Pathology Commons^™

Informing Healthcare Operations With Integrated Pathology, Clinical, And Epidemiology Data: Lessons From A Single Institution In Kenya During Covid-19 Waves, Allan Njau, Jemimah Kimeu, Jaimini Gohil, David Nganga

Pathology, East Africa

Pathology, clinical care teams, and public health experts often operate in silos. We hypothesized that large data sets from laboratories when integrated with other healthcare data can provide evidence that can be used to optimize planning for healthcare needs, often driven by health-seeking or delivery behavior. From the hospital information system, we extracted raw data from tests performed from 2019 to 2021, prescription drug usage, and admission patterns from pharmacy and nursing departments during the COVID-19 pandemic in Kenya (March 2020 to December 2021). Proportions and rates were calculated. Regression models were created, and a t-test for differences between …

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 …

Covid-19 And Blood Clots: A Report Of Massive Pulmonary Embolism In Covid-19 Patient Supported On Veno-Venous Ecmo And The Utility Of Thrombolysis, Bindu Akkanti, Joseph Zwischenberger, Mark T Warner, Kha Dinh, Rahat Hussain, Farah Kazzaz, Pascal Kingah, Lisa M Janowiak, Biswajit Kar, Igor D Gregoric

Faculty, Staff and Student Publications

COVID-19 morbidity and mortality are not equivalent to other etiologies of acute respiratory distress syndrome (ARDS) as fulminant activation of coagulation can occur, thereby resulting in widespread microvascular thrombosis and consumption of coagulation factors. A 53-year-old female presented to an emergency center on two occasions with progressive gastrointestinal and respiratory symptoms. She was diagnosed with COVID-19 pneumonia and admitted to a satellite intensive care unit with hypoxemic respiratory failure. She was intubated and mechanically ventilated, but her ARDS progressed over the next 48 hours. The patient was emergently cannulated for veno-venous extracorporeal membrane oxygenation (V-V ECMO) and transferred to our …

Factors Associated With Severe Illness In Patients Aged <21 Years Hospitalized For Covid-19, Rewa Choudhary, Bryant J Webber, Lindsay S Womack, Hannah K Dupont, Sophia K Chiu, Valentine Wanga, Megan E Gerdes, Sophia Hsu, Dallas S Shi, Theresa M Dulski, Osatohamwen I Idubor, Arthur M Wendel, Nickolas T Agathis, Kristi Anderson, Tricia Boyles, Eleanor S Click, Juliana Da Silva, Mary E Evans, Jeremy A W Gold, Julia C Haston, Pamela Logan, Susan A Maloney, Marisol Martinez, Pavithra Natarajan, Kevin B Spicer, Mark Swancutt, Valerie A Stevens, Jessica Rogers-Brown, Gyan Chandra, Megan Light, Frederick E Barr, Jessica Snowden, Larry K Kociolek, Matthew Mchugh, David L Wessel, Joelle N Simpson, Kathleen C Gorman, Kristen A Breslin, Roberta L Debiasi, Aaron Thompson, Mark W Kline, Julie A Boom, Ila R Singh, Michael Dowlin, Mark Wietecha, Beth Schweitzer, Sapna Bamrah Morris, Emilia H Koumans, Jean Y Ko, David A Siegel, Anne A Kimball

Faculty, Staff and Students Publications

OBJECTIVES: To describe coronavirus disease 2019 (COVID-19)-related pediatric hospitalizations during a period of B.1.617.2 (Δ) variant predominance and to determine age-specific factors associated with severe illness.

METHODS: We abstracted data from medical charts to conduct a cross-sectional study of patients agedchildren's hospitals from July to August 2021 for COVID-19 or with an incidental positive severe acute respiratory syndrome coronavirus 2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation.

RESULTS: Of 947 hospitalized patients, 759 …

Mrnip Interacts With Sex Body Chromatin To Support Meiotic Progression, Spermatogenesis, And Male Fertility In Mice, Samina Kazi, Julio M Castañeda, Audrey Savolainen, Yiding Xu, Ning Liu, Huanyu Qiao, Ramiro Ramirez-Solis, Kaori Nozawa, Zhifeng Yu, Martin M Matzuk, Renata Prunskaite-Hyyryläinen

Faculty, Staff and Students Publications

Meiosis has a principal role in sexual reproduction to generate haploid gametes in both sexes. During meiosis, the cell nucleus hosts a dynamic environment where some genes are transcriptionally activated, and some are inactivated at the same time. This becomes possible through subnuclear compartmentalization. The sex body, sequestering X and Y chromosomes during male meiosis and creating an environment for the meiotic sex chromosome inactivation (MSCI) is one of the best known and studied subnuclear compartments. Herein, we show that MRNIP forms droplet‐like accumulations that fuse together to create a distinct subnuclear compartment that partially overlaps with the sex body …

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 …

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. …

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 …

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 …

Polymorphism & Parasites: Structure, Diversity And Selection Of The Mhcii Genes In A Weakly Electric Fish, Brachyhypopomus Occidentalis, Bruna L. Silva

Graduate Masters Theses

The major histocompatibility complex (MHC) class II molecules play a key role in inducing an immune response, by presenting foreign peptides to T-lymphocytes. They are considered one of the most polymorphic genes in the vertebrate genome and diversity has been associated with species diversification mediated by parasite, viral and bacterial infections. While MHC genes are well documented in teleost fish, none thus far have been described in the Gymnotiform order – a highly diverse group of neotropical electric fishes. Using a combination of a recently annotated genome and whole genome resequencing data, I identified and characterized both the classical MHCII …

Igg Antibodies To Sars-Cov-2 In Asymptomatic Blood Donors At Two Time Points In Karachi, Muhammad Hasan, Bushra Moiz, Shama Qaiser, Kiran I. Masood, Zara Ghous, Areeba Hussain, Natasha Bahadur Ali, Syed Hani Abidi, Kulsoom Ghias, Erum Khan, Zahra Hasan

Department of Pathology and Laboratory Medicine

Introduction: An estimated 1.5 million cases were reported in Pakistan until 23 March, 2022. However, SARS-CoV-2 PCR testing capacity has been limited and the incidence of COVID-19 infections is unknown. Volunteer healthy blood donors can be a control population for assessment of SARS-CoV-2 exposure in the population. We determined COVID-19 seroprevalence during the second pandemic wave in Karachi in donors without known infections or symptoms in 4 weeks prior to enrollment.
Materials and methods: We enrolled 558 healthy blood donors at the Aga Khan University Hospital between December 2020 and February 2021. ABO blood groups were determined. Serum IgG reactivity …

A Rare Metastatic Primary Rectal Melanoma In A Geriatric Male, Onyinye Ugonabo, Mujtaba Mohamed, Ebubechukwu Ezeh, Joseph Simmons, Jonathan Cuda, Shima Ghavimi

Internal Medicine

Primary rectal melanoma (PRM) is an uncommon malignancy whose etiology remains unknown. Most patients present with rectal bleeding. Distant metastasis is commonly seen in the lung and liver. The incidence rates for locoregional lymph node metastases on initial presentation are almost 60%. Histology and immunochemistry are useful and are the gold standard for diagnosis. The prognosis is very poor due to the late presentation of patients. Optimum surgical treatment remains controversial. Abdominoperineal resection was considered traditionally but over time, has been found to have no survival benefit. Current literature and studies, therefore, recommend wide local excision. The beneficial effects of …

Sclerosing Mesenteritis: A Rare Cause Of Abdominal Pain, Said Sharawi, Vincent A. Graffeo, Lynne J. Goebel

Internal Medicine

Sclerosing mesenteritis (SM) is a rare inflammatory fibrotic disease of the small intestine mesenteric fat often discovered incidentally on a CT scan. Clinical manifestations depend on the mass effect on the viscera and vessels. The most common symptoms are abdominal pain, bloating, and nausea. SM occurs predominantly in Caucasian men, during the fifth to seventh decades of life. We present a 69-year-old woman with SM whose symptoms were thought to be from irritable bowel syndrome. A 69-year-old female with a history of fibromyalgia presented with recurrent bouts of abdominal pain across her mid-abdomen lasting 30 minutes to an hour associated …

Performance Evaluation Of The Xt Microslide Assay Pairs On The Vitros Xt 7600 Compared To Vitros Single Microslide Assays On Vitros 5600, Lily Olayinka, Estella Tam, Sridevi Devaraj

Faculty, Staff and Students Publications

OBJECTIVES: Pediatric hospitals are always challenged by specimen volumes and thus any innovation in this realm is very welcome. With the introduction of Microslide assay pairs, we aimed to evaluate the analytical performance of the Vitros XT MicroSlide assay pairs on the Vitros XT 7600 compared to single MicroSlides.

DESIGN: Performance characteristics included within-run precision, analytical measurable range, method comparison, and interference verification. We compared six XT MicroSlide pairs on the Vitros XT 7600 with twelve corresponding single slide assays on the Vitros 5600 system.

RESULTS: The XT MicroSlides on Vitros XT 7600 demonstrated excellent precision, equivalent analytical measurable range, …

Case Report: Axilla Fibroadenoma - An Atypical Presentation, Safna Naozer Virji, Lubna Mushtaque Vohra, Syeda Sakina Abidi, Romana Idress

Department of Surgery Docs

No abstract provided.

Conventional And Advanced Mr Imaging Findings In A Cohort Of Pathology-Proven Dermoid Cysts Of The Pediatric Scalp And Skull, Bettina L Serrallach, Gunes Orman, M John Hicks, Nilesh Desai, Stephen Kralik, Thierry Agm Huisman

Faculty, Staff and Students Publications

BACKGROUND: In the pediatric population, dermoid cysts are among the most frequent lesions of the scalp and skull. Imaging plays a key role in characterizing scalp and skull lesions in order to narrow the differential diagnoses. In general, dermoids are described as heterogeneous T1-/T2-hypo- to hyperintense lesions on magnetic resonance imaging.

METHODS: The goal of this retrospective study is to evaluate the diffusion weighted imaging findings while reviewing the conventional T1-/T2-/T1+C-weighted MR characteristics in a pathology-proven series of 14 dermoids of the pediatric scalp and skull.

RESULTS: In our pediatric cohort (eight boys, six girls, age range 3-95 months), half …

Reporting Of Mycetoma Cases From Skin And Soft Tissue Biopsies Over A Period Of Ten Years: A Single Center Report And Literature Review From Pakistan, Mohammad Zeeshan, Saira Fatima, Joveria Farooqi, Kauser Jabeen, Arsalan Ahmed, Afreen Haq, Muhammad Omer Arif, Afia Zafar

Department of Pathology and Laboratory Medicine

Background: Mycetoma is an important neglected tropical disease associated with debilitation, disfigurement and death if not diagnosed and treated adequately. In Pakistan, mycetoma cases have frequently been diagnosed in histopathology and microbiology laboratories. However, there is scarcity of published data from this country. Therefore, the objectives of this study were to evaluate the frequency and type of mycetoma reported in skin and soft tissue biopsies from a single center over 10 years and review of published literature from Pakistan.
Method: This descriptive observational retrospective study was conducted at the Aga Khan University Hospital laboratory, Karachi, Pakistan. Laboratory data from 2009-2018 …

Use Of Autoreactive Antibodies In Blood Of Patients With Pancreatic Intraductal Papillary Mucinous Neoplasms (Ipmn) For Grade Distinction And Detection Of Malignancy, Niall Brindl, Henning Boekhoff, Andrea S Bauer, Matthias M Gaida, Hien Dang, Jörg Kaiser, Jörg D Hoheisel, Klaus Felix

Department of Surgery Faculty Papers

(1) Background: A reliable non-invasive distinction between low- and high-risk pancreatic intraductal papillary mucinous neoplasms (IPMN) is needed to effectively detect IPMN with malignant potential. This would improve preventative care and reduce the risk of developing pancreatic cancer and overtreatment. The present study aimed at exploring the presence of autoreactive antibodies in the blood of patients with IPMN of various grades of dysplasia. (2) Methods: A single-center cohort was studied composed of 378 serum samples from patients with low-grade IPMN (n = 91), high-grade IPMN (n = 66), IPMN with associated invasive cancer (n = 30), pancreatic …