Pathology Commons^™

A Rare Case Of Lenalidomide Associated B Cell Lymphoblastic Leukemia, Yagnapriya Ammakola, Nitya Batra, Ashbita Pokharel, Ishmael Jaiyesimi

Conference Presentation Abstracts

Introduction Autologous stem cell transplantation followed by maintenance with Lenalidomide has improved the overall survival and progression free survival in patients with Multiple Myeloma. However, maintenance therapy with Lenalidomide can increase the risk of several hematological adverse events including secondary B cell lymphoblastic leukemia. We present a case of 61 year old female who was previously treated for multiple myeloma and on maintenance Lenalidomide developed B lymphoblastic leukemia/lymphoma. Case presentation A 61 year old female initially presented with left sided hip pain and lower back pain in 2018.Chest X ray revealed mass like opacity in the left upper lobe and …

Orbital Perivascular Epithelioid Cell Neoplasm (Pecoma): A Case Report And Systematic Review, Jane Spadaro, Christopher Hysell, Robert Folberg, Alon Kahana

Conference Presentation Abstracts

No abstract provided.

Quantitative Evaluation Of Gantry Rotation Perturbation Effects On Spot-Scanning Arc Therapy (Sparc), Peilin Liu, Lewei Zhao, Gang Liu, Xiaoda Cong, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To quantitatively assess the impact of random gantry rotation perturbations on spot-scanning arc (SPArc) therapy.

Methods:

To simulate random gantry rotation perturbations, the initial gantry angle of SPArc treatment plans was modified using an in-house script. Four cases from different disease sites include brain, lung, liver and prostate were selected to evaluate. Original SPArc plans (SPArc_org) were developed through iterative processes, including control point re-sampling, redistribution of control points & energy layers, energy layer filtration, and re-sampling. Considering potential limitations, rotation perturbations of 1mm and 2mm were applied to al SPArc_org plans to generate perturbed SPArc …

A Wide Range Of Fusions And Alterations Are Detected In Myb- Or Mybl1- Altered Gliomas, S Rajan, Z Abdullaev, H Lidov, Y Wilson, D Thomas, Joseph Fullmer, K Jones, D Brown, P Kobalka, A Buckley

Conference Presentation Abstracts

Background: Diffuse astrocytoma, MYB- or MYBL1-altered are rare pediatric low-grade gliomas, reported in young adults that are often associated with refractory seizures and generally located in the supratentorial compartment. While GFAP is consistently expressed, interestingly OLIG2 expression (another glial marker) is not a common finding. Here we describe the various associated genetic alterations. Methods: Fourteen cases matching to methylation class (MC), Diffuse astrocytoma, MYB- or MYBL1-altered, were analyzed for structural variants/fusion partners. Results: The median age was 16 years (range 1-64), with male: female ratio of 1:1. All but one was supratentorial (one located in pons). On histology, some showed …

Erdheim-Chester Disease Presenting In The Foramen Magnum With Mass Effect Of A 39-Year-Old Male, Joseph Fullmer, Brandon Metcalf, Casey Schukow

Conference Presentation Abstracts

Background: Erdheim-Chester disease (ECD) is a rare clonal histiocytosis neoplastic condition. This condition is characterized by a non-specific infiltration of foamy macrophages in multiple organs, such as the bone or skeletal system (>95%), retroperitoneum, kidneys, and heart, resulting in inappropriate inflammation, fibrosis, and multi-end organ dysfunction. central nervous system (CNS) is present in a minority of cases. This condition is extremely rare with only a few hundred cases reported in medical literature. Methods: We present a case of ECD in a 39-year-old male with past medical history for type-2 diabetes mellitus, neuropathy, and low testosterone on replacement therapy who …

A Rare Case Of Primary Sclerosing Pneumocytoma In A Healthy Female, Nitya Batra, Atulya Aman Khosla, Mohammad Muhsin Chisti, Vikash Jaiswal, Ashbita Pokharel

Conference Presentation Abstracts

Introduction: Pulmonary sclerosing pneumocytoma is a rare group of benign pulmonary neoplasms that usually affects older adults over 50 years of age . This neoplasm is more commonly seen in women, with female to male ratio of 5:1 and is predominantly seen in Asian ethnicities. These tumors originate from type II alveolar pneumocytes and are hence classified as adenoma under the 2021 World Health Organization (WHO) classification of tumors . They account for 3-5 percent of total benign lung tumors. One of the striking aspects of PSP is its clinical presentation, or rather the lack thereof in many cases. It …

Audit Tumor Reports In Pathology For Completeness And Compliance By An Artificial Intelligence Tool, Chatgpt, Ashbita Pokharel, Keran Zhao, Reenal Patel, Jack W. Qu, Zhenhong Qu

Conference Presentation Abstracts

Context: A tumor synoptic report (TSR) audit is an important quality control tool for compliance with reporting requirements; however, no simple audit tool is readily available to most pathologists. ChatGPT (https://chat.openai.com/chat) is an emerging artificial intelligence tool with wide applications. Its ability to extract data from text content has been widely reported but lacks evidence-based validation for its application in medicine. We assess the effectiveness of ChatGPT to identify and extract key data elements of TSRs and detect missing elements.

Design: Forty synoptic reports of malignant tumors of the lung, kidney, colon, and uterus were collected randomly. Key data elements …

Enhancing Pathology Report Analysis With Artificial Intelligence: A Validation Study Of Chatgpt's Effectiveness In 444 Cases, Zhenhong Qu, Megan Wang, Christian Santiago, Jack W. Qu, Ping Zhang

Conference Presentation Abstracts

Context: Despite years of efforts, the pathology report lacks standardization for its gross description. This inevitably leads to the occasional omission of key data elements, and difficulty to identify key elements in a lengthy unstructured report. A novel artificial intelligence (AI) tool, ChatGPT by OpenAI (San Francisco, California), was reportedly proficient in extracting keywords from text content. We assess the effectiveness of ChatGPT to quickly find multiple data elements in reports and detect missing data elements.

Design: Gross description of 444 pathology reports of several common organ types was submitted to ChatGPT (https://chat.openai.com/chat) that extracted and listed key data elements …

Serum Tests For Donor-Derived Cell-Free Dna Are Well Correlated With Renal Transplant Rejection In Renal Biopsies: Our Preliminary Experience Of New Surveillance For Monitoring Rejection, Reenal Patel, Brandon Metcalf, Dilip Samarapungavan, Hassan D. Kanaan, Wei Li, Sarah T. Suliman, Atul Singh, Ping L. Zhang

Conference Presentation Abstracts

Context: Noninvasive serum test for donor-derived cell-free DNA (dd-cfDNA) has been found useful for monitoring acute cellular rejection (ACR) and antibody-mediated rejection (AMR) since 2018, and the accepted threshold to indicate rejection is 1%. The goal of this pilot study was to determine if this test can correlate with renal biopsy results during a 1-year period when the dd-cfDNA test was initiated in our medical center.

Design: Renal transplant biopsies were evaluated for various rejection and nonrejection etiologies. Their corresponding dd-cfDNA percentages were identified. The biopsy data and dd-cfDNA results were correlated.

Results: During a year, we noticed a trend …

Renal Cell Carcinoma With Fibromyomatous Stroma Has A Distinctive Staining Pattern With Gata3 And Cd133 From Clear Cell Rcc And Clear Cell Papillary Rcc (Ccp-Rcc), Brandon Metcalf, Jining Feng, Leilei Chen, Vaishali Pansare, Ping L. Zhang

Conference Presentation Abstracts

Context: Renal cell carcinoma with fibromyomatous stroma (RCC-FMS) is a provisional entity of renal cell neoplasm that can be difficult to distinguish from low-grade clear cell RCC and clear cell papillary renal cell carcinoma (CCP-RCC) owing to its fibromyomatous stroma, low-grade nuclei, and clear cell cytoplasm.

Design: In this pilot study, we evaluated the utility of GATA3 and CD133 (a stem cell marker) as immunostain markers for the standard panel of cytokeratin 7 (CK7), CD10, and CAIX in distinguishing RCC-FMS from clear cell RCC and CCP-RCC. We stained 6 RCC-FMSs, 5 clear cell RCCs, and 5 CCP-RCC samples for all …

Igm-Dominant Immune Complex-Mediated Glomerulonephritis Should Be Classified As Membranoproliferative Glomerulonephritis, Igm Subtype, Sarang Khan, Brandon Metcalf, Wei Li, Hassan Kanaan, Ping L. Zhang

Conference Presentation Abstracts

Context: Immunoglobulin M (IgM) glomerulopathy usually presents as drug-resistant nephrotic syndrome and is characterized by diffuse effacement of foot processes and scattered mesangial IgM deposits, which is considered within the spectrum of minimal change disease and primary focal segmental glomerulosclerosis. However, IgM-dominant immune complex–mediated glomerulonephritis (IgM-ICMGN) is a rare renal entity and usually characterized by a membranoproliferative pattern with light microscopy; dominant IgM staining by immunofluorescent staining; and subendothelial, mesangial, and occasional subepithelial deposits by electron microscopy.

Design: We report our experience of 5 IgM-ICMGN cases with their pathologic phenotypes and clinical scenarios.

Results: Patient ages ranged from 47 to …

Monoclonal Immunoglobulin-Associated Glomerulopathy: Single Health Center Experience With 16 Cases, Brandon Metcalf, Yazan A. Al-Othman, James Huang, Wei Li, Hassan D. Kanaan, Ping L. Zhang

Conference Presentation Abstracts

Context: In addition to monoclonal cryoglobulinemic glomerulopathy, nonorganized monoclonal immunoglobulin (Ig) can deposit in glomeruli, causing either proliferative glomerulonephritis or membranous glomerulopathy. We present our experience related to this phenomenon.

Design: Sixteen cases of monoclonal immunoglobulin-associated glomerulopathy (MIAGN) from 14 patients were identified during the past 13 years and their pathologic and clinical features were collected and presented.

Results: One case of membranous glomerulopathy with monoclonal immunoglobulin deposits (MGNMID) (also called membranous glomerulopathy with light-chain–restricted deposits) was found. The patient was a 71-year-old woman with serum creatinine at 0.7 mg/dL and nephrotic syndrome (urine protein to creatinine ratio at 5.41), …

Malignant Tumors Arising From Adult Polycystic Kidney Disease, Yazan Al-Othman, Mai Elzieny, Christopher Thorburn, John D. Schwartz, Susan I. Daraiseh, Hassan D. Kanaan, Zhenhong H. Qu, Ping L. Zhang

Conference Presentation Abstracts

Context: The prevalence of renal tumors arising from adult polycystic kidney disease (APKD) has been rarely reported in the pathology literature. We report our findings of various renal tumors in APKD nephrectomy specimens.

Design: We searched our database for APKD during the past 11 years and identified various primary malignant tumors within the kidneys of APKD.

Results: Forty-eight nephrectomies with APKD were evaluated. Ten malignant tumors were identified in the APKD kidneys, indicating a prevalence of 20.8% (10/48; Table). These included 4 clear cell (CC) renal cell carcinomas (RCCs) ranging from 1 mm to 6.7 cm, 3 papillary RCCs …

Combined Smad4 And Imp3 Immunohistochemical Stains To Increase The Probability Of Diagnosing Pancreatic Adenocarcinomas In Fine-Needle Biopsies, Reenal Patel, Ashbita Pokharel, Ping L. Zhang, Zhenhong H. Qu

Conference Presentation Abstracts

Context: SMAD4 and IMP3 are useful stains in diagnosing pancreatic cancer but not perfect to reach that goal individually. We attempted to determine if using both SMAD4 and IMP3 can increase the diagnostic specificity of fine-needle biopsies (FNBs) for pancreatic adenocarcinomas, as FNBs often showed limited tissue for the morphologic evaluation.

Design: Fifteen FNBs with or without prior cytology were evaluated with both SMAD4 and IMP3 stains. Nuclear loss of SMAD4 was graded as 0 (no loss), 1–2+ (partial loss), and 3+ (total loss), whereas IMP3 was graded 0–3+ by staining intensity. Staining results were correlated with morphologic changes for …

Doac Therapy Associated With Macroscopic Hematuria: Investigation Of The Underlying Urologic Etiologies, Catherine Xie, Mary Wyrzykowski, Subhash Edupuganti, Ming Xie

Conference Presentation Abstracts

Context: Direct oral anticoagulants (DOACs) have gained wide use in prevention and treatment of thromboembolic diseases. Both major and nonmajor bleeding events have been reported. Hematuria is a common bleeding complication in patients receiving DOACs.

Design: This study retrospectively investigates the underlying urologic etiologies responsible for DOAC therapy–related macroscopic hematuria. During a 1-year period, hospitalized patients with prolonged PTT and DOAC therapy–related hemorrhage were identified. Medical chart review focused on urology consult and related laboratory and imaging findings.

Results: Among 93 patients with DOAC therapy–related hemorrhage, 15 had macroscopic hematuria (16%), including 11 men and 4 women with a median …

Using An Artificial Intelligence (Ai) Tool (Chatgpt) To Identify The Main Indications And Side Effects Of Drugs In Patient Medical Records, Mai Elzieny, Zhenhong Qu

Conference Presentation Abstracts

Context: Drug history is important clinical information for the correct histologic diagnosis of a wide variety of nonneoplastic diseases, such as hepatitis, gastritis, and colitis. As pathologists, however, keeping a strong knowledge of all drugs (and variations of drug names) can be challenging. Using online databases to find relevant drug information one at a time is very time-consuming.

Design: Sixty-seven drugs were collected from the medical records of 5 randomly selected patients. ChatGPT (https://chat.openai.com/chat) was instructed to identify (1) the main clinical indications, and (2) the major side effects of each drug, using the prompt “List the major indications and …

Evaluation Of A Novel Lupus Anticoagulant Assay Designed To Reduce False Positive Results Due To Anticoagulation: A Retrospective Study At A Single Health System, Jessica D. Anderson, Tamara Sabih, Yuying Xing, Lili Zhao, Marc D. Smith

Conference Presentation Abstracts

Introduction: Lupus anticoagulants (LA) are antibodies directed against phospholipids/phospholipid-protein complexes involved in coagulation and are associated with thrombotic events and recurrent fetal loss. There is no gold standard test for LA, therefore at least two LA-specific tests are recommended before excluding LA. Potential testing methods involve dilute Russell viper venom time (dRVVT) and hexagonal phase phospholipid assays (HPPA); however, many of these tests are susceptible to interference with anticoagulant therapy which can lead to false positive results. In this study, we compared the performance of our current HPPA, StaClot LA (SCLA), with a novel assay reported to have relatively minimal …

57 Yo Man With High Grade Astrocytoma With Piloid Features And 2 Other Cns Lesions, Joseph Fullmer

Conference Presentation Abstracts

Patient is a 57 yo man who presented with periodic headaches and lower back pain, initially attributed to lifting heavy weights but symptoms persisted. Eventual imaging was performed and revealed a 4 cm heterogeneously enhancing left cerebellar mass, 1 cm enhancing lateral right frontal subcortical lesion, and enhancing T12-L1 spinal cord lesion and multiple smaller spinal cord lesions suggestive of drop metastasis. The cerebellar lesion was first resected and final results, including methylome profiling, were consistent with high grade astrocytoma with piloid features (HGAP). The T12-L1 spinal lesion was later resected and had somewhat distinct histology although intraoperatively surgeon felt …

Rare Autoimmune Disease Caused By Not-So Rare Virus, Tiffany Marchewka, Acho Bernard, Molly Kempa, Kathryn Heal, Joseph M. Fullmer

Conference Presentation Abstracts

No abstract provided.

Injured Proximal Tubules Stain Positivity For Arginase-1 To Indicate Acute Tubular Injury (Ati), Jessica Anderson, Neal Blatt, Olabisi Afolayan-Oloye, Hassan Kanaan, Wei Li, Larysa Wickman, Ping Zhang

Conference Presentation Abstracts

Background: A recent study indicates that arginase-1 participates in M2 macrophage-mediated renal tubular regeneration in a rodent model (Shin et al. JASN 2022). As injured proximal tubule cells have a phagocytotic capacity (stain positively for CD68 and kidney injury moleucule-1 in previous studies), we hypothesized that the injured proximal tubules may stain positively for arginase1. Design: We analyzed PAS-stained renal biopsy sections for evidence of ATI using a semiquantitative scale: 0 (no injury) to 1-2+ (mild to moderate ATI) to 3+ (severe ATI). First group (N=7) consisted of renal biopsies that had no evidence of ATI or were obtained from …

Ultrastructural Findings Of Budding Ballooning Clusters Are Best Correlated With Punctate Autoimmune Antibodies Seen By Immunofluorescence In Minimal Change Disease, Vasudevan Mahalingam, Seyedalireza Fatemi, Wei Li, Hassan Kanaan, Ping Zhang

Conference Presentation Abstracts

Background: The etiology of minimal change disease (MCD) remains a mystery as the only hallmark findings are the diffuse effacement of foot processes by electron microscopy (EM). Punctate IgG staining floating outside of glomerular capillary loops have recently been identified as autoimmune antibodies against nephrin in podocytes from a set of MCD cases (Watts AJB et al., JASN 2022;33:238-252). The corresponding ultrastructural findings by EM, however, of the autoimmune antibodies are not yet described. We hypothesized that budding ballooning clusters (BBC) seen in EM may be correlated with the punctate IgG staining granules. Design: We identified 7 patients with MCD …

A Case Of Hereditary Hemorrhagic Telangiectasia With Juvenile Polyposis Syndrome Associated With Smad4 Mutation, Mai Elzieny, Ashbita Pokharel, Zhenhong Qu

Conference Presentation Abstracts

Background: Hereditary hemorrhagic telangiectasia (HHT), also called Osler–Weber–Rendu syndrome, is an autosomal dominant disease characterized by aberrant blood vessel development throughout the body that results in telangiectasias, arteriovenous malformations (AVMs), and arteriovenous fistulas. Pathogenic variants in multiple genes can cause HHT, with three major disease associated genes, one of which is SMAD4. HHT caused by mutations in SMAD4 is also associated with juvenile polyposis syndrome (JPS), a condition termed JPS-HHT. Histologic features of HHT polyps have not been well characterized other than their non-adenomatous nature. Here we attempt to characterize the histologic features of such polyps in this typical case …

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 …

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 …

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 …

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 …

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 …

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 …

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. …

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 …