causes of vaginitis are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV). Two multiplex assays are commercially available for detection of DNA from organisms associated with vaginitis: BD Affirm™ VPIII Microbial Identification Test (Affirm) and BD MAX™ Vaginal Panel (MAX VP). Here, the performance of MAX VP was compared to that of Affirm, which was considered the standard of care. Four vaginal swabs were collected from each subject with the following: BD Affirm™ VPIII Ambient Temperature Transport System (ATTS), BD MAX™ UVE Specimen Collection Kit, Hologic Aptima® Vaginal Swab Specimen Collection Kit, and BD ESwab™ collection …

A Multicenter Evaluation Of A Sample To Answer Real-Time Pcr Assay For Toxigenic C. Difficile In Symptomatic Subjects, Preeti Pancholi, Steve Young, R Widen, Suzane Silbert, B Schmitt, R Dunn, A Drain, S A. Weissfeld

Pathology Research and Scholarship

We evaluated the performance of the Luminex ARIES® C. difficile Assay on 984 stool specimens prospectively collected from patients being tested for CDI at 4 clinical laboratories in the United States. Results were compared to direct and enriched toxigenic culture. Positive percent agreement (PPA) of the ARIES® C. difficile Assay was 98.1% versus direct toxigenic culture, and sensitivity versus direct plus enriched toxigenic culture was 90.5%. Negative percent agreement (NPA) of the ARIES® C. difficile Assay against direct culture was 92.6%, and specificity versus direct plus enriched toxigenic culture was 95.8%. The ARIES® C. difficile Assay was also compared to …