Pathology Commons^™

Evaluation Of The Sharkcore, Benjamin L. Witt, Rachel E. Factor, Barbara E. Chadwick, Justin Caron, Ali A. Siddiqui, Douglas G. Adler

Division of Gastroenterology and Hepatology Faculty Papers

Background and Objectives:

EUS guided core biopsy was once rarely performed but is now entering mainstream practice. Neuroendocrine tumors often warrant core biopsy as sufficient tissue must be obtained to allow for special staining to ensure a correct diagnosis. Traditionally these lesions were sampled with FNA needles. We performed a retrospective pilot study to evaluate the clinical value and efficacy of the a new EUS core needle biopsy needle as compared to a standard EUS FNA needle in the evaluation of patients with known or suspected neuroendocrine tumors.

Methods:

A retrospective analysis of the first 10 patients (between January 2015 …

Microbiological And Clinical Profile Of Infective Endocarditis Patients: An Observational Study Experience From Tertiary Care Center Karachi Pakistan, Uzma Shahid, Hasanat Sharif, Joveria Farooqi, Bushra Jamil, E. Khan

Department of Pathology and Laboratory Medicine

Background:
The study analyzed microbiological and antimicrobial susceptibility profile of organisms isolated from patients with infective endocarditis (2015–17) and compared disease outcomes in cohorts of endocarditis patient with history of prior invasive vascular intervention (high risk group) vs those without (native valve group). We hypothesized that high risk group would be more likely to have severe disease outcomes.
Methods:
This was a prospective cohort study (2015–17). All blood and cardiac tissue samples of enrolled patients suspected of endocarditis according to modified Duke’s criteria were followed for microbiological and antimicrobial susceptibility profile. The high risk group was compared with the native …

Neurological Complications In Patients With Plasmodium Vivax Malaria From Karachi, Pakistan, Mohammad Asim Beg, A Akhlaq, Najia Karim Ghanchi, B Usmani, R Shahzad, A Rahim, Mohammad Wasay

Department of Pathology and Laboratory Medicine

Background: Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide.
Method: We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan.
Results: The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral …

Evaluation Of Quality Of Warfarin Therapy By Assessing Patient's Time In Therapeutic Range At A Tertiary Care Hospital In Pakistan, Haris Hakeem, Ammar Zaman Khan, Kashif Aziz, Ayesha Abbasi, Anam Haider, Bushra Moiz, Mohammad Wasay

Section of Neurology

Objective: To assess the time in therapeutic range in patients on warfarin anti-coagulation therapy.

Methods: The retrospective chart review was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients having undergone anti-coagulation with warfarin from January 2013 to April 2015. To determine the mean time in therapeutic range, Rosendaal method was used. Association of time in therapeutic range with the composite outcome, bleeding and thromboembolic events was also assessed. Percentage of patients with time in therapeutic range <60% was calculated.

Results: There were 92 patients whose median time in therapeutic range was 34.9% (interquartile range: 20.0- 55.7). Overall, 71(77.2%) …

Does The Venus De Milo Have A Spinal Deformity?, Kevlian Andrew, Joe Iwanaga, Marios Loukas, Jens Chapman, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The Venus de Milo, an ancient Greek statue, has been viewed as one of the most celebrated pieces of art in Western culture. It was sculpted during the Hellenistic period between 150 and 50 BC and is believed to be the work of Alexandros of Antioch. The sculpture is thought to depict Aphrodite, the Greek goddess of love and beauty. When assembled, the two halves of the sculpture meet in an almost horizontal line that is purposefully obscured by a roll of garment around the hips. It has been noted that the midline of the statue's face is displaced slightly. …

Monocarboxylate Transporter 4 (Mct4) Knockout Mice Have Attenuated 4nqo Induced Carcinogenesis; A Role For Mct4 In Driving Oral Squamous Cell Cancer., Sara Bisetto, Diana Whitaker Menezes, Nicole A. Wilski, Madalina Tuluc, Joseph Curry, Tingting Zhan, Christopher M. Snyder, Ubaldo E. Martinez-Outshoorn, Nancy J. Philp

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Head and neck squamous cell carcinoma (HNSCC) is the 6th most common human cancer and affects approximately 50,000 new patients every year in the US. The major risk factors for HNSCC are tobacco and alcohol consumption as well as oncogenic HPV infections. Despite advances in therapy, the overall survival rate for all-comers is only 50%. Understanding the biology of HNSCC is crucial to identifying new biomarkers, implementing early diagnostic approaches and developing novel therapies. As in several other cancers, HNSCC expresses elevated levels of MCT4, a member of the SLC16 family of monocarboxylate transporters. MCT4 is a H⁺-linked …

Variant Of The Anconeus Epitrochlearis Muscle: A Case Report., Chrissie Massrey, Joe Iwanaga, Basem Ishak, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The anconeus epitrochlearis is a muscle variant sometimes present at the elbow. It is present in up to 34% of individuals and has been implicated in some cases of cubital tunnel syndrome. We report an unusual variant of this muscle with additional proximal attachments in the arm. We will review and discuss the background and the clinical relevance of such a muscle.

Common Pitfalls In Analysis Of Tissue Scores, David K. Meyerholz, Nathan L. Tintle, Amanda P. Beck

Faculty Work Comprehensive List

Histopathology remains an important source of descriptive biological data in biomedical research. Recent petitions for enhanced reproducibility in scientific studies have elevated the role of tissue scoring (semiquantitative and quantitative) in research studies. Effective tissue scoring requires appropriate statistical analysis to help validate the group comparisons and give the pathologist confidence in interpreting the data. Each statistical test is typically founded on underlying assumptions regarding the data. If the underlying assumptions of a statistical test do not match the data, then these tests can lead to increased risk of erroneous interpretations of the data. The choice of appropriate statistical test …

Lacrimal Gland Tumors In Turkey: Types, Frequency, And Outcomes., Yağmur Seda Yeşiltaş, Ahmet Kaan Gündüz, Esra Erden, Carol L. Shields

Wills Eye Hospital Papers

AIM: To evaluate the clinical, radiological, and treatment features of lacrimal gland tumors.

METHODS: Retrospective review of 99 eyes of 92 patients with lacrimal gland tumors diagnosed and managed in a single institution between January 1999 and March 2017. Clinical and radiological features, histopathology, treatment methods, and prognosis were evaluated.

RESULTS: The mean patient age was 40.3 (range: 7-80)y. The diagnosis was made histopathologically in 91 (91.9%) tumors and on a clinical and radiological basis in 8 (8.1%) tumors. Final diagnoses included idiopathic orbital inflammation (pseudotumor) in 46 (46.5%) lesions, pleomorphic adenoma in 14 (14.1%), adenoid cystic carcinoma in 12 …

Intestinal Carriage Of Third-Generation Cephalosporin-Resistant And Extended-Spectrum Β-Lactamase-Producing Enterobacteriaceae In Healthy Us Children., Shamim Islam, Rangaraj Selvarangan, Neena Kanwar, Rendie Mchenry, James D. Chappell, Natasha Halasa, Mary E. Wikswo, Daniel C. Payne, Parvin H. Azimi, L Clifford Mcdonald, Oscar G. Gomez-Duarte

Manuscripts, Articles, Book Chapters and Other Papers

Background: The epidemiology of antibiotic-resistant Enterobacteriaceae intestinal carriage in healthy US children has not been well characterized.

Methods: Children between 14 days and 14 years of age were enrolled during well-child visits in Oakland, California, Kansas City, Kansas, and Nashville, Tennessee, between December 2013 and March 2015. Data on recent antibiotic use by the child and travel and hospitalization history of all members of each child's household were obtained with a risk-factor survey. Stool specimens collected from the subjects were screened for extended-spectrum β-lactamase-producing (ESBL-P) bacteria using CHROMagar ESBL medium. Putative ESBL-P Escherichia coli and Klebsiella colonies underwent phenotypic confirmation …

Bifid Xiphoid Process: Case Report And Review., Seif Eid, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The xiphoid process is a bony process that comprises part of the sternum. This anatomical structure exhibits several morphological variations, which may complicate diagnostic examinations and invasive thoracic procedures. Variations include bifurcated or trifurcated, deflected, and curved processes. This report discusses a case of a bifid xiphoid process during cadaveric dissection and compares similar findings in the literature. The aim is to improve our knowledge of anatomical variations in an effort to reduce complications and improve patient care.

Additional Attachment Of The Semitendinosus And Gracilis Muscles To The Crural Fascia: A Review And Case Illustration., Asad Rizvi, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The semitendinosus and gracilis muscles insert primarily onto the superior medial aspect of the tibia. These tendons can be harvested for anterior cruciate ligament reconstruction, and knowledge of their accessory attachments is important for the success of such harvesting procedures. Here, we present a case illustration and review of the attachment of these muscles into the crural fascia (deep fascia of the leg), which is often an underappreciated insertion site.

Wormian Bone Of The Orbit: A Case Report., Asad Rizvi, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Wormian bones are formed due to abnormal ossification centers in various locations in the skull. Genetic and/or environmental factors have been proposed to explain their formation. These bones can be normal anatomical variants or associated with a number of pathological conditions. The literature reports the most common locations of these bones as the cranial sutures, and reports of the presence of these bones in the orbit are rare. Clinically, these bones in the orbit can simulate fractures on imaging or can dislodge during surgery causing injury to the surrounding structures. Herein, we report a case of wormian bones of the …

Anatomical Study Of The Lingual Nerve And Inferior Alveolar Nerve In The Pterygomandibular Space: Complications Of The Inferior Alveolar Nerve Block., Joe Iwanaga, Paul J Choi, Marc Vetter, Mayank Patel, Shogo Kikuta, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The inferior alveolar nerve block (IANB) procedure delivers anesthetics to the pterygomandibular space through which the lingual nerve (LN) and inferior alveolar nerve (IAN) travel. Injury to the LN has been reported more often than injury to the IAN. However, the number of anatomical studies of LN injury is limited. We aimed to establish evidence by investigating LN and IAN anatomy at the level of the mandibular foramen (MF). Forty-four sides from 22 Caucasian cadaveric heads (16 fresh-frozen and six formalin-fixed cadavers) were used in this study. The LN and IAN were laterally dissected, and the diameter and the distance …

A Cadaveric Case Of A Circular Torcular Herophili., Sasha Lake, Juan J Altafulla, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The torcular Herophili is formed by the joining of the straight sinus, superior sagittal sinus, and transverse sinus. The anatomic configuration of the torcular Herophili is highly variable. In the current literature, classification systems define up to nine subtypes of the torcular Herophili. The frequency of prevalence of these anatomical variants is also variable. Herein is a case report of a circularly-shaped torcular Herophili found during cadaveric dissection.

Tendinous Inscriptions Of The Rectus Abdominis: A Comprehensive Review., Rabjot Rai, Lilian C Azih, Joe Iwanaga, Marios Loukas, Martin Mortazavi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The rectus abdominis muscles are interrupted by tendinous inscriptions, which typically appear as fibrous bands crossing the muscle. The current literature on tendinous inscriptions is scarce; hence, this review will provide a detailed overview of their anatomical description, including their variation, embryology, comparative anatomy, and clinical application. Understanding the anatomy and function of the tendinous inscription assists in providing clinical relevance and in guiding reconstructive surgeons in their surgical planning and design.

Modeling The Dynamics Of Human Liver Failure Post Liver Resection, Babita Verma, Pushpavanam Subramaniam, Rajanikanth Vadigepalli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Liver resection is an important clinical intervention to treat liver disease. Following liver resection, patients exhibit a wide range of outcomes including normal recovery, suppressed recovery, or liver failure, depending on the regenerative capacity of the remnant liver. The objective of this work is to study the distinct patient outcomes post hepatectomy and determine the processes that are accountable for liver failure. Our model based approach shows that cell death is one of the important processes but not the sole controlling process responsible for liver failure. Additionally, our simulations showed wide variation in the timescale of liver failure that is …

Endorepellin Remodels The Endothelial Transcriptome Toward A Pro-Autophagic And Pro-Mitophagic Gene Signature., Thomas Neill, Eva Andreuzzi, Zi-Xuan Wang, Stephen C. Peiper, Maurizo Mongiat, Renato V. Iozzo

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Regulation of autophagy by proteolytically cleaved fragments of heparan sulfate proteoglycans is a novel and current research focus in tumor biology. Endorepellin is the C-terminal angiostatic fragment of the heparan sulfate proteoglycan perlecan and induces autophagy in endothelial cells. To further investigate this property, we used NanoString, a digital PCR platform for measuring pre-defined transcripts in biological samples to analyze a custom subset of 95 autophagy-related genes in human umbilical vein endothelial cells treated with ultrapure human recombinant endorepellin. We discovered an endorepellin-evoked pro-autophagic and pro-mitophagic gene expression signatures, which included two coordinately up-regulated mitochondrial-associated genes encoding the E3 ubiquitin …

Clear Cell Carcinoma Of The Pelvic Side Wall Arising From Endometriosis., Lisa N Abaid, John S Cupp, Miles Chang, Steven R Beanes, Bram H Goldstein

Articles, Abstracts, and Reports

Endometriosis is a condition wherein an ectopic layer of endometrial tissue arises in an extra-uterine location, often effecting significant pelvic pain and infertility. While very uncommon, there have been reported cases of endometriosis undergoing malignant transformation, frequently involving the ovaries and seldom in extra-gonadal regions. We recount a case depicting a 63 year-old woman who presented with an apparent inguinal hernia in 2017; she was ultimately diagnosed with a pelvic side wall clear cell carcinoma and attendant metastatic disease to the medial groin, which emanated from endometriosis. Malignant transformation of endometriosis identified in the pelvic side wall is a very …

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 …