Medicine and Health Sciences Commons^™

Increased Eosinophils In The Muscularis Propria Of Appendix May Indicate Early Symptomatic Appendicitis, Ping L. Zhang, Zhenhong Qu

Conference Presentation Abstracts

Background: The presence of neutrophils in muscularis propria is known to best correlate with clinical symptoms of acute appendicitis. Eosinophils present in the muscularis propria were noted in cases of acute appendicitis in 2000 (Carr, NJ. Annal of Diagnostic Pathology 2000;4:46–58), but the significance of their presence there has been unclear. The goal of this study was to investigate whether increased eosinophils in muscularis propria could be correlated with early symptoms of patients with clinical diagnosis of symptomatic appendicitis.

Methods: Seventeen patients with clinical diagnosis of acute appendicitis were identified as having acute symptomatology, but the resection specimens displayed a …

Prevalence Of Allergic Fungal Sinusitis In Nonspecific Allergic Sinusitis, P L. Zhang, H D. Kanaan

Conference Presentation Abstracts

Background: Increased eosinophils in sinus contents are regarded as nonspecific allergic sinusitis. However there are only a few studies addressing the rate of fungal infection associated allergic fungal sinusitis in non-specific allergic sinusitis. This study was to identify the prevalence of allergic fungal sinusitis in the sinus content specimens with increased eosinophils. Methods: A computer search for allergic sinusitis was done over a 4 year period of time. And allergic fungal sinusitis was individually identified within listed allergic sinusitis cases. Each individual case of allergic fungal sinusitis was reviewed in correlation with sinus culture findings and the prevalence of allergic …

Paneth Cell-Like Granules In Clear Cell Renal Cell Carcinomas Are Cd68 And Lysozyme Positive Lysosomes, P L. Zhang

Conference Presentation Abstracts

Background:Paneth cells with features ofneuroendocrine differentiation can be seen inmultiple organs and various tumours. Paneth cell-likegranules in clear cell renal cell carcinomas (RCC)have previously been reported, but are found noexpression of neuroendocrine markers. Given thatclear cell RCC are rich in phagocytic factors, wehypothesized that the Paneth cell-like granules inclear cell RCC were associated with lysosomes.Methods:In this study, 72 different renal tumoursincluded 42 clear cell RCC, 16 papillary RCC, 5 clearcell papillary RCC, 6 chromophobe RCC, 2 urothelialcarcinomas and one unclassified RCC. All tumourswere evaluated for the Paneth cell-like granules onhaematoxylin & eosin stained sections. In addition,PAS-D staining, immunohistochemical stains andelectron …

Varieties Of Renal Diseases Identified In Renal Biopsies Of Patients Infected By Covid-19, Jessica Anderson, Wei Li, Hassan D. Kanaan, Ping Zhang

Conference Presentation Abstracts

Context: COVID-19 has been shown to cause renal pathology by multiple proposed mechanisms. However, studies evaluating renal biopsies for the effects of COVID-19 remain limited. We report our experience in our health system in a variety of renal pathologic diagnoses caused by COVID-19 infection.

Design: We performed detailed analysis of 5 renal biopsies related to COVID-19 infection, of 812 renal biopsies over the previous 22 months (0.6% of all cases).

Results: The first 3 patients were 2 African American men, 34 and 45 years old, and 1 48-year-old white male transplant recipient who developed acute kidney injury and nephrotic range …

Lysozyme-Induced Nephropathy Secondary To Chronic Myelomonocytic Leukemia, Vasudevan Mahalingam, Jamal Abukhaled, Ping Zhang

Conference Presentation Abstracts

Lysozyme-induced nephropathy is a rare cause of acute kidney injury (AKI) in patients with chronic myelomonocytic leukemia (CMML). We report the case of an 85-year-old man with type II diabetes and hypertension who was being evaluated for an elevated serum creatinine of 2.27 mg/dL. Additional studies showed proteinuria (1 g), predominantly nonalbumin, along with an IgA λ monoclonal protein found on serum electrophoresis. His serum κ:λ ratio, however, was elevated and urinalysis showed free κ monoclonal protein. Further hematopathologic workup revealed CMML, and he also had progression of his AKI, for which a renal biopsy was performed. Light microscopy showed …

Spectrum Of C3 Glomerulopathies: A Single-Center Experience, Mustafa Deebajah, Wei Li, Hassan D. Kanaan, Ping Zhang

Conference Presentation Abstracts

Context: C3GNs represent a rare type of glomerulopathy due to the activation of alternative complement pathway, including C3-dominant glomerulonephritis (C3D-GN) and dense deposit disease (DDD). The goal of this study was to demonstrate a spectrum of C3GNs.

Design: The study searched 3165 renal biopsies to identify C3GNs and their clinical indices over an 8-year period.

Conclusions: Our data indicate that C3GN cases had a consistent finding of dominant C3 staining, and low serum C3 in most, but exhibited a wide range of clinical and pathologic changes in pediatric to elderly patients. The findings support the previously reported characteristics of C3GN. …

Igg4-Related Interstitial Nephritis Ranges From Kidney Mass To Acute Kidney Injury, Mai Elzieny, Wei Li, Hassan D. Kanaan, Ping Zhang

Conference Presentation Abstracts

Context: IgG4-related interstitial nephritis (IRIN) can present as either a renal mass or with acute kidney injury (AKI). The goal of this study was to present our 4 IRIN cases with different clinical scenarios.

Design: Over the past 5 years, we identified 4 cases of IRIN. Each case was evaluated.

Results: Case 1 involved a 60-year-old man with a 3-cm kidney mass. The core biopsy revealed storiform fibrosis and increased IgG4-positive plasma cells (>30 per high-power field), thus diagnosed as IRIN. Case 2 involved a 69-year-old man with medical history of polymyalgia rheumatica and low complements who developed AKI …

A Cost-Conscious Whole Slide Imaging System For Teaching And Teleconsultation In Pathology, Christopher Thorburn, Mustafa Deebajah, Keran Zhao, Zhenhong Qu

Conference Presentation Abstracts

Context: Whole slide imaging (WSI) systems can provide multiple users with concurrent access to slides without the need to be physically present at the same location. However, the cost of an all-in-one WSI system can be prohibitive for programs that do not already use WSI systems at a clinical scale. Here, we delineate a simple, inexpensive WSI system that is easy to implement and meets the need of a resident teaching environment.

Design: A digital camera (Basler acA2500, Mannheim, Germany) is mounted to a brightfield microscope with a 0.63× C-mount and connected to a computer with the manual WSI program …

Acute Pericarditis And Acute Pleuritis/Empyema Following Submandibular Infection In A Covid-19-Postive Patient: An Autopsy Revealing The Danger Space Of The Neck, Jessica Anderson, Seyedalireza Fatemi, Joseph Fullmer, Ping Zhang

Conference Presentation Abstracts

Acute pericarditis and empyema are life-threatening complications of severe odontogenic infections; reports of these findings from an autopsy perspective are rare. We report an autopsy case demonstrating infection from the mandibular molars to the pericardium and pleura in a patient following COVID-19 infection. A 53-year-old woman with history of COVID-19 (and on repeat testing at admission) presented with submandibular abscess that grew Streptococcus anginosus. Despite incision and drainage of the neck abscess and medical treatment, her condition deteriorated, with sudden death a week after admission. An autopsy with histologic analysis was performed. Externally, a surgical incision containing purulent drainage …

Association Of Isolated Colitis With Nonsteroidal Anti-Inflammatory Drug Usage, Ashbita Pokharel, Wei Li

Conference Presentation Abstracts

Context: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been known to produce various clinical gastrointestinal side effects and histopathologic changes. It has been reported that NSAID usage is associated with isolated colitis in the periappendiceal orifice region. This study aimed to further evaluate the clinicopathologic features of 16 patients with isolated colitis limited to the cecum or periappendiceal orifice region.

Design: A retrospective review was performed on biopsy specimens from 16 patients with histologically proven colitis (focal active colitis with no chronicity) limited to the cecum or periappendiceal orifice. No significant pathologic changes in the terminal ileum or other parts of the …

Validation Of A Whole Genome Methylation Profiling Classifier For Central Nervous System Tumors, Lucas Santana-Santos, Kwok Ling Kam, David Dittman, Stephanie De Vito, Matthew Mccord, Pouya Jamshidi, Hailie Fowler, Xinkun Wang, Alan Aalsburg, Daniel Brat, Craig Horbinski, Lawrence Jennings

Conference Presentation Abstracts

Whole genome methylation profiling is proving to be an incredibly powerful tool to diagnose tumors that are otherwise difficult to classify by histopathology and sequencing. The reference library of tumor DNA methylation data, using a machine learning-based tumor classifier, was developed by the German Cancer Research Network (DKFZ), and is available publicly on a research basis. However, medical institutions desiring to implement that classifier for routine clinical care need to import, adapt, and validate the classifier internally. We did this for our own DNA methylation-based classifier of central nervous system (CNS) tumors, using the same training and validation datasets as …

A Rare Case Of Segmental Arterial Mediolysis, Ashbina Pokharel, Lauren Reinhold, Ashbita Pokharel, Judith Bateman

Conference Presentation Abstracts

Segmental arterial mediolysis (SAM) is a rare vasculopathy of unknown etiology characterized by disruption of the arterial layer, which can result in vessel dissection, hemorrhage and ischemia. Literature review has demonstrated a varied presentation ranging from benign abdominal pain to life threatening hemorrhage. We report a case of 58 year old female with past medical history of deep vein thrombosis/pulmonary embolism secondary to Protein C and S deficiency on Coumadin who presented with right flank pain for 3 days. Complete blood count and complete metabolic panel were within normal limits. CT scan of abdomen and MRI showed ischemia of segment …

Anti-Nmda-Receptor Encephalitis In A Patient With Ovarian Teratoma, Harboring Brain Histology Of Varying Developmental Stages, Seyedalireza Fatemi, Joseph Fullmer

Conference Presentation Abstracts

Anti-NMDA-receptor encephalitis is a subacute, autoimmune disorder thought to be caused by autoantibodies directed against the N-methyl-D-aspartate (NMDA) receptor. Although NMDAR encephalitis is a familiar entity to psychiatrists and neurologists, it is less commonly reported in the pathology literature. Clinical symptoms of anti-NMDAR encephalitis may mimic schizophrenia and psychotic spectrum disorders or substance-induced psychosis. Although initially described in association with ovarian teratomas in women, anti-NMDAR encephalitis has been reported in individuals without paraneoplastic association, as well as in males. Previous literature has suggested NMDA receptor expressing teratoma neurons are densely aggregated and are smaller in size. Ki-67 index can be …

Myeloperoxidase (Mpo) Immunostaining Can Identify Endothelial Injury Of Peritubular Capillaries And Glomeruli In Renal Antibody Mediated Rejection, Olabisi Afolayan-Oloye, Megan Moore, Wei Li, Hassan Kanaan, Ping Zhang

Conference Presentation Abstracts

Background: C4d positive staining in peritubular capillaries (PTC) of renal grafts has been used as a marker to support antibody mediated rejection (AMR), if there are morphologic changes of AMR and the renal recipient has positive donor specific antibody. But it is not clear if the C4d staining is related to any peritubular and glomerular injury during AMR. As injured endothelial cells can uptake the MPO into the endothelial cells, we used MPO immunostaining to highlight glomerular endothelial injury in crescentic glomerulonephritis previously. The goal of this study was to determine if there was an endothelial injury of PTC and …

Proteinuria In Thrombotic Microangiopathy (Tma) Can Be Associated With Adaptive Partial Podocytopathy With Focal Podocyte Hyperplasia, Megan Moore, Olabisi Afolayan-Oloye, Wei Li, Hassan Kanaan, Ping Zhang

Conference Presentation Abstracts

Background: TMA associated renal failure is easy to understand, but it has been difficult to explain the significant proteinuria in some cases of TMA. We recently confirmed that 100% of hyperplastic podocytes in collapsing glomerulopathy stained positively for CD133 (a stem cell/progenitor marker) as previously reported. The goal of this study was to determine if there was significant fusion of foot processes (FFP) and CD133-positive hyperplastic podocytes in TMA to correlate with the proteinuria. Design: The study included 12 negative controls (renal parenchyma away from renal cell carcinoma) and 25 TMA cases, either induced by drugs or due to other …

A Soft Tissue Tumor With Eml4-Alk Fusion, Granular Cell Changes, Metastasis, And Response To Kinase Inhibitor Therapy In A Young Girl, Zhenhong Qu, Chris Hysell, Ping Zhang, Mark Micale

Conference Presentation Abstracts

Background: An increasing number of soft tissue neoplasms with fusion of well-defined driver genes are being discovered. We report such a case in a 3-year-old girl with a 2-year follow-up. Design: The patient first presented at age of 3.5 years with a painless right axillary/chest wall mass without constitutional symptoms. MRI demonstrated a 4.5 x 3.5 x 3.5 cm T2 hyper- and T1 hypointense mass. The mass was excised and showed a well-demarcated solid lesion with a homogeneous pale-white fleshy cut surface. No necrosis, myxoid or cystic change, hemorrhage, or calcification was noted. Microscopically, it was a variably hypercellular lesion …

Proteinuria In Thrombotic Microangiopathy (Tma) Can Be Associated With Adaptive Partial Podocytopathy With Focal Podocyte Hyperplasia, Megan Moore, Olabisi Afaolayan-Oloye, Wei Li, Hassan Kanaan, Ping Zhang

Conference Presentation Abstracts

Background: TMA associated renal failure is easy to understand, but it has been difficult to explain the significant proteinuria in some cases of TMA. We recently confirmed that 100% of hyperplastic podocytes in collapsing glomerulopathy stained positively for CD133 (a stem cell/progenitor marker) as previously reported. The goal of this study was to determine if there was significant fusion of foot processes (FFP) and CD133-positive hyperplastic podocytes in TMA to correlate with the proteinuria. Design: The study included 12 negative controls (renal parenchyma away from renal cell carcinoma) and 25 TMA cases, either induced by drugs or due to other …

A Soft Tissue Tumor With Eml4-Alk Fusion, Granular Cell Changes, Metastasis, And Response To Kinase Inhibitor Therapy In A Young Girl, Zhenhong Qu, Chris Hysell, Ping Zhang, Mark Micale

Conference Presentation Abstracts

Background: An increasing number of soft tissue neoplasms with fusion of well-defined driver genes are being discovered. We report such a case in a 3-year-old girl with a 2-year follow-up. Design: The patient first presented at age of 3.5 years with a painless right axillary/chest wall mass without constitutional symptoms. MRI demonstrated a 4.5 x 3.5 x 3.5 cm T2 hyper- and T1 hypointense mass. The mass was excised and showed a well-demarcated solid lesion with a homogeneous pale-white fleshy cut surface. No necrosis, myxoid or cystic change, hemorrhage, or calcification was noted. Microscopically, it was a variably hypercellular lesion …

Final Counts Of Monoclonal Gammopathy Of Renal Significance (Mgrs) After Bone Marrow Biopsies (Bmb) And Follow-Up, Brandon Metcalf, James Zhiyan Huang, Wei Li, Hassan Kanaan, Ping Zhang

Conference Presentation Abstracts

Background: MGRS is a relatively new concept for patients with renal paraprotein deposition (RPD) (except monoclonal cast nephropathy) with no bone marrow confirmed diagnosis of malignancy or premalignancy (< 10% monoclonal plasma cells). This concept has been used as a reason for a nephrology consult for a bone marrow biopsy (BMB), therefore it is important to evaluate the outcome of MGRS tentatively diagnosed via renal biopsy and confirmed by BMB. This study’s purpose was to identify what percentage of various subtypes of MGRS tentatively diagnosed via renal biopsy can be confirmed as MGRS by BMB and followup. Design: In total, 124 renal biopsies with variants of RPD were identified at our center out of 3811 renal biopsies (3.3% of overall cases) over past 10 years. Biopsy cases with known Myeloma, B Cell Lymphoma or Monoclonal Cast Nephropathy were separated as a heavy burden group. The remaining biopsies with RPD were considered as tentative MGRS diagnoses. Their BMB and clinical indices were followed up to determine the percent that resulted in a confirmed MGRS diagnosis. Results: Among the 124 renal paraprotein deposition cases, 43 cases (34.7%) were categorized to the heavy burden group (Figure). The remaining 81 cases with other variants of RPD were further divided into four categories based on the follow-up. Myeloma or Lymphoma were found in 34 cases (27.4%). Twelve outside consultation cases (10%) did not show follow-up biopsies as we were unable to obtain record access. BMB’s diagnosed as nonmalignant (6 cases, 4.8%) or premalignant (29 cases, 23.4%) were confirmed to be MGRS for a total of 35 cases (28.2%). Among the different categories of tentative MGRS, Monoclonal Light/Heavy Chain Deposition Diseases (L/HCDD) had the highest positivity rate for myeloma on the subsequent BMB. Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposition (PGNMID) had a high rate of nonmalignant or premalignant diagnosis by BMB. Monoclonal Amyloidosis had some nonmalignant and pre-malignant diagnoses after BMB although myeloma was associated with this renal entity. Conclusions: The data indicate that BMB is crucial for confirming a diagnosis of MGRS. The study also provides pathologists and clinicians with general expectations regarding the possible BMB outcome for the many variants of MGRS identified tentatively via renal biopsy.

Final Counts Of Monoclonal Gammopathy Of Renal Significance (Mgrs) After Bone Marrow Biopsies (Bmb) And Follow-Up, Brandon Metcalf, James Zhiyan Huang, Wei Li, Hassan Kanaan, Ping Zhang

Conference Presentation Abstracts

Background: MGRS is a relatively new concept for patients with renal paraprotein deposition (RPD) (except monoclonal cast nephropathy) with no bone marrow confirmed diagnosis of malignancy or premalignancy (< 10% monoclonal plasma cells). This concept has been used as a reason for a nephrology consult for a bone marrow biopsy (BMB), therefore it is important to evaluate the outcome of MGRS tentatively diagnosed via renal biopsy and confirmed by BMB. This study’s purpose was to identify what percentage of various subtypes of MGRS tentatively diagnosed via renal biopsy can be confirmed as MGRS by BMB and followup. Design: In total, 124 renal biopsies with variants of RPD were identified at our center out of 3811 renal biopsies (3.3% of overall cases) over past 10 years. Biopsy cases with known Myeloma, B Cell Lymphoma or Monoclonal Cast Nephropathy were separated as a heavy burden group. The remaining biopsies with RPD were considered as tentative MGRS diagnoses. Their BMB and clinical indices were followed up to determine the percent that resulted in a confirmed MGRS diagnosis. Results: Among the 124 renal paraprotein deposition cases, 43 cases (34.7%) were categorized to the heavy burden group (Figure). The remaining 81 cases with other variants of RPD were further divided into four categories based on the follow-up. Myeloma or Lymphoma were found in 34 cases (27.4%). Twelve outside consultation cases (10%) did not show follow-up biopsies as we were unable to obtain record access. BMB’s diagnosed as nonmalignant (6 cases, 4.8%) or premalignant (29 cases, 23.4%) were confirmed to be MGRS for a total of 35 cases (28.2%). Among the different categories of tentative MGRS, Monoclonal Light/Heavy Chain Deposition Diseases (L/HCDD) had the highest positivity rate for myeloma on the subsequent BMB. Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposition (PGNMID) had a high rate of nonmalignant or premalignant diagnosis by BMB. Monoclonal Amyloidosis had some nonmalignant and pre-malignant diagnoses after BMB although myeloma was associated with this renal entity. Conclusions: The data indicate that BMB is crucial for confirming a diagnosis of MGRS. The study also provides pathologists and clinicians with general expectations regarding the possible BMB outcome for the many variants of MGRS identified tentatively via renal biopsy.