Pathology Commons^™

Epidemiology And Microbiology Of Admission Surveillance Nasal Swabs In A Level Iv Neonatal Intensive Care Unit (Nicu) And Their Association With Subsequent Infections ​, Kedar Tilak, Neena Kanwar, Rangaraj Selvarangan, Venkatesh Sampath

Posters

Background Newborns, especially preterm infants, are highly susceptible to sepsis, a major cause of neonatal morbidity and mortality. Known risk factors include prematurity, low birth weight, prolonged NICU stay, and use of central venous catheters. The link between early nasal colonization (within the first week of life) and later infections is unclear. Although many NICUs screen for Staphylococcus aureus using nasal swabs, the predictive value of early colonization by other Gram-positive and Gram-negative bacteria is not well understood. In our NICU, admission nasal swabs were sent for aerobic cultures to detect these organisms, highlighting the need for further research into …

Steatotic Mass Secondary To Heterozygous Hemochromatosis, A Rare Case Of Biliary Obstruction, Saddam Zaidi Md, Cheng-Hung Tai, Joanna Gibson Md, Phd, Caroline Loeser

Posters

Heterozygous Hemochromatosis (HH) is a genetic disorder that increases iron absorption. Carriers of the C282Y HFE gene mutation have a higher risk of developing nonalcoholic fatty liver disease (NAFLD). Research indicates a significant association between liver fat accumulation (steatosis) and fibrosis in HH. This case involves a 31-year-old male with HH and an uncommon biliary obstruction caused by focal fat infiltration.

Amyloidosis: A Rare Cause Of Pan-Dysmotility, Rofinna Johnkennedy Md, Mph, Cheng-Hung Tai, Alexa Plato Md, Department Of Medicine,

Posters

Amyloidosis is a rare systemic infiltrative disease, with a prevalence estimated to be 6-10 cases per million person-years. It involves the extracellular deposition of beta-sheet fibrillar protein and can manifest in any organ system in the body. Diagnosis of gastrointestinal involvement of amyloidosis can be difficult, given its nonspecific symptoms including abdominal pain, nausea, dysphagia, and diarrhea.

The Severity Of Obstructing Tubulopathy Is Often Associated With Foci Of Renal Tubular Obstruction, Ping L. Zhang, Hassan D. Kanaan, Wei Li

Posters

Etiologies of renal failure due to renal tubular injury may result from either ischemic/toxic injury of proximal tubules (ATN), variants of interstitial nephritis or obstructing tubulopathy by the luminal blocking of either monoclonal casts, uric acid or calcified deposits. Our previous studies indicate that the polarizable semi-transparent calcium oxalate deposits block proximal tubules, whereas monoclonal casts, uric acid deposits and bluish calcium phosphates block the distal tubules. We hypothesized that the serum creatinine (SCr) levels and the number of tubular obstructing deposits were correlated so that pathologic identification of obstructing foci can be predictable for the extent of renal dysfunction.

Grading And Follow-Up Of T Lymphocyte-Mediated Acute Interstitial Nephritis Following Checkpoint Inhibitor Therapy, Ping L. Zhang, Wei Li, Hassan D. Kanaan

Posters

Immuno-check point inhibitors (CPI) such as PD-1/PD-L1 inhibitors have been used to treat a variety of metastatic carcinoma with positive effects. However, there are complications such as gastrointestinal, hepatic and endocrine symptoms and kidney dysfunction. We describe our experience with CPI-associated acute interstitial nephritis (AIN).

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

Posters

This study evaluated the efficacy of ChatGPT, an AI powered language model (1), in retrieving drug information for pathology practice compared to UpToDate. The research focused on 160 commonly prescribed drugs, assessing the speed and accuracy of information retrieval. Results showed that ChatGPT efficiently provided indications and side effects of multiple drugs in batches within seconds, comparable to UpToDate's information but remarkably faster (2). The study suggests that ChatGPT is a promising valuable tool to help pathologists in accessing drug information, potentially improving diagnostic accuracy and work efficiency

Optimize Artificial Intelligence Language Model Use In Medical Board Exams: Insights From Instruction Quality And Domain Context Analysis, Zhenhong Qu, Mai Elzieny, Kanika Arora

Posters

Artificial intelligence language models (AI-LMs) show promise in medical education and clinical problem solving, but their performance in medical board exams has been inconsistent (1,2,3).

This study investigated how prompt engineering and providing essential reference material influence AI-LM performance on board exam questions.

We tested ChatGPT and Claude-2 on 360 questions in various formats under three conditions: simple prompt, elaborate CRAFTS prompt, and CRAFTS prompt with references (CRAFTS stands for context, role, action, format, tone, and style).

Results showed significant improvement in accuracy from simple prompts (67-83.5%) to CRAFTS prompts (76.2-92.5%) to CRAFTS prompts with references (97.3- 99.4%)

These findings …

Cd21 Stains Dendritic Networks In Tertiary Lymphoid Structure Of Transplant Renal Biopsies To Avoid Misdiagnosis Of Borderline Changes, Brandon D. Metcalf, Wei Li, Hassan Kanaan, Ping L. Zhang

Posters

Tertiary Lymphoid Structures (TLS) have been described as germinal center-like lymphoid structures composed dendritic network, mixed lymphocytes and high endothelial venules in internal organs following primary lymphoid organs (thymus and spleen) and secondary lymphoid structures (lymph nodes and native lymphoid structures along GI tract).

The TLS is mainly located at peri-glomeruli, peri-vascular areas or renal pelvis following inflammatory insults. A recent study indicates that TLS can been seen up to 19 % of protocol transplant renal biopsies (TRB) (JASN, 2022;33:186-200).

We hypothesize that CD21 staining can identify dendritic cells of TLS so that borderline changes are not over-diagnosed.

A Rare Case Of A Giant Cell Tumor Of The Peroneal Tendon Sheath, Francois M. Lokenye Dpm, Breana Marine Dpm, Orlexia Thomas Dpm, Mariam Kamil Bs

Posters

This case report discusses a 31-year-old male with TGCT in the peroneal tendon sheath, detailing clinical and radiological features.

his study explores the surgical interventions, diagnostic challenges, treatment options, and outcomes of TGCT, emphasizing its consideration in the differential diagnoses of painful foot and ankle masses.

Effect Of Comorbidities And Choice Of Treatment On Overall Survival In Elderly Patients With Acute Myeloid Leukemia: A Beaumont Experience, Bilal M. Ali, Emma Herrman, James Huang Huang, Mohammad Muhsin Chisti

Posters

First line therapy for Acute Myeloid Leukemia (AML) is 7+3 regimen. It often cannot be used in elderly patients due to intensity. Venetoclax + hypomethylating agent (HMA) is approved for AML treatment in these patients. We investigate the efficacy of this treatment in a community setting where patients do not have the same resources available to them as a large academic center. Primary outcome was survival of patients greater than 60 years of age with a diagnosis of AML who received 7+3 therapy versus those who received venetoclax + HMA. Secondary outcomes included characteristics of those who received the two …

Case Report: Autoimmune Anemia And Thrombocytopenia Following Hematopoietic Stem Cell Transplant, Thomas Cochran, Gabor Oroszi, Nancy Terwilliger, Gabe Metzler, Lejla Music Aplenc

Posters

Background: Autoimmune cytopenias (AIC) post hematopoietic stem cell transplant (HSCT) are rare but exceptionally challenging complications. Here, we report anti E, warm autoimmune hemolytic anemia (WAIHA), cold autoantibody, polyagglutination and immune thrombocytopenia in a 5-year-old boy with a history of chronic granulomatous disease, who underwent an ABO incompatible, mismatched (9/10) unrelated HSCT. Study design: Case report. Four months after HSCT, the patient was admitted for fever, fatigue, and decreased appetite. His original blood type was O+ and donor’s blood type B+. Prior to the admission he was transfused with 2 doses of red cells and 2 doses of platelets. On …

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Frequency, Resistance And Antimicrobial Use, Edward Lyon, Jennifer Goldman, Brian Lee, Margaret Campbell, Rangaraj Selvarangan, Elizabeth Monsees

Posters

Background: Tracheal aspirates (TA) are frequently obtained in the pediatric intensive care unit (PICU); however, no data exists on the frequency or clinical management of multiple TA cultures on the same PICU patient. In this study, we describe the frequency of repeat TAs in PICU patients, the emergence of multidrug resistant organisms (MDRO), frequently cultured pathogens of TAs, and associated antibiotic prescribing patterns. Methods: We identified 70 PICU patients between 2018-2019 who met our criteria for retrospective chart review with ≥2 TAs obtained during their hospitalization. The following information was collected: patient demographics, number of TAs per patient, microbiology with …

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

Posters

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

Association Of Isolated Colitis With Non-Steroidal Anti-Inflammatory Drugs Usage, Ashbita Pokharel, Wei Li

Posters

Non-steroidal anti-inflammatory drugs (NSAIDs) have been known to produce various clinical gastrointestinal side-effects and histopathological changes. It has been reported that NSAIDs usage is associated with isolated colitis in periappendiceal orifice region. This study aims to further evaluate the clinicopathologic features of 16 patients with isolated colitis limited to the cecum or peri-appendiceal orifice region.

Cd30 Expression In Cutaneous B-Cell Lymphomas, Olabisi Afolayan-Oloye, Lili Zhao, Trilokraj Tejasvi, May P. Chan, Paul W. Harms, Douglas R. Fullen, Ryan A. Wilcox, Alexandra C. Hristov

Posters

CD30 expression has been infrequently described in cutaneous B-cell lymphomas (CBCL). We examined CD30 expression in reactive lymphoid hyperplasia (RLH) and CBCL and correlated expression with clinicopathologic features.

Characterization Of The Clinical Impact Of A Celiac Disease Algorithm On Diagnostic Workup Of Patients At Beaumont Hospital Royal Oak, Omid Vadpey, Gabriel N. Maine

Posters

INTRODUCTION
Advancements in medical technology and laboratory testing have prompted room for more accurate diagnostic procedures that can aid in diagnostic efficiency, reducing time to diagnosis, unnecessary test ordering, and costs. Celiac Disease is a complex gastrointestinal autoimmune disorder characterized by symptoms that mimic other bowel diseases, such as diarrhea, steatorrhea, and malnutrition. The primary goal of this pilot study is to determine if the implementation of a diagnostic serologic algorithm differs from the current standard of practice for patients that are suspected of celiac disease at Beaumont Health-Royal Oak (BH-RO).

Csf Flow Cytometry In Patients With Leukemia And Lymphoma, Patricia Rusli, James Huang

Posters

INTRODUCTION
The use of flow cytometric testing in analyzing bodily fluid for hematologic neoplasms is not novel. Flow cytometric immunophenotyping of cerebrospinal fluid (CSF) has previously been demonstrated to have high sensitivity and specificity for the detection of lymphoma and leukemia. They are able to determine definitive diagnostic information from even very low cellularity samples. In this study, we reviewed the experience of our clinical flow cytometry laboratory in evaluating CSF specimens in order to find the disease distribution of positive CSF samples.

Characterization Of Cd57+ T-Cell Subset In Blood, Bone Marrow, And Lymphoid Tissue, Michelle Ka Yan Wu, Xia Chen, James Huang

Posters

INTRODUCTION
A CD57+ T-cell subset has shown to have diagnostic and prognostic significances in some cancers. However, its specific distributions in tissues and specific variations among different diseases are yet to be further defined. This Embark project aims to examine the distributions and antigen expression profiles in the CD57+ T-cell subset in peripheral blood (PB), bone marrow (BM), and lymph node (LN).

Identification Of Aggressive Variants Of Mantle Cell Lymphoma Based On Flow Cytometry, Alan Nguyen, Alia Gupta, Marc Smith, James Huang

Posters

INTRODUCTION
Mantle cell lymphoma (MCL) is a rare subtype of B-cell non-Hodgkin lymphoma characterized by a (1,14) translocation resulting in overexpression of cyclin D1.1 MCL variants and a heterogenous disease presentation make this a challenging diagnosis with a highly variable outcome. Pleomorphic and blastic variants have an aggressive clinical course and shorter survival than the classical type.2 The pleomorphic variant shows a marked variation in nuclear size, shape, and mitotic index.3 The blastic variant appears small and immature with fine chromatin mimicking acute leukemia.3 The aim of our study is to explore if flow cytometry analysis can help with the …

A Deleterious Ephb4 Mutation Suppresses Prox1 Expression And Disrupts Lymphatic Development In Neonatal Non-Immune Hydrops, Gangaram Akangire, Heather Menden, Sheng Xia, Atif Ahmed, Venkatesh Sampath

Posters

Background: Non-immune hydrops fetalis is often a fatal condition and in 20% of cases related to lymphatic anomalies. Maldevelopment of lymphatic valves, atretic or absence of central lymphatic vessels has been described in hydrops fetalis, but the genetic basis of these anomalies remains undefined. Recent reports suggest that Ephrin type B receptor 4 (EPHB4) gene has a significant role in embryonic development of lymphatic system. To test the hypothesis that EPHB4 mutations can cause hydrops fetalis, we combined whole exome sequencing (WES) with functional and pathological analysis of an infant who succumbed to neonatal hydrops.


Objective: To discover the possible …

Development And Interim Analysis Of A Cystic Fibrosis-Specific Antibiogram, Claire Elson, Ellen Meier, Douglas Swanson, Rangaraj Selvarangan, Megan Gripka, Christopher M. Oermann

Posters

Antimicrobial therapy is essential to treat cystic fibrosis (CF) lung infections. Empiric antimicrobial selection is generally based on previous culture information and, if available, an institution-specific antibiogram (ABGM). Most institutions antibiograms exclude cultures from individuals with cystic fibrosis, imposing challenges with empiric antimicrobial selection and monitoring susceptibility patterns over time. A cystic fibrosis-specific antibiogram may help drive population-specific antimicrobial selection and improve antimicrobial stewardship.

Assessment And Improvement Of Data Collection Errors Through Inter-Departmental Collaboration, Charlott Williams, Kelli L. Behr, Mary Moffatt, Rangaraj Selvarangan

Posters

Specific Aims:

1. To maintain the ED team's high rate of accuracy in data collection
2. To begin team participation in corrective action planning
3. To improve interdepartmental problem solving

Conclusion

Open communication about errors among all collaborating departments, combing with a shared approach to solving them:

• improved morale and perception of error tracking by the team
• led to a decrease in errors overall, and
• increased interdepartmental collaboration

When all members of the interdepartmental team work together with a positive approach to corrective action, improvement in error rates is a natural outcome of the solutions derived.

Neuroblastoma In Adolescents And Children Older Than 10 Years: Unusual Clinicopathologic And Biologic Features, Laura Mccarthy, Katherine Chastain, Terrie Flatt, Eugenio Taboada, Robert E. Garola, John Herriges, Linda D. Cooley, Atif Ahmed

Posters

This poster describes four cases of neuroblastoma diagnosed since 2008 in children greater than 10 years and presents their clinical, histologic and biologic features, emphasizing unusual clinicopathologic characteristics and the role of DNA microarray analysis and Next Generation Sequencing in their management.

Oxcarbazepine Overdose In A Polysubstance Related Suicide, Melissa Beals, Robert J. Krumsick, C. Clinton Frazee Iii, Lindsey J. Haldiman, Uttam Garg

Posters

Introduction
Oxcarbazepine is a derivative of carbamazepine that is used primarily in the treatment of epilepsy, and experimentally as a mood-stabilizer in adjunctive therapy for the treatment of bipolar disorder. Oxcarbazepine is converted through oxidation to its pharmacologically active metabolite 10-OH-Carbazepine, which is thought to be responsible for most of the anticonvulsant action of the drug. Adverse effects of oxcarbazepine are generally dose-dependent and may include fatigue, somnolence, dizziness, diplopia, nystagmus, and ataxia. Additive sedative effects have been noted when oxcarbazepine is used in combination with other CNS depressionproducing medications. Furthermore, oxcarbazepine and 10-OH-Carbazepine are powerful CYP2C19 inhibitors, potentially increasing …

Review Of Karyotypic Data From Low Grade Glial Brain Tumors, Specifically Pilocytic Astrocytomas, And Correlation Of Genetic Aberrations With Tumor Recurrence., Linda D. Cooley, Scott C. Smith, Lisa Warren, Melissa Gener, Kevin Ginn, John Herriges

Posters

Abstract: Brain tumors are the most common solid tumor of childhood. Approximately 50% of pediatric CNS tumors are low grade gliomas (WHO grade I or II) and Pilocytic astrocytoma (PA) is the most common accounting for 33% of all gliomas in children 0-14 years and ~18% of all childhood brain tumors. Prognosis with this slow-growing tumor is excellent; 10 year overall survival of ~95%. However, event free survival averages ~50%. Patient age and extent of tumor resection are key prognostic factors; tumor location and size impact resection and outcome. Histopathological features indicate PA is a benign tumor and rarely are …

Implementing Daily Management System Huddle Boards To Improve Communication Across Satellite Laboratories, Sean Tucker

Posters

Background

In a laboratory setting with fast-paced changes and heavy demands on staff, day-to-day communication across departments is challenging, yet paramount to resource sharing and real-time problem solving. Children’s Mercy Hospital Kansas City (CMH) has implemented system-wide lean practices focused on clinical and operational excellence. Our laboratory mission, or True North, is to produce clinically relevant laboratory results and information to assist in the diagnosis, treatment and prognosis of patients in a timely manner, by: �� Reducing Errors – Pre-analytical, Analytical & Post-analytical �� Making encounters with the laboratory extraordinary �� Reducing turnaround times �� Maximizing employee engagement and productivity …

Reducing Discard Blood Draw Volumes From Subcutaneously Implanted Ports (Port) In Patients With End Stage Renal Disease (Esrd), Uttam Garg, Tyson Moore, Renita Trujillo, Penny Monachino, Amy Wiebold, Angela Ferguson, Gabor Oroszi, Vimal Chadha

Posters

Background
•To monitor clinical status, dialysis and transplant patients with ESRD frequently require blood draws.
•To preserve their veins and to avoid frequent intravenous access, these patients, especially young children, require PORT placement.
•The PORT is flushed with saline and filled with heparinized saline to prevent blood clotting between blood draws.
•To avoid contamination from PORT fluids, a fixed amount of blood is withdrawn and discarded before the blood sample is drawn for laboratory analyses. Currently, the recommended discard blood volume is 5 mL (five times the reservoir volume of most PORTs and attached catheters.)
•The volume of discarded blood …

Significant Loss Of Blood Amino Acids And Free Carnitine In Newborns Receiving Continuous Renal Replacement Therapy (Crrt), Uttam Garg, Marita Thompson, Bradley A. Warady, Vimal Chadha

Posters

Background

•Newborns with acute kidney injury (AKI) or end-stage kidney disease (ESKD) often receive prolonged CRRT when the early initiation of peritoneal dialysis is either contraindicated or unable to be performed. •These patients often receive total parenteral nutrition (TPN) to meet their nutritional goals. •Little to no information exists on the loss of blood amino acids (AA) and carnitine during CRRT in these patients. •The objective of this study was to determine the amino acids and carnitine losses in newborns receiving prolonged CRRT and TPN. Material and Methods

•Three newborns who received prolonged (> 2 weeks) CRRT and TPN were …

An Expanded Role For Nurses In Laboratory Utilization, Marilyn S. Hamilton, Rangaraj Selvarangan, Michele Fix, Lynn E. Shriver

Posters

Introduction: The majority of laboratory testing errors occur in the pre-analytical stage, including specimen collection. Children provide special challenges including small blood volumes, small veins, and an inability to cooperate. We describe collaboration between laboratorians and nursing staff to improve specimen collection and the reliability of test results.

Methods: We identified three areas for improvement: 1) Volume of blood for culture, 2) Urine collection, and 3) Appropriate blood collection through a line. Base line data was established. Guidelines for specimen collection were updated. Nurse members of the Laboratory Utilization Committee developed educational tools.

Results: Nursing education was effective at improving …

Hematuria Without Microalbuminuria, Angela Ferguson, Vimal Chadha, Amy Wiebold, Uttam Garg

Posters

Background

Microabubiminuria is a condition in which small amounts of albumin are excreted in the urine without overt nephropathy. Based on the

American Diabetic Association classification, microalbuminuria is defined as urinary excretion of albumin of 30–300 mg per 24 hours or 20–200 mcg/min or 30–300 mcg/mg creatinine. Various conditions such as diabetes, hypertension, and impaired renal tubular reabsorption can lead to microalbuminuria. Microalbuminuria is an indicator and predictor of the development of overt nephropathy. If identified and treated early, overt nephropathy can be prevented and averted. Proteinuria and hematuria are the two most common urinary abnormalities encountered during routine urinalysis. …